Informal work and maternal and child health: a blind spot in public health and research

More than 2 billion people (about 61% of the global workforce) are engaged in the informal economy; this represents 88% of total employment in India, over 80% for countries as diverse as the Plurinational State of Bolivia, Ghana, Indonesia and Morocco, and even 19% in the United States of America.1 In many low- and middle-income countries, informal work is the rule and not the exception. Informal economy workers cross a range of sectors, the most common being street vending, domestic work, waste picking, home-based work (such as producing garments or handcrafts) and construction. For these workers, caring for themselves and their children presents unique challenges. Mothers who work in the informal sector must continue to bring income to the household, care for their physical and mental health after childbirth, and attempt to exclusively breastfeed their infant and provide nurturing care. They must do all of this while working without any formal labour protection, such as maternity leave. In the informal economy, there are few, if any, public or private social protection initiatives to facilitate access to health care, protect income security or mitigate risks that help reconcile the tension between being a worker, a woman and a mother. Remarkably, public health research and practice has so far largely ignored this group.

How do women working in the informal economy manage care for themselves and their young children while earning a sufficient income without any of the benefits usually associated with formal employment? Here we briefly describe the scale and importance of recognizing informal employment from a health perspective and consider pathways to alleviating the trade-off that mothers working in the informal sector face.

As an illustration, we explore the difficulties for mothers wanting to exclusively breastfeed their infants during the first six months, as recommended by the World Health Organization (WHO), while still working in the informal economy.