When Joy Elizabeth had her first baby, she put into personal practice what she had professionally coached many mothers through – within an hour of her son’s birth she started breastfeeding him, immediately establishing her newborn’s foundation to build lifelong immunity.

The importance of breastfeeding is deeply familiar to Joy, a nutritionist at Busia County Referral Hospital in Kenya. As part of her job, she has actively engaged with Nutrition International programming, participating in a training of trainers on the baby-friendly community initiative to promote breastfeeding. She has run trainings for other health workers, as well as sensitized community members and provided counselling for mothers on the importance of early and exclusive breastfeeding for the first six months, and continued breastfeeding for two years and beyond.

“The knowledge I acquired during implementation of the Nutrition International funded activities like training on maternal, infant and young child nutrition helped me a lot because I knew what to do. It gave me a desire to practice and I experienced how it feels to breastfeed exclusively,” Joy shared.

Exclusive breastfeeding for the first six months, followed by introducing complementary foods with continued breastfeeding for at least two years, provides babies with the nutrition needed to support optimal growth, build a strong immune system and boost brain development. The developmental window of 1,000 days – from conception to a child’s second birthday – has lasting consequences, impacting school performance with a correlation to a person’s future earning potential.

But the ability to exclusively breastfeed can be jeopardized if the right conditions are not in place to support a mother to do so, especially when she heads back to work.

“There is a need to scale up workplace support for breastfeeding with more and more women becoming economically active,” said Stephen Mwangi, Nutrition International’s Senior Program Officer in Kenya. Maternity leave in Kenya is currently three months, half of the recommended time to exclusively breastfeed. “Looking at data, nationally, exclusive breastfeeding rates are impressive within the first three months, but where we start to decline is from the fourth month. One of the contributing factors is the issue of women going back to work because they have a dual responsibility to earn a livelihood while ensuring they continue to exclusively breastfeed their babies. We need to make the workplace conducive to breastfeeding.”

In Kenya, Nutrition International works closely with county governments to integrate, finance and implement essential nutrition actions through the health system. A key part of this is investing in and supporting implementation of county nutrition action plans that prioritize breastfeeding and help strengthen health systems to make breastfeeding feasible for a working mom.

“It gave me a desire to practice and I experienced how it feels to breastfeed exclusively.” – Joy Elizabeth, nutritionist and new mom 

Joy had a network of support as she embarked on her breastfeeding journey. She recalled how her husband helped place their newborn in her arms and position his head so he could latch, as Joy had given birth by caesarean section and so had limited mobility. Her community also rallied around her, available to support with household chores, cooking and cleaning, and providing needed emotional support.

But even still, it was challenging to return to work halfway through the period she planned to exclusively breastfeed. “When maternity leave ended, I felt like crying because my baby was three months,” Joy shared.

Her colleagues at the county nutrition office, aware of the importance of newborn nutrition, helped ease the transition. The office created an environment where Joy was given the flexibility to express breastmilk and leave work to go home and care for her baby when needed. Her hours and workload were adjusted to make it more conducive for her as a new mother. When she needed to travel for work, she was able to bring her son with her. “My colleagues travelled with me and helped me with carrying the baby during the journey, caring for my son during the entire workshop period as well as providing me with counselling and encouraging me. I felt loved and well accommodated,” she said.

Joy was able to find a work-life balance that supported her desire to exclusively breastfeed. She also had the at-home support needed to make a successful transition.

“We need to make the workplace conducive to breastfeeding.” – Stephen Mwangi, Senior Program Officer

Joy’s experience rests against the backdrop of a larger initiative currently happening in Kenya to mandate workplaces to provide lactation rooms. The 2019 Breastfeeding Mothers Bill closed its public consultation in July 2021. If passed, it would legally require workplaces to provide a private space for breastfeeding or to express breastmilk that will include storage facilities for safely storing milk. This bill builds on the existing Kenya Health Act, 2017, which also requires that an employer establishes a lactation station in the workplace and provides additional breaks for nursing employees.

Nutrition International is a strong advocate for policy changes that will institutionalize an enabling environment for breastfeeding. The hope is that the bill becoming law will drive enforcement so that lactation rooms become the norm. “I can say that Kenya has very comprehensive infant and young child policies. We have very conducive legislative pieces. The remaining work is to engage with government on enforcement,” said Mwangi. “We started discussions with the Ministry of Health so that laws give authority for more enforcement officers. Right now, it is restrictive to public health officers, but we would also like nutritionists to be included in supporting enforcement.”

Although Joy spoke of many positive accommodations after her maternity leave, the hospital where she works did not have a lactation room for staff. With the support of the county nutrition coordinator, Joy took the lead in changing that. She spoke to management and a room has been secured for this purpose. Plans are underway to have it equipped and soon it should be appropriately outfitted.

Nutrition International continues to work directly with government to strengthen county nutrition action plans to help turn policies and legislation into everyday practice.

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