When Nkiru Okeke gave birth last November, she looked forward to four months to start off exclusive breastfeeding.
Twelve weeks later, a call from the office dashed her hopes. HR was recalling her: her leave had ended.
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A journalist, she argued she was entitled to 16 weeks of paid leave, and had four more to go. She was told of a policy that gives her only three months of maternity leave, if she had already taken a month of annual leave in the year.
“They showed me a circular. It came directly from the Head of Service,” she recalls.
Millions of women like Okeke are having their exclusive breastfeeding dreams shot to pieces—and lives of children and the future of the country are caught in the middle.
The COVID-19 pandemic impacted health services in ways that are still unfolding. It gave women more time for child care, and by extension, breastfeeding.
“However, women have to return to work and need protection,” says Vivianne Ihekweazu, managing director at Nigeria Health Watch, in opening remarks on a recent nutrition policy dialogue. “Workplace plays a critical role.”
Laws and barriers to protection
Best practice when it comes to breastfeeding are three pronged: early initiation within an hour of birth, exclusive breastfeeding up to six months; continued breastfeeding with appropriate infant feeding for up to two years.
Working women are entitled to three months of maternity leave, but not all get it—both in private and public sector. Some states—Lagos, Ekiti, Enugu—have extended maternity leave to six months, but that covers only women in public sector. Kaduna’s extension is still in the works.
Setup of work—and returning to it—interferes with breastfeeding.
“The recommendation is that women should breastfeed for six months. It is not possible if maternity leave is just three months,” says Nemat Hajeebhoy, chief of UNICEF’s nutrition section.
Returning to work before six months is a key barrier to exclusive breastfeeding; and limited or nonexistent maternity protection policies prevent many women from having the time and space to breastfeed exclusively.
A survey of 2,111 working mothers by Alive and Thrive found the factor that most encouraged mothers to continue breastfeeding after returning to work was reduction in hours while breastfeeding.
“Given that nearly half of all women in Nigeria are part of the labour force and a substantial number are in the formal workforce, improving maternity protections in Nigeria, such as extending paid maternity leave and workplace support for breastfeeding, could help boost the low rates of exclusive breastfeeding,” the survey concluded.
At present, the rate of exclusive breastfeeding is 24%, despite a global target of 50% by 2025.
Proponents say the workplace must change to support and protect breastfeeding, but corporate Nigeria must first crunch the numbers for their bottomline.
Employers doing the maths are bothered about a woman staying away from work for six months while being paid.
The upside is breastfeeding encourages child spacing. For a woman with two children in a working life of 35 years, that’s two years’ downtime.
“Two years in a lifetime shouldn’t be a barrier,” says Hajeebhoy.
Studies have shown no correlation between maternity protection and employment loss. Instead they show more retention of women in workforce, improved productivity and employee loyalty.
“It can be done”
Kaduna has joined the list of states extending maternity leave to six months. It is also pushing the envelope on providing lactating spaces for mothers. It is as simple as 10square meters of space that isn’t a bathroom where mothers can breastfeed or express breastmilk while at work.
“We have used it to demonstrate that mothers can do it, and it helps make her more relaxed, more productive,” says Hajara Kera, director of public health at Kaduna state health ministry.
“It is going to take a little bit more time but we are pushing for ministries doing this to establish lactating rooms. Once people understand in the long term the benefits of breastfeeding, people will be more receptive.”
The Alive and Thrive survey found that while 72 in 100 women are in favour of extending maternity leave to six months, only three in 10 do take their entire maternity leave currently granted by legislation. Just nine in 100 organisation had a workplace breastfeeding policy – and 23 in 100 private-sector organisations provide creches or day care.
“If a woman is relaxed at work and her baby is nearby more milk flows. If we really want to increase our breastfeeding rates in Nigeria, we need to provide creches in workplace and schools,” says Temidayo Ajala.
But it isn’t always so simple to go about the legal right to breastfeed in the workplace.
A study at University of Port Harcourt Teaching Hospital has documented that the provision of a creche on its own is insufficient to ensure its patronage.
User education, support for optimal infant and young child feeding practices and maintenance of a friendly environment are also required, it said.
The willingness to actually breastfeed—and support for it—also counts. A study of working women in Lagos found around 29 in 100 women practised exclusive breastfeeding for up to six months after giving birth.
The major source of breastfeeding support came from the baby’s father while the least breastfeeding support came from the workplace, the researchers reported.
A commitment
“At the start of this year, governments, donors, civil society and the private sector united to launch the Nutrition for Growth Year of Action. The Year of Action is a historic opportunity to transform the way the world tackles the global commitment to eliminate child malnutrition,” said UNICEF at the state of the Breastfeeding Week this August.
“Breastfeeding is central to realising this commitment.”
Half of all childhood deaths are linked to malnutrition. Malnutrition itself accounts for $4 billion in annual household costs and $22 billion in health care system costs.
From an economic point of view, cutting off those costs could free up more funding for present emergencies like COVID-19, according to Kemi Agbaoye, senior programme manager at Nigeria Health Watch.
A handful of policies recognise the need for the best nutrition in the first 1,000 days of life—and it will take convincing organisations that breastfeeding strengthens their bottomline.
The policies, changes, adaptations to protect maternity comes in different shades—and the ministry of finance, budget and national planning has mandate to harmonise them all.
“We are monitoring them all,” says Chito Nelson, head of food and nutrition division at the ministry.
“All of us should act as change agents to ensure implementation of policy and guidelines.”
A bit late for Okeke, but she is not giving up.
The circular may have been recalled by the next time she has another baby. Her office may have provided for six months of paid maternity leave.
If not she must find a way to squeeze the most out of her leave—and ensure she gets the four months she is entitled to.
“We keep talking about the new normal in terms of COVID-19,” says Hajeebhoy. “But we need to make breastfeeding the new normal in Nigeria. It is not a woman’s responsibility; it is society’s responsibility.”
