Interventions in the workplace to support breastfeeding for women in employment

The median time to stopover exclusive breastfeeding among employed and unemployed mothers of infants aged 6-12 months in Ethiopia, 2019

Early discontinuation of breastfeeding is known to be associated with avoidable childhood morbidity and mortality. The effect of maternal employment on the duration of exclusive breastfeeding and its determinants has not been addressed adequately in in Ethiopia in general and in the stud area in particular. Hence, this study was aimed to compare the time to stop exclusive breastfeeding and its determinants among employed and unemployed mothers of infants 6-12 months of age. A community-based comparative cross-sectional study was conducted from March 1 to 30, 2019. A total of 426 mothers were recruited using a simple random sampling technique. The Kaplan-Meier curve with log-rank test was used to compare the difference in cessation of exclusive breastfeeding before 6 months. Bivariate and Cox proportional hazards model were computed. Hazard ratios and their 95% confidence intervals were computed to determine the level of significance. Four hundred twenty-six (213 employed and 213 un-employed) mothers were included in the final analysis. The median duration of exclusive breastfeeding was 4 months and 6 months for infants of employed and unemployed mothers, respectively. The likelihood of ceasing of exclusive breastfeeding before 6 months of age was significantly associated with family support of exclusive breastfeeding [AHR = 3.99, 95% CI (1.9, 8.3)], and lack of exclusive breastfeeding counseling during postnatal care [AHR = 7.76, 95% CI (2.99, 20.1)], primipara mothers [AHR = 1.5, 95% CI (1.14, 2.04)], maternity leave of 4 months [AHR = 7, 95% CI 2.2, 22.2)] and employed mothers [AHR = 3.77, 95% CI (2.4, 5.9)]. The median duration of exclusive breastfeeding was shorter among employed mothers than un-employed mothers. It is clear from this study that cessation of exclusive breastfeeding was associated with the duration of paid maternity leave for employed mothers. Family support and perceived adequacy of breast milk were associated with cessation of exclusive breastfeeding before 6 months among unemployed mothers.

Employers' perceptions of breastfeeding practice of employed mothers in Addis Ababa, Ethiopia: a qualitative study

BACKGROUND

The Ethiopian Demographic and Health Survey 2019 shows that 59% of children are exclusively breastfed for the first 6 months of life, then the rate decreases sharply with age. Nearly half of the Ethiopian labor force (46%) is comprised of women. This is encouraging since women's employment is one way of ensuring women's empowerment. However, various factors related to employment make it one of the commonly mentioned factors contributing for the low prevalence of breastfeeding. Hence, there needs to be a conducive work environment that accommodates maternal needs to not fall back from empowerment and to improve breastfeeding practice. There are not many studies in Ethiopia that focus on work environment in relation with employers' experience and their perception of breastfeeding of employed mothers. Therefore, this study aims to explore employers' experience and perception of employed mothers' breastfeeding experience in different working environments in Addis Ababa, Ethiopia.

METHODS

A qualitative study design using a descriptive phenomenology strategy was employed in this study and purposive sampling technique was used to recruit study participants. Data was collected between December 2016 and May 2017 in Addis Ababa city from 10 employers from private, governmental and non-governmental institutions through an in-depth interview. Thematic data analysis was performed where collected data was organized, coded and categorized into themes to give meaningful contributions to answering the research questions.

RESULTS

Understanding breastfeeding, current maternity leave, perception of breastfeeding supporting the conditions and mother-friendly work environment were the themes generated after analysis. Almost all employers in this study recognized the importance of breastfeeding despite their different work environments and they also acknowledged the importance of making the working environment mother-friendly for stability and motivation of employed mothers.

CONCLUSIONS

Providing mothers with a friendly environment is understood as a positive thing by employers. The current maternity leave of 3 months has low acceptance and both onsite childcare center and six-month maternity leave are believed to help in creating a mother-friendly work environment despite their pros and cons.

Work-Related Factors Affecting Exclusive Breastfeeding Among Employed Women in Ethiopia: Managers' Perspective Using a Qualitative Approach

Background

Only 21% of employed mothers in Ethiopia breastfeed exclusively until six months. Evidence from other countries has shown that support from managers encourages mothers to continue breastfeeding. Whereas lack of physical resources, time for breastfeeding and supportive policies adversely impact the continuation of breastfeeding. The aim of this study was to explore the perspective of managers regarding breastfeeding in the Ethiopian context.

Methods

Managers of district level, government institutions were interviewed in the Tigray region of North Ethiopia. Semi-structured, face to face interviews were used to explore managers’ perspectives and views about breastfeeding, the level of support they provide to breastfeeding mothers, and the challenges they faced. The data were transcribed verbatim and thematically analysed.

Results

Fifteen managers were interviewed from 12 organizations. The data were categorized into three themes. The first theme related to the attitudes and preference of managers and revealed that overall participants had positive views towards breastfeeding. The second theme highlighted managers’ concern about the impact of breastfeeding on staffing and workplace productivity. The third theme focused on managers’ assertions that, despite improvements, there were still inadequate policies and government strategies to support employed breastfeeding women in North Ethiopia.

Conclusion

It is promising that managers in North Ethiopia expressed a positive attitude towards supporting breastfeeding mothers. Managers raised concern about the impact of breastfeeding on work performance, as well as the lack of physical facilities and government resources that affects the level of support they can provide.

Taking the path of least resistance: a qualitative analysis of return to work or study while breastfeeding

Background

In order to meet World Health Organization recommendations for breastfeeding, many women need to combine breastfeeding with return to work or study. Barriers are often encountered when returning to work or study, which can lead to premature cessation of breastfeeding. This study aimed to explore Australian women’s experiences of breastfeeding at one multi-campus university.

Method

This paper draws on the qualitative findings from a mixed-methods study conducted between April and November 2017. An online survey was used to explore women’s experiences of breastfeeding at university. In total, 108 people participated in the survey. After the deletion of incomplete surveys, 79 staff and students survey responses were analysed. In-depth interviews were also carried out with 10 staff and students. Open text responses and in-depth interviews were analysed using thematic analysis.

Results

The analysis revealed four themes. The first theme, University as a positive and progressive environment for breastfeeding, explores staff and students’ experiences of maternity leave, flexible work arrangements, and on-campus childcare, and their relationships with tutors, supervisors, managers and colleagues. The second theme, Finding private and safe spaces for breastfeeding, presents staff and students’ experiences of using designated rooms, car parks, corridors, classrooms, and offices to breastfeed and express breast milk, and their experiences related to storage of breast milk. The third theme, Feeling self-conscious and unprofessional, reflects women’s experiences of mixing their professional and personal lives, and feeling guilty for taking time out to breastfeed. The fourth theme, Developing resilience to judgement, captures women’s realisation that breastfeeding on campus requires the development of a “thick skin” and the capacity to not be offended easily.

Conclusions

Sustaining breastfeeding requires time and commitment on behalf of the mother, as well as a supportive workplace or study environment. Transforming university campuses into breastfeeding friendly environments is long overdue and requires organisational commitment to achieve genuine reform.

Exclusive breastfeeding and mothers' employment status in Gondar town, Northwest Ethiopia: a comparative cross-sectional study

Background

Exclusive breastfeeding is defined as feeding an infant breast milk only, for the first six months. In Ethiopia, more than half of infants do not receive exclusive breastfeeding. Workplace barriers contribute to these low rates of exclusive breastfeeding practices. Understanding the sociodemographic, health related, behavioral and economic factors is crucial to promote the practice of exclusive breastfeeding in Ethiopia. Therefore, the aim of this study was to assess the extent of exclusive breastfeeding practice and associated factors among employed and unemployed mothers with children of age 7–12 months in Gondar town, northwest Ethiopia, 2015.

Methods

A community based comparative cross-sectional study was conducted in October 2015. Simple random sampling technique was used to select 649 eligible mothers with children age 7–12 months during the study period. A structured and pretested interviewer administered questionnaire was used to collect the data. Three logistic regression models: whole sample, employed and not employed, were fitted.

Results

A total of 649 (333 unemployed and 316 employed) mothers were interviewed. The mean duration of mothers to exclusively breastfeed was 4.77 months (± 1.36 Standard Deviation [SD]). Exclusive breastfeeding was higher among unemployed 48.0% with 95% Confidence Interval (CI) (42.0%, 54.0%) than employed (20.9%) with 95% CI (16.0%, 25.0%). Parity of three children and above (Adjusted Odds Ratio [AOR] = 3.48), and having social support (AOR = 3.45) were positively associated with exclusive breastfeeding while poor knowledge (AOR = 0.30), wealth index of the medium level (AOR = 0.38) were negatively associated among employed mothers. In the case of unemployed mothers, vaginal delivery (AOR = 2.60) and having social support (AOR = 3.03) were positively associated with exclusive breastfeeding while, poor knowledge (AOR = 0.28), and not having antenatal care (AOR = 0.56) were negatively associated.

Conclusions

The overall exclusive breastfeeding practice of mothers was low. However, unemployed mothers breastfeed more than employed mothers. Providing a special support for employed mothers and revising either the legislation of the two month postpartum maternity leave or applying different alternatives is recommended.

Electronic supplementary material

The online version of this article (doi:10.1186/s13006-017-0118-9) contains supplementary material, which is available to authorized users.

Employer-Based Programs to Support Breastfeeding Among Working Mothers: A Systematic Review

BACKGROUND

Many mothers experience barriers to maintaining a breastfeeding relationship with their infants upon returning to work and, consequently, terminate breastfeeding earlier than recommended or intended. As such, employers are in a unique position to help further increase breastfeeding rates, durations, and exclusivity.

OBJECTIVE

The purpose of this review is to examine the literature regarding employer-based programs, policies, and interventions to support breastfeeding among working mothers.

MATERIALS AND METHODS

A systematic literature search was conducted for peer-reviewed articles published before April 2016. Studies were included if they focused on workplace-based lactation/breastfeeding support programs, policies, or interventions to promote breastfeeding among employees. For inclusion, articles must have measured at least one outcome, such as breastfeeding duration, breastfeeding exclusivity, or employee satisfaction.

RESULTS

Twenty-two articles were included, representing 10 different countries and both public- and private-sector employers, including governmental offices, schools, hospitals, manufacturing/industrial companies, and financial settings, among others. Providing a lactation space was the most common employer-based support accommodation studied, followed by breastfeeding breaks and comprehensive lactation support programs. The majority of studies analyzing these three support types found at least one positive breastfeeding and/or nonbreastfeeding outcome.

CONCLUSIONS

This review suggests that maintaining breastfeeding while working is not only possible but also more likely when employers provide the supports that women need to do so. Although some employers may have more extensive breastfeeding support policies and practices than others, all employers can implement a breastfeeding support program that fits their company's budget and resources.

Employee perception of breastfeeding-friendly support and benefits of breastfeeding as a predictor of intention to use breast-pumping breaks after returning to work among employed mothers

BACKGROUND

Although increasing numbers of large companies are complying with demands for a breastfeeding-friendly workplace by providing lactation rooms and breast-pumping breaks, the effectiveness for intention to use breast-pumping breaks to express breast milk among employed mothers is uncertain. To explore the impact of employees' perceived breastfeeding support from the workplace and the benefits of breastfeeding on a woman's intention to use breast-pumping breaks after returning to work, we conducted a survey at a female labor-intensive electronics manufacturer in Taiwan.

SUBJECTS AND METHODS

A structured questionnaire survey was administered to 715 working mothers employed in an electronics manufacturing plant in Tainan Science Park in Southern Taiwan. Questionnaire content included female employee demographics, employment characteristics, and breastfeeding behavior after returning to work, as well as employees' perception of breastfeeding-friendly support and awareness of the benefits of breastfeeding when raising their most recently born child.

RESULTS

Higher education (odds ratio [OR] 2.33), non-clean room worksite (OR 1.51), awareness of breast-pumping breaks (OR 4.70), encouragement by colleagues to use breast-pumping breaks (OR 1.76), and greater awareness of the benefits of breastfeeding (OR 1.08) were significant predictors of the use of breast-pumping breaks after returning to work, whereas the perception of inefficiency when using breast-pumping breaks reduced an employed mother's intention to use breast-pumping breaks (OR 0.55).

CONCLUSIONS

This study finds an association between an appreciation of the benefits provided by the employer and the likelihood of increased usage of breastfeeding breaks. Workplaces and employers can help employed mothers to understand the benefits of breastfeeding, which may increase the intention of the mother to take breast-pumping breaks after returning to work.

Breastfeeding duration, social and occupational characteristics of mothers in the French 'EDEN mother-child' cohort

Socio-demographic characteristics of mothers have been associated with exclusive breastfeeding duration, but little is known about the association with maternal full- and part-time employment and return to work in European countries. To study the associations between breastfeeding, any and almost exclusive (infants receiving breast milk as their only milk) breastfeeding, at 4 months of infant's age and the socio-demographic and occupational characteristics of mothers. We used the EDEN mother-child cohort, a prospective study of 2002 singleton pregnant women in two French university hospitals. We selected all mothers (n = 1,339) who were breastfeeding at discharge from the maternity unit. Data on feeding practices were collected at the maternity unit and by postal questionnaires at 4, 8 and 12 months after the birth. Among infants breastfed at discharge, 93% were still receiving any breastfeeding (83% almost exclusive breastfeeding) at the 3rd completed week of life, 78% (63%) at the 1st completed month, and 42% (20%) at the 4th completed month. Time of return to work was a major predictor for stopping breastfeeding: the sooner the mothers returned to work, the less they breastfed their babies at 4 months of infant's age, independently of full-time or part-time employment. The association was stronger for almost exclusive breastfeeding mothers than for any breastfeeding ones. In a society where breastfeeding is not the norm, women may have difficulties combining work and breastfeeding. Specific actions need to be developed and assessed among mothers who return to work and among employers.

Labor epidural anesthesia, obstetric factors and breastfeeding cessation

Breastfeeding benefits both infant and maternal health. Use of epidural anesthesia during labor is increasingly common and may interfere with breastfeeding. Studies analyzing epidural anesthesia's association with breastfeeding outcomes show mixed results; many have methodological flaws. We analyzed potential associations between epidural anesthesia and overall breast-feeding cessation within 30 days postpartum while adjusting for standard and novel covariates and uniquely accounting for labor induction. A pooled analysis using Kaplan-Meier curves and modified Cox Proportional Hazard models included 772 breastfeeding mothers from upstate New York who had vaginal term births of healthy singleton infants. Subjects were drawn from two cohort studies (recruited postpartum between 2005 and 2008) and included maternal self-report and maternal and infant medical record data. Analyses of potential associations between epidural anesthesia and overall breastfeeding cessation within 1 month included additional covariates and uniquely accounted for labor induction. After adjusting for standard demographics and intrapartum factors, epidural anesthesia significantly predicted breastfeeding cessation (hazard ratio 1.26 [95% confidence interval 1.10, 1.44], p < 0.01) as did hospital type, maternal age, income, education, planned breastfeeding goal, and breastfeeding confidence. In post hoc analyses stratified by Baby Friendly Hospital (BFH) status, epidural anesthesia significantly predicted breastfeeding cessation (BFH: 1.19 [1.01, 1.41], p < 0.04; non-BFH: 1.65 [1.31, 2.08], p < 0.01). A relationship between epidural anesthesia and breastfeeding was found but is complex and involves institutional, clinical, maternal and infant factors. These findings have implications for clinical care and hospital policies and point to the need for prospective studies.

Working mothers: how much working, how much mothers, and where is the womanhood?

Motherhood confers upon a woman the responsibility of raising a child. This process also changes the way in which she is perceived in society and at her workplace. It can necessitate her to take more than available leave options, and job security can be at risk. Significant social and personal adjustments are necessary to cope with such a situation. A working mother, especially one who has the good fortune to be able to balance her home and work, enjoys the stimulation that a job or career provides. She develops the ability of raising a useful member of society and at the same time gains financial independence. Along with motherhood, work adds to the completeness of being a woman.

State breastfeeding worksite statutes.…breastfeeding rates…and.…

BACKGROUND

State worksite breastfeeding statutes are thought to play a role in increasing rates of breastfeeding duration, which remain below Healthy People 2010 goals. As of 2010 24 states including the District of Columbia had such worksite statutes. Of these only 18 required both break time and a site. This preliminary analysis assessed if infants born in states with worksite breastfeeding statutes had longer breastfeeding duration.

METHODS

Using the 2009 National Immunization Survey we analyzed infants comparing breastfeeding duration at 6 months with type of worksite breastfeeding statute in place, while adjusting for year enacted and other state characteristics (years since founding of state breastfeeding coalition, breastfeeding supportive hospital practices). Other covariates included maternal and infant characteristics. Only those infants whose mothers were at least 18 years old and who had not changed state of residence since birth were included (n=16,145).

RESULTS

Although requiring a site and/or break time for breastfeeding increased the likelihood of breastfeeding at 6 months (odds ratio, 1.20; 95% confidence interval, 1.07-1.35; p=0.002), after accounting for other factors this relationship remained positive but was not significant (adjusted odd ratio, 1.07; 95% confidence interval, 0.92-1.24). Because all mothers, not just those in or returning to the workforce, were included in the analysis this relationship could be underestimated. Breastfeeding at 6 months was associated with being from a state that had had a breastfeeding coalition for a longer period of time (adjusted odds ratio, 1.25; 95% confidence interval, 1.04-1.49; p<0001).

CONCLUSIONS

State worksite breastfeeding statutes alone may not directly affect breastfeeding duration. Analysis of breastfeeding duration using the multiple levels of the social-ecological model is a potentially useful approach to understanding the impact of state breastfeeding statutes. The impact of state breastfeeding coalitions warrants further study.

Working mothers, breastfeeding, and the law

Workplace barriers contribute to low rates of breastfeeding. Research shows that supportive state laws correlate with higher rates, yet by 2009, only 23 states had adopted any laws to encourage breastfeeding in the workplace. Federal law provided virtually no protection to working mothers until the 2010 enactment of the "reasonable break time" provision of the Patient Protection and Affordable Care Act. This provision nonetheless leaves many working mothers uncovered, requires break time only to pump for (not feed) children younger than 1 year, and exempts small employers that demonstrate hardship. Public health professionals should explore ways to improve legal support for all working mothers wishing to breastfeed. Researchers should identify the laws that are most effective and assist policymakers in translating them into policy.

Effective community-based interventions to improve exclusive breast feeding at four to six months in low- and low-middle-income countries: a systematic review of randomised controlled trials

BACKGROUND

only about 25% of babies are exclusively breast fed until six months of age in developing countries and, given their greater risk of infection and infant mortality, there is a need to investigate ways of increasing this. The aim of this review is to assess the effectiveness of community-based interventions to improve the rates of exclusive breast feeding at four to six months in infants in low- and low-middle-income countries.

METHODS

a systematic review of literature identified through searches of Medline, Global Health and CINAHL databases to identify randomised controlled trials of community-based interventions to improve the rate of exclusive breast feeding in low- and low-middle-income countries.

FINDINGS

four studies, from four different countries, were included in the final review. Although they evaluated slightly different interventions, all showed a significant improvement in the rate of exclusive breast feeding with a pooled odds ratio of 5.90 (95% confidence interval 1.81-18.6) on random effects meta-analysis.

CONCLUSION

community-based interventions in low- and low-middle-income countries can substantially increase the rates of exclusive breast feeding and are therefore a viable option. The interventions included in the review varied, indicating that there are a number of ways in which this might be achieved; it is recommended that these are used as a starting point for determining the most appropriate intervention with regard to the setting. Given the importance of this issue, the lack of research in the area is surprising. The studies in the review demonstrate that good-quality randomised controlled trials of this area are possible and should encourage further research.

Evidence for perinatal and child health care guidelines in crisis settings: can Cochrane help?

BACKGROUND

It is important that healthcare provided in crisis settings is based on the best available research evidence. We reviewed guidelines for child and perinatal health care in crisis situations to determine whether they were based on research evidence, whether Cochrane systematic reviews were available in the clinical areas addressed by these guidelines and whether summaries of these reviews were provided in Evidence Aid.

METHODS

Broad internet searches were undertaken to identify relevant guidelines. Guidelines were appraised using AGREE and the clinical areas that were relevant to perinatal or child health were extracted. We searched The Cochrane Database of Systematic Reviews to identify potentially relevant reviews. For each review we determined how many trials were included, and how many were conducted in resource-limited settings.

RESULTS

Six guidelines met selection criteria. None of the included guidelines were clearly based on research evidence. 198 Cochrane reviews were potentially relevant to the guidelines. These reviews predominantly addressed nutrient supplementation, breastfeeding, malaria, maternal hypertension, premature labour and prevention of HIV transmission. Most reviews included studies from developing settings. However for large portions of the guidelines, particularly health services delivery, there were no relevant reviews. Only 18 (9.1%) reviews have summaries in Evidence Aid.

CONCLUSIONS

We did not identify any evidence-based guidelines for perinatal and child health care in disaster settings. We found many Cochrane reviews that could contribute to the evidence-base supporting future guidelines. However there are important issues to be addressed in terms of the relevance of the available reviews and increasing the number of reviews addressing health care delivery.

Maternal employment and breastfeeding: results from the longitudinal study of Australian children

AIM

To investigate the effect of maternal postnatal employment on breastfeeding duration in Australia in the first 6 months after birth.

METHOD

Secondary data analysis of the infant data (2004) from the Longitudinal Study of Australian Children (LSAC). Complete maternal and breastfeeding data were available for 3,697 infants. Multivariable logistic regression was used to investigate the effect of timing of resumption of maternal employment and maternal employment status on breastfeeding at 6 months postpartum after adjustment for maternal education, maternal age, maternal smoking during pregnancy and socioeconomic status of the child's area of residence.

RESULTS

Fewer women employed full-time were breastfeeding their infants at 6 months (39%) than nonemployed women (56%). Participation in full-time employment before 6 months had a strong, negative effect on the likelihood of continuing breastfeeding for 6 months, adjusted OR = 0.35 (95%CI: 0.22-0.55). Compared to nonemployed women, fewer women in part-time employment were breastfeeding at 6 months (44%), adjusted OR = 0.49 (95% CI: 0.37-0.64).

CONCLUSIONS

Results from this large representative cohort of Australian infants confirm that maternal employment in the first 6 months of life contributes to premature cessation of breastfeeding even when known risk factors for breastfeeding cessation are controlled for.