A mother is supposed to “get done” with procreating within the time assigned and return to work. Whether it is a woman in the more stereotypical work of being an educationist (mostly looked at as an “easier’ job with lesser working hours) or the corporate workforce that gets the law mandated 3 months’ maternity leave, the allowances for motherhood are finite in the eyes of state and society. There are smaller urban employers mostly including schools and education institutes that evade the maternity leave regulation or even if they provide it, they make the life of a new mother so miserable that she leaves work on her own.
Accompanying this external battle to make space for a small, demanding human being is the physical and emotional upheaval that continues within a mother. While she struggles to get appropriate postpartum leave and care, her body is going through quite a marathon of its own. As mammals, lactation is an essential part of the motherhood experience whether a mother chooses to breastfeed or not. For those who decide against it, it remains a process that leads to the body slowly ending the natural initiation of milk production. It may take a week or a month or more taking its own trajectory.
For those who decide to breastfeed in any quantity or form, that is (i) exclusive breastfeeding, (ii) combination feeding, (iii) feeding directly or, (iv) exclusively pumping to everything in between, things are very different from those who decide to prematurely end this function or are unable to continue.
Initial days for this mother (given that we have a state mandated 3 month paid maternity leave which is soon to be extended to 6 months) are only comparatively easier while the breastfeeding journey is effectively initiated and well established. Once a mother returns to work, she currently has a few options. Where mothers choose to switch to formula and bottle feeding, their supply is at a heightened risk to face a sharp decline. Since the child is exposed to an artificial nipple, their latch on the mother’s body also declines in efficiency again hurting the breastmilk supply. In practice we come across an array of situations which range from situations of gradual but complete cessation of breastmilk production as well as reduction in supply but continuation of breastfeeding from a few months up until even a year in some cases.
Initial days for this mother (given that we have a state mandated 3 month paid maternity leave which is soon to be extended to 6 months) are only comparatively easier while the breastfeeding journey is effectively initiated and well established. Once a mother returns to work, she currently has a few options. Where mothers choose to switch to formula and bottle feeding, their supply is at a heightened risk to face a sharp decline. Since the child is exposed to an artificial nipple, their latch on the mother’s body also declines in efficiency again hurting the breastmilk supply. In practice we come across an array of situations which range from situations of gradual but complete cessation of breastmilk production as well as reduction in supply but continuation of breastfeeding from a few months up until even a year in some cases.
In cases where the mothers choose to keep their breastmilk supply and aim to continue to either exclusively breastfeed or breastfeed for the most part with minimal supplementation with formula, they usually resort to the usage of a mechanical breast pump unless they have childcare facilities available at workplace and the baby accompanies them at work. These pumps are available in varying degrees of efficiency and while multi-user, hospital grade double electric breast pumps are the ones that usually sustain breastmilk output, there is an array of less competent pumps doing a sufficient job for many mothers. A good pump for single, personal usage will cost anywhere between PKR 50,000 to well beyond PKR 200,000 in a country where (sporadically implemented) minimum wage has just recently been approved to creep up to PKR 37,000. There are less expensive options but their reliability to support a supply is also directly proportionate to their price. Having said that, there are plenty of mothers using these cheaper pumps and successfully maintaining their supply. Their dilemma is one of discipline. They can never risk missing a session. These pumps, if malfunction (which they often do after a certain time) or the mother misses a scheduled session, lead to decline in supply which, to reverse in most cases will require the Ferraris of the breast pumping world usually out of reach for mid-tier working class families.
The situation is tricky. The more affordable pumps will only work if they already have a good supply, but they cannot be tardy with the schedule. An established supply will usually take a mother a lot of hard work because even the most top-tier hospitals will also have little to no breastfeeding support and initiate bottle usage even before bringing a baby to the mother for the first time post-birth. So, the onus lies with the mother to get the baby back on the breast effectively without much support, establish supply as well as keep the breastfeeding journey going before it is time for her to return to work while explaining to everyone why she does not wish for the child to be offered a bottle. Unfortunately, women who choose these science-backed approaches face a lot of push back from those in their close quarters. If a mother is able to sustain her breastfeeding journey up until her transition back to work, it is not a miracle but a show of sheer grit and resistance that often leaves her traumatised. That is an unfair baseline requirement to have of a woman to be able to do something as basic as breastfeeding that everyone so flippantly regards as the best practice for infant nutrition.
Once the mother is back at work, newer arduous avenues await her. The standard pumping schedule for maintenance is not arduous where a mother needs to empty her breasts once every three hours. This usually takes anywhere between 10-15 minutes per session. In a typical workday this will therefore only be needed a couple of times.
Frankly, people take longer, more frequent smoking breaks than this so this is an easy win for any Human Resources department where all they must provide a mother is a comfortable room with privacy. These are usually empty meeting rooms, prayer rooms or women’s common rooms, in some cases equipped with a screen and an extra chair and table. Storage of expressed milk is done by using cold packs and cooler kits and doesn’t necessarily require refrigerator space.
Despite this ease, a 2016 cross sectional study across employers in Karachi for breastfeeding support, only 15% provided breastfeeding breaks and less than 7% provided onsite childcare and other physical breastfeeding support services such as a breastfeeding corner, refrigeration, pump or nursery1. Since most of the decision makers are men, viewing maternity leave as a “vacation” already in the guise of procreation, the inflexibility prevails towards simple accommodations that can be made at work to support a working mother’s breastfeeding journey. This promotes job satisfaction for the female workers as well as contributes to lower absences due to an unwell child throughout the first 5 years of the baby’s life2.
Then there are stay at home moms or mothers who work part time or work from home either due to the kind of work they do or by virtue of support from their workplace mostly from either high-level multinational companies or from the tech sector. The two of these categories forming a very small percentage of working women. While still responsible to do all the aforementioned categories of work, breastfeeding is comparatively easier for them to manage than the mother that has to work displaced away from her child.
However, it doesn’t lessen the burden of the two kinds of work being assigned to them and expected to drop the ball on neither. They usually breastfeed directly every few hours given their working schedules or choose to pump during busier hours of the day.
The rural woman however stands at a constant handicap here. In most cases, whether it is the pressures of household work, caring for older children or the essential work in the fields that waits for no one, they hardly ever get time to ease into motherhood and breastfeeding. Neither do they have access to electric breast pumps nor formula in many cases and end up with moving small babies to cow’s milk and water neither of which are fit for them and often lead them to diarrhea which is one of the notable causes of infant mortality3.
While the urban woman by access of medical facilities and pumps has an advantage over rural women, their psychological and social dilemma often resembles. The community around them at work or home rarely understands the basic requirements to be able to sustain breastfeeding and then is very quick to blame the mother once it ceases or slows down. The modern woman irrespective of her geographical location is stuck between a rock and a hard place and struggling for basic needs to be able to do this very important work that lays the groundwork for her child’s lifelong health and longevity, an instinctual need for a mother of any species to ensure. Much education is required in this regard for not just new or expectant mothers but also the public at large as to how they can support a new mother in this journey that across generations has become quite a puzzle to crack.
Hareem is a finance professional and International board certified lactation consultant with over 20 years of corporate experience and freelance consulting. Motivated by personal breastfeeding challenges, she transitioned to health sciences and now trains healthcare professionals, provides telehealth support globally, and operates a lactation clinic in Lahore.
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breastfeeding support in Karachi, Pakistan: a cross-sectional study. International breastfeeding journal, 11(1),
24. https://doi.org/10.1186/s13006-016-0084-7
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systematic analysis for 2010 with time trends since 2000 [published correction appears in Lancet. 2012 Oct
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