Disparities in exclusive breastfeeding by current maternal employment status in Peru, 2005-2023: a cross-sectional...

Exclusive breastfeeding (EBF) improves child survival and maternal health, but structural and employment-related conditions may affect its continuity. Evidence from Peru on EBF disparities by current maternal employment status remains limited.

To estimate descriptive disparities in EBF prevalence by current maternal employment status and describe their temporal and territorial patterns in Peru from 2005 to 2023.

We conducted an analytical cross-sectional study using pooled data from the Peruvian Demographic and Family Health Survey [Encuesta Demográfica y de Salud Familiar (ENDES)] from 2005 to 2023. The revised descriptive sample included 15,780 mother-child dyads with infants younger than six months and mothers currently married or cohabiting. EBF was defined by 24 h recall. Maternal employment status was classified as no current survey-defined employment, current active formal-sector employment, or current active informal-sector employment, based on current work and employer type. Survey-weighted prevalences and crude and adjusted prevalence ratios (PRs) were estimated; adjusted models included maternal age, educational level, wealth quintile, parity, child age, child sex, residence area, natural region, and survey year. Temporal trends, absolute gaps, and departmental ecological correlations were assessed.

The revised weighted prevalence of EBF was 72.6%. In the complete-case model sample (n = 15,101), EBF prevalence was 76.2% among mothers with no current survey-defined employment, 46.5% among mothers with current active formal-sector employment, and 74.2% among mothers with current active informal-sector employment. Compared with no current survey-defined employment, current active formal-sector employment was associated with lower EBF prevalence in both crude (PR = 0.61; 95% CI: 0.55-0.67) and adjusted models (adjusted PR = 0.72; 95% CI: 0.65-0.79). Current active informal-sector employment showed little difference after adjustment (adjusted PR = 0.97; 95% CI: 0.94-1.00). At the departmental level, current active formal-sector employment was negatively correlated with EBF prevalence (r = -0.72; p < 0.001).

In this descriptive cross-sectional analysis, current active formal-sector employment was associated with lower EBF prevalence. These findings identify mothers actively participating in formal-sector work as a group requiring further evaluation of employment-compatible breastfeeding support, without implying causal effects of labor formality or direct evidence about specific workplace or health policies.