Date of Award

Fall 2025

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

First Advisor

Leila M. Larson

Abstract

Background

Breastfeeding can be particularly challenging for mothers who recently returned to work. The decision-making process that working mothers undertake as they navigate the return-to-work period is largely understudied, leaving a critical gap in the understanding of how this decision is made and the influences on the decision-making process. Furthermore, women in low-and-middle-income countries are positioned in a complex network of social relationships, that play important roles in influencing child caregiving decisions, including child feeding decisions and practices. The perspectives of social network members on their roles and influences on the infant-feeding decisions and practices of working mothers have not been extensively studied in Nigeria and Sub-Saharan Africa. This study sought to describe the decision-making process that working mothers undergo as they make the decision regarding feeding their children in the return-to-work period and the influences on their decision-making process, including how social networks are part of this decision-making process and how they influence the decision around infant feeding.

Methods

Data were collected from August to December 2024 from a purposive sample of 42 mothers and 22 social network members which comprised 10 husbands, 5 friends, 4 grandmothers, 2 siblings, and 1 health professional, using semi-structured in-depth interview guides to understand infant feeding decisions of mothers prior to and upon return to work and involvement of social network members in infant feeding decisions and social support. Mothers were eligible to participate in the study if they were at least 18 years old, had an infant nine months old or younger, resided in the city of Ibadan, were employed by government or private organizations, and had returned to work. Social network analysis was conducted with mothers, and an adult member of mothers’ social network who had influenced their infant-feeding decisions or practices or provided them with infant-feeding information was interviewed. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted using NVivo version 12.

Results

Prior to work resumption, mothers engaged in a decision-making process for infant feeding, which comprised three steps that often occurred iteratively. Mothers acknowledged workplace influences, acquired infant feeding information, and evaluated infant feeding information prior to making the decision either to continue breastfeeding exclusively after work resumption or introduce formula or complementary foods to their children alongside continued feeding with breast milk. The decision-making process was influenced by individual characteristics of mothers, perspectives of social network members and the workplace environment. Multiple reasons were identified for which mothers chose one of the three infant feeding alternatives. The existence of supportive workplace policies and environments, such as breastfeeding breaks, availability of daycare centers within work premises, and reduced work hours facilitated the decision to continue breastfeeding exclusively upon work resumption. Some mothers decided to introduce formula mostly because of the need to return to work, which they believed necessitated the discontinuation of exclusive breastfeeding. Others introduced complementary foods because they determined their child to be of age and, therefore, needed to transition to complementary foods. While most mothers could implement their infant feeding decision as planned, others adjusted their decision after work resumption. Social network members either participated in infant feeding decisions, deferred to the mother’s decision, provided infant feeding advice, were uninvolved or opposed the mother's decision, or supported mothers to resist contradictory infant feeding advice from other social network members. Varying forms of social support such as instrumental, informational, and emotional support were provided by social network members and received by mothers both in the early post-partum period and after work resumption to enable mothers to care for their child.

Conclusion

Steps that mothers engaged in during the infant feeding decision-making process prior to work resumption were acknowledging workplace influences, acquiring infant feeding information, and evaluating that information. Multiple influences and reasons were described for which mothers decided either to continue breastfeeding exclusively or introduce formula or complementary foods to their children when returning to work. Specific to the decision for continuing exclusive breastfeeding is that mothers’ commitment to achieving the six-month exclusive breastfeeding goal after work resumption was enhanced by supportive structures and policies available to them at work, the absence of which influenced changes in mothers’ decision in favor of introduction of formula. Family members influence infant-feeding decisions in this context either by participating in the decision-making, providing information to enhance the decision, or supporting or opposing mothers’ decisions. Social network members also provide social support that mothers report to be helpful both in the early post-partum period and after work resumption. There is, therefore, the need to employ a family systems perspective to appropriately target interventions not only towards mothers but also the key individuals within family settings.

Rights

© 2025, Victoria Oluwapamilerin Adebiyi

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