Mothers’ Agency in Managing Breastfeeding and Other Work in Dar es Salaam, Tanzania and New Delhi, India

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