MOTHER BABY FRIENDLY WORKPLACE INITIATIVE IN KENYA-ROLES AND RESPONSIBILITIES OF DIFFERENT STAKEHOLDERS Betty Samburu1, Gladys Mugambi1, Laura Kiige2, Grainne Moloney2 , Elizabeth Kimani Murage3, Triza Njoki3, Fredrick Wekesah3, Peter Muriuki3, Milka Wanjohi3, Gloria Ndekei4, Paula Griffiths5,   1 Ministry of Health Nutrition and Dietetics Unit, 2 UNICEF Kenya, 3Africa Population for Health Research center (APHRC), 4KEPSA Trustee. 5Loughborough University, UK

Outline Background –work environment in Kenya Breastfeeding indicators Workplace project goals & partnership Key outputs Progress in achieving key output Recommendations Conclusion

Work environment in Kenya Women workforce is estimated to be 62% in Kenya Majority 52% of return to work within 3 months after birth Despite the WHO recommendation of six months EBF Most of these working women experience challenges which prevent them complying with the recommendations: Reduction in the frequency of feeds lowering milk production. An insufficient milk supply- Most mothers stop breastfeeding. Kenya allows 90 days paid maternity leave and two weeks paternity leave plus annual leave (Kenya Employment Act 2007). However studies have shown that women in private sector are offered short term contracts as a way of avoiding maternity leave Working for long hours

Breastfeeding indicators in Kenya Infant and young child feeding practices 1998 KDHS 2003 KDHS 2008 KDHS 2014 KDHS Initiation of breastfeeding (% of babies breastfed within 1 hour of birth) 58% 52% 62% Exclusive breastfeeding 17% 13% 32% 61% Breastfeeding at age 2 20% 21% 51% Bottle feeding (% of breastfed babies 1 to 12 months of age fed from bottles in the last 24 hours) 18% 28% 25% 11%

Exclusive Breastfeeding and Child Mortality in Kenya- KDHS Exclusive Breast feeding rates Child mortality (<5) 2003 13% 115/1000lb 2008 32% 74/1000lb 2014 61% 52/1000lb As EBF rates increase, there is reduction in child mortality

The workplace support Project The Ministry of Health is partnering with the following organizations to improve working conditions for women especially in private sector UNICEF-Financial and technical support African Population for Health Research Centre (APHRC)-research Kenya Private Sector Alliance (KEPSA)- enabling environment in working with the private sector

Overall goal and objectives Contribute to the reduction of maternal and newborn deaths OBJECTIVES: Improve leadership, policies and partnerships to support scale up of maternal and newborn health care including breastfeeding programs in Kenya . Improving maternal infant and young child feeding through making the workplaces mother and baby friendly Provision of evidence based research on workplace conditions for mothers working in private sector for scale up

Roles of different stakeholders in the workplace project=MOH, UNICEF, APHRC, KEPSA 2015

Ministry of Health Provide MIYCN policy environment –guidelines Coordination of all activities leading to workplace support for breast feeding-national and county Capacity building Advocacy Provision of technical expertise and support to county staff Regular support supervision and mentorship Provide the necessary infrastructure for implementation Lead in county level assessment, external assessments, re-assessments on the status of workplace Guides and contributes to the dissemination of the study findings to policy makers at the national level. 

African Population and Health research Centre (APHRC) Inform with evidence the design & implementation of a scalable model of workplace support for breastfeeding initiative in a tea plantation and test its operational feasibility, effectiveness and cost-effectiveness How will they do it? Baseline survey, continuous monitoring including real time learning and evidence generation Final evaluation –endline Documentation of best practices

Kenya Private Sector Alliance (KEPSA) KEPSA is an umbrella body for all private sector entities in Kenya Facilitate engagement of companies in the agricultural sector Technical support and sensitization to partnering agency boards and stakeholders for establishing “Better Business Practices for Children’’ Supporting/profiling “best business practices” and reporting on progress Advocacy and lobbying efforts through consumer networks, stakeholders and Kenya Human Rights Commission (KHRC) to improve the workplace support for breastfeeding. Advocacy efforts to have policies passed in parliament.

UNICEF Supporting MOH in championing child rights and better business practices for children Provide technical expertise in the interventions design and implementation and support policy engagement Provide financial support to enhance the workplace support

What are we aiming to achieve Compliance ILO.C.NO 183 14 weeks of paid maternity leave Non discrimination for pregnant & breastfeeding women who are employed & employment protection, Breastfeeding breaks 2. 2007 Kenya employment Act Part IV section 29 implemented A female employee shall be entitled to three months maternity leave with full pay. 3. Review work place policies on flex time, Flexibility for short breaks to express breast milk

What are we aiming to achieve? Promote, protection and support of exclusive breastfeeding through work place sensitization Providing a designated clean, private area for mothers to express breast-milk or breastfeed their babies Providing supportive environment including appropriate furniture (chair/table) and access to water and soap to clean storage items Establishment of cretches in agricultural farms and other sectors to support breastfeeding mothers at workplace Generate research evidence to inform policy

Key outputs Lobby, Advocacy and Dialogue forums on Best Business Practices in Children held with Government and Other Stakeholders Development of guidelines on workplace support for breast feeding Capacity Building of public and private sector member organizations. Establishment of a model baby friendly facility Identification of Better Business Practices Private Sector Champions Evidence on Best Business Practices in the Private Sector documented and disseminated Mainstreaming BBPC in the private sector. Generate evidence through research on workplace at a tea estate Set up monitoring system for workplace support

Activity & progress Establishment of workplace support committee at national Membership MOH-divisions and units within the ministry UNICEF Central Organization of Trade Union (COTU) Federation of Kenya Employers (FKE) Kenya Private Sector Alliance (KEPSA)-Chair African Population for Health and Research Centre (APHRC) Children department – Ministry of labour social security and services

Development of guidelines on workplace support: Technical committee on workplace during the development of guidelines for workplace support- membership- APHRC, Aghakan Foundation, KEPSA, COTU, FKE, UNICEF, MOH, & county representatives

Development and dissemination of guidelines for securing a baby friendly breastfeeding environment

Implementation of workplace support research in a tea estate Visitation to the tea estate to establish rapport and way forward for research at Kericho tea estate (UNICEF, APHRC, MOH-National &County)

A photo with the Governor for Kericho county –Prof Chepkwonga (middle) at a tea estate during a reconainces visit to introduce the project –on workplace support

Research ongoing Qualitative results ready Work environment and challenges faced by pregnant and breastfeeding mothers working in the tea estate An FGD for fathers in session

Advocacy forums Certificate of recognition of best practices in workplace support Recognition of organizations that have set best practices for supporting women to combine work and breastfeeding (6 months maternity leave, cretches, rooms for expression

Way forward We hope to generate evidence for policy formulation More advocacy required Need for clear guidance and global guidelines on workplace support More research evidence needed

ACKNOWLEDGEMENT UNICEF APHRC KEPSA COTU FKE MOH-UNITS AND DIVISIONS