Theory and social practice of agency in combining breastfeeding and employment: A qualitative study among health workers in New Delhi, India.

ABSTRACT

BACKGROUND: Women's agency, or intentional actions, in combining breastfeeding and employment is significant for health and labour productivity. Previous research in India showed that mothers use various collaborative strategies to ensure a "good enough" combination of breastfeeding and employment. Bandura's theoretical agency constructs previously applied in various realms could facilitate the exploration of agency in an Indian context. AIM: To explore manifestations of agency in combining breastfeeding and employment amongst Indian health workers using Bandura's theoretical constructs of agency and women's experiences. METHODS: Qualitative semi-structured interviews were conducted with ten women employees within the governmental health sector in New Delhi, India. Both deductive and inductive qualitative content analyses were used. FINDINGS: Bandura's features and modes of agency revealed that intentionality is underpinned by knowledge, forethought means being prepared, self-reactiveness includes collaboration and that self-reflectiveness gives perspective. Women's interviews revealed four approaches to agency entitled 'All within my stride or the knowledgeable navigator'; 'Much harder than expected, but ok overall'; This is a very lonely job'; and 'Out of my control'. CONCLUSIONS: Agency features and their elements are complex, dynamic and involve family members. Bandura's theoretical agency constructs are partially useful in this context, but additional social practice constructs of family structure and relationship quality are needed for better correspondence with women's experiences of agency. The variation in individual approaches to agency has implications for supportive health and workplace services.