Maternal employment in low- and middle-income countries is associated with improved infant and young child feeding

Abstract

Background: Women's employment improves household income, and can increase resources available for food expenditure. However, employed women face time constraints that may influence caregiving and infant and young child feeding (IYCF) practices. As economic and social trends shift to include more women in the labor force in low- and middle-income countries (LMICs), a current understanding of the association between maternal employment and IYCF is needed.

Objective: We investigated the association between maternal employment and IYCF.

Design: Using cross-sectional samples from 50 Demographic and Health Surveys, we investigated the association between maternal employment and 3 indicators of IYCF: exclusive breastfeeding (EBF) among children aged <6 mo (n = 47,340) and minimum diet diversity (MDD) and minimum meal frequency (MMF) (n = 137,208) among children aged 6-23 mo. Mothers were categorized as formally employed, informally employed, or nonemployed. We used meta-analysis to pool associations across all countries and by region.

Results: According to pooled estimates, neither formal [pooled odds ratio (POR) = 0.91; 95% CI: 0.81, 1.03] nor informal employment (POR = 1.05; 95% CI: 0.95, 1.16), compared to nonemployment, was associated with EBF. Children of both formally and informally employed women, compared to children of nonemployed women, had higher odds of meeting MDD (formal POR = 1.47; 95% CI: 1.35, 1.60; informal POR = 1.11; 95% CI: 1.03, 1.20) and MMF (formal POR = 1.18; 95% CI: 1.10, 1.26; informal POR = 1.15; 95% CI: 1.06, 1.24). Sensitivity analyses indicated that compared to nonemployed mothers, the odds of continued breastfeeding at 1 y were lower among formally employed mothers (POR = 0.82; 95% CI: 0.73, 0.98) and higher among informally employed mothers (POR = 1.19; 95% CI: 1.01, 1.40).

Conclusion: Efforts to promote formalized employment among mothers may be an effective method for improving diet diversity and feeding frequency in LMICs. Formally employed mothers may benefit from support for breastfeeding to enable continued breastfeeding through infancy. This trial was registered at clinicaltrials.gov as NCT03209999.

FIGURE 1

Estimates for the association between formal and informal maternal employment and exclusive breastfeeding by world region. Random effects meta-analysis (using the metan command in Stata) was used to generate PORs, comparing formal employment to nonemployment and informal employment to nonemployment, for 49 countries (n = 47,340). The POR represents the weighted average of these statistics across all countries and by region. I² represents the heterogeneity by region and larger values show increasing heterogeneity. Models are adjusted for maternal education (less than primary school complete, primary school or higher complete), maternal age (years), marital status (married or living together compared to single, widowed, divorced), parity, morbidity (presence of diarrhea or fever in the last 2 wk), child age (months), within-country urban/rural status. Type of employment was based on 4 indicators: 1) employment during the last 12 mo (yes, no); 2) aggregate occupation category (skilled, unskilled); 3) type of earnings (cash only, cash and in-kind, in-kind only, unpaid); and 4) seasonality of employment (all year, seasonally, occasionally). Exclusive breastfeeding was modeled as a binary variable, indicating whether infants aged 0–5 mo were fed exclusively with breast milk. POR, pooled odds ratio.

FIGURE 2

Estimates for the association between formal and informal maternal employment and minimum diet diversity by world region. PORs compare formal employment to nonemployment and informal employment to nonemployment for 50 countries (n = 137,208). Children (aged 6–23 mo) who achieved minimum diet diversity were those who received foods from ≥4 of the following 7 food groups: grains, roots, and tubers; legumes and nuts; dairy products (milk, yogurt, cheese); flesh foods (meat, fish, poultry and liver/organ meats); eggs; vitamin A–rich fruits and vegetables; and other fruits and vegetables. POR, pooled odds ratio.

FIGURE 3

Estimates for the association between formal and informal maternal employment and minimum meal frequency by world region. PORs compare formal employment to nonemployment and informal employment to nonemployment for 50 countries (n = 137,208). Breastfed and nonbreastfed children (aged 6–23 mo) who achieved minimum meal frequency were those who received solid, semisolid, or soft foods the minimum number of times or more. POR, pooled odds ratio.