Effect of maternal employment on exclusive breastfeeding practice among mothers of infants 6–12 months old in Wolkite town, Ethiopia: a comparative cross-sectional study

(2022) 22:222 Zewdie et al. BMC Women’s Health https://doi.org/10.1186/s12905-022-01816-9 Open Access RESEARCH Effect of maternal employment on exclusive breastfeeding practice among mothers of infants 6–12 months old in Wolkite town, Ethiopia: a comparative cross‑sectional study Amare Zewdie*, Temesgen Taye, Abebaw Wasie Kasahun and Abdu Oumer Abstract Introduction: Exclusive breastfeeding (EBF) means providing only breast milk for infants for up to six months without the addition of solid or liquid matter. Even though EBF had great benefits for infants and mothers, the rate of EBF is so limited below the global target. In Ethiopia, the overall EBF practice is 59%. This low EBF practice had a great unexplained variation among employed and unemployed mothers. Therefore, this study aimed to compare EBF practice and associated factors among employed and unemployed mothers of infants aged 6–12 months in Wolkite town, Southern Ethiopia, 2020. Methods: A community-based comparative cross-sectional study was conducted in March 2020. A total sample of 485 (241 employed and 244 unemployed) study subjects was involved in the study. A simple random sampling technique was used to recruit study subjects. A pre-tested structured interviewer-administered questionnaire was used. Multivariable logistic regression was used to identify associated factors of EBF practice for the whole study participants and then for employed and unemployed mothers independently. Results: The pooled prevalence of exclusive breastfeeding practice was 63.9% [95% CI (59.8–68.2%)]. Exclusive breastfeeding practice was 54.8% [95% CI (48.5–61.4%)] and 73% [95% CI (66.8–78.7%)] among employed and unemployed mothers respectively. Three or more years of a birth interval [AOR = 4.03; 95% CI (1.80–8.99)], three or more ANC visits [AOR = 5.39; 95% CI (1.49–19.45)], and having PNC service [AOR = 4.56; 95% CI (2.0–9.4)] significantly associated to exclusive breastfeeding practice among employed mothers. No history of breastfeeding counseling during ANC visits [AOR = 0.15; 95% CI (0.06–0.41)], had history of breast disease [AOR = 0.28; 95% CI (0.08–0.99)], three or more ANC visits [AOR = 5.11; 95% CI (1.66–15.8)], and having social support [AOR = 3.05; 95% CI (1.23–7.6)] significantly associated to EBF practice among unemployed mothers. Conclusion: Employment among mothers was found to discourage EBF practice. The predictors of exclusive breastfeeding practice are different for employed and unemployed. Therefore Policymakers and program planners are called to come together and create a conducive environment for lactating employees, and appropriate intervention at respective predictor variables is needed to enhance EBF practice. *Correspondence: Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Zewdie et al. BMC Women’s Health (2022) 22:222 Page 2 of 11 Keywords: Exclusive breastfeeding practice, Mother’s employment, Infant feeding, Comparative cross-sectional, Ethiopia Introduction Exclusive breastfeeding (EBF) means providing only breast milk for infants for up to six months without the addition of solid or liquid matter with the exception of oral rehydration solution, or drops/syrups of vitamins, minerals, or medicines [1, 2]. Breast milk in the first six months contains all the necessary nutrients provided in a bioavailable and easily digestible form. It is among the most effective ways to promote maternal and child health [3]. Exclusively breastfed infants can be protected from diarrhea, acute respiratory infections, risk of obesity, and allergies [4]. It is also important to the mother in returning the uterus to pre-pregnancy size faster; reduces the risk of breast, ovarian, uterine cancers, and osteoporosis. It also creates a special bond between mother and infant and aids in household food security by saving money [5, 6]. World health organization recommends EBF for the first six months of life. Then safe and adequate foods should be started after the six months, and breastfeeding continued up to two years and beyond [1, 7]. Globally, in 2021 only 44% of infants 0–6 months old are exclusively breastfed [8]. In Sub-Saharan Africa and East Africa, EBF practice was 31% and 42% respectively [9]. Ethiopian demographic health survey (EDHS) 2019 showed that EBF practice in Ethiopia was estimated to be 59% [10]. Despite appropriate feeding practice, being the most cost-effective intervention to reduce child morbidity and mortality, WHO in 2013 reported that nonexclusive breastfeeding contributes to 11.6% of mortality in children under the age of five years. This was equivalent to about 804,000 child deaths [11]. UNICEF in 2018 noted that improving breastfeeding rates around the world could save the lives of more than 820,000 children under the age of five every year [3]. Non-exclusive breastfeeding results in an estimated 40% of under‐five stunting in Western and Central Africa [12]. In Ethiopia, adequate EBF practices are expected to save the life of 70,000 infant deaths per year which is 24% of the total infant deaths annually [13]. In 2016, Ethiopia developed several nutritional strategies to increase the nutritional status of the child. These are: Promoting EBF for the first 6 months, establishing a baby-friendly health facility initiative in all public and private health facilities, enforcing the International Code of Marketing for Breast milk Substitutes, promoting the enactment of maternity leave, implementing breastfeeding rooms in major service providing institutions, and support employed breastfeed mothers to exclusively breastfeed their child [14]. Although repeated recommendations were given to EBF practice in Ethiopia, a trend study from 200 to 2016 revealed that the improvement in EBF practice was not statistically significant [15]. Similarly, EDHS showed that EBF practice (...truncated)