Breastfeeding has numerous health, environmental, and economic benefits, and the promotion and support of breastfeeding has been at the centre of efforts from many global organizations such as WHO and UNICEF to promote maternal and child health. Interventions developed from such policies tend to be inaccessible to those who are economically marginalized, however, and thus may further inequities. Understanding the lived experiences of women occupying this segment of society, such as sex workers, illuminates the social and structural determinants of breastfeeding and how they constitute structural vulnerability that renders breastfeeding difficult. This qualitative study explores breastfeeding practices and decisions among sex workers in Mumbai and the factors shaping their experiences. We look at proximal factors-those that women directly indicate as influencing their breastfeeding decision-making or behaviour, and distal factors-macrolevel forces identified by the women, as indication of their structural vulnerability, particularly in relationship to the decision to initiate and sustain breastfeeding. We conclude with discussing the need to promote appropriate infant feeding practices through culturally responsive interventions and mechanisms, taking both proximal and distal factors into account, to work towards equity in health outcomes.

中文翻译：

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孟买女性性工作者的结构性脆弱性和母乳喂养。

母乳喂养具有许多健康，环境和经济利益，促进和支持母乳喂养一直是世界卫生组织和联合国儿童基金会等许多全球组织促进母婴健康的努力的中心。但是，那些被经济边缘化的人往往无法获得从此类政策中发展出来的干预措施，因此可能进一步加剧不平等现象。了解占据这一社会阶层的妇女（例如性工作者）的生活经历，阐明了母乳喂养的社会和结构决定因素，以及它们如何构成使母乳喂养困难的结构脆弱性。这项定性研究探讨了孟买性工作者中的母乳喂养习惯和决策以及影响其经历的因素。我们关注的是近端因素-妇女直接表明影响她们的母乳喂养决策或行为的因素，以及远端因素-由妇女确定的宏观水平力量，以表明她们的结构脆弱性，特别是与开始和维持母乳喂养的决定有关。最后，我们讨论了需要通过文化上敏感的干预措施和机制，同时考虑到近端和远端因素，促进适当的婴儿喂养方式，以实现健康结果的公平。