How work holds back mothers from breastfeeding in Tanzania

Stella Mutta 30, sits in her office balancing cash books. She is an auditor and a woman rights advocate. She started having problems with her employer the moment she got pregnant before completing a year of her contract. “They started treating me like a liability, and decided not to pay me when I went on maternity leave,” she narrates when I visited her office located on Uhuru Street in Mwanza City.

Luckily for her, she knew her rights and went to the labour court, which directed her employer to pay her.

From then, her workload was increased, making it impossible for her to take breaks totalling two hours as ensured by labour law. She decided to express milk for her baby, but then her nanny did not know how to handle the milk properly, so her baby ended up getting cold milk that caused the child to get tonsillitis.

At this point, Mutta decided to quit her job and concentrate on raising her baby.

For Monica Shabani, 28, a mother of one and half years baby who is a medical doctor in Dar es salaam, breastfeeding was difficult when she started working after maternity leave because there was no nursery nearby to take breastfeeding breaks and feed her baby near her work place.

“My challenge was that we don’t really have a nursery there or nearby, so that it would have been easier to leave my baby with someone there, I live in Tabata Kinyerezi and I work in town.”

“I don’t pump because it is another challenge as to where to store the breast milk. There are no facilities as such, no private rooms/ designated rooms to breastfeed/pump. So in my 12 hours shift, the child does not breastfeed at all,” she states.

“When I delivered, four other people also had delivered, so there was a shortage of staff. During my time for breastfeeding, I had to struggle with my HR (department), and some of my department people on, for instance, why I need to leave work early or why I need to get home on time to breastfeed my baby.

It is difficult for those who haven’t given birth, to understand what a mother goes through. I think some sort of awareness program is needed for them to understand and learn about this. Work pressure can sometimes take a toll on you psychologically, especially if people in your department aren’t cooperative. That in turn affects your breastfeeding.”

Ms Mutta’s and Ms Shabani’s cases are not unique. Many working mothers face obstacles when it comes to balancing breastfeeding with their demanding job requirements.

The World Health Organization (WHO) recommends feeding babies on breast milk exclusively for the first six months of their lives. This means babies should only feed on breast milk and nothing else.

Tanzania has some mother-friendly laws to ensure that women can achieve optimal breastfeeding, but some employers do not abide by them, thus affecting the health of infants whose mothers cannot breastfeed them adequately.

Though Tanzania has made progress by getting the number of children who breast-feed up to 59.2 per cent, according to 2016 Demographic and Health Survey, the remaining gap means many mothers still have to choose between their jobs and breastfeeding. Those who can’t afford to quit their jobs or face other barriers have to introduce formula milk or supplementary feeding before their babies are ready for weaning.

Evidence suggests that breastfeeding saves 823,000 deaths among children under five annually. That suggests the country needs to do more to support mothers so they can breastfeed.

Dr Daniel Safi, a resident doctor in the pediatric unit at Bugando Hospital, a top referral Hospital in the Lake Zone, couldn’t agree more. He points out that breastfeeding improves a child’s emotional, cognitive and psychosocial development and the positive affects last long even after children stop breastfeeding.

“Breastfeeding has a special healing effect as it is a complete nutritious food that protects children from infections and chronic diseases like diabetes,” he states, adding that babies who are breastfed exclusively have higher IQ.”

Women who breastfeed also have lower levels of stress, which helps with post-pregnancy recovery and with forming bonds with their children well.

Over the long term, it also lowers the risk of obesity, osteoporosis and breast and ovarian cancer according to the Encyclopedia of Early Childhood Development. Ms Mutta puts it this way, “For most employers, it is either you quit if you want to achieve optimal breastfeeding or be loyal to the company and work as the baby suffers.”

Such an expectation would violate the Tanzania Employment and Labour Relations Act of 2014, which states that “new mothers have the right to breastfeed their children for two hours a day for the first six months after completing the maternity period.” It also would run counter to the United Nations International Labor Organization Maternity Protection Convention 2000 (NO.183), which specifically entitles women to 14 weeks paid maternity leave and lactating mothers to one to two paid breastfeeding breaks per working day.

But working women who participated in two focus groups convened by the Citizen – one in Dar es salaam and one in Mwanza – confirmed that such violations are commonplace. One participant, for instance, said her workplace gave her no place to express her milk, so she had to crawl under her table to pump milk then store it in a cooler bag. Her employer told her she could work half day, but didn’t reduce her workload, so it was an empty promise.

Emmanuel Safari, the Legal Officer of the Association of Tanzania Employers argued that employers aren’t to blame for the problem. “In a city like Dar es Salaam, traffic jams make it practically impossible for mothers to go breastfeed and return to work, but in other places, it is easy as mothers can actually rush out to breastfeed and return to work. So you see it is not employer who is the issue here but infrastructure.”

Safari argued that employers are aware that mothers are entitled to two hours breastfeeding time, but cannot afford to employ extra people to take over the burden for nursing mothers. He said employees have to figure out how to manage their workloads. “Just like when you break for lunch, you find work awaiting you,” he said.

Women who participated in the focus group discussion complained of lack of rooms for breastfeeding or pumping milk, storage fridges for milk. They also spoke of poor socio-professional support, short maternity leaves and unsupportive attitudes among male colleagues.

Some said male colleagues start making snide remarks the moment a woman gets pregnant, and then complain about women who take maternity leave. “Interestingly, these men are fathers, husbands, sons and brothers,” one participant said during the discussion.

The participants noted that in Kenya, 35 per cent of employers have established clean rooms that have a wash basins and fridges for storing milk and electric outlets and lighting as directed by the government.

In Kenya, 61.4 per cent of babies are breast fed.

According to the DHS index 2015-2016, the portion of babies who are exclusively breast fed in Tanzania stands at 59.2 per. In neighbouring Uganda, which established a breast milk bank, the figure is 65.5 per cent while Rwanda’s rate is 87.3 per cent.

Tackling the issues raised in the focus group discussions and interviews

The Mwanza Regional Medical Officer, Dr Thomas Rutachunzibwa, underscored that lack of breastfeeding is linked to overweight, stunting, and death for children under five. “This is why we are advocating exclusive breastfeeding within an hour from birth up to six months,” he said, adding that the Ministry of Health has put everything in place to ensure optimal breastfeeding is achieved – including directing employers to allow women working in all sectors breastfeeding breaks as stipulated in the labour law.

He suggested that working mothers should freely give feedback to the Health Ministry if their employers do not give them breastfeeding breaks as stipulated in the law.“ Breastfeeding working mothers should not suffer in silence since the effects of not breastfeeding have long-term health impacts on the child,” he stated.

Cessy Mrema, Mwanza Regional Reproductive and Child Health Coordinator said, “Employers who are not allowing mothers to take breastfeeding breaks are breaking the law.” She added that the maternity leave is not adequate.

She called on men to change their attitude and help to ensure that women get enough rest and have supportive environments both at work and at home to breastfeed. “Supportive environment and rest help women to be relaxed so milk flows adequately during the breastfeeding period,” she said. “

Dr Elisha Osati, the President of Medical Association of Tanzania (MAT) and an Internal Medicine physician at Muhimbili National Hospital, suggested men should be continuously involved in both ante-natal and post-natal care. He also advised mothers to take own initiative to express milk.

“If there are mothers willing to donate milk to assist other babies achieve all these health outcomes then we can embrace the same.”

Dr Miriam Noorani, a pediatrician and lactation expert at Agakhan University Hospital in Dar es Salaam suggested that working mothers should be pumping or expressing breast milk to ensure that their babies get it even when they are at work to ensure their milk supply doesn’t run dry. She said women can carry cooler bags with ice packs to store expressed milk if they can get a place to express milk at work.

From the focus group discussions, various women pointed out that inadequate attention to policies that help women remove barriers to successful breastfeeding are the root cause of supplementary feeding. The working mothers who participated in the Dar es salaam focus group are now calling upon the Minister of Health Ummy Mwalimu and her Labour counterpart Jenister Mhagama to go back to the drawing board, discuss this issue comprehensively to ensure that employers comply with the labour laws on breastfeeding to ensure children’s health is not affected. This would save them from dying from lack of breastfeeding related complications.

The women have called on the Health Minister to lobby Parliament to extend maternity period to ensure babies are optimally breastfed. This supportive legislation would ensure all working mothers enjoy paid maternity leave and breastfeeding breaks, job security and non-discrimination at work place.

The third and final article in the series will take a closer look at some of the obstacles to making breast-feeding a universally accepted practice, including the influence of the formula industry, concerns some women have that breastfeeding will change their appearance and the role of men and the entertainment industry in stoking such fears. It will look at what government and communities can do to surmount these challenges.

This special project was produced with support from the International Centre for Journalists (ICFJ)

The author is an Early Childhood Development Fellow with the International Centre for Journalists (ICFJ)