Employment gives mothers the resources to strengthen their households’ food security, which in turn improves the likelihood of breastfeeding. Yet work demands after maternity leave tend to limit the attention that mothers can give to their infants. This column explores whether there is a ‘win/win’ scenario, potentially supported by legislation, which can promote a mother’s return to work and her ability to continue breastfeeding.
Breastfeeding has enormous benefits for both the mother and the child. For the child, breast milk contains nutrients with the required composition to meet the changing physiological needs of a growing infant. In addition, it contains antibodies that boost immunity and fatty acids that boost brain development. For the mother, sustained breastfeeding has been linked to reduced risks of ovarian and breast cancer, reduced post-birth bleeding, and reduced risks of type 2 diabetes and hypertension.
Is Kenya making progress in promoting breastfeeding?
Positive messages about breastfeeding seem to be appreciated by mothers in Kenya. In 2014, for example, at least six out of ten women in the country were breastfeeding their children exclusively for the first six months, while one in two women continued breastfeeding until their children were two years old. This means that over half of the children in Kenya (53%) are gaining the full benefit of breastfeeding, compared with the World Health Assembly’s target of 90%.
With all its benefits, why aren’t all mothers breastfeeding exclusively and why aren’t they breastfeeding for up to two years?
How does the transition to work affect breastfeeding?
Research shows that a mother’s working patterns significantly influence how long and how frequently she breastfeeds. In Kenya, working mothers generally have lower breastfeeding rates and shorter durations of breastfeeding compared with unemployed mothers. The main reason cited for this is the challenge of balancing breastfeeding demands and work.
In a qualitative study of women of higher socio-economic status in Kenya, mothers indicated that returning to work after maternity leave was the main challenge to continued breastfeeding. They reported insufficient workplace support, such as spaces for expressing breast milk and lack of facilities for storing it.
But research among women of lower socio-economic status indicates that reduced household income led to reduced household food security, which in turn led to reduced breastfeeding duration and frequency.
This presents a dilemma. Mothers need employment for resources to support their households’ food security, which in turn improves the likelihood of breastfeeding. But at the same time, work demands limit the attention a mother can give to her breastfeeding infant.
Is there a win-win scenario that can promote a mother’s return to work and her decision to continue breastfeeding?
What legal provisions has Kenya made to support breastfeeding working mothers?
The government of Kenya has sought to address this challenge through the Breastfeeding Mothers Bill (no. 74 of 2019). The bill explicitly prescribes minimum standards with regard to space, equipment, and time that an employer should designate for breastfeeding mothers, as well as the penalties for non-compliance regardless of the size of the organization.
The bill builds on the Health Act (no. 21 of 2017), which legally requires employers to provide sufficient time and a lactation station – a private space where a mother can express and store breast milk. The bill goes further than the Health Act by explicitly prescribing conditions required to make up a lactation center.
For example, in addition to a room for expressing breast milk, the room can also be a breastfeeding room. This implies the need for support facilities such as staff to care for the baby when the mother is working, a baby changing table, and flexi-time to allow the mother to breastfeed.
The bill also explicitly states the amount of time required to allow the mother to breastfeed or express breast milk: a maximum of 40 minutes every four hours. The fine for non-compliance is a penalty of up to one million shillings, one year’s imprisonment or both. The bill also applies to public places such as restaurants, airports, and bus terminals with regard to suitable spaces for mothers to change their babies.
So far, the bill has undergone its first reading, but has not yet been adopted as an Act. A qualitative study of the legal measures that promote breastfeeding in Kenya indicates that provisions stipulated in the 2017 Health Act are more likely to be achieved by large to medium-sized enterprises, but they would be difficult for smaller enterprises with limited space and resources.
The provisions would also be difficult to implement in institutions that rely on casual workers and sales people. This would require innovative solutions crafted to suit the realities of the developing world. One example is the Mobile Creche, an initiative in India designed to offer daycare services for children whose parents work in construction sites based on the child’s age and needs.
Considering the level of investment that an employer would need to make, and the diversity of workplaces across the nation, it would be prudent to consider the bill from a position of implementation, even before it has been passed.
For example, how many workplaces have so far complied with the bill’s predecessor, the 2017 Health Act? What challenges do employers face in setting up such spaces? What is the main barrier: resources, awareness, or motivation?
And what about mothers: what is their experience of using spaces when they exist? What frustrations do mothers in different workplaces face in balancing breastfeeding with work? Would a lactation center address that challenge?
It would also be prudent to consider the bill from the point of incentives for the employer. One idea would be for governments to provide tax subsidies for employers that offer extended maternity leave support or flexi-time to working mothers.
The key message in supporting mothers in breastfeeding is that it will take the support of family, employers, government, and indeed, all of society.