The World Alliance for Breastfeeding Action (WABA) and local host  
ARUGAAN, an  NGO specialising in child-care, held an international  
workshop entitled Breastfeeding, Women and Work: Human Rights and  
Creative Solutions from 1 - 5 June 1998, in Quezon City, Manila. The  
workshop brought together over 60 participants, including WABA seedgrant recipients, from twenty countries and from diverse fields such as  
breastfeeding support, women's organisations, trade unions, grass roots  
activists, policy makers, architects and engineers.  

Officiated by the Mayor of Quezon City, Ismael A. Mathay, the workshop  
was given a noteworthy start with speeches from representatives of  
UNICEF, ILO, the World Health Organisation (WHO), WABA and the Mayor. This was followed by a mime performance by ARUGAAN which depicted working women's plight in developing countries.  

The introductory keynote by well known Filipino feminist Marianita   
Villariba, addressed the lack of recognition given to women's  
reproductive work in our modern era and called for feminist paradigms  
for change.  The second keynote, by UNICEF legal officer David Clark,  
highlighted existing international instruments that protect, promote and  
support breastfeeding, and how these can be used to ensure a child's  
right to the highest attainable standard of health. Four plenary  
sessions tackled the essential issues:  

• Breastfeeding as a social norm and long-term strategies
• Principles of mother-friendly workplaces
• Legislation 
• Support systems for women's working environment and in public places

On the second day of the workshop, UNICEF Manila and ARUGAAN organised site visits to six mother and baby-friendly establishments around  
Manila. Some of the places visited include the Philippines General  
Hospital, a government health and day-care centre in Laguna, the ABS-CBN television network office in Quezon City and ARUGAAN sites in the Visayas Islands. After the field trip, participants attended a  
three-hour 'sharing session' describing what they had seen. The greatest  
lesson was to see how women came up with their own creative solutions  
and that no two places had the exact same solutions.  

Two practical sessions were held towards the end of the workshop: the  
first shared various tools available for networking and forging new  
partnerships. It brought together a panel of representatives from a  
trade union, a women's organisation, a business corporation and the  
media. Each speaker spoke of the realities of working women's lives from  
the point-of-view of their respective careers and suggested ideas to  
improve the situation. Of importance was a discussion on how the  
breastfeeding groups can best establish partnerships with these new  
allies.  

The second practical session focused on designing advocacy strategies  
for global action on ensuring women's and children's right to  
breastfeed. It involved the active participation of the two major  
working groups which addressed key concerns of the formal and non-formal work sectors.  The result was a viable set of recommendations for the  
respective sectors and an action plan for WABA and network partners.  

WABA's webpage on Women & Work was launched by webmaster, Denise Arcoverde, during the Inter-Cultural Evening held to mark the closing of the workshop. Participants and invited guests were very impressed by the design and contents of the webpage. Papers and reports pertaining to the workshop presentations have been put up on the website and can be easily downloaded from the Women & Work section.  

Four key outcomes emerged at the conclusion of the workshop:  

• A Declaration launched by workshop participants called The Quezon City Declaration. The Declaration provides the way forward in dealing with the multi-faceted challenges faced by working women who choose to combine paid work with breastfeeding and other reproductive tasks. It also provides an opportunity for women's organisations to draw attention to the value of reproductive work, and for policy makers to recognise the full  value of breastfeeding. 
• A platform for global actions by concerned groups and individuals interested in influencing the revision of the ILO Maternity Protection Convention Number 103 and Maternity Protection Recommendation Number 95 (1952).
• Pledges by participants to improve working conditions for pregnant and lactating women in their respective countries and communities. The pledges include setting up more creches, strengthening mother support groups, ensuring code implementation, lobbying ILO delegations, and producing materials for working women. 
• The production of a report to be written in a popular and easy-to-read style, in a 'magazine' format, to reach a wide audience. It is estimated that the report will be ready for distribution by November 1998.

This workshop was made possible with the financial support of the  
Swedish International Development Cooperation Agency (Sida). UNICEF  
Manila contributed to part of the field trip expenses and to the  
national open forum. This was held after the international workshop to  
give opportunity for the local groups to express national level concerns  
and for exchange with the international participants.  

Excerpts from Keynote and plenary presentations:   

• The Story of Work and Women - Marianita Villariba (Director, ISIS International)
• Children's rights to the highest attainable standard of health - (David Clark, Legal Advisor to UNICEF)
• Human Rights & Long-term Solutions - Ted Greiner (SIDA Consultant)
• Principles of Mother-Friendly Workplaces - Penny Van Esterik, Workshop Programme & Task Force Coordinator
Excerpts from Country Presentations  
  
• Ghana
• Canada
• Guatemala
• Bangladesh
• Philippines

The Story of Work and Women   
Marianita Villariba (Director, ISIS International)  

In her keynote speech, Marianita Villariba took us back into her country's history to see how breastfeeding, an unquestioned part of women's ancestral role, became "a subversive activity" after the invasion of the Spanish conquistadors.  Drawing a parallel with the lives of slave women in the Caribbean, she hypothesized that the traditions of strong women leaders from pre-colonial times were carried on by women using their wisdom about women's reproduction to resist the cultural changes brought by the introduction of Catholicism and Spanish domination.  Thus, she gives breastfeeding a place among feminist concerns as a way for women to assert or reclaim autonomy over their bodies.  

Women's work, which is at the heart of the feminist struggle, has made possible the great accumulations of wealth under capitalism and socialism. Under colonialism, the indigenous woman was valued for her productive work, not for her work as a mother. The same is true of capitalism.  

A feminist definition of work acknowledges that the work mothers do is essential.  This acknowledgment would provide a way to value women's real production and maintenance of human beings and the things that enhance human life, in contrast to the things of no intrinsic worth, for instance financial speculation and global spending on militarism, that are valued by the current economic system.  

Children's rights to the highest attainable standard of health     
(David Clark, Legal Advisor to UNICEF)  

The existing international human rights framework and machinery provide an opportunity to engage governments in a dialogue aimed at assisting them to fulfill their obligations to protect the rights of women and children.  These provisions are the keys that open the door to a meaningful and practical approach to the promotion, protection and support of breastfeeding.  

UNICEF has placed the rights of women and children at the very basis of its programming, moving from a "needs-based" to a "rights based" approach in its work.  This approach emphasizes keeping human rights in the forefront when planning and carrying out activities.  Of particular interest to breastfeeding advocates is the notion of the legal and moral obligation and accountability of the State and its institutions with regard to meeting the basic needs of its people.  191 states have ratified the Convention on the Rights of the Child (CRC) and 161 have ratified the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW). The role of advocates can thus be to remind these states of their binding legal obligations to protect, promote, and support breastfeeding as outlined in these conventions.  

Three particular rights draw our attention as breastfeeding advocates.  First, as the principal means to food security, proper nutrition and care for the child, breastfeeding plays a role in the child's right to the highest attainable standard of health.  Thus, protection, promotion, and support for breastfeeding are a means to fulfilling that right.  Second, a woman has the right to be supported in carrying out her role as a mother.  Third, she has the right not to be discriminated against in the workplace on the basis of pregnancy or maternity.  These rights of women may be threatened when society does not create a supportive environment for breastfeeding.  
  
Human Rights & Long-term Solutions   
Ted Greiner (SIDA Consultant)  

Ted Greiner discussed how people can actually change social norms through conscious struggle, and by overcoming the tendency to be passive when faced with enormous challenges.  

Modern society did not know about the importance of exclusive breastfeeding and mother-infant bonding when we engineered the societies we live in today. But these issues are important enough to justify changing society; indeed they are such fundamental rights for such vulnerable members of society who cannot speak for themselves that others are obligated to argue on their behalf.  

Once the right to breastfeed is accepted as a social norm, working women can more easily obtain the support they need for exclusive breastfeeding: baby-friendly hospitals,  mother-baby-friendly work and public places, basic health care services, emotional and economic support and lactation counselling. Breastfeeding rights could even become a political platform. And the feminists will join the struggle when they realise advocates of these rights are not adding to women's burden, but call for improving the conditions women live and work in, including the support they need to exercise this right to breastfeed.  

Social norms can be changed through conscious struggle. This will require working on two fronts simultaneously:  

1. Long term goal: To fight for the right of working mothers and newborns to spend the first few months together, preferably the six-month recommended period of exclusive breastfeeding; and  

2. Short term goal: To find ways to help working mothers cope with difficult situations in which this right is denied, such as having breastfeeding facilities at the workplace.  

Principles of Mother-Friendly Workplaces   
Penny Van Esterik, Workshop Programme & Task Force Coordinator  

Why has there been so little progress on improving the conditions of breastfeeding mothers at work? Breastfeeding and women's work is an exceptionally important topic, but it is not a simple problem resolved through single, short-term interventions. Penny provides three suggestions to help us develop useful strategies.  

Know the Opposition:   

There are many potential allies who should be supporting action on employment and breastfeeding - gender and development programmes, environmental groups, women's health advocates, even family planning programmes. However, these groups are not yet aware that their interests converge with those who are pressing for new breastfeeding initiatives. Bring them on-board.  

Deepen our thinking about basic concepts:   

WABA's definitions of work, time, space and support developed in 1993 as generic principles for a mother-friendly workplace were adequate for advocacy action then. But now we need to re-examine them in light of policy making.  

Work: Work has been defined as any activity that you can pay someone else to do for you. You cannot pay anyone else to eat, sleep, or make love for you, but you could pay someone else to breastfeed for you. Consider wet-nursing, milk banking, or intergenerational breastfeeding when grandmothers breastfeed grandchildren. Our definitions of work will need to be consistent and compatible with policy makers' definitions.  

Time: Three kinds of time affect the breastfeeding mother who must work away from her baby. Biological rhythms are basic to the mother's life with her baby---her rhythms of sleeping and waking, of milk filling her breasts and being emptied by the baby. In addition, there is interactive time, in which the mother relates to the world in tandem with her baby rather than as an individual. The mother in paid employment, however, must force her baby and her own body to conform to another kind of time, institutional time. Schedules, clocks, calendars, assembly lines, shifts, and limited break times dictate when the baby and mother will have access to each other. The rigidity of institutional time may conflict with the needs of baby and mother for flexibility in their interactive time.  

Space: A breastfeeding woman relates to the world in tandem with an infant rather than as an individual - a practice lodged in interaction time. Synchronizing the temporal schedules of two people is a complex task. But when the two people are a mother and a newborn, the constraint is not normally great, since the infant cannot travel unaided. Mother and infant must be co-present to breastfeed, sharing both time and space.  

Tell more stories: Learning from Lives  

It is important to link the objective conditions of workplace policies with the subjective experiences of women who balance the work of nurturing children with other responsibilities. To find practical solutions for breastfeeding mothers at work, we need regular "reality checks" to ensure that policies are grounded in women's realities.  

Excerpts from Country Presentations    

Ghana    
Charlotte Acquah, GINAN  

Traditionally, Ghanaian women have been breastfeeding their children from birth to about two years, but the onslaught of indiscriminate infant formula promotion has influenced women to supplement breastmilk with other liquids.  

With the inauguration of the Ghana Infant Nutrition Action Network  
(GINAN) in 1987, the tide changed in favour of breastfeeding. This reform was given a further boost with the formation of the BFHI task force that trains health workers in lactation management. The exclusive breastfeeding rate has risen from 2% in 1983 to 20% in 1995. GINAN estimates the figure could be as high as 50% if statistical computation included rural communities.  

Some of the activities GINAN engaged in to raise the breastfeeding rate include:  

• Training women in the formal (office workers) and non-formal sectors (hairdressers, dressmakers and market workers) in lactation management. All these women have been trained to support other women who bring their babies to the salon or market. They were also taught to form mother-support groups in their respective areas and meet monthly to discuss activities and resolve any problems.
• Disseminating information to women in the formal  and non-formal sectors in lactation management. GINAN has been working with several 'Ladies Clubs' on breastfeeding education through the use of audio-visuals. Club members are taught manual expression techniques, breastmilk storage and cup feeding. Women in the non-formal sector are invited regularly to talks, video shows and group discussions, held at the marketplace, to teach them the benefits of breastfeeding and the importance of exclusive breastfeeding for six months.

Canada   
Pat Martens, University of Manitoba  

The breastfeeding promotion strategy in the Sagkeeng-Anicinabe community, a First Nation community in Manitoba, Canada is based on the use of a booklet containing drawings of First Nation mothers done by a local artist, and a peer counsellor (PC) programme.  

Pat Martens, a  doctoral candidate at the University of Manitoba, found that using the booklet during prenatal instruction increased the rate of breastfeeding. There was also a significant increase in the duration of breastfeeding among the majority who are teenage mothers still attending school when they participated in the peer counselling programme. Compared to a control group, mothers who had peer counselling were twice as likely to be breastfeeding at any point. The peer counsellor in charge was also involved in educating seventh and eighth graders in school, which resulted in a significant increase in students' knowledge on breastfeeding. WABA's seedgrant helped to support part of the production of the booklet and training of the peer counsellor.  

Based on the success of the pilot project, the local health board granted permanent funding to keep the peer counselling programme going as part of the health care team.  

According to regional population statistics of 31 Dec 1993, the Sagkeeng First Nation has an on-reserve population of 3,075 and an off-reserve population of 1,592.  

Guatemala   
Ruth Elena de Arango, CONAPLAM  

Conditions in the Central American nation of Guatemala pose many challenges to breastfeeding promotion, said National Commission for Promotion of Breastfeeding (CONAPLAM)'s coordinator Ruth Elena de Arango. One of these challenges is cultural diversity. The country has four main indigenous population groups and 23 languages. Migration has meant the loss of extended family networks to support new mothers. Moreover, political violence affects the family and causes rapid cultural changes.  

Many indigenous women work in the maquillas, low-paying sweatshop factories where labour rights violations occur frequently. Although labour laws exist to protect working women, many are unaware of their rights and the Ministry of Labour does not monitor compliance. Despite this obstacle, indigenous mothers have better breastfeeding incidences and duration and are less likely to use local complementary foods than urban mothers.  

In line with CONAPLAM's focus on improving gender equality, education for girls and breastfeeding, they carried out several activities to develop better conditions for working mothers. These include:  

1. Producing a brochure to inform women of their rights, backed-up by training carried out by a team of legal monitors. Posters with information on workers rights were also put up in factories.  

2. Working in partnership with the Labour Office, the Social Security and NGO groups. Produced educational materials on the value of colostrum and rooming in. Traditional sling baby carriers were developed and distributed to indigenous groups.  

3. Creating cloth posters which cleverly used images of the sun, moon and sky to illustrate the relationship between a mother and her child.  

Bangladesh   
Shamsun Nessa, Naripokho  

The patriarchal system in Bangladesh  prevents  women from participating in the national economic arena despite possessing requisite professional skills. Instead, women are solely responsible for raising children at home. What this means is that half the population of the country, comprising women, are unable to contribute towards the productive economy. And when the few have such opportunity, requesting maternity benefits will put them at a disadvantage vis à vis men.  

A Bangladeshi women's activist organisation, Naripokho, working together with other kindred groups have, for several years, campaigned for a woman's right to work outside the home, and for her child to be breastfed.  

Employing methods like advocacy, research and training, the groups are championing several causes, including:  

• advancement of women's rights
• building resistance against violence, discrimination and injustice
• women and childrens' right to breastfeeding

In 1994, Naripokho conducted a short study to analyse the impact of setting-up a creche in a garment factory. They found that:  

• frequent turnover of skilled workers was reduced, resulting in a reduction of financial losses for the factory
• children were breastfed regularly every day
• children felt happy, healthy and safe; mothers were also healthier and less anxious
• husbands were less reluctant to allow their wives to work outside, because the children could be taken care at the workplace

Filipino women workers are natural advocates of breastfeeding because they usually come from the provinces, and were breastfed themselves, says Bobie Jopson, director of the Workers' Foundation of the Philippines Kababaihan (Congress of Women). It is the working environment that draws them away from breastfeeding. Although much has been done by international and local women's groups in the area of maternity rights, the government's failure to address the problem in a holistic manner remains a problem and requires immediate attention.  

A 60-day paid maternity leave meets only one of the requirements to support a working breastfeeding mother. Women also need additional support to enable them to breastfeed exclusively for six months. They require child care centres to leave their children while working, and breastfeeding counsellors to assist when breastfeeding problems arise.  

From the viewpoint of workers' organisations, the looming spectre of globalisation is also a threat to trade unions around the world. While business is 'modernising,' and moving forward, workers' rights are simultaneously put into reverse. There are 7,274 union groups with 3.5 million members registered in the Philippines, but only half are covered by collective bargaining agreements (CBA). And although more women are employed, this increase in employment exists under casual and contractual arrangements without protection, not even the 60-day paid maternity leave.  
She recommends international organisations like WABA, and international development agencies like UNICEF and ILO, to push for the right to organise unions. In the final analysis, unions are the most effective channel in monitoring and safeguarding the rights of working women.