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.

The effect of maternal education on gender bias in care-seeking for common childhood illnesses.

This paper assessed gender bias within hospitalisation rates to ascertain whether differential care-seeking practices significantly contribute to excess female mortality. It then examined the impact of socio-economic factors, particularly maternal education and economic status, on gender bias. The results find both the clear and significant impact of gender on hospitalisation rates, as well as the simultaneous inability of rising education and economic status to alleviate this bias. A secondary analysis was conducted within a uniquely large and ongoing randomised control trial that sought to measure the impact of Zinc supplementation on hospitalisations and deaths in low-income communities in New Delhi, India. During the course of the study, 85,633 children were enrolled and monitored over one year of follow-up. Of the 430 deaths that occurred, 230 were female (0.57% of total females), while 200 were male (0.43% of all males). Despite this higher mortality amongst females (p<0.02), girls were hospitalised far less frequently than boys. Of the 4418 children who were hospitalised at least once, 2854 (64.6%) were males and only 1564 (35.4%) were females, indicating a significantly lower rate of care-seeking for females (p<0.00). Curiously, our results show that gender bias is highest amongst highly educated mothers, and decreases steadily for children of mothers with a middle school education, a primary school education, and is lowest amongst mothers with no formal education. Put differently, female children of mothers with no formal education were significantly more likely to be hospitalised than children of mothers with several years of formal education, even after adjusting for all other factors. Economic status was not found to affect the association of gender and hospitalisation, though overall odds of hospitalisation rose with increasing economic status. Paternal education was found not to be significantly related to hospitalisation.