Employed mothers’ breastfeeding: Exploring breastfeeding experience of employed mothers in different work environments in Ethiopia

Background One of the most cost-effective interventions to enhance child health with the potential to reach families of all economic backgrounds is breastfeeding. Despite the many benefits optimal breastfeeding has, its practice is low due to various barriers among which maternal employment is mentioned repeatedly. Accordingly, this study has explored the experience of employed mothers with regards to breastfeeding, employment, and work environment in Addis Ababa Ethiopia. Methods and findings A descriptive Phenomenology strategy was employed among 17 mothers drawn from different organizations, conveniently, that offer accommodation of six months maternity leave or onsite child care center or had only three months maternity leave. Data were collected through in-depth interviews until information saturation was reached. Recorded interviews were transcribed and translated and the information obtained was then organized and coded to generate overarching themes. Two themes on facilitators and barriers, and addressing barriers were generated after analysis. Mothers recognize the importance of breastfeeding for children but returning to work at three months is expressed as a major barrier to continuous breastfeeding. Mothers who have access to supporting conditions at their workplace expressed better breastfeeding practice and better satisfaction with their job. Conclusions Providing employed mothers with a supporting environment helps them work with better stability, motivation, and satisfaction. This however requires a suitable accommodation with a focus on the different kinds of work environments of the mothers and the different risks related to each respective environment via scaling up and monitoring breastfeeding interventions and calling upon institutions to remove structural and societal barriers to breastfeeding.

Mothers’ Preferences for Their Children’s Format for Return to School During the Coronavirus Disease-2019 Pandemic: Are There Differences Between Full-Time Employed Mothers and Mothers Who are Not Employed?

The present study assessed factors associated with maternal preferences for their children’s educational format (i.e., completely in-person, completely online/remote, or hybrid of in-person and online/remote) for return to school during the COVID-19 pandemic and whether these associations differed between full-time employed mothers and mothers who were not employed. Participants were 911 mothers of school-aged children from the United States (full-time employed, n = 650; not employed, n = 261). Recruitment took place online via social media during Summer 2020. Questionnaires on school modality preference, maternal work status, and demographic characteristics were filled out online through Qualtrics. Compared to mothers who were not employed, full-time employed mothers were more likely to endorse a preference for a hybrid in-person and online/remote educational format for their children and less likely to endorse a preference for a completely online/remote educational format for their children. The factor most strongly associated with maternal preferences for their children’s educational format for return to school in both groups of mothers was being worried about my child getting COVID-19 and their health being severely impacted (rs’s ranged from −56 to −58; p < .01). Regardless of maternal employment status, this factor continued to have the strongest association with a maternal preference for a completely online educational format in the polynomial regression analysis after controlling for relevant demographic variables (Odds Ratios ranged from 3.63 to 37.64; p < .01). These findings highlight that concerns about child health during the COVID-19 pandemic influence maternal preferences for their children’s educational format, regardless of maternal employment status.

Complementary Feeding Practice by Maternal Employment Status in Eastern Ethiopia: A Comparative Cross-Sectional Study

Background: Appropriate complementary feeding practice during the first two years of age prevents life cycle health problems that cannot be averted later in life. Appropriate complementary feeding practices are associated with various factors and the practice may vary between populations. This study aimed to investigate the complementary feeding practice among mothers with children aged 6-23 months by maternal employment status in eastern Ethiopia. Methods: A community-based comparative cross-sectional study was conducted in Gemachis district from 10 July to August 2020, eastern Ethiopia. A multi-stage sampling technique was used to sample a total of 674 mothers. Data were collected by face-to-face interview and analyzed using STATA version 14.2. Multivariable logistic regression analysis was conducted to identify factors associated with appropriate complementary feeding practice with 95 % CI or a P-value of less than 0.05.Results: Over all only 9.9% of all mothers were practicing appropriate complementary feeding, with 5.9% among employed and 11.9% unemployed mothers. After controlling for confounders, traveling to the workplace less than two hours (AOR= 5.9; 95% CI: 1.30, 16.14), giving birth at home (AOR= 0.08; 95% CI:0.01, 0.72, and having at least one ANC visit (AOR=6.5; 95% CI: 1.40, 25.7) were significantly associated with appropriate Complementary feeding practice among employed mothers while having children aged 9−23 months (AOR = 3.2; 95% CI: 1.3, 8.5), spending 17−24 hours on child care (AOR = 4.8; 95% CI: 1.6, 14.12], working 1-8 hours per day (AOR =0.17; 95% CI: 0.44, 0.63], and having at least one ANC visit (AOR = 7.6; 95% CI: 3.6, 14.01] were significantly associated with appropriate complementary feeding practice among unemployed mothers. Conclusion: The overall prevalence of appropriate complementary feeding practice was very low in this study area. There is a need to strengthen maternal health service utilization such as ANC and institutional delivery to improve complementary feeding practices. Further, considering adequate maternity leave and designing a subsidized alternative child care center is essential to improve the complementary feeding practice for employed mothers.

When parents wish to reduce their work hours: Does sorting into occupations and work organizations explain gender differences in working-time adjustments?

Objective: This study investigates whether sorting into occupations and work organizations contributes to gender differences in parents’ likelihood to reduce their working hours. Background: While mothers reduce their work hours to reconcile their work and personal lives, fathers increasingly wish to reduce their hours but face obstacles to doing so. Mismatches between parents' desired and actual work hours prompt the question of whether fathers' realization of working-time reductions is constrained due to their sorting into more time-intensive occupations and/or work organizations. Method: Cross-classified multilevel models were applied to German linked employer-employee data analyzing gender differences in parents' likelihood of reducing work hours. Including sorting indicators, the question of whether differences in full-time employed mothers' and fathers' working-time reductions were driven by sorting into different work contexts (occupations/work organizations) was explored. Results: The results confirmed that full-time employed mothers are more likely to reduce their work hours than full-time employed fathers. While occupations play almost no role in determining working-time adjustments, work context does at least partly contribute to parents’ variation in working-time reductions. However, neither gendered sorting into occupations nor gendered sorting into work organizations explained gender differences in parents’ likelihood of scaling back their work hours. Conclusion: It is concluded that gender differences in German parents' reduction of working hours rather respond to traditional gender norms than being influenced by the different occupations or work organizations mothers and fathers sort themselves into.

Exclusive Breastfeeding Practice and Maternal Employment among Mothers of Infants: A Comparative Cross-Sectional Study

INTRODUCTION Exclusive breastfeeding (EBF) practices during first six months of life are the most cost-effective intervention for reducing infant and child morbidity and mortality. However, adherence to EBF practices in developing countries remains unsatisfactory, where maternal employment has been identified as one of the influencing factor. The study aims to identify and compare EBF practices and its factors influencing among employed and unemployed mothers. MATERIALAND METHODS An institutional based comparative cross-sectional study was conducted among 362 mothers of infants visiting the immunization clinic of Universal College of Medical Sciences, Bhairahawa, Nepal, from December 2020 to March 2021 following ethical clearance (UCMS/IRC/114/20) and verbal consent from participants. Descriptive statistics was used to compare EBF practices and multivariate logistic regression to identify independent predictors of EBF. RESULTS Total 362 (181 employed and 181 unemployed) mothers were interviewed. Prevalence of EBF was 13.8% and 81.2% among employed and unemployed mothers respectively. Further EBF practice had significant association with working status of mothers (AOR= 15.44, 95% CI 6.76-35.25) and monthly family income (AOR=3.31, 95% CI 1.24-8.84). Among employed, EBF practice had significant association with carry infant to work place (AOR= 12.36, 95% CI 4.35-49.87) whereas type of delivery (AOR= 3.88, 95% CI 1.69-8.90) was significantly associated among unemployed mothers. CONCLUSION EBF practices among employed mothers were less than that of unemployed mothers. Provisions to provide additional supports, either by revising the period of maternity leave or adopting different alternatives to prolong the period of EBF may be beneficial for employed mothers and their children.

Breastfeeding and employed mothers in Ethiopia: legal protection, arrangement, and support

Background Breastfeeding is the single, most cost-effective intervention to reduce worldwide child mortality. Women empowerment interventions have positive impacts on child and maternal nutritional, and health status. Women’s employment and economic participation in Ethiopia have shown progress over the past three decades. However, consistent evidence indicated that maternal employment is often negatively associated with optimal breastfeeding in Ethiopia. The existence and enforcement of breastfeeding law, arrangement, and support in the workplace have vital roles in protecting employed mothers’ ability and right to breastfeed upon return to work from maternity leave. This commentary compared the breastfeeding laws, policies, and arrangements in Ethiopia with international standards, recommendations, and evidence-based practices. Workplace breastfeeding policies in Ethiopia Public legislations of Ethiopia poorly protect the breastfeeding right of most new mothers. Ethiopian revised Labor Proclamation (No.1156/2019) incorporates most of the International Labour Organization maternity protection recommendations. However, it poorly safeguards breastfeeding rights and abilities of employed women. The provided maternity leave period is also shorter than the recommended exclusive breastfeeding duration. The revised Federal Civil Servant Proclamation of Ethiopia (NO.1064/2017) mandates the establishment of a nursery in government institutions where female civil servants could breastfeed and take care of their babies in a private room. Though, it protects only a small proportion of working mothers in Ethiopia, as majority women employed in the agriculture and informal economy sectors. So far, there are no notable workplace breastfeeding arrangements and support for employed mothers by employers and other initiatives. The ILO recommendation and experience of other middle income and low-income countries can be legal and practical grounds for establishment of breastfeeding-friendly workplace in Ethiopia. Conclusions The lack of workplace breastfeeding laws, arrangements, and supports in Ethiopia limits mothers’ right to practice optimal breastfeeding. Policymakers, the government, and all concerned bodies should give due attention to enacting and enforcing sound laws and arrangements that will enable employed mothers to practice optimal breastfeeding upon return to work.

Mothers’ Employment and Nutritional Status of Under-five Children Attending Selected Child Welfare Centre, Dhaka Cantonment

Introduction: Nutritional status of children is one of the major predictors of child survivors and a proxy indicator for assessing the entire population health status. Despite the various efforts, malnutrition among children is remaining as a major public health problem in Bangladesh. Maternal employment status exerts strong influence over child nutrition status. Aim: To find out the effect of maternal employment on nutritional status of 0-59 month-old children attending Malabika CWC at Dhaka Cantonment. Methods: This cross sectional study was conducted at ‘Malabika’ Child Welfare Centre at Dhaka Cantonment from 01 March 2012 to 30 June 2012. A total of 110 children were selected conveniently. Data were collected from mothers by face to face interview and analyzed by SPSS 19. Association was assessed with Chi square test. The prevalence of malnutrition assessed by different indices of nutritional status based on Weight for Age Z-score, Height for Age Z-score and Weight for Height Z –Score following the WHO and NCHS guidelines and cut-off points. Results: The prevalence of stunting, underweight and wasting was found to be 61.4%, 56.3% and 61.3% among the children of employed mother respectively. These all 3 prevalence are higher than the children of unemployed mothers. The association between nutritional status of under-five children of employed and non-employed mothers was found statistically significant (p<0.05). Nutritional status of employed mothers ’children were found worsen than unemployed mothers’ children. Conclusion: This study provides an account of still high prevalence of malnutrition which trade-off between mothers’ employment and children’s nutritional status. Addressing factors like family size, duration of breast feeding, empowering women, monthly family income, mothers’ education are key efforts to reduce child’s malnutrition. JAFMC Bangladesh. Vol 15, No 1 (June) 2020: 58-60

Social Support, Maternal Agency, Postnatal Depression, and Domestic Violence Influence the Formal Employment-Exclusive Breastfeeding Relationship: Evidence From Kenya

Objectives We previously demonstrated that formal employment among mothers in Kenya is associated with a lower prevalence and odds of exclusive breastfeeding (EBF). This study evaluated the influence of maternal social support, agency, postnatal depression, and domestic violence on the association between formal employment and EBF in Naivasha, Kenya, where many women work in agricultural labor. Methods Using cross-sectional data (n = 1,186), we examined validated scales of social support, agency, domestic violence, and postnatal depression as effect modifiers in adjusted, stratified models of the association between employment and EBF. We hypothesized that higher social support and agency would attenuate the odds ratios that evaluated employment and EBF, and domestic violence and depression would further decrease the odds of EBF based on employment. Results Comparing formally employed to non-formally employed mothers, women with higher social support were more likely to practice EBF at 14 weeks: OR high (95%CI) = 0.22 (0.09, 0.51) and OR low = 0.12 (0.05, 0.29). The same trend was observed at 24 weeks. Among mothers with higher maternal agency compared to those with lower agency, the negative association between formal and EBF was decreased at both 14 weeks [OR high = 0.21 (0.09, 0.47) versus OR low = 0.16 (0.06, 0.44)] and 24 weeks. Comparing mothers who reported experiencing domestic violence to those who had not, the negative association between formal and EBF was increased at both 14 weeks [OR = 0.06 (0.01, 0.31) versus OR No violence = 0.18 (0.09, 0.36)] and 24 weeks. At 14 weeks, mothers with depression decreased the association between employment and EBF: [OR dep = 0.11 (0.03,0.45) versus OR no depression = 0.16 (0.08, 0.33). At 24 weeks, the employment-EBF relationship was non-significant among mothers with depression: [OR dep = 0.31 (0.08, 1.30) but remained significant among mothers without depression: OR no dep = 0.22 (0.12, 0.40). Conclusions Among formally employed mothers, maternal social support and agency improve the employment-breastfeeding relationship, while women exposed to domestic violence or postnatal depression experienced a further decrease in the likelihood of EBF. Supportive interventions to improve EBF and other maternal health factors are needed in the postpartum period for employed mothers. Funding Sources NIH Fogarty International Center

Effect of Access to Workplace Supports for Breastfeeding Among Formally Employed Mothers in Kenya

Objectives We evaluated the availability of workplace breastfeeding (BF) supports, and the associations between these supports and BF practices among formally employed mothers in Kenya – where many women work in horticulture farms and legislation requiring workplace BF supports is being implemented. We hypothesized that the availability of supports would be associated with a higher prevalence and greater odds of exclusive breastfeeding (EBF). Methods We conducted repeated cross-sectional surveys among formally employed mothers at 1–4 days, 6 weeks, 14 weeks, and 36 weeks (to estimate 24 weeks) postpartum at 3 health facilities in Naivasha from Sept. 2018 to Oct. 2019, 13 months after the 2017 Kenyan Health Act, which requires workplace BF support, was passed. We evaluated the associations of workplace BF supports with EBF practices using tests of proportions and adjusted logistic regression. Results Among formally employed mothers (n = 564), reported workplace supports included on-site housing (16.8%), on-site daycare (9.4%), and private lactation spaces (2.8%). Mothers who used workplace on-site childcare were more likely to practice EBF than mothers who used community- or home-based childcare at both 6 weeks (95.7% versus 82.4%, p = 0.030) and 14 weeks (60.6% versus 22.2%, p &lt; 0.001; [aOR (95% CI) = 5.11 (2.3, 11.7)]. Likewise, mothers who visited daycares at or near workplaces were more likely to practice EBF (70.0%) compared to those who did not visit a daycare (34.7%, p = 0.005) at 14-weeks. Among all mothers, 84.6% with access to workplace private lactation spaces practiced EBF, compared to 55.6% without such spaces, p = 0.037. Mothers who live in on-site housing were twice as likely [aOR (95% CI) = 2.06 (1.25, 3.41)] to practice EBF compared to those without access to on-site housing. Conclusions Formally employed mothers in Kenya who used on-site childcare, lived in on-site housing, and had access to private workplace lactation rooms are more likely to practice EBF than mothers who lack these supports, while the use of community-based childcare in this context is associated with a lower prevalence of EBF. As the Kenya Health Act is implemented, provision of these supports and strategies to help women visit their children in daycare can enable EBF among employed mothers. Funding Sources NIH Fogarty International Center.