Role conflict and rapid socio-economic change: breastfeeding among employed women in Thailand

Breastfeeding after Returning to Work: A Systematic Review and Meta-Analysis

BACKGROUND

The benefits of breastfeeding are widely known; however, continuation after returning to work (RTW) is not. We aimed to conduct a systematic review and meta-analysis to assess the prevalence of breastfeeding after RTW. The secondary objectives were to compare the economic statuses between continents.

METHOD

PubMed, Cochrane Library, Base, and Embase were searched until 1 September 2020, and two independent reviewers selected the studies and collated the data. To be included, articles needed to describe our primary outcome, i.e., prevalence of breastfeeding after RTW.

RESULTS

We included 14 studies, analyzing 42,820 women. The overall prevalence of breastfeeding after RTW was 25% (95% CI, 21% to 29%), with an important heterogeneity (I² = 98.6%)-prevalence ranging from 2% to 61%. Stratification by continents and by GDP per capita also showed huge heterogeneity. The Middle East had the weakest total prevalence with 10% (6% to 14%), and Oceania the strongest with 35% (21% to 50%). Despite the prevalence of breastfeeding in general increasing with GDP per capita (<US$5000: 19%, US$5000-30,000: 22%; US$30,000 to 50,000: 25%, >US$50,000 42%), the prevalence of non-exclusive breastfeeding follows more of a U-curve with the lowest and highest GDP per capita having the highest percentages of breastfeeding (<US$5000: 47% and >US$50,000: 50%, versus <28% for all other categories).

CONCLUSION

Breastfeeding after RTW is widely heterogeneous across the world. Despite economic status playing a role in breastfeeding after RTW, cultural aspects seem influential. The lack of data regarding breastfeeding after RTW in most countries demonstrates the strong need of data to inform effective preventive strategies.

Maternal employment in low- and middle-income countries is associated with improved infant and young child feeding

Background

Women's employment improves household income, and can increase resources available for food expenditure. However, employed women face time constraints that may influence caregiving and infant and young child feeding (IYCF) practices. As economic and social trends shift to include more women in the labor force in low- and middle-income countries (LMICs), a current understanding of the association between maternal employment and IYCF is needed.

Objective

We investigated the association between maternal employment and IYCF.

Design

Using cross-sectional samples from 50 Demographic and Health Surveys, we investigated the association between maternal employment and 3 indicators of IYCF: exclusive breastfeeding (EBF) among children aged <6 mo (n = 47,340) and minimum diet diversity (MDD) and minimum meal frequency (MMF) (n = 137,208) among children aged 6-23 mo. Mothers were categorized as formally employed, informally employed, or nonemployed. We used meta-analysis to pool associations across all countries and by region.

Results

According to pooled estimates, neither formal [pooled odds ratio (POR) = 0.91; 95% CI: 0.81, 1.03] nor informal employment (POR = 1.05; 95% CI: 0.95, 1.16), compared to nonemployment, was associated with EBF. Children of both formally and informally employed women, compared to children of nonemployed women, had higher odds of meeting MDD (formal POR = 1.47; 95% CI: 1.35, 1.60; informal POR = 1.11; 95% CI: 1.03, 1.20) and MMF (formal POR = 1.18; 95% CI: 1.10, 1.26; informal POR = 1.15; 95% CI: 1.06, 1.24). Sensitivity analyses indicated that compared to nonemployed mothers, the odds of continued breastfeeding at 1 y were lower among formally employed mothers (POR = 0.82; 95% CI: 0.73, 0.98) and higher among informally employed mothers (POR = 1.19; 95% CI: 1.01, 1.40).

Conclusion

Efforts to promote formalized employment among mothers may be an effective method for improving diet diversity and feeding frequency in LMICs. Formally employed mothers may benefit from support for breastfeeding to enable continued breastfeeding through infancy. This trial was registered at clinicaltrials.gov as NCT03209999.

Developing a workplace breast feeding support model for employed lactating mothers

Resuming work is often considered an obstacle for continued breast feeding. The objectives of this participatory action research study were to develop a breast feeding support model in the workplace and to compare breast feeding rates before and after implementation of the breast feeding support campaign. Twenty-four women participated before the implementation of the breast feeding support campaign, whereas 31 women participated after the campaign. Data were collected by interviewing employed women about their breast feeding practices within six months post partum. Additional data were collected through interviews with the workplace administrator and head of work sections as well as observation of the breast feeding support campaigns. Qualitative data were analysed using thematic analysis, whereas quantitative data were analysed using descriptive statistics and χ(2) test. The workplace breast feeding support model was developed based on the concept of Mother-Friendly Workplace Initiatives by the World Alliance for Breastfeeding Action (WABA) and the Thai government׳s promotion of a workplace breast feeding corner. Within this model, a committee for breast feeding support was created for working with the research team to develop breast feeding activities and media for breast feeding education and breast feeding support campaigns in the workplace. Breast feeding rates at six months after implementation of the breast feeding support campaign were significantly higher than rates before, both for exclusive breast feeding and any breast feeding at levels .004 and .033, respectively. These results suggest that breast feeding should be encouraged in every workplace depending on context. Individual advice and help for employed mothers should be provided from pregnancy through weaning in the postpartum period.

Maternal return to paid work and breastfeeding practices in Bangkok, Thailand

This study explored the association between mothers' work-related factors and breastfeeding practices in Bangkok, Thailand. Data were collected from 84 working mothers with a child aged 6 to 24 months who visited the breastfeeding mobile clinic at a nursery goods exhibition. Thai interviewers collected data using a structured questionnaire. Analysis of the data showed that exclusive breastfeeding for 3 months was 78.6%, and for 6 months it was 38.1%. Mothers who returned to work 3 months or more after giving birth exclusively breastfed more than the mothers who returned to work in less than 3 months (crude odds ratio [OR] = 4.26, 95% confidence interval [CI] = 1.39-13.05; adjusted OR = 4.15, 95% CI = 1.15-14.95). Moreover, mothers who worked at self-employed or family-owned businesses and some mothers working at private companies showed tendencies of returning to work in less than 3 months. Results suggest that longer maternity leave would help extend the duration of exclusive breastfeeding. In addition, the improvement of a breastfeeding supportive environment in the workplace would be valuable and may be an effective means to improve breastfeeding practices and infant health.

Social theory and infant feeding

Clinicians, public health advisors, nutritionists and others have been attempting to increase breastfeeding rates for the last few decades, with varying degrees of success. We need social science researchers to help us understand the role of infant feeding in the family. Some researchers in the area of food and nutrition have found Pierre Bourdieu's theoretical framework helpful. In this editorial, I introduce some of Bourdieu's ideas and suggest researchers interested in infant feeding should consider testing these theories.

Work related determinants of breastfeeding discontinuation among employed mothers in Malaysia

Background

This cross-sectional study assesses factors that contribute to discontinuing breastfeeding among employed mothers in Malaysia.

Methods

A structured questionnaire was used in conducting this study involving all government health clinics in Petaling district between July and September 2006. Respondents were Malaysian women with children between the ages of six to twelve months who were formally employed. Factors studied were selected socio-demographic and work-related characteristics.

Results

From a total of 290 respondents, 51% discontinued breastfeeding. The majority (54%) of mothers who discontinued breastfeeding had breastfed their babies for less than three months. Compared to Malay mothers, the risk of breastfeeding discontinuation were higher among Chinese (AOR 3.7, 95% CI: 1.7, 7.8) and Indian mothers (AOR 7.3, 95% CI 1.9, 27.4). Not having adequate breastfeeding facilities at the workplace was also a risk factor for breastfeeding discontinuation (AOR 1.8, 95% CI: 1.05, 3.1).

Conclusion

It is important that workplaces provide adequate breastfeeding facilities such as a room in which to express breast milk and a refrigerator, and allow mothers flexible time to express breast milk.

Maternal return to work and breastfeeding: a population-based cohort study

BACKGROUND

In recent decades there has been a marked rise in the participation of women with infants in the labour market, while there has been a decline in the prevalence rate of breastfeeding.

OBJECTIVE

To explore the relationship between maternal return to work and breastfeeding.

DESIGN

An on-going prospective longitudinal study.

SETTING AND PARTICIPANTS

Multistage stratified systematic sampling was designed to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. Participating women underwent two home interviews at 6 and 18 months after giving birth, following structured questionnaires. A total of 21,248 and 20,172 women were interviewed, and the completed interview rate was thus 87.8% and 83.4% at 6 and 18 months, respectively. All study participants provided informed consent as approved by the Ethics Review Board of the National Taiwan College of Public Health.

RESULTS

The overall prevalence of initial breastfeeding was 83.7%. Postpartum women returning to work less than or equal to 1 month had the lowest initiation of breastfeeding rate (77.5%), but had a higher prevalence of breastfeeding duration less than or equal to 1 month (34.9%) than the overall population (26.8%). Overall 67.9%, 39.4%, 25.4%, and 12.7% mothers who started breastfeeding still breastfed their infants at the age of 1, 3, 6 and 12 months, respectively. Women with maternal leave of less than or equal to 6 months ceased breastfeeding earlier than those with maternal leave beyond 6 months and those who did not return to work up to 18 months after birth. After adjustment for potential confounders, odds ratios of initial breastfeeding seemed no different, except those for postpartum women who returned to work less than or equal to 1 month and those who did not return to work. Mothers returning to work within 1 year after giving birth were significantly earlier in weaning than those without return to work.

CONCLUSION

In our study, an early maternal return to work, especial within 6 months after giving birth, was a barrier to the initiation and continuation of breastfeeding. Thus, a comprehensive strategy is required to encourage the practice of breastfeeding in working women from pregnancy to the return to work, and nurses should work to promote breastfeeding in the different occasion.

The combined effect of employment status and transcultural marriage on breast feeding: a population-based survey in Taiwan

In recent decades there has been a marked rise in both the labour market participation of women with infants and transcultural marriage in Taiwan. The objectives of this study were to explore the combined effect of employment status and transcultural marriage on the prevalence and factors relating to initiation and continuation of breast feeding in Taiwan. We used multistage stratified systematic sampling to recruit 2048 postpartum women from the Taiwan National Birth Registration database for the period November to December 2003. They were interviewed at home within 6 months of delivery using a structured questionnaire; 87% of the sampled population completed the interview. We used logistic regression analysis to estimate the odds ratio (OR) of breast-feeding initiation and Cox regression (survival) analysis to predict continued breast feeding. The prevalences of initial breast feeding for employed Taiwanese mothers, unemployed Taiwanese mothers, employed foreign-born mothers and unemployed foreign-born mothers were 84.4%, 83.7%, 79.1% and 79.7%, respectively. Among the four groups of mothers who initiated breast feeding, 12.9%, 27.2%, 14.7% and 39.7% of their infants, respectively, were still breast feeding at the age of 6 months. Factors associated with initiation of breast feeding were high maternal education (OR 3.80; 95% confidence interval [CI] 1.81, 7.98) and normal spontaneous delivery (OR 1.36; 95% CI 1.04, 1.78). The main reason for not breast feeding in 52% of the mothers was insufficient or no milk. There existed a combined effect of employment status and transcultural marriage on the continuation of breast feeding. Employed Taiwanese mothers were earlier than others at weaning. Unemployed foreign-born mothers breast fed the longest [hazard ratio (HR) 0.54; 95% CI 0.42, 0.70]. Other factors related to late weaning were high maternal education (HR 0.67; 95% CI 0.47, 0.96), older maternal age (HR 0.76; 95% CI 0.61, 0.94), mother sleeping with baby at night (HR 0.68; 95% CI 0.59, 0.78), and no supplemental baby food before the age of 6 months (HR 0.78; 95% CI 0.68, 0.90). The initiation of breast feeding was high but it decreased dramatically after the postpartum period in Taiwan. There was a significant combined effect of employment status and transcultural marriage on the continuation of breast feeding. Employment is a persistent barrier to continued breast feeding.

In practice, the theory is different: a processual analysis of breastfeeding in northeast Brazil

'Na prática, a teoria è outra' (in practice, the theory is different) is an old Brazilian saying. This phrase summarizes well the general practice of breastfeeding in Brazil: 'Breast is best' is central in the pregnant women's future oriented 'theory' of how their infant should be fed. In the subsequent weeks after delivery, however, in the daily practicalities of feeding their infant, this theory is, to a large extent, abandoned. The present study is based on a sample of 300 mothers in the city of Aracaju in the Northeast of Brazil. Through interviews, the differences and similarities between knowledge and practice with respect to infant feeding were established. An explanation of these differences is developed on the basis of a processual analysis of the qualitative and quantitative results of the interview data. Nearly all mothers were knowledgeable of the need to breastfeed, and nearly all mothers had initiated breastfeeding. However, only a minority was exclusively breastfeeding at the time of the interview. A distinction is made between a breastfeeding process and a de-breastfeeding process. The data suggest that mothers, in general, start the de-breastfeeding process with the positive intention of ameliorating the infant's situation without realizing the negative processual consequences that most likely ends in a cessation of breastfeeding. The study supports the view that health policy should underline the processual character of both breastfeeding and de-breastfeeding when promoting the importance of exclusive breastfeeding.

Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: a cross-sectional survey

BACKGROUND

In recent years, the creation of supportive environments for encouraging mothers to breastfeed their children has emerged as a key health issue for women and children. The provision of lactation rooms and breast pumping breaks have helped mothers to continue breastfeeding after returning to work, but their effectiveness is uncertain. The aim of this study was to assess the effects of worksite breastfeeding-friendly policies and work-related factors on the behaviour of working mothers.

METHODS

This study was conducted at a large Taiwanese semiconductor manufacturer in August-September 2003. Questionnaires were used to collect data on female employees' breastfeeding behaviour, child rearing and work status when raising their most recently born child. A total of 998 valid questionnaires were collected, giving a response rate of 75.3%.

RESULTS

The results showed that 66.9% of survey respondents breastfed initially during their maternity leave, which averaged 56 days. Despite the provision of lactation rooms and breast pumping breaks, only 10.6% mothers continued to breastfeed after returning to work, primarily office workers and those who were aware of their company's breastfeeding-friendly policies.

CONCLUSION

In conclusion, breastfeeding-friendly policies can significantly affect breastfeeding behaviour. However, an unfavourable working environment, especially for fab workers, can make it difficult to implement breastfeeding measures. With health professionals emphasizing that the importance of breastfeeding for infant health, and as only females can perform lactation, it is vital that women's work "productive role" and family "reproductive role" be respected and accommodated by society.

Traditional beliefs about pregnancy and child birth among women from Chiang Mai, Northern Thailand

OBJECTIVE

To examine women's embodied knowledge of pregnancy and birth, women's explanations of precautions during pregnancy and birth and preparations for easy birth and the role of a traditional midwife in a Thai birthing care.

DESIGN

In-depth interviews relating to traditional and changed beliefs and practices of pregnancy and childbirth with Thai women in Northern Thailand.

SETTING

Chiang Mai city and Mae On sub-district in Chiang Mai province, Northern Thailand.

PARTICIPANTS

30 Thai women living in Chiang Mai in Thailand.

FINDINGS

The social meaning of childbirth in Thai culture is part of the larger social system, which involves the woman, her family, the community, society and the supernatural world. Traditional beliefs and practices in Thai culture clearly aim to preserve the life and well-being of a new mother and her baby. It seems that traditional childbirth practices have not totally disappeared in northern Thailand, but have gradually diminished. Women's social backgrounds influence traditional beliefs and practices. The traditions are followed by most rural and some urban poor women in Chiang Mai.

IMPLICATIONS FOR PRACTICE

The findings of this study may assist health professionals to better understand women from different cultures. It is important to recognise many factors discussed in this paper within the context of Thai lives and traditions. This will prevent misunderstanding and, consequently, encourage more sensitive pregnancy and birthing care for pregnant women.

‘Supply’ and ‘demand’: breastfeeding as labour

This paper presents findings from a recent critical ethnographic study conducted in two maternity units in England, UK. The study explored the influences upon 61 women's experiences of breastfeeding within the postnatal ward setting. Participant observations of 97 encounters between midwives and postnatal women, 106 focused interviews with postnatal women and 37-guided conversations with midwives were conducted. Basic, organising and global themes were constructed utilising thematic networks analysis. The metaphor of the production line, with its notions of demand and efficient supply, illustrated the experiences of breastfeeding women. They conceptualised breastfeeding as a 'productive' project, yet expressed deep mistrust in the efficacy of their bodies. Their emphasis centred upon breast milk as nutrition rather than relationality and breastfeeding. Women referred to the demanding and unpredictable ways in which their baby breached their temporal and spatial boundaries. They sought strategies to cope with the uncertainty of this embodied experience in combination with their concerns regarding returning to a 'normal' and 'productive' life. The hospital setting and health worker practices played a contributing and reinforcing role. The paper discusses ways of re-establishing trust in women's bodies and breastfeeding, while respecting difference and diversity. It argues for embracing the concepts of embodiment and relationality whilst avoiding a return to essentialism. This requires collective efforts to erode deeply embedded cultural understandings of women's bodies centering upon disembodied and efficient production.

Implications of women's work for child nutritional status in sub-Saharan Africa: a case study of Nigeria

The study examines the relationships between women's work and child nutritional status (stunting and wasting) of 5331 Nigerian children aged 0-59 months, using data from the 1990 Nigerian Demographic and Health Survey. In defining women's work, the study considers whether women earned cash from their work and carried their children to work in order to assess the importance of childcare and income, which are the principal pathways through which women's work affects child nutritional status. The study also examines infants and children differently in order to assess the influence of child's age on nutritional status. The results reveal that wasting among infants increased when mothers did not take them to work. Furthermore, mothers' work reduced stunting in their children, but the expected positive effect of earning cash from work on childhood nutrition was less visible from the results. Other results from the study revealed that during infancy, having recent episodes of diarrhea or shorter breast-feeding duration increased wasting. Additionally, wasting was lower during infancy for children in households with pit toilets and children with Christian mothers. For infants, immunization reduced stunting, but longer duration of breast-feeding, being a higher parity child, being in households with pit toilets increased stunting. During childhood, higher birth weight, immunization, and having a Christian mother reduced stunting and wasting. Children in wealthy households are less likely to be stunted, while mother's education and being a higher parity child increased stunting. Also during childhood, having a Christian mother reduced wasting while recent episodes of fever increased wasting.

Breast-feeding and the working mother in Nairobi

OBJECTIVE

In the fast growing city of Nairobi, women often combine the roles of mother and worker in trying to achieve better standards of living. The objective of this study was to document the effect of returning to work on breast-feeding by mothers in Kenya.

DESIGN

A cross-sectional survey.

SETTING

Outpatient clinics of two major hospitals in Nairobi, one government hospital in an economically deprived area and one high-fee private hospital.

SUBJECTS

Four hundred and forty-four working mothers from low and higher socio-economic areas in Nairobi. All working mothers with infants aged 4 to 12 months attending during the survey period were invited to participate.

RESULTS

The prevalence of breast-feeding at the time of interview was found to be 94.1%. The lower socio-economic group exhibited a higher prevalence of breast-feeding (99%), 10% greater than the higher socio-economic group. The mean number of hours the mothers were away from home due to work was 46.2 hours each week. The majority (54.4%) of the mothers employed a 'house-girl' to care for their infant while they were at work, while 28.4% were able to take their infants to work. Most of the breast-feeding mothers (95%) breast-fed their infants at least three times a day and only 23 mothers reported not being able to breast-feed their infants during the day. The lower socio-economic group had a mean of 5.09 breast-feeding times per day while the higher socio-economic group had a mean of 3 times a day. In a logistic regression analysis the mode of work (fixed working hours vs. shift working hours) was associated with exclusive breast-feeding at one month (odds ratio (OR)=0.45) and two months (OR=0.39).

CONCLUSION

In Western countries 'return to work' is often cited as the reason that breast-feeding is discontinued prematurely. In this study we have shown how mothers in Kenya are able to successfully continue breast-feeding after they have returned to work, often for very long hours.

Contemporary Trends in Infant Feeding Research

▪ Abstract  This review examines current research in the subfields of anthropology and related disciplines on the biocultural process of breastfeeding and broader questions of infant and young-child feeding. The themes of sexuality, reproduction, embodiment, and subjective experience are then linked to the problems women who breastfeed face in bottle-feeding cultures. Anthropologists have contributed to policy-relevant debates concerning women's work and scheduling in relation to infant care and exclusive breastfeeding. The extensive ethnographic work on children's transition to consuming household foods demonstrates the need to integrate research on breastfeeding with research on complementary feeding. Current debates around HIV and chemical residues in breastmilk call for a critical examination of the effects of globalization and corporate control on infant feeding practices. The literature shows how the narrow specialty of infant feeding has broad implications for the discipline.

Influences of mother's work, childhood place of residence, and exposure to media on breast-feeding patterns: experience of Nigeria and Uganda

This study uses data from the Nigerian Demographic and Health Survey collected in 1990 and the Ugandan Demographic and Health Survey collected in 1995 to examine the implications of mother's work, childhood place of residence, and exposure to the media for breast-feeding patterns (exclusivity and intensity) in Nigeria and Uganda. Nigeria and Uganda present an interesting contrast because Nigeria is more modernized and economically developed than Uganda, thus providing a good indication of the influence of modernization on breast-feeding patterns. Mother's work status is defined by considering whether mothers earned cash from work and took their children to work, hence emphasizing the compatibility of work with child care. Work least compatible with child care had a negative effect on breast-feeding intensity in Nigeria. The negative effect of mother's work on exclusive breast-feeding (that is, if the mothers used formula or milk instead) observed for some working mothers in Nigeria and Uganda was partly confounded by urban residence, exposure to media, and other socioeconomic factors. Mother's work did not have a negative effect on breast-feeding intensity in Uganda. The relationship between mother's work, urban residence, media exposure, and breast-feeding practice seems to be stronger in Nigeria than Uganda.

Normative vs. attitudinal considerations in breastfeeding behavior: multifaceted social influences in a developing country context

The aim of the paper is to test the basic assumptions underlying the theory of reasoned action (TRA) for exclusive breastfeeding behavior taking place in the rather complicated social environment of women who have just given birth. The paper aims (i) to argue that normative rather than attitudinal considerations are more important in engaging the correct breastfeeding behavior, and (ii) to demonstrate that the TRA concept of social norm should be treated as a multi-layered construct which involves several enabling factors in predicting complex behaviors such as breastfeeding. Data were collected in three phases as part of a prospective cohort follow-up design. The first phase of data collection was conducted in the hospital with mothers after the delivery. Two follow-up questionnaires were administered at the end of the first and second months. Results did not confirm the assertions of the TRA. Logistic regression models and multiple regression analyses indicated that intention and belief/attitude measures taken at the time of birth did not predict end-of-first-month full breastfeeding behavior. Overall, results revealed that intention by itself was not a strong determinant of breastfeeding unless it was conditioned by enabling factors such as social support and subjective norms regarding breastfeeding.

Breastfeeding, wage labor, and insufficient milk in peri-urban Kathmandu, Nepal

This article presents a case study of breastfeeding mothers who are working as carpet-makers in peri-urban Kathmandu, Nepal. A sample of women surveyed about their current infant feeding practices revealed that half of the infants aged three to four months had been introduced to non-breast milk foods and liquids. During in-depth interviews some mothers explained that they supplemented breastfeeding with either milk or solids if they felt that they did not have enough breast milk for their infants. Reports of insufficient milk (IM) among these Nepali women is discussed within the larger context of IM as a worldwide phenomenon that is often associated with the cessation of breastfeeding and the switch to bottle-feeding based on commercial milk products. On average, the women in this study breastfed their infants until the latter were approximately three years of age. A status quo method for determining median duration of breastfeeding indicates that there is no significant difference in the duration of breastfeeding between mothers who work in carpet-making factories and those who spin wool at home. It is argued that reports of IM in this setting are not associated with the abandonment of breastfeeding, for a number of reasons including: the cultural approbation of breastfeeding; the low usage of baby bottles among peri-urban mothers, and the flexible labor practices of the carpet-making industry.