Factors associated with breastfeeding duration and exclusivity in mothers returning to paid employment postpartum

Maternal employment characteristics as a structural social determinant of breastfeeding after return to work in the European Region: a scoping review

BACKGROUND

The European Region has the lowest rate of exclusive breastfeeding at 6 months worldwide. Improving work-related breastfeeding issues is important given that women may have difficulties combining work and breastfeeding, especially those in precarious working situations, which adds to their adversity. This scoping review overviews research on the maternal employment characteristics that support breastfeeding continuation after return to work in the European Region.

METHODS

Studies published from 2013 to 2023 were collected from Scopus, PubMed, and PsycInfo. Quantitative and qualitative studies published in English or French that explored the association between maternal employment characteristics and any breastfeeding status, duration, or experience were included. Participants included were mothers of healthy children who continued breastfeeding after resuming work. The main determinants were work-related factors that can lead to socially differentiated working conditions, including type of employment (e.g., occupation, employed/self-employed status, type of contract, working time, occupational prestige), working conditions (e.g., work schedule, decision latitude, latitude to organize worktime), and work environment (e.g., occupational exposure, family-friendly workplace policy, social support). The geographic area encompassed countries included in the World Health Organization European Region.

RESULTS

Of the 693 single studies retrieved and screened, 13 were included in the review. Eight studies focused on combining work and breastfeeding, while the others had a broader spectrum by investigating breastfeeding determinants. The represented countries were Spain (n = 4), France (n = 4), UK (n = 2), Ireland (n = 2), and the Netherlands (n = 1). Results highlighted the heterogeneity of measures, time frames, and fields of inquiry, thus revealing a lack of conceptual framework regarding the links between work, breastfeeding, and social health inequalities. Nonetheless, being self-employed, working in a non-manual profession with time flexibility, having lactation rooms at work, being supported by co-workers, and having a breastfeeding workplace policy were salient factors that supported breastfeeding in working mothers.

CONCLUSIONS

Supporting working mothers who choose to breastfeed is important given the myriad of adverse factors faced by mothers and their children. These results advocate for targeted actions at the workplace such as time flexibility, breastfeeding facilities, and the promotion of breastfeeding-friendly policies.

Returning to work after maternity leave: a systematic literature review

PURPOSE

Working women often experience difficulties associated with balancing family and career, particularly if they choose to have children. This systematic literature review aimed at investigating women's experience in returning to work after maternity leave.

METHODS

The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The literature search led to the identification of 52 articles, which underwent data extraction and qualitative analysis.

RESULTS

Results were organized in 5 categories: (1) Work-life balance; (2) Women's mental and physical health; (3) Job-related wellbeing and working experience; (4) Breastfeeding. Women's both mental and physical health seem connected to a longer maternity leave and a greater coworkers' and supervisors' support. Returning to work seems to constitute one of the most important barriers for exclusive breastfeeding or breastfeeding continuation. A shorter duration of maternity leave, a higher workload and the lack of occupational policies supporting breastfeeding seem to be hindering factors. Partner and family support, and the opportunity for fathers to work under a flextime system after childbirth seem to increase both breastfeeding initiation and duration. Women who continue breastfeeding after returning to work seem to experience more family-to-work conflict and overload.

CONCLUSIONS

This paper show that there are still many understudied aspects in exploring women's experience of returning to work after maternity leave. This represents an important gap in the literature, since returning to work represents a particularly critical time in women's personal and occupational life, in which challenges and barriers may arise, potentially affecting their experience in the immediate future and years to come.

Association between maternal socioeconomic status and breastfeeding: Results from the Japan environment and children's study

Although breastfeeding has various benefits for mothers and children, there are several barriers to continuing breastfeeding practices. However, little is known about the relationship between breastfeeding in Japan and maternal socioeconomic circumstances. Based on data from the Japan Environment and Children's Study (n = 75,742), we evaluated maternal socioeconomic factors associated with breastfeeding 1 year after giving birth. Socioeconomic status (education, employment status, and household income), working hours, and breastfeeding were assessed using a self-administered questionnaire. After descriptive analysis, a logistic regression analysis was conducted with adjustments for age, educational level, employment status, and household income. Mothers with higher education and full-time homemakers were more likely to breastfeed one-year-old children. Mothers working long hours (both part-time and full-time) were less likely to breastfeed their one-year-old children. To improve breastfeeding among working mothers, it may be helpful to promote awareness of breastfeeding for every mother as well as to make the workplace environment conducive for working mothers to breastfeed.

Comparing Experiences of Women Who Were Direct Breastfeeding and Women Who Used Expressed Breast Milk to Feed Their Infants

PURPOSE

To provide understanding about feeding experiences of women who provide breast milk through direct breastfeeding and exclusive expression and to compare these experiences.

STUDY DESIGN AND METHODS

A qualitative study was conducted to gather experiences from the perspectives of women who had given birth to a healthy, term infant within the past 12 months and exclusively fed breast milk for at least 2 weeks. The sample was recruited from motherhood and breastfeeding support groups on Facebook. Groups had state- or national-based memberships. Interviews were examined for themes that were compared between feeding groups using thematic analysis.

RESULTS

Fifteen new mothers participated. Under the primary themes of Similarities and Differences, seven subthemes were identified: Fatigue, Importance of Support, Finding Joy in a Common Goal, Mixed Feelings, Trusting versus Tracking, Latching versus Body Failure, and Pumping in Isolation.

CLINICAL IMPLICATIONS

Mothers who provide breast milk share common experiences and feelings of satisfaction. Expressed breast milk feeding offers some mothers a way to provide the benefits of breast milk while preserving a balance between maternal and infant physical and mental health needs. Understanding the different ways in which women manage breast milk feeding while balancing maternal and infant needs can prepare nurses to discuss various methods of breast milk feeding and provide individualized support.

The Role of Work as a Social Determinant of Health in Mother's Own Milk Feeding Decisions for Preterm Infants: A State of the Science Review

In the United States, 10% of infants are born preterm (PT; <37 weeks gestational age) each year and are at higher risk of complications compared to full term infants. The burden of PT birth is borne disproportionately by Black versus non-Black families, with Black mothers significantly more likely to give birth to a PT infant. One proven strategy to improve short- and long-term health outcomes in PT infants is to feed mother's own milk (MOM; breast milk from the mother). However, mothers must make decisions about work and MOM provision following PT birth, and more time spent in paid work may reduce time spent in unpaid activities, including MOM provision. Non-Black PT infants are substantially more likely than Black PT infants to receive MOM during the birth hospitalization, and this disparity is likely to be influenced by the complex decisions mothers of PT infants make about allocating their time between paid and unpaid work. Work is a social determinant of health that provides a source of income and health insurance coverage, and at the same time, has been shown to create disparities through poorer job quality, lower earnings, and more precarious employment in racial and ethnic minority populations. However, little is known about the relationship between work and disparities in MOM provision by mothers of PT infants. This State of the Science review synthesizes the literature on paid and unpaid work and MOM provision, including: (1) the complex decisions that mothers of PT infants make about returning to work, (2) racial and ethnic disparities in paid and unpaid workloads of mothers, and (3) the relationship between components of job quality and duration of MOM provision. Important gaps in the literature and opportunities for future research are summarized, including the generalizability of findings to other countries.

Early cessation of breastfeeding and the associated factors among mothers with children aged 2 to 3 years in rural Southern Ethiopia: a community-based cross-sectional study

BACKGROUND

Breast milk is the first natural food for babies. It has nutritional, immunological, developmental, psychological, societal and environmental advantages. Failing to feed children for twenty-four months has so many negative consequences to children. Though studies have well documented the duration of breast feeding in the first six months, the proportion of women completing the recommended duration and factors associated with it has not been well investigated in rural places of Ethiopia. Therefore, this study aims to fill this gap in evidence among mothers with children aged 2 to 3 years in Arba Minch Health and Demographic Surveillance Site in 2021 E.C.

METHODS

A community-based cross-sectional study was conducted in all kebeles of the surveillance site by employing multi-stage sampling technique. Descriptive statistics was done to summarize findings and binary logistics regression model was used to identify factors significantly associated with early breast-feeding cessation respectively. OR with its 95% CI was obtained to quantify the degree of association between explanatory variables and early breastfeeding cessation.

RESULT

The proportion of early cessations of breast feeding was 29.30% (25.02, 33.64%). Being from a household with no fathers 'education or primary education [AOR=0.22; 95%CI (0.07, 0.74)] and [AOR=0.30; 95%CI (0.12, 0.76)], farmer mothers [AOR=6.40; 95%CI: (1.38, 29.74)], birth interval of less than 2 years [AOR=2.07; 95%CI: (1.03, 4.16)], and with mothers' one or two to three antenatal care visits [AOR = 2.73; 95%CI: (1.27,5.88)] were factors significantly associated with early cessations of breast feeding.

CONCLUSION AND RECOMMENDATION

The proportion of early cessations of breast feeding was high. Father's education, being farmer, birth interval and ante natal care visit were significant factors. Health education about proper breast feeding practice and improving ante natal care attendance might improve premature cessation of breast feeding among women.

Breastfeeding in the pandemic: A qualitative analysis of breastfeeding experiences among mothers from Canada and the United Kingdom

BACKGROUND

Previous research shows that the COVID-19 pandemic resulted in both barriers and facilitators to breastfeeding. However, little research has looked specifically at first-time mothers' experiences of breastfeeding during the pandemic or compared experiences of mothers living in different countries.

AIM

This research explores mothers' breastfeeding experiences to describe how the COVID-19 pandemic has affected breastfeeding journeys in Canada and the United Kingdom.

METHODS

Ten semi-structured online interviews were undertaken with first-time mothers who breastfed their baby at least once during the COVID-19 pandemic and are living in Canada or the United Kingdom. Interview transcripts were coded inductively using thematic analysis.

FINDINGS

One overarching theme (all on mother) and four sub-themes were identified: 1) accessing and advocating for health care, 2) social support, 3) becoming a mother in isolation, and 4) breastfeeding baby. Similar themes were constructed for both countries.

DISCUSSION

Mothers reported that diminished health care and social support created challenges in their breastfeeding journey. Many mothers reported receiving virtual breastfeeding support, which was largely experienced as unhelpful. Some mothers reported fewer distractions from visitors and more one-on-one time with their infant, which helped them to establish breastfeeding and a strong mother-infant bond.

CONCLUSION

In both Canada and the United Kingdom, new mothers need consistent, reliable health care and social support when breastfeeding. This study supports the need to protect breastfeeding support in the midst of a global emergency and beyond to ensure positive breastfeeding experiences for both mother and baby.

Survey of Korean pediatrician's perceptions of barriers to and improvements in breastfeeding

BACKGROUND

Although the benefits of breastfeeding are broadly acknowledged with the efforts of the government and several medical societies, the rate of exclusive breastfeeding through 6 months is lower in Korea than in developed countries.

PURPOSE

This study aimed to investigate pediatricians' perceptions of breastfeeding barriers and the current breastfeeding counseling environment and propose government policies to encourage breastfeeding in Korea.

METHODS

Fourteen survey questions were developed during meetings of Korean Society of Breastfeeding Medicine experts. The Korean Pediatric Society emailed a structured questionnaire to domestic pediatricians registered as official members of the Korean Pediatric Society on May 4, 2021, and June 3, 2021. This study examined the survey responses received from 168 pediatricians.

RESULTS

The 168 respondents included 62 professors, 53 paid doctors, and 53 private physicians. Breastfeeding was recommended by 146 Korean pediatricians (86.9%). However, only 99 responders (59%) currently provide breastfeeding counseling in hospitals. Most respondents stated providing less than 15 minutes of breastfeeding counseling time in the clinic. Moreover, 89.88% of the respondents responded that they would participate in breastfeeding counseling education if an appropriate breastfeeding counseling program was newly established.

CONCLUSION

This study showed that, although Korean pediatricians had a positive attitude toward breastfeeding, limited counseling was provided for parents. Along with policy support to improve the medical environment through the establishment of an appropriate breastfeeding counseling program, high-quality counseling and an increased breastfeeding rate are expected.

Exact Gestational Age, Term Versus Early Term, Is Associated with Different Breastfeeding Success Rates in Mothers Delivered by Elective Cesarean Section

Objectives: The study was intended to verify the association between the gestational age of newborns classified as term and the success of breastfeeding in babies born by elective cesarean section. Also, to analyze how the variability of gestational age within the term influences breastfeeding. Materials and Methods: Retrospective study of a cohort, which included full-term newborns and their mothers, whose deliveries occurred by elective cesarean section. Among the inclusion criteria are delivery due to elective cesarean section and minimum gestational age of 37 weeks. The database consisted of medical birth information and interviews with mothers. Results: This study included 954 full-term newborns born by elective cesarean section. Exclusive breastfeeding at 3 months and being breastfed at 6 months showed a statistically significant association in the correlation with the variability of gestational age. There was a statistically significant association between exclusive breastfeeding at 3 months and breastfeeding at 6 months in the correlation between early term and full term. The trend test showed a significant progressive in the breastfeeding curve versus gestational age. Conclusion: Full-term newborns show better results of exclusive breastfeeding at 3 months and continued breastfeeding at 6 months, compared with those born at early term. Gestational age, even in term, has an influence on the success of breastfeeding in newborns undergoing elective cesarean delivery.

The Lived Experiences of Women without COVID-19 in Breastfeeding Their Infants during the Pandemic: A Descriptive Phenomenological Study

The coronavirus disease 2019 (COVID-19) outbreak in 2020 has led to several changes and disturbances in the daily lives of the general public. Particularly for new (first-time) mothers, there has been a significant impact on the practices of raising and feeding their babies. Social distancing measures everywhere have made mothers hesitant to breastfeed their babies anywhere else but at home. Combined with the fear of being infected with COVID-19, the present situation has created unprecedented barriers for breastfeeding mothers to accessing various types of support: emotional, instrumental, informational, and appraisal. There has been no research on the influence of the pandemic on social support regarding breastfeeding in Hong Kong. This study aimed to explore the social support and impact of COVID-19 on mothers breastfeeding their babies. Semi-structured interviews were conducted with 20 currently breastfeeding women in Hong Kong. Colaizzi’s seven-step method was used for data analysis. Two key themes emerged from the interview data: (1) positive influences on breastfeeding support during COVID-19 and (2) negative influences on breastfeeding support during COVID-19. Our findings may help mothers prepare to breastfeed their babies in places other than their homes.

Early Postpartum Patterns of Breastfeeding Exclusivity and Perceived Insufficient Milk by Prepregnancy Body Mass Index

OBJECTIVE

To explore trajectories of breastfeeding exclusivity and perceived insufficient milk (PIM) over the first 8 weeks postpartum among primiparous women and the association of these trajectories with prepregnancy body mass index (BMI).

DESIGN

Secondary analysis of data from a randomized controlled trial.

SETTING

Recruitment for the primary study was conducted in Pittsburgh, Pennsylvania.

PARTICIPANTS

One hundred twenty-two primiparous women with intention to exclusively breastfeed.

METHODS

We used group-based trajectory modeling to classify participants into breastfeeding exclusivity and PIM trajectory groups. We used logistic regression to explore the predictive relationship between prepregnancy BMI and breastfeeding exclusivity and PIM trajectory group memberships.

RESULTS

We identified two trajectories each for breastfeeding exclusivity and PIM over the first 8 weeks postpartum. For breastfeeding exclusivity, one group (n = 60, 49%) had low initial probability of exclusive breastfeeding with linear decline in likelihood of exclusivity over time. The other group (n = 62, 51%) had greater initial probability of exclusive breastfeeding, which remained constant over time. For PIM, one group (n = 41, 34%) had consistently greater probability of endorsing PIM at each time point, whereas the other group (n = 81, 66%) had consistently low probability of endorsing PIM over time. Prepregnancy BMI did not predict group membership in breastfeeding exclusivity, χ²(1) = 2.8, p = .094, or PIM, χ²(1) = 0.72, p = .397.

CONCLUSION

Breastfeeding exclusivity and PIM appeared to be relatively stable phenomena in the postpartum period among a sample of predominately White primiparous women who intended to breastfeed. We did not find a clear association with prepregnancy BMI.

Modifiable predictors of breastfeeding status and duration at 6 and 12 months postpartum

BACKGROUND

Breastfeeding practices are determined by complex multilevel factors. This study assessed pregnant women's knowledge of breastfeeding and intention to breastfeed and investigated modifiable predictors for breastfeeding status (exclusive or any breastfeeding) and duration at 6 and 12 months postpartum.

MATERIALS AND METHODS

Longitudinal data were extracted from a trial in Sydney, Australia, 2017-19. Women (n = 1155) were recruited from antenatal clinics and followed up for telephone interviews at baseline (third trimester), then at 6 and 12 months postpartum. Data collected included mothers' demographics; knowledge of breastfeeding and intention to breastfeed; work status; support from caregivers; breastfeeding environment; breastfeeding status and duration. Multiple logistic and Cox regression models were built to identify predictors for breastfeeding.

RESULTS

At baseline, most mothers knew the recommendation to exclusively breastfeed until 6 months (66%) and the benefits (65%). The modifiable predictors for breastfeeding duration at 12 months included the following: mothers' knowledge of the recommendation (adjusted hazard ratio (AHR) 0.73, 95% confidence interval (CI) 0.60-0.90) and the benefits of exclusive breastfeeding (AHR 0.68, 95% CI 0.55-0.82), intention to meet the recommendation (AHR 0.76, 95% CI 0.63-0.93), and intention to breastfeed for two years (AHR 0.38, 95% CI 0.27-0.52) measured at baseline; mothers not working or studying (AHR 0.70, 95% CI 0.55-0.89), having support from other caregivers (AHR 0.64, 95% CI 0.43-0.96), and having breastfeeding women around (AHR 0.80, 95% CI 0.65-0.98) measured at 6 months.

CONCLUSIONS

Support for women to meet the breastfeeding recommendations should commence during pregnancy and focus on breastfeeding education and enabling environments.

Working mothers' breastfeeding experience: a phenomenology qualitative approach

Background

Breastfeeding practice is influenced by the mother’s attitude toward and knowledge of breastfeeding. Working mothers face many challenges and need support to maintain breastfeeding. This study aimed to explore working mothers’ breastfeeding experiences and challenges that can influenced their practices.

Methods

The qualitative phenomenological approach involving working mothers in Kota Bharu who fulfilled the inclusion criteria and consented to participate in the study were recruited using purposive sampling. Sixteen participants aged 24 to 46 years were interviewed using semi-structured in-depth interviews in the study. All interviews were recorded in digital audio, transcribed verbatim and analyzed using thematic analysis.

Findings

Three main themes emerged from the data analysis: perception of breastfeeding, challenges in breastfeeding, and support for breastfeeding. Two subthemes for perceptions were perception towards breastfeeding and towards infant formula. Challenges had two subthemes too which were related to perceived insufficient milk and breastfeeding difficulty. Where else, two subthemes for support were internal support (spouse and family) and external support (friends, employer, and healthcare staff).

Conclusions

Maintaining breastfeeding after return to work is challenging for working mothers and majority of them need support to continue breastfeeding practice. Support from their spouses and families’ influences working mothers’ decision to breastfeed. Employers play a role in providing a support system and facilities in the workplace for mothers to express and store breast milk. Both internal and external support are essential for mothers to overcome challenges in order to achieve success in breastfeeding.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04304-4.

Factors associated with breast-feeding initiation and continuation in Canadian-born and non-Canadian-born women: a multi-centre study

OBJECTIVE

To identify factors associated with breast-feeding initiation and continuation in Canadian-born and non-Canadian-born women.

DESIGN

Prospective cohort of mothers and infants born from 2008 to 2012: the Canadian Healthy Infant Longitudinal Development (CHILD) Cohort Study.

SETTING

General community setting in four Canadian provinces.

PARTICIPANTS

In total, 3455 pregnant women from Vancouver, Edmonton, Winnipeg and Toronto between 2008 and 2012.

RESULTS

Of 3010 participants included in the current study, the majority were Canadian-born (75·5 %). Breast-feeding initiation rates were high in both non-Canadian-born (95·5 %) and Canadian-born participants (92·7 %). The median breast-feeding duration was 10 months in Canadian-born participants and 11 months in non-Canadian-born participants. Among Canadian-born participants, factors associated with breast-feeding initiation and continuation were older maternal age, higher maternal education, living with their partner and recruitment site. Rooming-in during the hospital stay was also associated with higher rates of breast-feeding initiation, but not continuation at 6-month postpartum. Factors associated with non-initiation of breast-feeding and cessation at 6-month postpartum were maternal smoking, living with a current smoker, caesarean birth and early-term birth. Among non-Canadian-born participants, maternal smoking during pregnancy was associated with lower odds of breast-feeding initiation and lower odds of breast-feeding continuation at 6 months, and older maternal age and recruitment site were associated with breast-feeding continuation at 6 months.

CONCLUSIONS

Although Canadian-born and non-Canadian-born women in the CHILD cohort have similar breast-feeding initiation rates, breast-feeding initiation and continuation are more strongly associated with socio-demographic characteristics in Canadian-born participants. Recruitment site was strongly associated with breast-feeding continuation in both groups and may indicate geographic disparities in breast-feeding rates nationally.

The Effect of Maternal Self-Regulated Motivation on Breastfeeding Continuation

OBJECTIVE

Women frequently report breastfeeding problems in the early postpartum period. Women who have self-endorsed beliefs that breastfeeding benefits their babies and themselves are more likely to continue breastfeeding despite breastfeeding barriers. Maternal self-endorsed beliefs is a key component of maternal self-regulated motivation. The present study examined the association between maternal self-regulated motivation, breastfeeding duration and exclusivity in Chinese women.

METHODS

This was a prospective cohort study, of which we recruited participants in postnatal maternity units of publicly funded hospitals in Hong Kong. Postpartum women were asked to fill in the validated breastfeeding self-regulation questionnaire (BSRQ) before hospital discharge and their breastfeeding status was assessed by telephone follow-ups at 6 and 12 weeks postpartum. Multiple logistic regression was used to study the relationship between breastfeeding self-regulated motivation and the duration of breastfeeding at follow-up.

RESULTS

At 6 and 12 weeks postpartum, women who breastfed exclusively scored significantly higher in self-regulated motivation than those who formula-fed. The self-regulated motivation was associated with higher odds of exclusive breastfeeding at 6 weeks and any breastfeeding at 12 weeks postpartum.

CONCLUSIONS FOR PRACTICE

The study found that self-regulated motivation was positively related to breastfeeding duration. Maternal self-regulated motivation toward breastfeeding could be enhanced by the availability of social support and breastfeeding-friendly facilities, resulting in longer breastfeeding duration.

Exclusive breastfeeding continuation and associated factors among employed women in North Ethiopia: A cross-sectional study

Background

Exclusive Breastfeeding (EBF) can prevent up to 13% of under-five mortality in developing countries. In Sub-Saharan Africa the rate of EBF at six months remains very low at 36%. Different types of factors such as maternal, family and work-related factors are responsible for the low rate of EBF among employed women. This study aimed to assess the prevalence of EBF continuation and associated factors among employed women in North Ethiopia.

Materials and methods

A community-based, cross-sectional study was conducted in two towns of Tigray region, North Ethiopia. Employed women who had children between six months and two years were surveyed using multistage, convenience sampling. Women filled in a paper based validated questionnaire adopted from the Breastfeeding and Employment Study toolkit (BESt). The questions were grouped into four parts of sociodemographic characteristics, maternal characteristics, family support and work-related factors. Factors associated with EBF continuation as a binary outcome (yes/no) were determined using multivariable logistic regression.

Results

Four-hundred and forty-nine women participated in this study with a mean (SD) age 30.4 (4.2) years. Two hundred and fifty-four (56.4%) participants exclusively breastfed their children for six months or more. The main reason for discontinuation of EBF was the requirement of women to return to paid employment (31.5%). Four-hundred and forty (98.2%) participants believed that breastfeeding has benefits either to the infant or to the mother. Three hundred and seventy-one (82.8%) of the participants received support from their family at home to assist with EBF, most commonly from their husbands and mothers. Having family support (adjusted odds ratio [AOR] = 2.1, 95%, CI 1.2–3.6; P = 0.005), having frequent breaks at work (AOR = 2.6, 95% CI, 1.4–4.8; P = 0.002) and the possibility of buying or borrowing required equipment for expressing breast milk (AOR = 1.7, 95% CI, 1.0–3.0; P = 0.033) were statistically associated with an increased chance of EBF.

Conclusion

Although returning to work was reported by the study participants as the main reason for discontinuation of EBF, families and managers’ support play significant roles in EBF continuation, which in the absence of six-month’s maternity leave for employed women in Ethiopia would be of benefit to both mothers and children.

Breastfeeding knowledge and practices of working mothers in the informal economy in New Delhi: A formative study to explore new intervention pathways towards improved maternal and child health outcomes

This was a formative study to yield evidence on the conceptual and empirical pathways to improve maternal and child health (MCH) outcomes among informally working mothers while securing livelihoods, and for this, explores how informally working women navigate time sensitive childcare practices such as exclusive breastfeeding (EBF) with their work, and how do the conditions and nature of informal employment shape it. This study was conducted in February-May 2017 using non-probability sampling for cross-sectional semi structured interviews (n = 92) and focus group discussions (n = 56) with working mothers with a child under 2 and 5 years respectively, having regular and stable working history in the informal economy. The study team partnered with Self-Employed Women's Association for site selection and recruitment of study participants across 4 sectors of work in New Delhi, India: home-based work, pheri or barter work, street vending and domestic work. While 65% women report EBF for 6-months, checks with infant feeding recall reveal several disruptions from customary practices and working conditions, and successful EBF only in home-based work, the least paying of all. 59% women reported returning to work under 6-months, leading to early weaning. 90% women were aware of the importance of EBF in the standard language of public health messaging, however, checks with non-standard language queries reveal a drop to 55-80% exhibiting lack of effective knowledge that women could use. The findings emphasise that conditions and nature of informal employment shape MCH outcomes in cities of the global south, where such employment dominates. Furthermore, we use the findings to suggest the following responsive approaches for intervention: delaying mother's return to work, increasing proximity between mother and child, deeper and engaged knowledge of breastfeeding and early child development practices, improving problem solving capacity and agency of the mother, and enabling home and workplace conditions.

Intervention Strategies and Lessons Learned From a Student-Led Initiative to Support Lactating Women in the University Setting

The benefits of breastfeeding for mother and baby are strongly supported by research. However, lactating parents who return to school or work soon after delivery face many barriers to continued breastfeeding. This article presents a student-led initiative to support lactation at a large public university that emerged from advocacy efforts of student mothers of color. The socioecological model was used as a framework to understand and address the multifaceted influences on breastfeeding practices. Project activities included providing breastfeeding education to lactating parents and their partners, measuring availability and accessibility of lactation spaces, improving lactation spaces, connecting university stakeholders, and strengthening university lactation policies. The project achieved the following outcomes: formation of a stakeholder group with members across campus departments, improvement in accessibility and appropriateness of lactation spaces, provision of breastfeeding services through workshops and one-on-one appointments with lactation educators, and creation and dissemination of an online toolkit outlining parents' lactation rights and support available on campus. Comprehensive lactation support at universities is essential to enhance educational and professional equity for women and to promote postpartum and infant health. Throughout the project implementation, the team learned many lessons that can help guide similar university initiatives.

The financing need for expanding paid maternity leave to support breastfeeding in the informal sector in the Philippines

In low- and middle-income countries, almost three-fourths of women in the labour force lack maternity protection. In the Philippines, current laws do not guarantee paid maternity leave to workers in the informal economy. A non-contributory maternity cash transfer to informal sector workers could be used to promote social equity and economic productivity and could provide health benefits by helping mothers meet their breastfeeding goals. The objective of the study is to provide a realistic cost estimate and to assess the financial feasibility of implementing a publicly financed, non-contributory maternity cash transfer programme to the informal sector in the Philippines. Using a costing framework developed in Mexico, the study estimated the annual cost of a maternity cash transfer programme. The methodology estimated the unit cost of the programme, the incremental coverage of maternity leave and expected number of enrollees. Different unit and incremental costs assumptions were used to provide a range of scenarios. Administrative costs for running the programme were included in the analysis. The annual financing need of implementing maternity cash transfer programme in the Philippines ranges from a minimum scenario of USD42 million (14-week maternity cash transfer) to a more ideal scenario of USD309 million (26-week maternity cash transfer). The latter is financially feasible as it is equivalent to less than 0.1% of the country's gross domestic product substantially lower than the share cost of not breastfeeding (0.7%). The annual cost of the programme is only 10% of the total cost of the largest conditional cash transfer programme.

An Evaluation of On-Campus Lactation Spaces for Student-Parents

BACKGROUND

Numerous researchers have evaluated the influence of federal and workplace lactation policies on breastfeeding duration, however few have considered the experiences of breastfeeding people returning to school.

RESEARCH AIM

The aim of this study was to evaluate the availability, accessibility, acceptability, and quality of existing on-campus lactation spaces.

METHODS

In-depth interviews were conducted with student-parents (N = 18) who had expressed milk on campus. Data collection and thematic analysis were based on the availability, accessibility, acceptability, and quality framework for evaluating health services from the human rights literature and adapted for this study.

RESULTS

For most participants with proximal access to a designated lactation space, room availability was exceptional and quality was marginally adequate. The provision of breast pumps, in-room sinks, and study desks were important aspects of quality discussed by the participants. Not all participants made use of the university's designated lactation spaces due to either physical or informational inaccessibility. If designated lactation spaces were not convenient, participants found closer alternatives (e.g., bathroom, staff offices, or during the academic session).

CONCLUSION

Breastfeeding parents who return to school experience obstacles similar to those reported by employed parents who return to work. They require convenient access to appropriate spaces and sufficient privacy to express milk for their infants. In order to best support all learners, university leaders must consider the needs of this unique student population.

Effectiveness of a breastfeeding program for mothers returning to work in Japan: a quasi-experimental study

BACKGROUND

Maternal employment has been described as a barrier to breastfeeding in many countries. In Japan, many mothers quit breastfeeding after returning to work because they do not know how to continue breastfeeding. The primary objective of this study was to investigate the effectiveness of a breastfeeding support program for mothers. The secondary objective was to explore the effectiveness of a pamphlet for mothers returning to work.

METHODS

This was a quasi-experimental design study with a program group (n = 48), pamphlet group (n = 46) and comparison group (n = 47) that took place from February 2017 to August 2018. Participants in the program and pamphlet groups were women who planned to return to work within 4-12 months after giving birth, while the comparison group included women who had been back at work for at least 3 months. The program involved a 90-min breastfeeding class, a pamphlet, a newsletter, and email consultation. The pamphlet group was sent only the pamphlet, while the comparison group received no intervention. The outcome was breastfeeding continuation rate at 3 months after returning to work.

RESULTS

The breastfeeding continuation rate 3 months after returning to work was significantly higher in the program group than in the comparison group (79.2% vs. 51.1%, p = 0.004). After adjusting for background factors, the program intervention had an effect on breastfeeding rates (adjusted odds ratio = 4.68, 95% confidence interval: 1.57, 13.96; p = 0.006). However, comparing the pamphlet and comparison groups revealed no significant differences in breastfeeding continuation rates at 3 months after returning to work (69.6% vs. 51.1%, p = 0.07).

CONCLUSIONS

Program intervention was associated with a significant increase in breastfeeding continuation rates 3 months after returning to work. Randomized controlled trials are needed to make this program applicable in practice. Pamphlet intervention resulted in no significant difference. Further study is necessary after examining the contents of the pamphlet.

Compliance of mothers' breastfeeding and complementary feeding practices with WHO recommendations in Turkey

BACKGROUND/OBJECTIVES

This study aimed to evaluate how breastfeeding and complementary nutrition practices of mothers of 0-24-month-old children comply with the World Health Organization (WHO) recommendations for infant and young child feeding and to compare the results with selected demographic parameters related to the mother and child.

SUBJECTS/METHODS

The research sample comprised mothers (n = 250) with children less than 2 years old. Data were obtained via questionnaire and were analyzed using SPSS 20.0 package program. The Pearson χ2 or Fisher's exact tests were used for assessing relationships between categorical variables. The one-sample t-test was used for comparisons with reference values.

RESULTS

Most mothers (97.2%) breastfed their babies immediately after birth. The mean time to breastfeeding after delivery was 47.8 ± 14.8 minutes, and 40.8% of the mothers complied with the WHO recommendation. Furthermore, 59.8% of the mothers exclusively breastfed their children for 6 months (mean 5.2 ± 1.5 months). The mean duration to the start of providing complementary food was 5.8 ± 0.6 months, and 76.1% of mothers who complied with the WHO recommendation. Only 12.3% of mothers breastfed their children for at least 12 months (mean 7.7 ± 3.3 months). On average, mothers gave cow milk to their children for the first time at 10.1 ± 1.7 months and honey at 11.8 ± 2.3 months. The mothers' rates of compliance with the WHO recommendations on cow milk and honey feeding were 32.0% and 71.6%, respectively. The rate of mothers who complied with the WHO minimum meal frequency recommendation was 88.3%.

CONCLUSIONS

We suggest that the WHO recommendations on this subject will be realized more fully by emphasizing the importance of the positive effects of breastfeeding until the age of 2 years and of a timely start of complementary food provision. Such changes will affect child health over the long term.

Alignment of State Regulations With Breastfeeding and Beverage Best Practices for Childcare Centers and Family Childcare Homes, United States

OBJECTIVES

Childcare is an important setting for nutrition; nearly half of young children in the United States participate in licensed childcare, where they consume up to two-thirds of their daily dietary intake. We compared state regulations for childcare with best practices to support breastfeeding and healthy beverage provision.

METHODS

We reviewed regulations for childcare centers (centers) and family childcare homes (homes) in effect May-July 2016 and rated all 50 states for inclusion (1 = not included, 2 = partially included, 3 = fully included) of 12 breastfeeding and beverage best practices. We calculated average ratings for 6 practices specific to infants aged 0-11 months, 6 practices specific to children aged 1-6 years, and all 12 practices, by state and across all states. We assessed significant differences between centers and homes for each best practice by using McNemar-Bowker tests for symmetry, and we assessed differences across states by using paired student t tests.

RESULTS

States included best practices in regulations for centers more often than for homes. Average ratings (standard deviations) in regulations across all states were significantly higher in centers than in homes for infant best practices (2.1 [0.5] vs 1.8 [0.5], P < .001), child best practices (2.1 [0.6] vs 1.8 [0.6], P = .002), and all 12 best practices combined (2.1 [0.5] vs 1.8 [0.6], P < .001).

CONCLUSIONS

Although best practices were more consistently included in regulations for centers than for homes, many state childcare regulations did not include best practices to support breastfeeding and the provision of healthy beverages. Findings can be used to inform efforts to improve regulations and to reduce differences between centers and homes.

Perceptions, Experiences, and Outcomes of Lactation Support in the Workplace: A Systematic Literature Review

BACKGROUND

Despite legislation requiring break time and a private space to express milk, variations exist in accommodations for breastfeeding employees in the United States.

RESEARCH AIMS

We aimed to describe employee and employer perceptions of and experiences with workplace lactation support in the United States and to identify research needed to inform workplace lactation support programs.

METHODS

We searched Academic Search Complete, Business Search Complete, CINAHL, MEDLINE, PubMed, and PsycInfo for peer-reviewed articles published from 2009 to 2019 (n = 1638). We included 27 articles. Studies were categorized into four non-exclusive themes: (a) employee perceptions of and experiences with workplace lactation support; (b) employer reports of workplace lactation support; (c) association between workplace lactation support and business outcomes; and (d) association between workplace lactation support and breastfeeding outcomes.

RESULTS

Analyses of associations between lactation support at work and employee breastfeeding outcomes (n = 14, 52%), and employee perceptions of and experiences with lactation support at work (n = 14, 52%) were most common, followed by employer reports of lactation support (n = 3, 11%) and associations between lactation support at work and job satisfaction (n = 3, 11%). Results indicated that workplace lactation support varied by employer, and that employee perceptions of and experiences with workplace lactation support varied by demographic and employment characteristics. The use of cross-sectional designs, unvalidated instruments, and limited representation from women with low incomes and minorities were common study limitations.

CONCLUSIONS

More research is needed to learn about experiences of employers and low-income and minority women with workplace lactation support and associations with business-relevant outcomes.

Breastfeeding practices and complementary feeding in Ecuador: implications for localized policy applications and promotion of breastfeeding: a pooled analysis

Background

Best practices in breastfeeding are often not followed despite appropriate levels of knowledge and positive attitudes regarding the benefits of human milk. For many reasons, some women do not initiate breastfeeding, suspend breastfeeding early, or initiate complementary feeding earlier than recommended. Usual measurement methods use large sample surveys at a national scale, which are not well suited for monitoring sub-national differences.

Methods

In order to understand how local infant feeding practices could influence policy and promotion practices, we apply data pooling methodology to analyse breastfeeding patterns in different Ecuadorian settings: Cumbayá parish, located near Quito, the Ecuadorian capital; the city of Macas and rural surroundings in the Amazon basin province of Morona Santiago; and the province of Galapagos. Surveys were conducted independently between August 2017 and August 2018; while they are representative of each respective setting, sampling designs and survey methods differ, but the same demographic information and data based on standard breastfeeding indicators established by the World Health Organization (WHO) were collected. In order to account for differences in the different settings, the design effect of each survey was considered in the analysis.

Results

Significant differences were found in breastfeeding practices between the suburban Cumbayá parish near Quito and Galapagos on one hand, and urban and rural parts of Morona Santiago, on the other. The rates of early breastfeeding initiation and age-appropriate breastfeeding are significantly higher in urban and rural Morona Santiago then in Cumbayá or Galapagos, while the rate of exclusive breastfeeding is highest in rural parts of Morona Santiago. No significant differences were found in complementary feeding practices between Cumbayá and Galapagos, but there are with urban and rural Morona Santiago. Initiation of breastfeeding in the first hour after birth occurs in only 36.2% of cases in Cumbayá but in 75.4% of cases in urban Morona.

Conclusions

Differences among regions reflect specific opportunities and barriers to practices related to promoting optimal infant health and nutrition. Consequently, regional or local conditions that often are not apparent in national-level data should orient policies and promotion activities in specific populations.

Early Cessation of Breastfeeding and Determinants: Time to Event Analysis

Background

The onset of breastfeeding has a high success rate in most countries, but the time for termination of breastfeeding varies between countries.

Objective

This survey was aimed to determine the effective factors on the early termination of breastfeeding.

Methods

This study was conducted in 2018, in Iran. About 410 mothers were enrolled in the study. All considered factors were evaluated as factors influencing the continuity of breastfeeding. Survival analysis was used to analyze data.

Results

The mean age of the mothers was equal to 29.48 ± 5.8 years. The frequency of termination of breastfeeding before the first 2 years was equal to 34%. The mean of breastfeeding duration was equal to 21.49 ± 5.3 months. The percentage of infants who had been breastfed for 24 months was equal to 65.8%. An infant's birth weight (2500-4000 gr) (hazard ratio: 0.54), neonatal birth order (hazard ratio: 0.69), neonatal pathologic jaundice (hazard ratio: 1.52), starting time of using complementary food (hazard ratio: 2.45), using pacifier (hazard ratio: 2.82), and the status of using artificial milk (hazard ratio: 3.29) were significantly associated with cessation of breastfeeding before 24 months of age. The probability of termination of breastfeeding at 6, 12, 18, and 24 months of age was reported by 6%, 8%, 15%, and 34%, respectively.

Conclusions

There were notifiable variations in breastfeeding rates both in national and international levels. Nevertheless, in this study, the mean of breastfeeding duration was longer compared to a number of countries and previous national studies.

Exposure to baby-friendly hospital practices and mothers' achievement of their planned duration of breastfeeding

BACKGROUND

Both breastfeeding intentions and exposure to baby-friendly hospital practices were found to be associated with a longer duration of breastfeeding. This study aims to examine the effect of exposure to baby-friendly hospital practices on mothers' achievement of their planned duration of breastfeeding.

METHODS

A total of 1011 mother-newborn pairs from the postnatal units of four public hospitals in Hong Kong were recruited. Sociodemographic data and breastfeeding intention data were collected via self-report questionnaires during the postnatal hospitalization and exposure to Baby-Friendly hospital practices were assessed through hospital records and maternal self-report. Breastfeeding status after hospital discharge was assessed through telephone follow-up for up to 12 months postnatal, or until participants were no longer breastfeeding.

RESULTS

Only 55% (n = 552) of study participants achieved their intended duration of breastfeeding. Participants with higher socioeconomic status, previous breastfeeding experience, and those who had lived in Hong Kong for less than 5 years, were more likely to achieve their planned duration of breastfeeding. Among baby-friendly hospital practices, feeding only breast milk during the hospitalization and providing information about breastfeeding support on discharge were associated with participants' achieving their individual breastfeeding intentions. After adjustment, when compared with women who experienced onebaby-friendly practice, participants who experienced six baby-friendly hospital practices were significantly more likely to achieve their planned duration of breastfeeding (adjusted odds ratio = 8.45, 95% confidence interval 3.03-23.6).

CONCLUSIONS

Nearly half of participants did not achieve their planned breastfeeding duration. Exposure to baby-friendly hospital practices, especially in-hospital exclusive breastfeeding and providing breastfeeding support information upon hospital discharge may help more mothers to achieve their individual breastfeeding goals.

[Impact of institutional aspects on breastfeeding for working women: a systematic review]

Breastfeeding is considered the ideal feeding method early in life. Despite the scientific evidence, the worldwide prevalence of breastfeeding is low. Maternal work is pointed out as one of the obstacles to maintain this practice. To systematically review studies that evaluated the association between institutional aspects and breastfeeding and exclusive breastfeeding among working women. A literature search until June 2016 was carried out using PubMed, LILACS, and SciELO (MeSH terms: breastfeeding, workplace and observational study). Eighteen observational studies were included. A positive association with breastfeeding were found for later or not return to work, part-time work, availability or the use of lactation room, breast pumping breaks, professional advice on maintaining breastfeeding after returning to work, and attendance at breastfeeding support program. A negative association with breastfeeding was shown for full-time work. Simple interventions in the workplace and some changes in company policy to encourage breastfeeding can positively influence its maintenance after women return to work.

Combining breastfeeding and work: findings from the Epifane population-based birth cohort

Background

Return to work is often cited as a reason for early cessation of breastfeeding (BF). Our objectives were to study the time span during which women employed prior to pregnancy returned to work according to BF duration category, and to identify sociodemographic, behavioral and pregnancy characteristics of women who continued BF after returning to work.

Methods

Information on BF mode and work status was prospectively collected in a French nation-wide birth cohort up to 1 year after delivery. Time of return to work according to BF category was addressed using Kaplan-Meier curves and Poisson regression adjusted on co-variates. Multiple logistic regression enabled to identify characteristics associated with the combination of BF with work.

Results

Among 2480 women holding jobs prior to pregnancy, 82.0% returned to work within a year postpartum. Women who breastfed > 4 months returned at median of 6.5 months, whereas those who did not breastfeed at all returned to their jobs at 4.0 months, those who had breastfed for less than 1 month returned at 4.5 months, and those who had breastfed for 1 to 4 months returned at 4.0 months. Around one-third of women (34.5%) combined BF and work, and breastfed for a longer duration (median: 213 days, vs. 61 days for women who stopped BF before returning to work). Women born outside of France or who were self-employed were more likely to combine BF and work, while intermediate employees, manual workers, women who quitted smoking during pregnancy, who had smoked before and during pregnancy, or who had given birth by cesarean section were less likely to combine BF and work.

Conclusion

Women who had breastfed for less than 4 months, or not at all, returned to their jobs at comparable times. This suggests that working women should be encouraged to breastfeed, even for a short duration. Moreover, only one-third of working women succeeded in combining BF and work, highlighting the need for a support system that would encourage flexibility.

A descriptive study to explore working conditions and childcare practices among informal women workers in KwaZulu-Natal, South Africa: identifying opportunities to support childcare for mothers in informal work

Background

Although women working in the informal economy are a large and vulnerable group, little is known about infant feeding and childcare practices among these women. The aim of this study was to explore childcare practices among mothers in informal work.

Methods

A cross-sectional survey among mothers with children aged < 2 years working in the informal economy in an urban and a rural site in KwaZulu-Natal, South Africa. Participants were selected using purposive and snowball sampling.

Results

A total of 247 interviews were conducted with 170 informal traders and 77 domestic workers. Most mothers lived with their child (225/247, 91.1%), had initiated breastfeeding (208/247; 84.2%) and many were still breastfeeding (112/247; 45.3%). Among 96 mothers who had stopped breastfeeding, the most common reason was returning to work (34/96; 35.4%). Many mothers relied on family members, particularly grandmothers, to care for their child while they were working (103/247, 41.7%) but some mothers took their child with them to work (70/247; 28.1%). Few fathers participated in the care of their child: 54 mothers (21.9%) reported that the father had ever looked after the child while she was away from home. Domestic workers were less likely than informal traders to take their child to work (p = 0.038).

Women reported receiving a salary from an informal employer (119), or being own-account workers (120) or being unpaid/paid in kind (8). Most participants were in stable work (> 4 years) with regular working hours, but received very low pay. Domestic workers were more likely than informal traders to have regular working hours (p = 0.004), and to be earning >$240 per month (p = 0.003). Mothers reported high levels of food insecurity for themselves and their child: 153 mothers (61.9%) reported having missed a meal in the past month due to lack of resources to buy food, and 88 (35.6%) mothers reported that their child had missed a meal for this reason.

Conclusion

This study provides a preliminary description of informal women workers who, despite having stable work, are vulnerable, low paid and food insecure. These women may require support to provide optimal childcare and nutrition for their children.

Association Between Stressful Life Events and Exclusive Breastfeeding Among Mothers in the United States

Background: Despite the known benefits of breastfeeding, many women in the United States do not exclusively breastfeed for the recommended 6 months due to various factors. Limited studies have examined the association between prenatal stressful life events and exclusive breastfeeding duration. The aim of this study was to examine the association between prenatal stressful life events and exclusive breastfeeding duration for 3 months among mothers in the United States. Materials and Methods: We analyzed data from 2009 to 2011 (Phase 6) Pregnancy Risk Assessment and Monitoring System (PRAMS; n = 43,934). Multivariable logistic regression analyses were performed to estimate adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). Results: Overall, 43% of the study participants exclusively breastfed for 3 months and 52.1% reported having no stressful life events during pregnancy. In the multivariable model, there was a statistically significant interaction between maternal age and number of stressful life events on 3-month exclusive breastfeeding, the odds of exclusive breastfeeding for 3 months were lower among women ≤24 years old who experienced at least ≥2 stressful life events compared with women who did not experience any stressful life events: OR 95% CI 0.80 (0.66-0.98) for 1-2 stressful life events, 0.67 (0.54-0.82) for 3-5 stressful life events, and 0.58 (0.43-0.80) for ≥6 stressful life events, respectively. Conclusions: Identification of stressful life event exposure among young mothers is important for extending support toward this population to increase exclusive breastfeeding duration.

Association between maternal education and breast feeding practices in China: a population-based cross-sectional study

OBJECTIVE

To investigate the association between maternal education and breast feeding in the Chinese population, with a consideration of household income and health-seeking behaviours.

DESIGN

A nationally representative population-based cross-sectional study.

SETTING

77 counties from 12 geographically distinct regions in China.

PARTICIPANTS

10 408 mothers with children from 0 to 12 months of age, aged 15-53 years old (mean: 29.15, SD: 5.11) were classified into primary school or below group (n=781), middle school group (n=3842), high school/vocational school group (n=1990), college or above group (n=3795), according to their highest completed education.

OUTCOMES

Five breastfeeding outcomes, including early initiation of breast feeding (EIB), exclusive breast feeding (EBF) under 6 months, predominant breast feeding under 6 months, current breast feeding and children ever breast fed, were calculated based on the standardised questionnaire from the WHO and Wellstart International's toolkit for monitoring and evaluating breastfeeding activities.

RESULTS

The absolute risk of EIB and EBF in the lowest maternal education level was 64.85% and 26.53%, respectively, whereas the absolute risk of EIB and EBF in the highest maternal education level was 77.21% and 14.06%, respectively. A higher level of maternal education was positively associated with EIB (risk ratio (RR): 1.22; 95% CI: 1.12 to 1.30) and was inversely associated with EBF (RR: 0.59; 95% CI: 0.38 to 0.88). Stratified by household income, a positive association with EIB was observed only in the group with the highest household income and an inverse association with EBF was found in both low household and high household income groups.

CONCLUSIONS

Mothers with a higher education were more likely to initiate early breast feeding when they were also from a high-income household while also being less likely to exclusively breast feed their babies. Routine and successful nursing is crucial for the health of infants and is influenced by maternal education. Future public health interventions to promote breast feeding should consider the issues related to the educational level of mothers.

Maternity or parental leave and breastfeeding duration: Results from the ELFE cohort

Previous studies have shown a high level of noncompliance with recommendations on breastfeeding duration, especially in France. The objective was to describe the association between breastfeeding initiation and duration and the statutory duration of postnatal maternity leave, the gap between the end of legal maternity leave and the mother's return to work, and maternal working time during the first year post-partum. Analyses were based on 8,009 infants from the French nationwide ELFE cohort. We assessed the association with breastfeeding initiation by using logistic regression and, among breastfeeding women, with categories of breastfeeding duration by using multinomial logistic regression. Among primiparous women, both postponing return to work for at least 3 weeks after statutory postnatal maternity leave (as compared with returning to work at the end of the statutory period) and working less than full-time at 1 year post-partum (as compared with full-time) were related to higher prevalence of breastfeeding initiation. Among women giving birth to their first or second child, postponing the return to work until at least 15 weeks was related to a higher prevalence of long breastfeeding duration (at least 6 months) as compared with intermediate duration (3 to <6 months). Working part-time was also positively related to breastfeeding duration. Among women giving birth to their third child or more, working characteristics were less strongly related to breastfeeding duration. These results support extending maternity leave or working time arrangements to encourage initiation and longer duration of breastfeeding.

Extended Maternity Leave and Breastfeeding in Active Duty Mothers

BACKGROUND AND OBJECTIVES

In 2016, the Department of Defense extended maternity leave from 6 to 12 weeks for active duty mothers to support breastfeeding initiation and duration. Limited data exist regarding the impact of prolonged maternity leave. Our objective was to evaluate the prolongation of maternity leave on the initiation and duration of breastfeeding in active duty mothers.

METHODS

In this single-center retrospective cohort study, we used data collected from Department of Defense electronic health care records of infants born to active duty mothers who were delivered during calendar years 2014 and 2016. The primary outcomes were initiation and duration of breastfeeding and breastfeeding exclusivity evaluated throughout the first year of life. Secondary outcomes were differences in breastfeeding rates between military-branch affiliation and military rank.

RESULTS

No changes in breastfeeding initiation occurred between the 2 cohorts (n = 423 and 434). However, an increase in breastfeeding establishment was identified at the 2- (81.5% vs 72.4%; P = .002), 4- (70.5% vs 56.7%; P < .001), 6- (60.3% vs 46.5%; P < .001), and 9-month (45.4% vs 34.9%; P = .003) visits in the 12-week leave cohort. Exclusive breastfeeding increased at 2 (56.4% vs 47.2%; P = .007), 4 (47.5% vs 36.4%; P = .001), and 6 (37.3% vs 29.3%; P = .016) months.

CONCLUSIONS

Increases in maternity leave correlated with increased breastfeeding duration and exclusivity through 9 months for active duty mothers. These data support the benefit of extended maternity leave in the military and the need for future studies to validate findings at other military treatment facilities.

Factors associated with cessation of exclusive breastfeeding at 1 and 2 months postpartum in Taiwan

Background

Breastfeeding benefits both mothers and infants. Even though Taiwan national policy promotes exclusive breastfeeding (EBF), the rates in Taiwan are below those in other developed countries. This study aimed to investigate factors associated with EBF cessation at 1 and 2 months postpartum.

Methods

This study was conducted in a community hospital in southern Taiwan between December 2016 and June 2017. Birth mothers (n = 1077) were interviewed by telephone at 1 and 2 months postpartum to collect information on infant feeding patterns (EBF since birth or not) and reasons for EBF cessation. Multivariate logistic regression models were used to determine risk factors associated with EBF cessation at 1 and 2 months.

Results

At 1 month, 432 participants (40.1%) maintained EBF. Factors associated with cessation were lack of tertiary education, primiparity, perceived low milk quantity, mother/infant separation, medical condition in mother, inconvenience/fatigue due to breastfeeding, and baby-centered factors. At 2 months, 316 participants (29.3%) maintained EBF. Factors associated with cessation were lack of tertiary education, primiparity, perceived low milk quantity, and return to work.

Conclusions

Education level, primiparity, perceived low milk quantity, and return to work are associated with premature cessation of EBF in Taiwan. Strategies about health education, family support, and baby-mother friendly environment can be used to achieve higher EBF rate.

Infant Feeding Practices In a Diverse Group of Women: The Healthy Start Study

Background

To describe infant feeding practices among a diverse group of mother-offspring pairs and identify factors associated with adherence to the American Academy of Pediatrics (AAP) recommendations.

Methods

Data were analyzed from 835 mother-offspring dyads in The Healthy Start Study, an ongoing longitudinal prebirth cohort in Denver, Colorado. Maternal report of infant feeding practices was obtained at 4 to 6 months and 18 to 24 months postnatally. Practices were classified according to the following AAP recommendations: exclusive breastfeeding for first 6 months, continued breastfeeding through 12 months, and introduction of solid foods around 6 months of age. Participants who met all 3 recommendations were categorized as "adherent." All others were categorized as "not adherent."

Results

About 77% of dyads did not adhere fully to the AAP recommendations. Women who worked ⩾35 hours/week or had a higher prepregnancy body mass index were more likely to be nonadherent. Women who were older, college educated, or had offspring with greater weight for gestational age at birth were less likely to be nonadherent.

Conclusions

Most of the women in a large contemporary cohort are not adhering to AAP infant feeding recommendations. Our results highlight the specific subgroups of women who may need additional support to optimize infant feeding practices.

Breastfeeding outcomes among early-term and full-term infants

BACKGROUND

When compared with full-term birth (39 to <42 weeks), early-term birth (37 to <39 weeks) is associated with adverse neonatal outcomes that may impede breastfeeding. Breastfeeding provides numerous benefits to infants and could potentially offset the effects of early-term birth. However, the effect of early-term birth on any and exclusive breastfeeding duration among healthy normal weight infants is unclear.

OBJECTIVES

The objective of this study was to examine the association between early-term birth and breastfeeding duration and exclusivity among healthy term infants.

METHODS

Two prospective cohorts of 2704 healthy mother-infant pairs were recruited in Hong Kong in 2006-07 and 2011-12. Participants were followed prospectively for 12 months or until they stopped breastfeeding.

RESULTS

Approximately one-third (32.8%) of the infants were born early-term. More than one-half of all participants had stopped breastfeeding by three months postpartum and approximately one-half of the infants were not being exclusively breastfed by two weeks postpartum. There was no significant difference in the odds of any (adjusted odds ratio [aOR] = 1.05; 95% 0.85, 1.31) or exclusive (aOR = 0.89; 95% 0.73, 1.08) breastfeeding at one-month postpartum between infants born early-term and at full-term. There was also no significant difference in the duration of any (adjusted hazard ratio [aHR] = 1.0; 95% 0.91, 1.10) or exclusive (aHR = 1.0; 95% 0.91, 1.09) breastfeeding between early-term and full-term infants.

CONCLUSION

In this cohort, early-term birth was not associated with breastfeeding duration and exclusivity. This suggests that, in the absence of neonatal complications, early-term birth itself may not lead to a shorter duration of any or exclusive breastfeeding.

Impact of Key Workplace Breastfeeding Support Characteristics on Job Satisfaction, Breastfeeding Duration, and Exclusive Breastfeeding Among Health Care Employees

Background: Although national breastfeeding rates have improved across recent decades, women continue to face barriers to achieving recommended breastfeeding targets. Returning to work presents a unique set of challenges for breastfeeding continuation, even in health care settings tasked with promoting breastfeeding among patients. This study examined the association between key workplace breastfeeding support characteristics, job satisfaction, and breastfeeding outcomes among health care employees. Materials and Methods: We used data from a cross-sectional survey of employees in a large integrated health care system. The study sample included female employees who had breastfed in the past 3 years (n = 165). The Employee Perceptions of Breastfeeding Support Questionnaire (EPBS-Q) measured organization, manager, and coworker support for breastfeeding. Regression analyses tested the association between workplace support factors and breastfeeding duration, breastfeeding exclusivity, and job satisfaction. Results: Managerial support increased median job satisfaction by 0.39 standard deviations (p < 0.001), and increased the odds of prolonging exclusive breastfeeding (odds ratio [OR] 1.47; confidence interval [CI] 1.03-2.09). Organizational support increased median job satisfaction by 0.27 standard deviations (p < 0.001), and increased the odds of exclusive breastfeeding by nearly twofold (OR 1.80; CI 1.05-3.09). No significant associations were found between workplace support factors (organizational, managerial, and co-worker support) and overall breastfeeding duration. Conclusions: Organizational and managerial support are key aspects of workplace lactation support, which may positively impact job satisfaction, rates of exclusive breastfeeding, and duration of exclusive breastfeeding among female health care employees. This intersection of outcomes salient for the business community and public health practitioners highlights opportunities for collaborations to improve workplace and breastfeeding outcomes.

Impact of an Infant Friendly Business Designation

In response to suboptimal breastfeeding rates, North Dakota added a provision to SB 2344 (public indecency legislation) creating an Infant Friendly business designation for employers providing specified lactation accommodations to employees. However, there has been no evaluation of this designation to determine effectiveness. The purpose of this article is to examine the impact of the Infant Friendly business designation in North Dakota on breastfeeding continuation rates within the context of the social ecological model (SEM). Between November 2016 and March 2017, an 85-item online questionnaire, designed using the SEM, was distributed to working women across the state using various sampling methods. T tests, analysis of variance, and regression were used to analyze results. Designated (intervention) and nondesignated (control) businesses were targeted. There was no statistically significant difference in breastfeeding duration between designated and nondesignated businesses. There was a 2-month difference in duration between continually designated businesses and those with lapsing designations. Twenty-eight percent of the women working for Infant Friendly businesses were aware that their businesses were designated, indicating a lack of awareness regarding the designation. The designation is a starting point for worksite breastfeeding support. A policy promotion plan based on the SEM targeting individual awareness and employee education may improve the designation's effectiveness.

Does extending the duration of legislated paid maternity leave improve breastfeeding practices? Evidence from 38 low-income and middle-income countries

Introduction

Among all barriers to breastfeeding, the need to work has been cited as one of the top reasons for not breastfeeding overall and for early weaning among mothers who seek to breastfeed. We aimed to examine whether extending the duration of paid maternity leave available to new mothers affected early initiation of breastfeeding, exclusive breastfeeding under 6  months and breastfeeding duration in low-income and middle-income countries (LMICs).

Methods

We merged longitudinal data measuring national maternity leave policies with information on breastfeeding related to 992 419 live births occurring between 1996 and 2014 in 38 LMICs that participated in the Demographic and Health Surveys. We used a difference-in-differences approach to compare changes in the prevalence of early initiation and exclusive breastfeeding, as well as the duration of breastfeeding, among treated countries that lengthened their paid maternity leave policy between 1995 and 2013 versus control countries that did not. Regression models included country and year fixed effects, as well as measured individual-level, household-level and country-level covariates. All models incorporated robust SEs and respondent-level sampling weights.

Results

A 1-month increase in the legislated duration of paid maternity leave was associated with a 7.4 percentage point increase (95%  CI 3.2 to 11.7) in the prevalence of early initiation of breastfeeding, a 5.9 percentage point increase (95%  CI 2.0 to 9.8) in the prevalence of exclusive breastfeeding and a 2.2- month increase (95%  CI 1.1 to 3.4) in breastfeeding duration.

Conclusion

Extending the duration of legislated paid maternity leave appears to promote breastfeeding practices in LMICs. Our findings suggest a potential mechanism to reduce barriers to breastfeeding for working mothers.

Improved rates of exclusive breastfeeding at 14 weeks of age in KwaZulu Natal, South Africa: what are the challenges now?

Background

Increasing the rate of exclusive breastfeeding (EBF) to 50% in the first six months of life is one of six major global targets set by the United Nations Decade of Nutrition, and is essential to achieve the sustainable development goals to eradicate hunger and end malnutrition by 2030.

Methods

A survey using multistage random sampling design included 99 primary health care (PHC) clinics in all 11 districts in KwaZulu-Natal (KZN). All mothers and caregivers of infants 14 weeks of age attending the clinics in the study period were requested to participate in a structured interview to explore feeding practices since birth. As non-maternal caregivers may not have detailed knowledge of feeding practices, they provided limited information about current feeding practices. Respondents who consistently reported giving no other food or fluids except breastmilk since birth were classified as practising exclusive breastfeeding (EBF), and those who were currently breastfeeding but had given other food or fluids since birth were categorised as practising mixed breastfeeding (MBF).

Results

A total of 4172 interviews were conducted with mothers and caregivers of 14 week old infants. Among mothers 49.8% were EBF, 23.1% were MBF and 27.0% were not breastfeeding. Among non-maternal caregivers 11.8% reported EBF, 23.4% MBF and 62.3% were not giving breastmilk. Higher education (OR 0.6, 95% CI 0.4–0.8) and being in the highest socio-economic tertile (OR 0.7, 95% CI 0.6–0.9) were risk factors for not practising EBF, while returning to work (OR 0.3, 95% CI 0.2–0.3) or school (OR 0.2 95% CI, 0.1–0.3) was associated with less EBF. HIV-positive mothers were more likely to have never started breastfeeding (OR 3.6, 95% CI 2.7–4.8). However, they were similar in having stopped breastfeeding by 14 weeks (OR 1.1, 95% CI 0.9–1.4) compared to HIV-negative mothers, and, they had similar rates of EBF at 14 weeks of age (OR 1.0, 95% CI 0.9–1.3).

Conclusions

Estimates of breastfeeding practices at 14 weeks in KZN are higher than previously shown. However, particular challenges that should be addressed if international targets for EBF are to be achieved include improving breastfeeding practices of HIV positive mothers and supporting all mothers, particularly working or schooling mothers to continue giving breastmilk while they are away from their children.

The impact of immigration on the breastfeeding practices of Mainland Chinese immigrants in Hong Kong

BACKGROUND

Researchers have found breastfeeding disparities between immigrant and native-born women in many countries. However, most studies on immigration and breastfeeding practices have been in Western countries. The aim of this study was to examine the effect of length of time since immigration on the breastfeeding practices of Mainland Chinese immigrants living in Hong Kong.

METHODS

We recruited 2704 mother-infant pairs from the postnatal wards of four public hospitals in Hong Kong. We examined the effect of migration status on the duration of any and exclusive breastfeeding.

RESULTS

Breastfeeding duration was progressively shorter as the time since immigration increased. When compared with mothers who had lived in Hong Kong for <5 years, Hong Kong-born participants had a 30% higher risk of stopping any breastfeeding (hazard ratio [HR] 1.34 [95% confidence interval {CI} 1.10-1.63]) and exclusive breastfeeding (HR 1.33 [95% CI 1.11-1.58]). In both Hong Kong-born and immigrant participants, breastfeeding cessation was associated with return to work postpartum and the husband's preference for infant formula or mixed feeding. Intention to exclusively breastfeed and to breastfeed for >6 months, and previous breastfeeding experience substantially reduced the risk of breastfeeding cessation for both Hong Kong-born and immigrant participants.

CONCLUSIONS

Health care professionals should consider immigration history in their assessment of pregnant women and provide culturally adapted breastfeeding support and encouragement to this population.

Factors associated with the time to cessation of breastfeeding among mothers who have index children aged two to three years in Debre Markos, northwest Ethiopia: a retrospective follow up study

Background

Breastfeeding of children, which needs to continue until two years and beyond, is one of the essential requirements for child survival. However, in Ethiopia there is scarcity of literatures on the duration of breastfeeding. Therefore, the aim of this study was to assess the rate of cessation of breastfeeding among mothers with index children aged 2 to 3 years, northwest Ethiopia.

Methods

A retrospective follow-up study was conducted at Debre Markos town from March 1, 2014 to March 30, 2016. A total of 500 mother-child pairs were selected using the systematic random sampling method by moving from house to house with an interval of three eligible houses. A structured questionnaire was used to collect data. The Cox regression model was employed to identify the predictors of breastfeeding cessation.

Results

The proportion of women breastfeeding until 2 years was 13.70 per 1000 person- months. HIV-positive mothers decreased the time of breastfeeding by 3.4 times compared to HIV-negative mothers (AHR = 3.41, 95% CI: 1.96, 5.94). Government employee mothers decreased the time of breastfeeding by 2.8 times compared to housewives (AHR = 2.8, 95% CI: 1.80, 4.40).Better education increased the time of breastfeeding (AHR = 0.45, 95% CI: 0.24, 0.58). Number of children, family income, and place of delivery were the other significant predictors of time to cessation of breastfeeding (p < 0.05).

Conclusion

In this study, the rate of cessation of breastfeeding was good. HIV negative mothers, government employment, number of children, place of delivery, and family monthly income were significant predictors to the time of breastfeeding cessation. Therefore, family planning and breastfeeding education in health institutions are essential to increase breastfeeding duration.

Contraception and Breastfeeding at 4 Months Postpartum Among Women Intending to Breastfeed

OBJECTIVE

To estimate the association between postpartum contraception and breastfeeding among women intending to breastfeed.

METHODS

We analyzed data from the Infant Feeding Practices Study II, a prospective cohort study of U.S. mothers (2005-2007). Among 1,349 women with prenatal intention to breastfeed at least 4 months who reported contraception use 3 months postpartum, we used multivariable logistic regression to estimate odds and predicted probabilities of breastfeeding by contraceptive category. We considered prenatal breastfeeding intention, age, race, education, income, marital status, region, depressive symptoms, parity, and timing of return to work as potential confounders, using standard statistical methods to determine model covariates.

RESULTS

At 3 months postpartum, contraception was reported as follows: 720 (53%) nonhormonal contraceptives (NHCs), 256 (19%) combined hormonal contraceptives (CHCs), 217 (16%) progestin-only pills (POPs), 92 (7%) intrauterine devices, and 64 (5%) depot medroxyprogesterone acetate. Compared with NHCs, adjusted odds ratio (aOR) for any breastfeeding at 4 months postpartum among women using POPs was 3.15 (95% confidence interval [CI] 1.42-7.02), and for women using CHCs aOR was 0.17 (95% CI 0.10-0.29). For women using NHCs, predicted probability of any breastfeeding at 4 months postpartum was 90% (95% CI 85-94); it was 97% (95% CI 92-99) among those using POPs and 61% (95% CI 46-74) among those using CHCs.

CONCLUSION

In a cohort of women intending to breastfeed at least 4 months, women using POPs were most likely, and women using CHCs were least likely, to achieve their breastfeeding intentions.