Breastfeeding and Complementary Feeding Practices among Working Women with 6 Months of paid Maternity Leave in a Municipal Zone of South West Delhi

Abstract

There is a lack of data from India on the effect of paid maternity leave under the Maternity Benefit Amendment Act (2017) on infant feeding practices. The aim was to find out the infant feeding practices among the working mothers who had availed 6 months of maternity leave. Cross-sectional study among women teachers of primary schools of Najafgarh Zone, Municipal Corporation of Delhi. A school-based survey of 100 women teachers who had a child aged 6 months to 2 years and who had availed maternity leave was conducted using a prevalidated interview schedule. Descriptive statistics such as proportion was used to find out the various infant feeding factors among the working mothers. Around one-third (34%, 95% CI 24.7–43.3) of the working mothers who availed 6 months of maternity leave practiced 6 months of exclusive breastfeeding, with those residing nearer (within 2 km) to the workplace showing significantly higher breastfeeding rates. Exclusive breastfeeding rates for 6 months were found to be low among working women who had availed maternity leave.

INTRODUCTION

Women’s employment has been found to strongly affect their intentions, which restricts them from practicing optimal infant and young child feeding.[1] It demands the need to balance work and child-bearing and child-rearing responsibilities. Thus, it is important to give special attention to maternity leave’s role in infant feeding practices among the working mothers.

Maternity leave provides the required professional and financial security to the working mothers and also helps them in taking efficient care of the nutritional requirements of their infants. In India, Maternity Benefit (Amendment) Act was enforced on March 27, 2017, which increased the maternity leave duration in India from earlier 12 weeks to 26 weeks.[2] The Maternity Benefit Act in India supports women before and after the birth of their child. It safeguards and protects their interests and livelihood and allows them to nurture their newborns while taking care of themselves.

Even though it is expected that maternity leave of 6 months will lead to better rates of 6 months of exclusive breastfeeding and timely introduction of complementary feeding, there is less evidence available on the infant feeding practices among employed mothers who have availed 6 months of maternity leave. We aimed to find out the infant feeding practices among the working mothers who had availed 6 months of maternity leave.

MATERIALS AND METHODS

A cross-sectional study was conducted among women teachers in Primary Schools within the Najafgarh Zone of the Municipal Corporation of Delhi. This zone covers a total area of 262 square kilometers and has approximately 118 MCD primary schools; it borders Haryana. The study received approval from the Institutional Ethics Committee-Human Research (IEC-HR) and permission from the Deputy Director, Education Department, MCD prior to data collection. The study included all women teachers currently employed in primary schools of MCD in Najafgarh Zone, who had children between 6 months and less than 2 years and had availed 6 months of maternity leave for that child. Mothers on leave throughout the study period and those unreachable after three school visits were excluded.

Extensive literature review revealed no published study regarding exclusive breastfeeding among mothers availing 6 months of maternity leave. For an estimated proportion of 50%, which gives the maximum sample size for a given confidence interval and absolute precision and considering a 95% CI and 10% absolute precision, the sample size came out to be 97 using Epi Info software. This was rounded off to 100.

Simple random sampling was used. The primary sampling unit was schools. The participants were randomly selected from a list of all the MCD primary schools in Najafgarh Zone, obtained from the Education Department of MCD. There were a total of 44 double-shift and 48 single-shift schools. Women teachers were contacted at their schools and assessed for inclusion and exclusion criteria. For those who consented to participate, a convenient time was arranged, preferably before or after school hours. Following written informed consent, face-to-face interviews were conducted by the principal investigator.

Data were collected using a semistructured, prevalidated, interviewer-administered schedule, partially adapted from the WHO manual of ‘Indicators for Assessment of Infant and Young Child Feeding practices.’[3] The schedule had the following sections, namely, sociodemographic details and the Infant and Young Child Feeding questionnaire. The 24-hour recall method was used to find out the complementary feeding practices.

Statistical analysis

The data were entered in Microsoft Excel, cleaned, and then imported into SPSS 20.0 software for analysis. Categorical variables such as duration of exclusive breastfeeding and the status of Infant and Young Child Feeding practices are presented as proportions and the 95% CI. The Chi-square test assessed the association between 6 months exclusive breastfeeding and the various sociodemographic characteristics. Multivariate logistic regression was used to find out the independent predictors of 6 months of EBF among the participants. All statistical tests were two-tailed with a significant level set at P < 0.05.

RESULTS

The sociodemographic details of the working mothers and certain delivery-related characteristics are depicted in Table 1. The majority (88%) of the participants were assistant primary teachers, while the remaining (12%) were nursery teachers. Most of the mothers (78%) were graduates or lesser degree holders, and the median (IQR) family income per month was INR 130,000 (100,000–170,000).

Table 1.

Sociodemographic details of working mothers and certain delivery-related characteristics (n=100)

Variables	Frequency	Percentage
Educational status of mothers Postgraduate level Graduate level or less	22 78	22 78
Designation of mothers Assistant Primary Teachers Nursery Teachers	88 12	88 12
Type of family Joint Nuclear	65 35	65 35
Distance of residence from the workplace (km) ≤2 >2	19 81	19 81
Mode of delivery Normal Vaginal Caesarean	53 47	53 47
Gestation at birth Term Preterm	96 04	96 04
Sex of the child Male Female	53 47	53 47
Birth order of the child First Second	45 55	45 55

SD: Standard Deviation, INR: Indian National Rupees, IQR: Interquartile Range, Age of the mothers (years), mean (SD)=30.5 (2.5), Total family income per month (INR), Median (IQR)=1,30,000 (1,00,000-1,70,000)

The majority (86.0%) of the mothers had availed child care leave in addition to the maternity leave. Around one-third (32%, 95% CI 23.0–42.1) of the mothers initiated breastfeeding within less than 1 hour of birth, while 34% (95% CI 24.7–43.3) practiced exclusive breastfeeding for 6 months. No significant associations were found between exclusive breastfeeding and certain sociodemographic factors such as mother’s age and education. However, mothers residing within 2 km of their workplace had significantly higher rates of 6 months of exclusive breastfeeding by bivariate analysis (OR 3.47) and also by multivariate analysis (adjusted OR 4.45). Distance of residence from the workplace was found to be an independent predictor of exclusive breastfeeding for 6 months.

Additionally, 64.0% (95% CI 54.6–73.4) initiated complementary feeding at the recommended 6 months of age, while 4.0% (95% CI 0.16–7.84) started earlier and 32.0% (95% CI 22.9–41.1) initiated later than 6 months. Only 33.0% of the children met minimum meal frequency, 28.0% were fed the adequate minimum dietary diversity, and 27.0% received an adequate minimum acceptable diet according to Infant and young Child Feeding guidelines.

DISCUSSION

We found that one-third of the women teachers of primary schools who availed 6 months of maternity leave practiced 6 months of exclusive breastfeeding as well as initiation of breastfeeding within 1 hour of birth of the child. In contrast, the National Family Health Survey-5 (2020–21) report noted higher rates of EBF (64.3%) and early initiation of breastfeeding (51.2%) in Delhi.[4] The current study focused on children aged 6–24 months, obtaining retrospective breastfeeding data from their mothers, while NFHS used a 24-hour recall method for children under 6 months, which might account for the difference between NFHS and our data findings.

Boralingiah P et al. (2016) in Mysore, Karnataka, found low EBF rates among working women, while Ranjitha R et al. reported a significantly higher prevalence (60%) of exclusive breastfeeding for 6 months among healthcare workers in Delhi.[5,6] This shows that the rate of 6 months of EBF among working mothers was lower than that reported among community surveys, which mostly comprise of nonworking women.

Majhi N et al.[7] (2021) have reported that longer maternity leave is associated with more sustainability in exclusive breastfeeding among working mothers in urban residential areas of East Delhi.

We found that around one-third of mothers delayed the initiation of complementary feeding. This was found similar to the findings of a study conducted by Ranjitha R et al.[6] in 2019–21 among the working mothers of two hospitals in East Delhi.

Working mothers who resided closer to workplaces (<2 km) had higher rates of 6 months of exclusive breastfeeding than those who resided farther away (>2 km). Similar findings have been reported in studies from Ghana and Kenya.[8,9] This may be because the mothers residing farther away from their workplace may lack confidence in maintaining EBF once they return to work and therefore may tend to shift to artificial milk near the end of their maternity leave duration.

The findings of this study are limited to working mothers in educational professions within a single Municipal Zone in Delhi, restricting their generalizability. The statistical tests used are exploratory as the sample size may not be sufficiently powered enough for hypothesis testing.

CONCLUSION

The infant feeding practices among working women teachers who had availed maternity leave for 6 months were found to be suboptimal with lower rates of 6 months of EBF and delayed initiation of complementary feeding among one-third of the mothers. More studies with a larger sample size and with comparison groups are needed to find out the effect of maternity leave on infant feeding practices.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.