Formal employment prevents mothers from exclusive breastfeeding

A study in Kenya has recommended added support to help extend the period of exclusive breastfeeding (BF), which can benefit formally employed mothers and their children, as more and more women engage in formal employment in low- and middle-income countries.

A cross-sectional survey was carried out among 1,186 mothers from September 2018 to October 2019 at four postpartum time points: at hospital discharge (n=296) and at week 6 (n=298), week 14 (n=295), and week 36 (to estimate BF at 24 weeks; n=297) postpartum. Mothers reported their BF status as well as their reasons for discontinuing exclusive BF.

The investigators used multivariable logistic regression models to test the association between formal maternal employment and three outcomes, namely, early BF initiation (within 1 h or birth), exclusive BF at each time point, and continued BF at 9 months. A directed acyclic graph (a causal diagram used to characterize the relationship among variables that influence the independent [employment] and dependent [BF status] variables) informed the models.

Exclusive BF did not differ by employment status at hospital discharge or at 6 weeks postpartum, but formally employed mothers were less likely to report exclusive BF at 14 weeks (59.0 percent vs 95.4 percent; adjusted odds ratio [aOR], 0.19, 95 percent confidence interval [CI], 0.10–0.34) and at 24 weeks (19.0 percent vs 49.6 percent; aOR, 0.25, 95 percent CI, 0.14–0.44) than those not formally employed.

No between-group difference was seen in the prevalence of continued BF at 36 weeks (98.1 percent for formally employed vs 98.5 percent for nonformally employed women; aOR, 0.80, 95 percent CI, 0.10–6.08).

Returning to work (46.5 percent) was the most common reason reported for early cessation of exclusive BF, followed by introducing other foods based on the child’s age (33.5 percent) and perceived milk insufficiency (13.7 percent).