Breastfeeding taskforce

Review of the impact of COVID-19 on exclusive breastfeeding in Kenya and beyond

February 14, 2022

By Robert A. Poarch

Dr. Scott Ickes

Scott Ickes, PhD, has a unique perspective on the impact of COVID-19. A graduate of the Gillings School of Global Public Health (Nutrition and Epidemiology, 2010), Ickes has worked for four years on a National Institutes of Health research project that allows him to live six months a year in Naivasha, Kenya.

Working on the other side of the world from where he teaches the rest of the year at Wheaton College in Illinois has allowed him to see firsthand, in two countries, the connection between the economy and breastfeeding for a pandemic.

Connecting Breastfeeding Challenges to the Workplace

Naivasha’s large flower industry – with more than 40 farms in the city – provides work for many women. Kenya also offers the health research and policy infrastructure that Ickes needs to gather important data on a topical issue in maternal and child health.

“Kenya is the perfect case study of increased female labor force participation coupled with stagnant breastfeeding rates,” Ickes said. “You have more women in paid employment, a growing economy, some really good things happening for women’s empowerment and policies to protect breastfeeding in the workplace. But there is also a difficult implementation situation where many farms are struggling to put in place the necessary and recommended supports that help working mothers breastfeed. We hypothesized that the COVID-19 pandemic adds another layer to this ongoing challenge.

Gillings School Connection

Dr Stephanie Martin

Dr Stephanie Martin

Seeking help with the project, Ickes turned to the Gillings School and contacted Stephanie Martin, PhD, assistant professor in the Department of Nutrition.

“Stephanie and I, along with a team of UNC students and colleagues from Kilimanjaro Christian Medical University College in Moshi, Tanzania, worked on a project on maternal employment and breastfeeding in sub-Saharan Africa. This new project was an extension of that effort,” Ickes said.

Dr Aunchalee Palmquist

Dr Aunchalee Palmquist

Ickes also works with Aunchalee Palmquist, PhD, MA, IBCLC, assistant professor in the Department of Maternal and Child Health and affiliated with the Carolina Global Breastfeeding Institute at Gillings School. Pamquist studies the intersectionality of maternal, newborn, and young child perinatal health disparities globally and in the United States, with a focus on breastfeeding.

“One of my ethical considerations before committing to international work is that I am invited into a partnership,” Palmquist said. “Does it appropriately reinforce the priorities, needs and agendas of the people who will be most affected, who are the people in Kenya that we are working with? All of these things are important to me, and I’m really excited to be part of this project.

Linking COVID-19 to food insecurity

The initial study recruited mothers from more than 20 flower farms. The part related to COVID-19 gives priority to mothers who have given birth since March 2020.

The work includes a survey of 600 mothers and a qualitative survey. Palmquist is supporting the ethnographic study with investigators from the Kenya Medical Research Institute and the University of Nairobi interviewing mothers, health workers and employers to find out how COVID-19 has affected mothers’ breastfeeding experience .

One of the first findings of the project revealed that mothers describe a perceived feeling of insufficient milk due to food insecurity.

“We are seeing reports of low food security — where mothers lack consistent, affordable food due to economic shocks from the COVID-19 pandemic,” Ickes said. “It affects their sense of being able to breastfeed their babies adequately and exclusively.”

Ickes acknowledges that the relationship between COVID-19 and breastfeeding requires further research and policy support, as many mothers receive mixed messages and misinformation. His current study aims to assess how COVID-19 has influenced breastfeeding perceptions, attitudes and practices – and he feels the urgency to publish the results quickly.

“Research related to COVID-19 must be timely and effective in responding to the pandemic we find ourselves in, as well as planning for the future in terms of how these major economic and health shocks affect vulnerable populations and groups. marginalized,” says Ickes. “I believe the connection with the Carolina Global Breastfeeding Institute can help this project shape policy and improve global understanding of COVID-19 and breastfeeding.”

“I agree,” added Palmquist. “Public health research tends to lag behind clinical science.”

Connect two countries

Living in both the United States and Kenya while looking at the pandemic through the lens of breastfeeding has informed Ickes’ perspective on global health.

“Recognizing how governments can effectively help their citizens prevent some of these hardships is great to see,” he said. “But we also appreciate that many companies are struggling to muster the resources needed to implement and leverage policies into timely actions.”

“The issue of returning to work and breastfeeding support is actually the same for high-income countries. Lack of paid time off is a major barrier for American women,” Palmquist said. “In low- and middle-income countries, or in countries in the Global South, there are policies that sometimes support lactation in the workplace or offer protections during the postpartum period – but these protections are generally limited to women working in the formal sector. This does not affect women who work in much more difficult situations.

Ickes believes the work in Naivasha will serve as a model to show how not just commercial agriculture, but similar industries around the world, can support breastfeeding mothers, especially when events like COVID-19 worsen the food insecurity.

“I think there’s definitely that need,” Ickes said. “Given what we live in in high-income countries, I think this work will be hugely useful in any context where we see this link between employment and childcare; trying to manage COVID restrictions while supporting breastfeeding.


Contact the communications team at UNC Gillings School of Global Public Health at [email protected].