Few issues are as incendiary as breastfeeding. Well-worn arguments tend to pit women’s empowerment against the rights of the child. Sometimes what is in the best interest of the child is not what is in the best interest of the mother, or at least not aligned with her self-interests and/or aspirations.(1) Some mothers will always choose to breastfeed; Some mothers will always choose to not breastfeed. But these “sides” present a false dichotomy that serves mostly to let government and other stakeholders off the hook. The longer the debate stays rooted in these ageless arguments–instead of what needs to be done to create an environment that supports a basic biological function of nearly 40% of the global workforce–the longer nothing changes.
Importance of breastfeeding for women and children. Decades of research underlie the mantra that “breast is the best” for most infants. In brief, breastfeeding confers protection for infants from diarrheal and respiratory diseases, and is associated with improved cognitive development, and reductions in overweight and diabetes.(2) It also reduces the mothers’ risk of breast cancer and improves birth spacing, and is associated with decreased risk of ovarian cancer and diabetes.(3) In low-income countries and households especially, breastfeeding can be critical for child survival. Over 800,000 child deaths could be saved by breastfeeding each year, mostly by reducing diarrhoea, respiratory infections and malnutrition from diluted formula – itself a reflection of poor water, sanitation and hygiene and the unsustainable expense of formula in these contexts.(4) And the evidence of positive linkages is still growing, with recent research highlighting the important role of breastfeeding in development of the infant’s gut microbiome.(5)
Evolution of female labour force participation. Women account for approximately 40% of the total labour force globally and 45% of the total labour force in low income countries, data that have remained steady since 1990. (6) Globally, over half of women work; In low-income countries that increases to over two-thirds.(7) The decision to participate in wage labour is not made in isolation; it shapes and is shaped by other household practices and time allocation of other household members.(8) Most women work out of economic necessity. An undeterminable proportion of working women are mothers with young children. Evidence from Australia suggests that nearly a third return to work in the first year of their baby’s life. (9) However there is little information available on breastfeeding practices of working women globally, how considerations for breastfeeding contribute to women’s decision to return to work, or ,vice versa, how returning to work contributes to women’s decision to breastfeed.
“. . . if breastfeeding were accepted as necessary and usual practice by government and employers, then arrangements must be made for a woman’s baby to be near her for the first six months or so of life” – Margaret Mead
Impact of women’s work on breastfeeding. Adherence to breastfeeding recommendations–and the factors influencing them–are numerous and vary globally and across the socio-economic spectrum.(10) A working mother faces constraints on her time available and proximity for child care and feeding (11). Instead of breastfeeding, she may opt for formula feeding or early introduction of complementary foods. The impact of the complex trade-offs between time and income on child care and nutrition is also influenced by other factors such as the status of the mother within the household, and age of the child (individual); the socio-economic status, farming system, and availability of other caregivers (household and community); community production structures (12), and food prices and wages (13) (community); and social and labour policies (societal). Literature commonly ascribes returning to work as a reason for weaning, and evidence from such disparate contexts as Thailand and the U.S. indicate that prevalence and duration of breastfeeding among working women may be cut in half compared to unemployed women.(14) However, overall empirical evidence for the effect of women’s work on breastfeeding–and child nutrition more generally–is mixed and inconclusive.(15)
Urbanization and women’s work. Traditionally–and in contexts where children can accompany their mothers to work–women have simultaneously performed the dual roles of producer and reproducer. But with increasing urbanization and participation in the formal labour market, patterns of work for women are changing, requiring regular and sustained separation of mother from child. (16) To sustain lactation and maintain adequate milk supply requires hand expression of milk, use of formula or animal source milk, or use of a wet nurse.(17) Challenges for working mothers in urban and/or formal markets–and low income women especially–are numerous and function at various levels, and there is little practical advice available.(18) It is therefore unsurprising that low-income working women in urban settings demonstrate a clear trend towards decreased exclusive breastfeeding and decreased duration of breastfeeding.(19)
Fostering a “mother friendly” workplace. Female labour force participation is beneficial for women, their families, their communities and their employers. (20) Yet benefits to the child secured through women’s increased income earned may be undermined if obtained at the expense of time for and/or quality of child care. (21) However, around the world women have fought long and hard to acquire the freedom to work, and women’s work need not necessarily be a detriment to quality child care if there are substitute caregivers—older siblings, grandmother, father, or crèche—and/or other key provisions available. (22) As women are inextricably linked to the health and welfare of their children, it is essential that efforts to increase women’s economic opportunities incorporate appropriate provisions for the care of children. The question is not whether women’s work is good, but rather how to put in place policies and services to encourage and promote women’s work without compromising women’s or their children’s nutrition.
Studies showing that women decide feeding practices as early as the first trimester of pregnancy suggest that interventions to enable working women to breastfeed–and bolster her confidence in her own ability to nurture her baby–may be effective in prolonging breastfeeding duration. (23) It is entirely possible for women to successfully combine employment and breastfeeding, and the nature of her workplace can be the deciding factor. Serious commitment to systemic supports for women in the workforce to continue breastfeeding is needed, so that mothers are not forced to choose between their own well-being and that of their child. Fostering ‘mother friendly’ workplaces that recognise mothers’ needs and support her in her dual roles–and demanding that the biological needs of 40% of the global workforce be recognized–can make the difference.
See Annex 2 for specific interventions that can help.
World Development Indicators (database), World Bank, Washington, DC (accessed 2018), http://data.worldbank.org/data-catalog/worlddevelopment-indicators.
Annex 1. A few good (recent) resources on the basics of breastfeeding
- NYTimes (https://www.nytimes.com/2018/07/08/health/world-health-breastfeeding-ecuador-trump.html)
- CNN (https://edition.cnn.com/2016/01/28/health/breast-feeding-global-rates-health-impact-lancet/index.html)
- NPR’s Goats and Soda (https://www.npr.org/sections/goatsandsoda/2018/07/13/628105632/is-infant-formula-ever-a-good-option-in-poor-countries)
- Al Jazeera (https://www.aljazeera.com/news/2018/07/long-protected-commercial-interests-breastfeeding-180714091204660.html)
Annex 2. Illustrative mother-friendly workplace interventions.
In 1993, the World Alliance for Breastfeeding Action (WABA) launched the Mother-Friendly Workplace Initiative (MFWI), which proposes specific interventions in terms of time, space, and support across multiple levels of influence (employee, employer and the workplace).
- ILO 1976; Holmboe-Ottesen 1988
- Victora et al. 2016
- Rubin 1990
- James 1999
- Wolfe & Behrman 1982; Soekirman 1985; Engle & Pedersen 1989; Engle 1991; Pérez-Escamilla et al. 1995; Yimyam & Morrow 1999; Lakati et al. 2002; Flores et al. 2005; Agunbiade & Ogunleye 2012; Njai & Dixey 2013; Lesorogol et al. 2017
- Popkin & Solon 1976; Leslie & Paolisso1989; Blau 1996; Lamontagne et al. 1998
- Rubin 1990
- Blau 1996
- Yimyam & Hanpa 2014
- Van Esterik & Greiner 1981
- Brown 1970; Popkin & Solon 1976; Greiner 1979; Van Esterik & Greiner 1981
- Jelliffe 1979; Popkin 1980; Van Esterik & Greiner 1981
- Hills-Bronczyk et al. 1993; Auerbach 1984; Farmer 1988; Laterra et al. 2014; James 1999; Lesorogol et al. 2017
- Dearden et al. 2002; Dörnemann & Kelly. 2013; Menon et al. 2005; Zalla 2015; Lesorogol et al. 2017)
- IFC 2017
- Abbi et al. 1991; Lamontagne et al. 1998; Kadiyala et al. 2014
- Gryboski 1996; Hawkes 1997; Nti et al. 1999; Quinlan 2005; Keng & Lin 2005; Agunbiade & Ogunleye 2012; Dörnemann & Kelly 2013; Njai & Dixey 2013; Lesorogol et al. 2017;
- James 1999