The World Health Organisation celebrates World Breastfeeding Week every year and in 2023, their theme was, “Let’s make breastfeeding and work, work!” It focused on advocacy for maternity protection for working women by employers, which will translate into better breastfeeding practices for the child.
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Given that most countries recognise breastfeeding as a right of both the mother and the child, many accommodations are already in place in most of them. This is particularly important in a country like India which is riddled with child malnutrition. However, the practical realisation of these accommodations in the healthcare industry is riddled with difficulties.
“India, for example, has a maternity law which states that women get paid leave for six months after birth to breastfeed their children, and is also availed by physicians and nurses,” says Tobey Ann Marcus, an obstetrician in Vellore, Tamil Nadu. “But feeding beyond that period is near impossible for most healthcare professionals,” she adds.
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“There is a provision in the Maternity Benefits Act of 2017 which entitles a working woman to two breaks of fifteen minutes each until the child reaches the age of 18 months, to breastfeed or express breast milk”, adds Himadri Sinha, a consultant dermatologist based in Delhi. “However, there are many practical difficulties which make it almost impossible for a healthcare professional to avail this benefit,” she adds.
“It is so ironic that as healthcare professionals, we keep preaching to others about the importance of breastfeeding and yet our children suffer because we are unable to maintain a good breastfeeding practice due to work.”Dr. Tobey Ann Marcus, an obstetrician in Tamil Nadu
According to Namrata Mathew, a resident in Internal Medicine, the lack of a back-to-work policy in Indian healthcare is probably one of the reasons for the inability to implement these benefits. “Most other countries have a back-to-work policy which ensures that new mothers returning after their maternity leave will be giving them only 60% of their responsibilities allowing them to take the breaks necessary to breastfeed. But I did a 24-hour call the first day I was back,” she says.
Mothers who are healthcare professionals often resume full responsibilities on returning to work post-maternity. There are also instances where female physicians returning from maternity leave were asked to take on extra responsibilities immediately to make up for their absence during the maternity period and were blamed for the inconvenience caused to the covering physicians, especially if they were postgraduate residents. The cultural narrative is that the breastfeeding breaks taken by a doctor are a burden on their teammates.
“The allowance of breaks holds no meaning unless the responsibilities are scaled down,” says Dr. Himadri. “Female physicians and other healthcare workers realise soon that they will have to stay later than usual to complete their duties if they avail the breaks which may further cut into the time they want to spend with their child.”
In Turkey, female physicians are given the right to leave work three hours earlier than usual for the first six months after delivery and 1.5 hours earlier than usual for the next six months. Turkey also allowed female physicians the right to not work night shifts for 24 months after delivery. These rights appear to directly translate into the increased duration of both exclusive as well as total breastfeeding.
The other problem is the lack of safe, hygienic spaces to breastfeed in most hospitals. “I had to lock my OPD room door and sterilise my table to express breast milk. There was truly no other place I could do the same. I was, however, lucky for the hour-long lunch break, which I could use for this purpose,” says Dr. Sinha.
“It is so ironic that as healthcare professionals, we keep preaching to others about the importance of breastfeeding and yet our children suffer because we are unable to maintain a good breastfeeding practice due to work,” says Dr. Tobey, who found herself taken aback at returning to work and finding no accommodation.
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“As there was no place provided to me, I made one for myself,” she adds. “I set up a breast milk pumping station in my office and used a fridge that someone had donated to the store. So it ended up working out for me,” she says, “I hung a sign outside the room whenever I needed to use it which said ‘Being used as a lactation room, come back in 30 minutes’. A colleague who delivered after me did the same with a break room. Once we stopped needing this set-up, it went on to help so many other healthcare workers in the hospital.”
According to a study published in JAMA, tailoring breastfeeding policies to the unique needs of healthcare professionals is required as the medical field has a high-commitment workplace culture which is unlike many other workstreams. It is important to initiate conversations and educate people to achieve a lactation-positive workplace culture.
“Hospitals must also provide places for physician mothers to store breastmilk,” adds Kanimozhi, a lactation counsellor who works in Coimbatore. “Most hospitals have neonatal ICUs which have storage facilities for expressed breast milk for infants, a physician mother could request to store her breastmilk there if a dedicated refrigerator is not present in the lactation space provided to her,” she says. “Most physician mothers do not know that one does not need to sterilize the breast milk pump after each use,” she mentions. “The entire unit can be refrigerated when one is at work and then can be sterilized when one goes home. It is only necessary to sterilize a pump every 24 hours as long as it is refrigerated between pumps,” she says. This knowledge will help mothers in healthcare eliminate a few extra steps in their breastfeeding and lactation practice which will encourage them to continue expressing their breastmilk.
“Many female physicians are also unaware of their rights and maternity benefits,” adds Kanimozhi. “Many institutions do not explain their rights to them transparently because they may suffer economic losses if they provide them with accommodations,” she says.
These things indicate that even if a mother in healthcare decides to stick with her breastfeeding journey despite the many inconveniences, she has to jump through many hoops to make that possible. The stress on the mother because of the same may then negatively affect her workplace performance and patient care, as well as her mental health and come in the way of her duties to her child. This reveals that existing policies may need to be revised and re-tailored to cater to a high-commitment career choice such as medicine.
Published - November 07, 2023 08:52 pm IST
