Livelihood and Nurturing Care: a longitudinal study to explore child care and infant feeding among women informal workers

The LiNCs research team are, from the left: Silondile Luthuli, Cleo Phewa and Sphindile Maphumulo.


The informal work environment provides paid work for millions of women globally, many of whom are also mothers of young children. Informal workers lack the social protection legislated for formal workers, including access to sick leave, maternity leave or unemployment benefits. Informal work is characterised by poor job security, low earnings, and unsafe working conditions, and there are high rates of poverty, food insecurity and vulnerability among informal workers. However, little is known about feeding and child care practices among women informal workers. The constraints are self-evident: how do women working with precarious quality of employment and economic vulnerability navigate the need and choice to work with the requirements of breastfeeding and child care? Although the absence of structured maternity leave defines all forms of informal work, in different sectors of informal work, there are more specific constraints. Women working as street vendors, for example, may face spatial challenges in work sites for breastfeeding because they work in public spaces. Women working collecting waste to sell face concerns about safety of their children in the workplace. There is little systematic research aimed to determine the impact of informal work on maternal and child health. The LINC project developed from previous formative work undertaken with women informal workers in KZN in 2017. This work was a collaborative effort between study teams based in India and South Africa with technical input from the World Health Organization.

We conducted a longitudinal mixed methods cohort study over a period of one year. A qualitative longitudinal design focusses on the stories of individual participants and allows researchers to capture critical moments and change processes as they occur over time. The aim of the study was to explore the lives of informal workers focussing on their plans, experiences and practices about infant feeding and work during pregnancy, after delivery and on returning to work. Further, we aimed to prospectively explore the role of support networks and relationships in enabling women to manage their multiple roles and responsibilities for work, family and childcare. In addition, we explored anxiety, depression and resilience to adverse events during pregnancy and after delivery among women in informal work.

The study was conducted in two urban townships in Durban, KwaZulu-Natal (KZN). Economic development within these townships has increased informal business development, with women occupying a substantial space in the informal sector. Twenty-four women informal workers were recruited during pregnancy and followed up until they had returned to work or for one year whichever was the shorter. Mothers were contacted by telephone every two weeks during the study period to track significant transition points for the mother and baby, and to schedule interviews. Interviews were conducted at a convenient place for the mother and were conducted in IsiZulu or English, according to the mother’s preference. Data were collected using quantitative questionnaires and in-depth interviews at three time points, pre-delivery, post-delivery, and after the return to work. On completion of the in-depth interviews a series of FGDs was conducted with cohort participants to explore their experiences of having a baby and returning to work with a particular focus on support systems, child care arrangements and how informal working mothers managed their multiple responsibilities for earning a living and caring for their children.

Data collection was completed in October 2019. In total 87 interviews were conducted with the women over follow up period of approximately one year. These included 24 interviews at pre-delivery, 24 post-delivery, 18 pre-work, 18 after return-to-work, and four baby-in-care interviews. 11 FGDs were conducted with cohort participants.

Analysis is ongoing and manuscripts have been prepared and submitted for publication.


The following papers have been published from this work:

Luthuli S, Haskins L, Mapumulo S, Rollins N, Horwood C: ‘I decided to go back to work so I can afford to buy her formula’: a longitudinal mixed-methods study to explore how women in informal work balance the competing demands of infant feeding and working to provide for their family. BMC Public Health 2020, 20(1):1847.

Horwood C, Haskins L, Hinton R, Connolly C, Luthuli S, Rollins N: Addressing the interaction between food insecurity, depression risk and informal work: findings of a cross-sectional survey among informal women workers with young children in South Africa. BMC Womens Health 2021, 21(1):2.

Horwood C, Hinton R, Haskins, Luthuli S, Mapumulo S, Rollins N: ‘I can no longer do my work like how I used to’: a mixed methods longitudinal cohort study exploring how informal working mothers balance the requirements of livelihood and safe childcare in South Africa. BMC Womens Health 2021 (in press)

The following papers are submitted or under review

Haskins L, Luthuli S, Mapumulo S, Kathree T, Horwood C: The changing face of fatherhood in South Africa: exploring the supportive role fathers played during pregnancy and after childbirth from the perspective of women informal workers (BMC Womens Health submitted)

Mapumulo S, Haskins L, Luthuli S, Horwood C:  More needs to be done to address high levels of disrespect and abuse of women during labour and childbirth: a qualitative study in Durban, South Africa (PLoS ONE, under review)

Horwood C, Luthuli S, Chiliza J, Mapumulo S, Haskins L: It’s not the destination it’s the journey: lessons from a longitudinal ‘mixed’ mixed-methods study among female informal workers in South Africa. (International Qualitative Methods, under review)

Luthuli S, Haskins L, Mapumulo S, Horwood C: Why is obtaining the Child Support Grant still so difficult? Barriers to applying and accessing the Child Support Grant (CSG) among women in informal work in Durban, South Africa. (South African Medical Journal, submitted)