Experiences With Antenatal Care, Breastfeeding Education, and Employment During the COVID-19 Pandemic: Perspectives From Mothers and Healthcare Workers in Kenya

The impact of the COVID-19 pandemic on breastfeeding practices in low and middle-income countries is not well understood. Modifications in breastfeeding guidelines and delivery platforms for breastfeeding education are hypothesized to have affected breastfeeding practices during the COVID-19 pandemic. We aimed to understand the experiences with perinatal care, breastfeeding education and practice among mothers who delivered infants during the COVID-19 pandemic. We conducted key informant interviews among 35 mothers with deliveries since March 2020 and 10 healthcare workers (HCW) from two public health facilities in Naivasha, Kenya. Mothers described COVID-related income loss and lack of support from family and friends as a worse challenge to practicing EBF as they wished or planned. While mothers noted that HCWs provided quality care and breastfeeding messaging, one-on-one perinatal breastfeeding education was cited to be less frequent than before the pandemic due to altered conditions in health facilities and COVID safety protocols. Knowledge among mothers about the safety of breastfeeding in the context of COVID was limited, with few key informants reporting of specific receipt of information such as COVID transmission through human milk and the safety of nursing during a COVID infection. Mothers stated that some HCW messages emphasized the immunologic importance of BF. COVID restrictions limited or prevented familial support at facilities and home, causing stress and fatigue for mothers. In some cases, mothers noted income loss due to furloughs and layoffs, time spent seeking new means of employment, and food insecurity as causes for perceived milk insufficiency, which was, in turn, connected to introducing weaning foods and liquids before six months. The COVID-19 pandemic created changes to the perinatal experience for mothers. While messages the importance of practicing exclusive breastfeeding were provided, altered HCW education delivery methods, social support and food insecurity limit EBF practices in for mothers in this context. Mothers lacked consistent knowledge about the safety of breastfeeding in the context of COVID-19. National Institutes of Health Fogarty International Center.