Structural vulnerabilities and breastfeeding among female sex workers in Mumbai

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 such policies tend to be inaccessible to those who are economically marginalized, however, and thus may further inequities. Understanding 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 look at proximal factors-those that women directly indicate as influencing their breastfeeding decision-making or behaviour, and distal factors-macrolevel forces identified by the women, as indication of their structural vulnerability, particularly in relationship to the decision to initiate and sustain breastfeeding. We conclude with discussing the need to promote appropriate infant feeding practices through culturally responsive interventions and mechanisms, taking both proximal and distal factors into account, to work towards equity in health outcomes.