Civil society organizations are urging the government to extend maternity leave from three to six months after breastfeeding dropped due to mothers returning to work within three months.

This leads to increased use of breast-milk substitutes (BMS) and affects young children's long-term health. In addition, the country's economy stands to lose $137.7 million annually due to inadequate breastfeeding.

Only nine percent of infants were exclusively breastfed for six months among working mothers. Almost two-thirds of infants had received breast-milk substitutes (BMS) on the day preceding the data collection, according to the recent research by GIZ.

In Cambodia, almost 2,000 children’s lives could be saved each year if optimal breastfeeding is practiced and inadequate breastfeeding results in approximately half a million avoidable cases of childhood diarrhea and pneumonia each year.

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In addition, 5,000 children become obese annually. The economy stands to lose $137.7 million annually due to inadequate breastfeeding, this combined health system, mortality, and cognitive losses.

Preliminary baseline results were conducted between February and March 2022 among 308 women employees with children younger than 12 months of age from the GIZ-MUSEFO funded Workplace and Infant and Young Child Feeding (IYCF) Support Project, currently being implemented by Helen Keller Intl (Helen Keller).

Almost two-thirds (61 percent) of infants had received BMS on the day preceding the data collection. The average cessation of breastfeeding was three months, with half (51 percent) of mothers ceasing breastfeeding at or before three months postpartum.

This was assumed to be because of the short duration of maternity leave. Of the mothers who stopped breastfeeding, almost half (49 percent) stated that the reason they stopped breastfeeding was due to returning to work, according to a GIZ press release on Tuesday.

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The International Labor Organization (ILO) estimates that as many as 93 percent of workers in Cambodia are informal workers, of which an estimated three quarters (77 percent) of employed women work in the informal sector.

With more women entering the workforce each year and evidence showing the numerous barriers working mothers face to achieving optimal breastfeeding, there is a need for the government to strengthen maternity entitlement laws and policies to help protect, promote, and support breastfeeding.

According to the Cambodia Labour Law, Section 8, ‘Child Labor – Women Labor’, Section C. Women Work – Articles 182-183, women are entitled to a maternity leave of 90 days at half of their wage, including prerequisites, paid by the employer. However, the wage benefits as specified are granted only to women with a minimum of one year of uninterrupted service in the enterprise.

Hou Kroeun, Country Director of the Helen Keller organization, said there are two main reasons that the organization would like to request the government considers expanding the duration of maternity leave longer than three months to six months. After conducting the research, it found out that breastfeeding rates have decreased and the reason behind that is due to mothers having only three months for maternity leave.

“After we did the research we found out that they [mothers] have to go back to work again. Therefore, if we still keep pursuing this we will not be able to achieve the goal that the government has set the target to only provide breastfeeding to infants to reach 85 percent in 2030,” he said.

However, the NGO is trying to negotiate with the government about how long to extend maternity leave. More than three months are still in process.

In Vietnam, maternity leave was increased to six months in 2018. As a result, the rate of breastfeeding has increased by 23 percent, which the director of Helen Keller marked as a huge improvement in Vietnam, adding that Cambodia can learn from this success.

Other regional countries, such as Malaysia, Laos and Myanmar, have also increased maternity leave, according to Kroeun.

Economic experts estimate that if mothers are able to fully breastfeed for six months, according to the World Health Organization standards, the country will be able to save up to $330 million in a year. This can guarantee about 370,000 new born kids have a chance to receive sufficient breastfeeding.

The aim of the full-day workshop on “Improving infant and young child feeding and maternity leave for working women in Cambodia” is to evaluate the ability and possibility of increasing maternity leave of women working in the country, to promote breastfeeding, and discuss establishing regulations or new standards for food supplements for kids aged six to 24 months.

“Even though Cambodia has achieved success in cutting down mortality rates and greek rate (stunting rate). Nonetheless, there are many issues that we have to solve. Especially, the dropping rate of breastfeeding and rising rate of eating packaged processed foods and drinks with high sugar content among Cambodian children,” Kroeun noted in the ceremony.

In addition, a recent study by the Ministry of Health and Helen Keller revealed that sugar sweetened beverages and unhealthy food consumption was highly prevalent among young children. Furthermore, there are currently no Cambodian regulations or standards that specifically govern the composition, nutrient content, and labeling, including appropriate nutrient content claims, of commercially-produced complementary feed products for children aged six to 24 months.

He continued, “The latest research has shown that there are many reasons that breastfeeding rates drop, especially regarding the length of maternity leave. Most of the mothers have told us the reason they stop breastfeeding is because they have to go back to work and switch from breastfeeding to feeding their children with formula milk powder instead.”

Many countries in the region have expanded or made selective amendments to their maternity leave entitlements. In Vietnam, the length of maternity leave has been increased from 16 to 26 weeks, Laos PDR from 12 to 15 weeks, the Philippines from 8.5 to 15 weeks, and in Malaysia from 8.5 weeks to 13 weeks.

In Bangladesh, the combined maternity and postnatal leave is six months, and they recently increased entitlements for female workers in the education and financial sectors. In Myanmar, expanded provisions were given during the Covid-19 pandemic. Since extending maternity leave to six months in Vietnam, the rate of exclusive breastfeeding has increased from 22 to 45.4 percent.

The Royal Government of Cambodia is committed to increasing the rate of exclusive breastfeeding practices to 85 percent by 2030. In the past, Cambodia was successful in the promotion of breastfeeding practices. However, the rate of exclusive breastfeeding for children aged 0 to five months have decreased significantly, from 74 percent in 2010 to 51 percent in 2021-2022.

The deterioration is particularly marked in urban areas, which experienced a drop from 64 percent to 34 percent between 2010 and 2014. This drop in exclusive and continued breastfeeding, especially in urban areas, has been partially attributed to increased use of BMS, as well as mothers returning to work following maternity leave, stated the GIZ press release.

Prak Sophonneary, Secretary of State at the Ministry of Health, also raised concerns about the difficulties mothers in recent generations face, including lack of time to feed their children properly with breastmilk.

“Over the past years, most Cambodian women were doing household chores, farming or any other work to feed their family’s livelihood near their homes, which allowed them to have more time to breastfeed their children for a longer period. Nowadays, we notice that almost 80 percent of Cambodian women are workers,” she said.

“It is also a concern since most women now work in the civil public sector, private companies, industries, and enterprises that they have to take some time to earn more income and at the same time they have to take care and feed their children for better growth.”

Increasing the duration of maternity for female workers will provide more benefits for mother and their baby’s health. It will help reduce the incidence of breast and cervical cancer for mothers who are breastfeeding for six months and infants are less likely to face being overweight, diabetes, and high-blood pressure, while cutting down the risk of death caused by serious disease, Sophonneary said.

“There will be a lot of advantages because the breast milk from birth until six months is perfect. It means it contains the full nutrition that infants need. So, if the mother has only three months for breastfeeding it is equivalent to the baby not getting enough nutrition and effects their growth and leads to sickness,” she added.

Cambodia’s labor law does not meet the minimum 14 weeks of maternity leave or minimum pay of two-thirds of the woman’s earnings prior to taking leave currently recommended in the ILO’s Maternity Protection Convention (No. 183).

The limited duration of maternity leave also presents significant challenges for working women to meet the WHO/UNICEF recommendations for exclusive breastfeeding in the first six months of life. Cambodia’s present maternity entitlement reforms have been limited compared to neighboring countries.