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Mothers’ Agency in Managing Breastfeeding and Other Work in Dar es Salaam, Tanzania and New Delhi, India
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Combining breastfeeding and other forms of work is desirable from both public health and labour productivity perspectives. This is often challenging, especially in low- or middle-income fast-growing urban settings. The aim of this thesis was to gain a deeper understanding of mothers’ perspectives on combining breastfeeding and other work in the urban contexts of Dar es Salaam, Tanzania, and New Delhi, India. Individual semi-structured interviews were conducted with community mothers (n=8) and health worker mothers (n=12) in Dar es Salaam, and mothers working in the health (n=10) and education sectors (n=10) in New Delhi. The methods of analysis were:  qualitative content analysis, grounded theory approach, and directed and general inductive content analyses. Mothers’ agency manifested in several ways. Striving to integrate or segment the competing domains of home and work was a goal of these mothers to reduce conflicts in managing breastfeeding and other work. Spatial and time constraints led mothers to engage in an array of carefully planned actions and troubleshooting tactics that included ways of ensuring proximity between them and their baby and efficient time managing. The timing of these strategic actions spanned from pregnancy, over maternity leave, to the return to employment. Managing breastfeeding and work triggered emotions such as stress, frustration and guilt, but also satisfaction and joy. Mothers negotiated with family, employers, colleagues and informal networks to gain support for their strategies, displaying both individual, collective and proxy agency. Changing family structures and roles highlight the potentially greater supportive role of the partner/husband. Work/Family Border Theory and Bandura’s agency constructs provided frameworks for a deeper understanding of mothers’ perspectives, but using existing family relationship constructs would better diffentiate between various modes of agency. Workplaces and maternity protection conditions were generally inadequate. Interventions are required: to strengthen the breastfeeding mother’s own agential capacity using an individual approach; to provide information to families and communities; to improve regulatory, structural and attitudinal conditions at workplaces, and to strengthen health and social services to adequately support mothers in managing breastfeeding and other work.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. , 68 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1086
Keyword [en]
Breastfeeding, Women, Mothers, Work, Employment, Agency, Tanzania, India
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
URN: urn:nbn:se:uu:diva-247759ISBN: 978-91-554-9208-3 (print)OAI: oai:DiVA.org:uu-247759DiVA: diva2:797377
Public defence
2015-05-26, Room IX, Universitetshuset, Biskopsgatan 3, Uppsala, 13:00 (English)
Opponent
Supervisors
Available from: 2015-05-04 Created: 2015-03-23 Last updated: 2015-07-07
List of papers
1. Whom can I rely on? Mothers' approaches to support for feeding: An interview study in suburban Dar es Salaam, Tanzania.
Open this publication in new window or tab >>Whom can I rely on? Mothers' approaches to support for feeding: An interview study in suburban Dar es Salaam, Tanzania.
2007 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 23, no 2, 172-183 p.Article in journal, Editorial material (Refereed) Published
Abstract [en]

Objective

to explore and describe mothers’ perceptions of baby feeding and approaches to support for baby feeding.

Design

individual qualitative semi-structured interviews conducted with mothers. Method used for analysis was qualitative content analysis.

Setting

suburban Dar es Salaam, Tanzania.

Participants

8 mothers with babies under 6 months of age.

Findings

the study revealed four categories of mothers’ perceptions of baby feeding: (1) baby feeding, housework and paid work have to adjust to each other; (2) breast feeding has many benefits; (3) water or breast milk can be given to quench baby's thirst; and (4) crying provides guidance for baby feeding. Four different themes describing approaches to support emerged from the data: (1) adhering to diverse sources; (2) relying wholeheartedly on a mother figure; (3) working as a parental team; and (4) making arrangements for absence from the child.

Key conclusions and implications for practice

knowledge of the different approaches to support for baby feeding described in this study can help define counselling and promotional strategies in order to reach mothers with more effective messages and support for optimal baby-feeding practices.

Keyword
Infant feeding, Mother´s perceptions, Support, Tanzania, Interviews
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-11057 (URN)10.1016/j.midw.2006.05.002 (DOI)17049695 (PubMedID)
Available from: 2007-05-16 Created: 2007-05-16 Last updated: 2015-07-07Bibliographically approved
2. How do health workers balance infant feeding and employment?
Open this publication in new window or tab >>How do health workers balance infant feeding and employment?
2008 (English)In: Afrikan Journal of midwifery and women´s health, Vol. 2, no 1, 46-52 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-13076 (URN)
Available from: 2008-01-21 Created: 2008-01-21 Last updated: 2015-07-07
3. ‘Negotiating the tensions of having to attach and detach concurrently’: A qualitative study on combining breastfeeding and employment in public education and health sectors in New Delhi, India
Open this publication in new window or tab >>‘Negotiating the tensions of having to attach and detach concurrently’: A qualitative study on combining breastfeeding and employment in public education and health sectors in New Delhi, India
Show others...
2015 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, no 4, 473-481 p.Article in journal (Refereed) Published
Abstract [en]

Objective: the aim of this study was to explore the factors involved in combining breastfeeding and employment in the context of six months of maternity leave in India.

Design: qualitative semi-structured interviews were conducted and analysed using a Grounded Theory approach.

Setting: Health and Education sectors in New Delhi, India,

Participants: 20 first-time mothers with one 8-12 month-old infant and who had returned to work after SIX months maternity leave.

Measurements and findings: the interviews followed a pre-tested guide with a vignette, one key question and six thematic areas; intentions, strategies, barriers, facilitators, actual experiences and appraisal of combining breastfeeding and employment. Probing covered pre-pregnancy, pregnancy, maternity leave, the transition and return to work. This study revealed a model of how employed women negotiate the tensions of concurrently having to attach and detach from their infant, work, and family. Women managed competing interests to ensure trusted care and nutrition at home; facing workplace conditions; and meeting roles and responsibilities in the family. In order to navigate these tensions, they used various satisficing actions of both an anticipatory and troubleshooting nature.

Key conclusion: in spite of a relatively generous maternity leave of six months available to these women, several individual, familial and workplace factors interacted to both hinder and facilitate the process of combining breastfeeding and employment. Tension, negotiation and compromise are inherent to the process.

Implications for practice: antenatal and postnatal interventions providing information and support for working mothers need to address factors at the individual, family and workplace levels in addition to the provision of paid maternity leave to enable the successful combination of breastfeeding and employment.

National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-247658 (URN)10.1016/j.midw.2014.12.008 (DOI)000353526100011 ()25660847 (PubMedID)
Available from: 2015-03-23 Created: 2015-03-23 Last updated: 2017-12-04Bibliographically approved
4. Theory and social practice of agency in combining breastfeeding and employment: A qualitative study among health workers in New Delhi, India
Open this publication in new window or tab >>Theory and social practice of agency in combining breastfeeding and employment: A qualitative study among health workers in New Delhi, India
Show others...
2014 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 27, no 4, 298-306 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Women's agency, or intentional actions, in combining breastfeeding and employment is significant for health and labour productivity. Previous research in India showed that mothers use various collaborative strategies to ensure a "good enough" combination of breastfeeding and employment. Bandura's theoretical agency constructs previously applied in various realms could facilitate the exploration of agency in an Indian context.

AIM:

To explore manifestations of agency in combining breastfeeding and employment amongst Indian health workers using Bandura's theoretical constructs of agency and women's experiences.

METHODS:

Qualitative semi-structured interviews were conducted with ten women employees within the governmental health sector in New Delhi, India. Both deductive and inductive qualitative content analyses were used.

FINDINGS:

Bandura's features and modes of agency revealed that intentionality is underpinned by knowledge, forethought means being prepared, self-reactiveness includes collaboration and that self-reflectiveness gives perspective. Women's interviews revealed four approaches to agency entitled: 'All within my stride or the knowledgeable navigator'; 'Much harder than expected, but ok overall'; This is a very lonely job'; and 'Out of my control'.

CONCLUSIONS:

Agency features and their elements are complex, dynamic and involve family members. Bandura's theoretical agency constructs are partially useful in this context, but additional social practice constructs of family structure and relationship quality are needed for better correspondence with women's experiences of agency. The variation in individual approaches to agency has implications for supportive health and workplace services.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-232781 (URN)10.1016/j.wombi.2014.07.002 (DOI)000346617900022 ()25108676 (PubMedID)
Available from: 2014-09-25 Created: 2014-09-25 Last updated: 2017-12-05Bibliographically approved

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Omer-Salim, Amal

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