Working mothers are finding innovative ways to breastfeed and bond with their babies

Innovative breastfeeding spaces in Kenya are helping working mothers,extended breastfeeding despite economic and workplace challenges.[Courtesy]

Hard economic times forced Tabitha Akinyi Onyango into casual work in Nyando’s rice fields to fend for her family shortly after giving birth to her fifth child.

But the mother of five was determined not to let financial constrain force her into introducing her daughter to complementary foods too early.

The only casual jobs available on rice farms included planting rice, weeding and harvesting, fetching between Sh300 and Sh400 each day, depending on the amount of work available.

At the time, her daughter was barely one month old.

Her husband’s earnings, also a casual labourer, were not enough to meet the needs of the family.

With nowhere to leave her baby, Onyango would carry her to the farm.

At the farm, the mother of five and other breastfeeding mothers  came up with a simple innovation-a makeshift ‘lactating space’ where they could safely keep their babies while they worked.

The improvised structures have effectively become lactation and childcare spaces in the middle of the rice farms.

Sacks are spread on the ground to keep the babies clean, while water is provided for handwashing and maintaining basic hygiene.

The spaces also have simple play materials, including toys made of banana fibers and leaves. They keep the babies occupied as their mothers work on the farms.

At the lactating space, the casual laborers employ a caretaker, who keeps a tab on the babies.

Every two hours, Onyango would take a break from the rice fields, return to the makeshift space to breastfeed her daughter and then resume work.

“I used to go to work with my baby. There was nobody at home to take care of her, so this space really supported me,” says Onyango. “When the baby cries, the person taking care of the children calls the mother.”

She reports to the farm at about 8 am, working until 4 pm or 5 pm, depending on the workload.

For Onyango, the arrangement has made it possible to earn an income, exclusively breastfeed her baby for six months before introducing complementary feeding. She continues to breastfeed her daughter, a role she says she happily plays, until the daughter clocks two years.

Her daughter is now one year and six months old.

Although Onyango had practiced exclusive breastfeeding with her older children, maintaining breastfeeding after returning to work had previously been difficult.

She would prepare porridge and leave the babies with neighbors, but remained worried about their safety.

The arrangement allows mothers to remain close to their babies, breastfeed them during breaks and continue bonding with them while working.

For 30-year-old Caroline Akinyi, a mother of five from Kasang’any village, started working on a rice farm two months after giving birth to her youngest child.

Akinyi reports to the farm at 7 am and leaves at around 3 pm, earning between Sh300 and Sh450 a day.

Her duties include planting, weeding and chasing away birds that threaten to destroy the rice.

Though the work is physically demanding, Akinyi says the makeshift childcare space has made it easier to work while caring for a young baby.

“Before, I would breastfeed the baby mostly at night after returning home. But now, I can breastfeed whenever the baby needs to,” she says.

The arrangement is part of efforts in the area to promote the Baby-Friendly Initiative, which supports mothers on breastfeeding, infant care and ways of maintaining breastfeeding after complementary feeding is introduced.

Supported by the Ministry of Health and UNICEF, the initiative encourages pregnant and lactating mothers to find practical ways of keeping their babies close and continuing breastfeeding despite the demands of casual work.

According to health officials, the intervention has helped improve breastfeeding practices in the area.

Pauline Odhiambo, the Kadibo Sub-County Nutritionist, describes the makeshift spaces as a local innovation that emerged from knowledge and support provided to breastfeeding mothers under the Baby Friendly Initiative training.

“We are witnessing mothers exclusively breastfeeding their babies,” says Odhiambo.

Data shows that before the programme was implemented two years ago, exclusive breastfeeding stood at 66 per cent in the area. It has since increased to 95 per cent.

Through the programme, mothers have been taught to exclusively breastfeed their infants for the first six months before introducing age-appropriate complementary foods while continuing breastfeeding.

Odhiambo says the improvement in breastfeeding has also been accompanied by a decline in diarrhea cases, which had previously been among the top five illnesses affecting infants in the sub-county.

There has also been a decline in malnutrition.

The intervention is particularly significant in an area where food insecurity remains a challenge.

Kadibo, formerly known as Nyando, is dry for much of the year but experiences flooding during the rains, affecting food security and livelihoods.

Mothers have consequently been trained to diversify farming practices while also receiving information on infant and young child nutrition.

Odhiambo discourages mothers from introducing complementary foods too early, saying this can expose children to both undernutrition and overnutrition.

She says mothers are taught to understand that crying does not necessarily mean a baby is hungry.

“The only verbal communication a child has is crying. Crying does not translate to hunger. Mothers are taught to respond and get to understand their babies may be hungry, wet or sick so they can interpret,” she says.

The initiative also has a component of peer mentorship and mother-to-mother support that has helped dispel myths surrounding breastfeeding.

While women in Nyando’s rice fields have improvised breastfeeding spaces from simple structures, mothers employed at Alupe Sub-County Hospital have a different experience.

Inside the facility is a dedicated lactation room where mothers breastfeed, express milk and safely store it while remaining at work.

The room is carpeted, allowing babies to lie down and rest, while a refrigerator provides storage for expressed breast milk.

There is water and soap for handwashing, as well as a heater to warm water for mothers who need it.

The room is free to access and is open to lactating mothers during the hospital's working hours.

The room is open during the hospital's working hours and is open for any lactating mother seeking services.

Unlike in the past, when women could only wait to get back home to breastfeed their babies, in fear of an evil eye, babies are now breastfed on demand.

“Rarely will you see women breastfeed babies in the open, because they fear the evil eye, which spells diseases on their babies, just by looking at their breasts, or their babies,” says Linet Mukhongo, the Sub-County Nutritionist for Teso South and nutritionist in charge at Alupe Sub-County Hospital.

The breastfeeding room was established in May 2024 as part of the hospital's implementation of the Baby-Friendly Hospital Initiative.

One of the initiative's deliverables was to establish breastfeeding stations for working mothers within the facility and women visiting the hospital for services.

The facility recognised that many mothers return to work when their babies are still very young, making it difficult to maintain breastfeeding.

“Several breastfeeding staff are on contract, so they have to be back at work early after delivery. Some report to work early, while their babies are still asleep, meaning they can go for long hours without breastfeeding,” explains Mukhongo.

The breastfeeding room allows mothers to bring their babies to the facility, breastfeed them and return to their workstations.

In the room, Health Magazine meets Sheilah Nekesa, 28, a mother of two, breastfeeding her nine-month-old baby.

Nekesa is a contract worker at the hospital and was required to return to work just one month after giving birth.

The thought of returning to work so soon made her anxious. She worried about losing her job while wondering how she would continue caring for and breastfeeding her baby.

The breastfeeding room gave her a reprieve.

“The breastfeeding room enabled me to settle back at work; I comfortably worked and took breaks to breastfeed my baby,” says Nekesa.

She also expressed milk in the room and stored it in a refrigerator at home for the baby to feed when she was unable to breastfeed directly.

At nine months, her baby is taking complementary foods alongside breast milk.

For Nekesa, the room has meant that returning to work did not necessarily mean stopping breastfeeding.

The experiences of the mothers in Nyando and Alupe illustrate the need to support women who return to work after giving birth.

Kenya's policies provide for maternity leave and require workplaces to support breastfeeding mothers, including through lactation spaces.

Janet Ntwiga, a Nutrition Officer at UNICEF Kenya, says barriers to breastfeeding exist across different settings, including among working mothers.

For example, some women are required to return to work two or three months after delivery, while others return immediately.

“Among working mothers, some employers require them to report back to work two or three months after delivery, or immediately. Among non-employed mothers, some go working immediately after birth, to feed their families,” says Ntwiga.

UNICEF has been working with the government to ensure that both formally employed mothers and casual labourers have practical ways of caring for their babies while continuing breastfeeding.

According to the official, a lactation room does not necessarily have to be an expensive facility.

It can be a simple, private space equipped with necessities such as water for handwashing, a seat or couch, ventilation and, where possible, a refrigerator for storing expressed milk.

“A lactating room can be a simple room or space, just segregated, that offers privacy for a mother,” explains Ntwiga.

“The space should allow a mother to walk into it between breaks to breastfeed her baby. So the issue of breastfeeding rooms or workplace support is possible. It is currently working, and has made mothers in active employment continue breastfeeding and be able to take it to the six months,” she adds.

The policy requirement is intended to ensure that returning to work does not automatically bring breastfeeding to an end.

Beyond the workplace, the Baby-Friendly Initiative also uses community structures to support mothers.

Under the community strategy, community health promoters are trained to provide breastfeeding messages, support mothers and help communities find solutions to challenges affecting breastfeeding.

The promoters also work to demystify myths and misconceptions surrounding breastfeeding and refer mothers to health facilities where they have concerns that require medical attention.

Ntwiga observes that CHPs are key because they understand the communities they serve and can communicate with mothers in familiar languages.

They are also able to dispel myths and misconceptions in breastfeeding.

In Nyanza and Western Kenya for example, some mothers fear breastfeeding or walking with their babies in public because of beliefs around the “evil eye”, where it is believed that an individual can cast a spell of sickness simply by looking at a newborn.

Some mothers, more so teenagers, face concerns about breast sagging, while another misconception is that breast milk is insufficient for boys.

Such beliefs, according to Ntwiga, contribute to early introduction of complementary foods.

Ntwiga says community-level support is therefore important in addressing misconceptions alongside practical challenges such as work, to boost uptake of exclusive and continuous breastfeeding.

Kenya’s exclusive breastfeeding stands at 60 percent, according to 2022 KDHS, a drop by 0.5 percent in 2014.

Additional data by the Ministry of Health shows only six out of 10 babies are breastfed within an hour after birth. This is despite colostrum, the first breast milk produced after birth, acting as a baby’s first vaccine.

However, Kenya's breastfeeding performance also varies across counties.

For instance, Busia records an exclusive breastfeeding rate of 96.6 per cent, while Kisumu, Migori and Homa Bay record 86, 88 and 81 per cent respectively.

“Breastfeeding rates have been growing over the years, but we have reached a point where I would say we are stagnating,” regrets Ntwiga.

In an interview, the official explains that “When a baby is born, the first protection against disease may not come in a syringe or a bottle. It comes from the breast”

Exclusive breastfeeding means giving a baby nothing other than breast milk during the first six months, apart from prescribed medicines when the child is sick.

Breast milk is key to a newborn, as it is the baby’s first immunisation, notes Ntwiga.

Also, breast milk offers immune factors that help protect newborns from infections and illnesses at a time when their bodies are still developing.

The first six months she explains, are critical because a baby’s immature gut is not yet ready for other foods.

“Breast milk is a balanced diet,” she says, explaining that it provides the nutrients a baby needs for growth, development and brain development,” she explains.

Beyond nutrition and protection from disease, breastfeeding also strengthens bonding between mother and child and provides health benefits to the mother.

Scientifically, she notes that the act of suckling triggers the mother’s uterus to contract after birth, helping it return to its normal size and supporting recovery.

For the baby, breastfeeding also protects against illnesses that can cause weight loss and malnutrition, particularly diarrhoeal diseases.

Because of the benefits of breast milk, she emphasises on the need to support lactating mothers, including those in informal and formal employment.

Supporting breastfeeding mothers, she says does not always require sophisticated infrastructure, but creating an environment where mothers can remain close to their babies and breastfeed during breaks.