PERINATOLOGY • Vol 24 • No. 1 • May–Aug 2023 • 41 Review Article Mangla M, et al. Improving Breastfeeding Rates in Working Mothers Despite the efforts of the WHO and various other breastfeeding-promoting organizations, EBF is still not followed by millions of women around the world. The rates of EBF in India are better (65%–75%, with regional variations) compared with the global rate of 40%.3 Still there are many babies who are not being given the benefit of this natural practice. Women constitute about 30% of the total workforce in India.4 Improving the rates of breastfeeding among working mothers can improve the national rates of breastfeeding. The “double burden” of being the primary caregiver for the baby and earning an income for the family is, almost always, a significant stress for working mothers. Maintaining an adequate balance between their personal and work life is a significant factor that forces women to quit jobs or quit breastfeeding. This is being reflected in both the decline in the women workforce in India over the past 2 decades, in both the rural and urban sectors, and in the low breastfeeding rates. Aim To summarize the barriers that working women face in successfully breastfeeding their babies, and suggest possible solutions Barriers to Successful Breastfeeding and Solutions Tere are numerous barriers to achieving universal EBF in India. These barriers operate at multiple levels, including social, cultural, economic, and even individual levels. Some of these are poor health of lactating mothers, dependence on infant formula for ease, actual or perceived insufficient milk production, and lack of proper guidance. Furthermore, in India, for working mothers, lack of proper infrastructure, facilities, and time to breastfeed are other major hurdles in achieving this target of EBF. Sociocultural practices Breastfeeding in public places is still considered a taboo in India. A woman feeding her baby in public parks, railway stations, malls, or even in temples is considered shameful and unacceptable by society. According to a survey published in The Hindu, only 6% of breastfeeding mothers comfortably breastfed their babies in public as they had access to lactation and nursing rooms. However, it was highly inconvenient for the remaining 94% of the mothers, as they had to feed in cars, public transport, parks, or even in washrooms. Women found that the most significant deterrents to breastfeeding were uncomfortable stares from people passing by and the lack of privacy and hygiene.5 We, as a society, still consider breastfeeding as the mother’s job, which she should finish at home before going out. Perceptions of the other sex toward breastfeeding are also major deterrents in achieving universal breastfeeding goals. While men in some sectors consider it a woman’s job to breastfeed her baby, others recognize the importance of breastfeeding for the mother and the baby but strongly feel that women should cover themselves while feeding in public areas.6 This is predominantly because of the hypersexualization of the female breast. A change in attitude—of recognizing the practice of breastfeeding to be as natural as eating and drinking—is imperative. The practice of giving prelacteal feeds such as honey or ghutti (water mixed with honey and herbs), which are believed to clear the intestine of meconium by acting as a laxative; gripe water to promote digestion; and water to prevent dehydration is followed rampantly in some regions of India. These prelacteal feeds shorten the duration of EBF, and they significantly increase the possibility of formula consumption by the baby. It also hinders the development of suckling, thereby further hindering breastfeeding. Peers force new mothers to give formula feeds to the baby because it promotes weight gain, and they tell the mother that her breast milk would be insufficient for the baby. In some cultures, especially in rural areas, women who have recently given birth are considered unclean, and are thereby not allowed to cook or handle food or participate in other religious errands.6 In some countries
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