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Try out PMC Labs and tell us what you think. Learn More. Breastfeeding has numerous health, environmental, and economic benefits, and the promotion and support of breastfeeding has been at the centre of efforts from many global organizations such as WHO and UNICEF to promote maternal and child health. Interventions developed from lactation prostitution policies tend to be inaccessible to those who are economically marginalized, however, and thus may further inequities.
Lactation prostitution the lived experiences of women occupying this segment of society, such as sex workers, illuminates the social and structural determinants of breastfeeding and how they constitute structural vulnerability that renders breastfeeding difficult. This qualitative study explores breastfeeding practices and decisions among sex workers in Mumbai and the factors shaping their experiences.
We conclude with discussing the need to promote appropriate infant feeding practices through culturally responsive interventions and mechanisms, taking both proximal and distal factors intoto work towards equity in health outcomes. Breastfeeding is widely promoted as a mechanism to reduce maternal and child health inequities and can prevent infant death, particularly when water safety is of concern.
To be effective, global policies must lactation prostitution on those who are most at risk of not breastfeeding in these settings e. This qualitative study advances our understanding of how female sex workers' structural vulnerabilities shape their breastfeeding decisions and practices. These findings can help shape the development of culturally responsive, and more effective programmes for female sex workers, to encourage and support breastfeeding when indicated.
Breastfeeding is promoted worldwide as the ideal way to feed an infant. International efforts to promote breastfeeding have been underway for nearly 30 years, from the Innocenti Declaration and the UN Convention on the Rights of the Child Rollins et al.
WHO recommends exclusive breastfeeding to 6 months and partial breastfeeding up to 2 years of the infant's life or longer WHO, Failing to achieve this optimal breastfeeding rate has both economic and environmental costs as well as health implications—including maternal and child morbidity and mortality Rollins et al. Breastfeeding is a mechanism of disease prevention as formula fed infants have increased risk of infant mortality because of conditions such as diarrhoea, respiratory infections such as pneumonia, and undernutrition WHO, The increased availability of formula has resulted in an increase in the infant mortality rate by 9.
Approximately In India, For the entire Southeast Asia region, DALY has decreased between and Institute for Health Metrics and Evaluation, ; however, there is variation within and across nations. In India, there was modest improvement during this timeframe in the proportion of the population exclusively breastfeeding through 6 months of age; however, examination of this trend by wealth quintiles shows that gains were made among those in the highest economic quintile. To meet breastfeeding goals among those most at risk of poor health outcomes, we must examine how women in the lowest economic quintiles e.
Ideally, recommendations from health care providers on the safest way to feed an infant would be based on a woman's medical status and the provider's assessment of her specific risk factors Suryavanshi et al. This illustrates the complexity that health care providers face when advising sex workers on how best to feed their infant. Nevertheless, a relatively high percentage of FSWs in India initiate breastfeeding. One exploratory study of breastfeeding among FSWs in India found that Little is known on the duration of breastfeeding, or breastfeeding exclusivity among FSWs, however.
A woman's decision about breastfeeding is complex and encapsulates attitudes, beliefs, and knowledge, as well as cultural norms and perception of risk. It is important to understand the contexts and factors shaping women's breastfeeding decisions, in order to ensure that overarching global human rights policies can be actualized in a way that is effective and accessible to those who are most at risk. The purpose of the current study is to explore FSWs breastfeeding decisions and capture how they are informed by factors constituting their distinct sociopolitical context.
Two organizing concepts were applied to this study—a conceptual model of determinants of breastfeeding as introduced by Rollins et al. To understand patterns of breastfeeding, it lactation prostitution not sufficient to view it as an individual health behaviour; rather, we must contextualize it as nested within historical, structural, cultural, and market factors. Rollins et al. This framework illuminates structural and cultural factors and highlights how women experience and interpret them within their lived experiences, given their particular social positioning.
Structural vulnerability can be used to examine how macrolevel risk factors are embodied through diseases, perspectives, or health behaviours Rhodes et al. Although elements of marginalization or oppression are often generalizable, say for all individuals of a lower caste, specific populations in particular sociopolitical contexts i. To date, there have been studies applying the concept of structural vulnerability to FSWs generally see Miller et al.
Macrolevel policies that contextualize breastfeeding as a health behaviour decision constrained by overarching forces e. This study seeks to move the concept of structural risk factors and the direct ways in which lactation prostitution are experienced by FSWs into the concrete and practical realm. This qualitative study answers the following research questions: a How do women working as FSWs in Mumbai, India, describe their infant feeding decisions and experiences?
Women's ages ranged from 23—50 years, with a median age of 30 years. Participants had between one and five children, with a median of two. Although women were asked about their reproductive health, they were not explicitly asked to disclose their HIV status.
Women interested in participating were asked to contact the second author. A snowball sampling strategy was also used to recruit additional participants. These were completed in December Interviews lasted from 1 to 3 hr and took place in brothels where the women worked. Questions focused on maternal health, infant feeding, lactation prostitution mothering. Interviews were conducted in Hindi by the second author of the paper and were translated and transcribed into English. Strategies for rigour included detailed journalizing during data collection and analyses for reflexivity and to track the development of key concepts.
Members of the research team brought a diverse range of applicable skills and expertise applicable to this topic including the aforementioned research and practice experience with FSWs in India second authorresearch and practice experience related to breastfeeding first and third authorand experience with human trafficking and social determinants of health fourth author. Each author has one or more graduate degrees in social work and experience working in public health or studying topics relevant for the discipline.
Given the vulnerability of the population, measures were implemented to protect participants' privacy and ensure the research was conducted ethically. For example, given varying levels of literacy, women were verbally informed of the purpose of the study and their rights related to participation, and they were asked to provide verbal consent to participate.
Structural vulnerability was explored a priori as a sensitizing concept; however, it did not drive a prescriptive coding or thematic development process. The codebook was cocreated by two members of the research team using an inductive approach Thomas, All transcripts were then dual coded; discrepancies were addressed through consensus. Focused coding was then used for thematic development, with an emphasis on identifying themes that aligned with the research questions, which were informed by structural vulnerability.
Findings from the analyses are presented below, in direct response to each of the three research questions. The first section explores women's infant feeding practices, whereas the second and third sections focus on proximal and distal factors, respectively, that shaped women's breastfeeding decisions and practices. Among women who gave birth prior to engaging in sex work, a higher proportion initiated breastfeeding Among those who did initiate breastfeeding, their breastfeeding duration ranged from a few days to 2 years. Women discontinued breastfeeding for a of reasons.
Several women who either breastfed a short duration or not at all indicated issues with breastmilk supply. They stated that either their milk did not come in immediately after giving birth or they had insufficient milk production. This may have been a perception of insufficient milk supply or may have been physiological given the constraints to breastfeeding on demand and the mothers' increased levels of stress Geddes, Some women reported lactation prostitution an injection to stop their milk production, either voluntarily or by force.
For women who did not initiate breastfeeding, or who experienced early weaning, formula often called bottled milk, powdered milk, or outside milk was the most common supplemental lactation prostitution feeding method. It is important to note that most women relied on formula as a result of breastfeeding constraints, rather than having an expressed preference for infant formula. In fact, the use and cost of formula often presented a ificant challenge for women. Several described struggling to pay for formula; some had help lactation prostitution their adami partnerwhereas others borrowed money.
One woman described selling her possessions to pay for milk:. She said she will sell to buy milk for him and food. It was really difficult … no one to help me. No one fed my son. Not even me. I could not get help. He got outside milk and as soon as he could started eating some food. How my children suffered only I know. This woman's experience also highlighted the early introduction of solid foods.
WHO recommends that complementary feeding begins no earlier than 6 months of age. However, several participants indicated they introduced solid foods early. Women identified six proximal factors that directly influenced either their infant feeding decisions or their feeding practices and the ways that these were experienced. Women described the relationship between working as a sex worker and infant feeding as complex and multifaceted; there was no singular factor that made breastfeeding and sex work largely incongruent but rather a constellation of the following factors.
Women discussed engaging in sex work until late in their pregnancies and returning to work quickly after giving birth, typically within a few weeks. For women who initiated breastfeeding, they were unequivocal about the impact this had on their ability to continue breastfeeding. Their return to work resulted in lactation prostitution a reduced amount of breastfeeding or discontinuation altogether.
The inverse relationship between a woman's return to sex work and ability to sustain breastfeeding was largely due to the impact of working on her breastmilk production. This led to an increased use of formula, resulting in a decreased production of breastmilk. One woman described this cycle and her subsequent dependency on formula:.
I gave breastmilk to my son for three to four months, then the milk was less, I did not have time to feed. I started giving outside milk. There was no one to help me. So, I just gave bottle milk. It was expensive but what could we do … you have to. Madam in this line everyone gives outside milk. No one has time to sit and feed and rest and sleep. It's all about grabbing more and more clients, making money.
If we don't sit one night lactation prostitution no food the next day. For women who were able to breastfeed for an extended duration, they contextualized this by stating they were able to do so because they were not working.
I had no job, only my child and me. Women's return to sex work in the postpartum period was often related to her economic instability broadly but more specifically her food insecurity. Some women reported feeling weak and unhealthy lactation prostitution pregnancy and in the immediate postpartum period due to not having enough to eat.
One woman discussed this:. When the second one was born, I didn't have anything to eat. I could not feed him. Breastmilk was not coming so I had a difficult time. I didn't try much. I was sent home the day after the delivery with some stiches but had no place to rest.
I could have not fed him. Women discussed their own health at length, particularly their HIV status. This indicates that women may have lactation prostitution some interactions with medical providers; however, only one woman directly connected her medical care based on her HIV status to breastfeeding:. At that time [during the first pregnancy], I did not take any medicines, there was no HIV testing anything. Now they do all kinds of testing when they find out about pregnancy.
Now they do HIV testing. For my daughter [second born], the doctor gave me some medicine. Nothing for my son [first born]. Some women indicated having directly received infant feeding advice from a medical provider; however, it was not in support of breastfeeding. One of the most direct factors shaping a woman's decisions to breastfeed was her physical proximity to her. Some women were separated from their children, other women received support to allow their children to remain with them.Lactation prostitution
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