Choosing Between Work and Breastfeeding in Haiti

Faculty; Public Health; Research

New mothers in poor urban communities may feel the necessity to work and have a measure of food security rather than trying to find the time and ability for exclusive breastfeeding, a health issue that could be rectified with social support, researchers from the Brown School at Washington University in St. Louis found in a study in Haiti.

“Poor women and their families in the Petite Anse area of Cap Haitien, Haiti, face serious challenges due to poverty,” said Carolyn Lesorogol, professor and associate dean for global strategy and programs.

She is lead author of the paper, “Economic Determinants of Breastfeeding in Haiti: The Effects of Poverty, Food Insecurity and Employment on Exclusive Breastfeeding in an Urban Population,” published in the journal Maternal & Child Nutrition. In the study, Lesorogol and her co-authors found that food insecurity, women’s time and employment all had negative implications for exclusive breast feeding (EBF).

“When a woman has a baby, she often faces a stark choice between staying home with the baby in order to exclusively breastfeed but forgoing income from employment, or leaving the baby at home while she works and forgoing exclusive breast feeding,” Lesorogol said.

“In either case, household income may be so low that food insecurity persists, triggering perceptions of breast milk insufficiency leading to abandonment of EBF, or continuation of last-resort EBF that might put mother and child at risk of undernutrition.”

The study used mixed methods to show the relationships among urban context, poverty factors and breastfeeding practices. The research suggests that policies and programs addressing these constraints may increase EBF with positive implications for maternal and child health.

“Breastfeeding is important in Haiti and elsewhere for the health effects on children,” Lesorogol said. “EBF confers many benefits for infants in terms of nutrition, immunity to disease, and also protection from harmful pathogens in the environment that they are exposed to if they are fed other foods or liquids too early.”

Thus, she said, the international recommendation is for six months of exclusive breastfeeding.

“In our research, we found that women valued EBF and wanted to do it, but the barriers that we discussed in the article were preventing them from optimal breastfeeding,” Lesorogol said. “Also, ‘last-resort’ breastfeeding presents a challenge since it means that women are adhering to breastfeeding guidelines, but out of necessity rather than by choice, and given the high level of food insecurity that drives them to ‘last-resort’ EBF, they and their babies may actually be at greater risk for undernutrition.

“The upshot is that women and infants need more and better supports to enable them to practice optimal breastfeeding behaviors.”

Co-authors on the study are Lora Iannotti, associate professor at the Brown School; Caitlin Bond of Indiana University; and Sherlie Jean Louis Dulience of Universite Publique du Nord au Cap Haitien.