Breastfeeding knowledge and practices of working mothers in the informal economy in New Delhi: A formative study to explore new intervention pathways towards improved maternal and child health outcomes

This was a formative study to yield evidence on the conceptual and empirical pathways to improve maternal and child health (MCH) outcomes among informally working mothers while securing livelihoods, and for this, explores how informally working women navigate time sensitive childcare practices such as exclusive breastfeeding (EBF) with their work, and how do the conditions and nature of informal employment shape it. This study was conducted in February–May 2017 using non-probability sampling for cross-sectional semi structured interviews (n = 92) and focus group discussions (n = 56) with working mothers with a child under 2 and 5 years respectively, having regular and stable working history in the informal economy. The study team partnered with Self-Employed Women's Association for site selection and recruitment of study participants across 4 sectors of work in New Delhi, India: home-based work, pheri or barter work, street vending and domestic work. While 65% women report EBF for 6-months, checks with infant feeding recall reveal several disruptions from customary practices and working conditions, and successful EBF only in home-based work, the least paying of all. 59% women reported returning to work under 6-months, leading to early weaning. 90% women were aware of the importance of EBF in the standard language of public health messaging, however, checks with non-standard language queries reveal a drop to 55–80% exhibiting lack of effective knowledge that women could use. The findings emphasise that conditions and nature of informal employment shape MCH outcomes in cities of the global south, where such employment dominates. Furthermore, we use the findings to suggest the following responsive approaches for intervention: delaying mother's return to work, increasing proximity between mother and child, deeper and engaged knowledge of breastfeeding and early child development practices, improving problem solving capacity and agency of the mother, and enabling home and workplace conditions. •Develops intersectionality between informal work and health.•Informal work amongst women shape breastfeeding outcomes.•Exclusive breastfeeding highest in lowest paying sector of work: home-based.•Majority of women returning to work under 6-months, leading to early weaning.•Pathways to create work-based interventions vary by informal work sector.