Improving National Workplace Policies for Exclusive Breastfeeding

Despite emphasis on importance of exclusive breastfeeding for infants during their first six months of birth, Sunday Ehigiator reports that Nigerian working mothers are expected to return to work after six weeks or at best, three months afterwards, thus jeopardising the general well-being of mother and child

In recent years, there has been renewed attention to the central role that clinicians and healthcare institutions can play to support women in initiating and sustaining breastfeeding through the first year of their infant’s life.

There has been, however, considerably less focus on how to support the breastfeeding needs of new mothers who return to work, particularly those who go back shortly after the birth of their infant.

While many women intend to continue breastfeeding when they go back to work, about one-third report exclusive breastfeeding as a major challenge.

The Labour Act

The Labour Act provides that a pregnant female worker (legally married or not) is entitled to six weeks leave period before her expected delivery Date (EDD), and another six weeks after delivery, making a total of 12 weeks.

It also provides that a female worker who has been in employment for a period of six months or more immediately before the maternity leave shall be entitled to at least 50 per cent of her salary during the duration of the maternity leave.

The Act also provides that any employee nursing her child is to be permitted half an hour, twice a day, during working hours for the purpose of breastfeeding her child.

Workplace Reality of a Nursing Mother in Nigeria

Speaking with THISDAY, a first-time mother, Mrs. Yewande Anifowose, who was blessed with two boys, a set of twins, narrated her ordeals in the hands of her employee in Lagos school, barely some days before and after putting to bed.

“My name is Mrs. Yewande Anifowose. I am married, and a mother to loving boys (twins). I am a graduate of the University of Lagos, with a BSc. Honours in Zoology (Applied Entomology).

“I got married, in December 2019, and I didn’t get pregnant until about March 2020. My joy knew no bound when I got the news I’ll be birthing twins after the first scan we did in July 2019 showed this.

“At this time, I was already teaching in the junior and senior secondary section of the school (name withheld). I discovered I was pregnant just a week to the lockdown that was enforced in Lagos state in March 2020.

“Following the lockdown, both teachers and students were compelled to stay at home. Although I was working from home, teaching classes online via WhatsApp, and emails, which I voluntarily took part despite the excruciating signs and symptoms of being pregnant

“The school finally resumed in September 2020, and I resumed back to school heavily pregnant. In fact my EDD was November 7, 2020, it was close.

“I decided not to apply for maternity leave immediately just because I felt it will be unjust to leave work considering the number of months of teaching from home, and also I have the interest of my students at heart, so I kept on working up until November, few days to my EDD before I officially applied for maternity leave.

“I began my leave on November 2, and I put to bed on November 7, 2020, through Caesarian Section (CS). My husband was really against me resuming back to work because it was close to my EDD and the gynecologist had already recommended a CS as a result of the breech presentation.

“So I applied for a paid maternity leave with my scan result attached to the letter, as required by the school management, a week to my delivery date but the school only approved two months instead of three months as provided by the NLA.

“A week after I put to bed, which is on the naming ceremony day (according to Christian norms), the school sent a delegate to me bearing a letter and a token of N2,500 as gifts for my children.

“In the letter, they asked me to confirm to them at least four weeks (a month) before the two months maternity I was given elapse, if I won’t or will be able to resume to work.

“The school made it clear to me that the growth of the establishment was paramount to the delivery of my children or my health (as I was still recovering from the CS).

“I was asked to send in my resignation if I won’t be able to resume after the two months leave elapses, as my delivery won’t be a reason for their step back, but can be a reason I become jobless despite all my sacrifices to the school.

“I was compelled to write back to the school with a resignation letter, explaining that I would have loved to resume if an extension to my leave period would be possible as I am yet to recover/heal from the CS and I also love to give my kids exclusive breastfeeding for at least three months.

“But since they demanded a resignation letter not less than four weeks to expected resumption date, it became unavoidable and mandatory to resign.

“Unfortunately after my resignation which should be official after my maternity leave period elapsed, I didn’t get a payment for the two months period I was home, which was approved for my leave.

“I called on the school management if there was an error to this but instead I was passed across the board to different administrators until I demanded to speak with the proprietor about the payment omissions, then she told me I should have resumed if I needed the payment rather than resigning.

“I was shocked to hear such a statement from a woman that is a mother like me and of whom I held in high esteem. Eventually I was not paid a dime, and that was how I lost my job simply because I gave birth, and I made the hard choice of giving my children exclusive breastfeeding.

“But it didn’t end there. Few months after my husband tried securing a job for me elsewhere, but I needed to present a reference letter from my previous employer. So I wrote to the school management to request for a reference, but I was denied one.

“After so much pestering I was asked to meet with the proprietress if she will honor it, apparently it was a way to discourage me so I stopped pestering. This prevented the opportunity of getting the employment offer my husband tried securing for me.

“Losing my job as a result of child birth and care period brought a stigma to me but I was able to place more focus and care for my kid’s early childhood development.

“It rather gave me the opportunity to undergo exclusive breastfeeding and watch my kids attain every of their milestone in development. On the other hand, it made me jobless and financially down, thus having to depend on my husband almost all time.

“Taking up a new job right now is like starting a new career afresh as I have been redundant for a while,” she lamented.

Mrs. Anifowose is just one victim among several other women who suffered and are still suffering the same fate at their workplace after given birth.

At some other workplace in Nigeria, especially the private sector, there are workplace policies that forbid women to get married or pregnant within a specified number of years which they are bound to agree to before they can be employed.

With such hostile treatment and policies against women at workplace, it begs the practicality of exclusive breastfeeding of infants for at least six months period as recommended by the World Health Assembly Resolution in 2012.

Paid Maternity Leave Policy in Nigeria

The 1999 Nigerian constitution, 2008 Public Service Rules and the 2004 Nigeria Labour Laws allow three months maternity leave for a woman in the civil service. This allows her to stay off work for 12 weeks (six weeks before the birth of her baby and six weeks after).

The Labour Act also allows for at least 50 per cent salary and upon return, to work half an hour twice a day during work hours, to breastfeed. However, there is no clarity on whether an organisation may be penalised if they deny women their maternity leave.

The federal government recently increased the period for maternity leave to 16 weeks with full salary, as well as two hours off each day to breastfeed for six months, after the employee resumes duty.

Despite this law, only three states, Lagos, Kaduna and Enugu, offer 24 weeks of fully paid maternity leave for mothers.

The National Maternity Assessment Survey conducted in Nigeria shows that some private and public institutions offer maternity leaves without pay, while some do not offer maternity leaves at all.

The study found this to be common among private educational institutions, manufacturers and hospitality sector.

The survey was aimed at examining the implementation and attitudes towards maternity entitlements and workplace lactation policies such as breastfeeding space in the country.

Global Recommendations

The United Nations International Children’s Emergency Fund (UNICEF) and the World Health Organisation (WHO) have been advocating for six months paid maternity/parent leave as the new global standard for new mothers.

This, the UN agencies said, will allow the mothers recuperate, bond with the babies and give time for six months exclusive breastfeeding.

In 2012, the World Health Assembly Resolution 65.6 endorsed a comprehensive implementation plan on maternal, infant and young child nutrition which specified six global nutrition targets for 2025.

The fifth target of this policy brief is “to increase to at least 50 per cent the rate of exclusive breastfeeding in the first six months,” globally.

Global Data

According to the WHO, globally, “only 38 per cent of infants zero to six months old are exclusively breastfed. Recent analyses indicate that sub-optimal breastfeeding practices, including non-exclusive breastfeeding, contribute to 11.6 per cent of mortality in children under 5-year old. This was equivalent to about 804 000 child deaths in 2011.”

National Data

The provision of adequate nutrition during infancy and early childhood is a basic requirement for the development and promotion of optimum growth, health and behaviour of the child.

According to the National Demographic and Health Survey 2018, the early initiation rate of breastfeeding is 42 per cent which clearly shows that not up to half of Nigerian children are breastfed within one hour of birth.

Also, the data puts exclusive breastfeeding rate in Nigeria at 29 per cent, indicating that only a mere percentage of infants aged 0-6 months are exclusively breastfed leaving a whopping 71 per cent of infants not enjoying the benefits of breast milk in their formative years.

The data also revealed that only nine per cent of organisations in Nigeria have a workplace breastfeeding policy.

Looking at the data, it has been a great challenge in Nigeria as mothers and caregivers are neither fully aware of the importance of breastfeeding nor received adequate support from the environment to optimally breastfeed their babies exclusively.

National Recommendations and Policies on Breastfeeding

The Federal Ministry of Health recommends early initiation of breastfeeding within one hour of birth, exclusive breastfeeding for the first six months of life, continued breastfeeding up to two years of age or beyond, with the introduction of appropriate complementary foods from six months.

Chapter 1, article 3.6 of the 2005, National Policy on Infant and Young Child Feeding in Nigeria, recommends that: “exclusive breastfeeding for the first six months of life shall be followed by the introduction of complementary foods that are safe, appropriate, locally available and nutritionally adequate, with continued breastfeeding for up to two years and beyond.

“The timing of introduction of complementary foods shall be from six months of life, except otherwise medically indicated.

The chapter 2, article 1.1 of the policy document also recommended that: “All mothers shall be encouraged to take adequate nourishment during pregnancy and lactation.

“All pregnant women, their relations and other relevant persons shall during ante-natal clinics, admissions of mothers or babies, postpartum clinics, child welfare clinics, home visits and at other opportune periods receive education on the advantages of breastfeeding, the dangers of bottle feeding.

“Breastfeeding shall be protected, promoted and supported unless medically contraindicated.

“All mothers shall be encouraged and assisted to put their newborn infants to the breast within half hour of delivery. Mothers shall be encouraged to exclusively breastfeed their babies on demand until the age of six months (with no water or other liquids including breast milk substitutes).

“All mothers shall be taught to express and preserve breast milk for feeding their infants during periods of unavoidable separation. Under these special circumstances, feeding with the cup is recommended.

“Thereafter, mothers shall be encouraged to continue breastfeeding with adequate complementary foods for up to two years and beyond.”

The chapter 4, article 5 of the policy document recommends that: “The Organised Private Sector shall: ensure compliance with laid down Government regulations and guidelines on issues relevant to this Policy.

“Provide appropriate support needed for effective implementation of this policy; be encouraged to partner with relevant stakeholders in the implementation of this policy.”

Despite this policy, implementation is yet to attain parity, especially at workplace. Also, there is yet an enabling law to back up the National Policy Initiative as it affects employer and employee relations for the protection of nursing mothers at her workplace.

Benefits of Exclusive Breastfeeding to Infants

The National Policy on Infant and Young Child Feeding in Nigeria, states that the period of birth to when a child is two years of age is recognised as a critical period for which adequate nutrition should be provided for the child to achieve optimum development and full potential.

In an address at 2020 celebration of the World Breastfeeding Week, The Minister of Health, Dr Osagie Ehanire, noted that: “Breastfed babies have stronger immunity, reduces the risk of infections and many childhood illnesses, and may also have longer-term health benefits including reduced risk of overweight and obesity in childhood and adolescence.

“Studies have shown that obesity rates are 15-30 per cent lower in breastfed babies compared to formula-fed babies. Again, about 80,000 child deaths are reported to be prevented annually when optimal breastfeeding is practiced.

“Looking ahead, we hope to achieve the global target of at least 50 per cent exclusive breastfeeding rate by 2025 as recommended in the National Policy on Food and Nutrition.”

Speaking with THISDAY, Private Consultant and Gynecologist, Dr. Esther Alake said, “Breastfeeding has been linked to higher IQ scores in later childhood in some studies.

“What’s more is the physical closeness, skin-to-skin touching, and eye contact between mother and child which help the baby bond better with the mother, and feel secure.

“Breastfed infants are more likely to gain the right amount of weight as they grow rather than become overweight children. Breast milk contains antibodies that help your baby fight off viruses and bacteria.

“It lowers your baby’s risk of having asthma or allergies. Plus, babies who are breastfed exclusively for the first six months, without any formula, have fewer ear infections, respiratory illnesses, and bouts of diarrhea. They also have fewer hospitalisations and trips to the doctor.”

Benefit to Mothers

On benefits of breastfeeding to mothers, Dr. Alake said, “Breastfeeding burns extra calories, so doing it exclusively can help you lose pregnancy weight faster.

“It releases the hormone oxytocin, which helps your uterus return to its pre-pregnancy size and may reduce uterine bleeding after birth. It also lowers your risk of breast and ovarian cancer. It may lower your risk of osteoporosis, too.”

Benefit to Businesses, Economy

Putting it in a simple context while speaking during the 2021 Nutrition Policy Dialogue organised by the Nigeria Health Watch, the Managing Director, Nigeria Health Watch, Vivianne Ihekweazu said, “exclusive breastfeeding begot a very healthy baby.

“If the society is encouraged to imbibe the culture of exclusive breast feeding, it will be filled with a generation of health babies in no time. And at such, as these children grow up, the workspace will be boosted with adults with a sound mind.

“And with workers of sound mind, productivity would drastically improve and that would further lead to increase in revenue generations by the organisations, and by extension, the country’s economy would greatly benefit from this through highly complains to tax.”

Ihekweazu equally noted that if women are adequately protected with policies that enables them breastfeed their children at workplace and practice exclusive breastfeeding, they would become more psychologically relaxed without worrying about the welfare of their child, and would by extension be more productive at work.

“But in a situation where they live in the fear of losing their job if they want to practice exclusive breastfeeding, or not being paid during maternity leave, they easily losses interest in the practices of the organisation and may become less productive.”

Expert Recommendations

In recent remarks, UNICEF’s Deputy Country Representative, Pernile Ironside, said a survey conducted in Nigeria shows that the rate of exclusive breastfeeding has improved from 17 per cent in 2013 to 27 per cent in 2018; which is however still far below the 50 per cent global target.

“Inadequate and low breastfeeding practice causes over 10 million avoidable childhood diarrhea cases and leads to more than 10,000 deaths a year. Nigeria is not reaching the breastfeeding target because of the practices and policies around maternity and paternity leaves in the country”.

Ironside said Nigeria is still lagging behind in the practice for exclusive breastfeeding, she therefore advocates that new mothers in public, private and institutions should be given full pay and rights to six months maternity leave.

In her view, a Public Health Expert with the Alive & Thrive Initiative, Abimbola Oduola, said the level of implementation of maternity leave policy was greater in the public sector compared to the private sector, as some do not offer any maternity leave or entitlements to working mothers.

According to Oduola, who was one of the researchers of the National Maternity Assessment Survey conducted in Nigeria, some organisations do not give mothers the full three months because it is usually converted to days, “thereby making official time less than three months in total.”

She said, “While the majority of women support the six-month maternity leave policy, employers and policy administrators are reluctant to adopt such policies because of the effect it would have on their establishments.

“The readiness to adopt six months of maternity leave in the country is still very low. These hesitations were echoed in the educational subsector, where respondents cited their strict school calendar.”

She however harped on the need for both the formal and informal sector to adopt policies that will support easy, exclusive breastfeeding. She said the provision of lactation and breastfeeding spaces policy in the workplace might be the way to go for working mothers to achieve exclusive breastfeeding.

From the forgoing, it is easier to conclude that the current provisions of the law in this regard are not in accordance with the contemporary international standards for the attainment of exclusive breastfeeding.

It does not guarantee and protect the freedom of the nursing mother to exclusively breastfeed the child for at least the six-months as propagated by the National Breastfeeding Policy.

Moreover, there is no enabling law to back up the National Policy Initiative as it affects employer and employee relations.

Oduola therefore recommended that a legal framework for effective implementation of the National Breastfeeding Policy for women in dependent labour relations be implemented.

“This recommendation is with hopes that, such laws will not only limit some of the harsh practices against women in employment, but also will encourage and promote exclusive breastfeeding behaviour by employed mothers.”

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Breastfed babies have stronger immunity, reduces the risk of infections and many childhood illnesses, and may also have longer-term health benefits including reduced risk of overweight and obesity in childhood and adolescence