Exclusive breastfeeding among working mothers in Kenya: Perspectives from women, families and employers

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.

The Prevalence of Exclusive Breastfeeding Practice and Its Predictors in the First Six Months of Life Among Working Mothers in Riyadh, Saudi Arabia

Introduction The United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) recommendations are early initiation of breastfeeding and exclusive breastfeeding (EBF) for the first six months of infants' lives. Despite the WHO and UNICEF recommendations and expanding evidence of the significance of exclusive breastfeeding, about two-thirds of infants worldwide have not received exclusive breastfeeding for the six recommended months. This study aims to estimate the prevalence of working mothers exclusively breastfeeding in the first six months of infants' lives and investigate their predictors in Riyadh, Saudi Arabia. Methods A cross-sectional community-based study was conducted for four months in 2022. The study included working mothers who have a child in the age range of 6-24 months living in Riyadh. Data was collected through an online questionnaire and analyzed using the Statistical Package for the Social Sciences (SPSS) version 29 (IBM SPSS Statistics, Armonk, NY) program. Results A sample of 118 participants were included in the study. Their prevalence for EBF practice for the recommended period is 28% (n=33). Around 58.5% (n=69) of the participants did not receive breastfeeding counseling during antenatal visits. Almost half the infants were given prelacteal feeding. Male infants are two times more likely to be exclusively breastfed for the recommended period than female infants. Work-related pressures were a key factor in the discontinuation of breastfeeding (53.4%, n=63). Conclusion This study highlights the lack of breastfeeding counseling and breastfeeding work regulation, alongside concerns about colostrum avoidance and prelacteal feeding. While EBF rates show progress, delayed initiation and work-related pressures remain challenges. Gender disparity in exclusive breastfeeding urges targeted interventions for more equitable outcomes.

Early Infant Feeding Practices among Women Engaged in Paid Work in Africa: A Systematic Scoping Review

Around the world, paid work without appropriate structural support is a key barrier to optimal breastfeeding practices. To better protect, promote, and support optimal breastfeeding practices among working women in Africa, this scoping review sought to understand how paid work influences infant feeding practices in the first 6 mo of life and what support women need to manage work and optimal infant feeding practices. We systematically searched PubMed, Scopus, Global Health, and CINAHL Plus, screened 2436 abstracts, and reviewed 322 full-text articles using Covidence for review and charting. We identified 203 articles that met the inclusion criteria. We identified 32 quantitative, 10 qualitative, 3 mixed-methods, and 2 review articles that focused on examining the relationship between work and breastfeeding, and 109 quantitative, 22 qualitative, 21 mixed-methods, and 4 review articles that included work as part of broader breastfeeding research but did not focus on work. Most studies reported a significant negative association between work and exclusive breastfeeding. Three major domains were reported in the qualitative studies: challenges to managing work and infant feeding, receiving support from employers and family members/caregivers, and strategies for feeding infants when the mother is working. Reviewed studies proposed recommendations to increase support for breastfeeding through changes to policies and support within worksites, the health system, and childcare; however, evidence of previously implemented policies or programs is limited. We recommend more consistent definitions and measurement of women's work. Future research is needed on the impact of implementing various strategies and benefits for breastfeeding at workplaces, as well as efforts to support breastfeeding among informal workers.

Mothers' Willingness to Use Workplace Lactation Supports: Evidence from Formally Employed Mothers in Central Kenya

Background

Formally employed mothers are vulnerable to early cessation of exclusive breastfeeding. Kenyan national policy requires employer-provided maternity benefits and workplace lactation supports.

Objective

The objective of this study was to evaluate willingness to use nationally mandated workplace lactation supports among formally employed women in Kenya.

Methods

We conducted a cross-sectional survey among 304 mothers of children ages ≤12 mo in Naivasha, Kenya, who were currently formally employed and employed before delivery of the most recent child to assess availability of and willingness to use current and potential future workplace lactation supports.

Results

The most available reported workplace lactation supports were schedule flexibility to arrive late or leave early (87.8%) or visit a child to nurse during lunch (24.7%), followed by company-funded community-based daycare (7.6%). Few (<4.0%) reported the availability of lactation rooms, on-site daycares, transportation to breastfeed during lunch, refrigerators for expressed milk, or manual or electric breastmilk pumps. If made available, >80% of mothers reported moderate or strong willingness to use flexible schedules to arrive late or leave early, break during lunch, and transportation to visit a child to nurse. A moderate proportion reported strong willingness to use on-site daycares (63.8%), company-funded community-based daycare (56.9%), on-site lactation rooms (60.5%), refrigeration for expressed milk (49.3%), manual (40.5%), and electric pumps (27.6%). Mothers expressed fear of missing production targets and reported more willingness to use on-site compared with off-site daycare to save transportation time but noted concerns about chemical exposures and early arrival times with young infants. Hesitations regarding the use of on-site lactation rooms included concerns about privacy, milk identification and storage, and use and sharing of pumps.

Conclusions

Flexible schedules were the workplace lactation supports in highest demand among formally employed mothers. Maternal willingness to use lactation rooms, refrigeration, and pumping equipment was moderate to low, suggesting sensitization may help to increase demand as the implementation of Kenyan policies moves forward.

Acceptability of breast milk donor banking: A qualitative study among health workers in Greater Accra Regional Hospital, Ghana

Despite the compelling evidence demonstrating the immediate and long-term health advantages of prompt breastfeeding from birth, not all newborns are breastfed exclusively for a variety of reasons. As a result, the World Health Organization has made new recommendations for the adoption of breastmilk donor banks to make sure that children receive breastmilk when mothers are unable to produce it. In order to better understand how health professionals at the Greater Accra Regional Hospital, who would be leading the charge in putting this policy into practice, perceive and accept the practice of storing breastmilk, this study was conducted. At the Greater Accra Regional Hospital, 18 healthcare professionals were chosen using maximum variation purposive sampling procedures. They were made up of eleven midwives, a medical officer, six nurses, and two nutritionists and all participants were interviewed face to face using a semi structured interview guide. Data was transcribed verbatim and was analyzed using thematic analysis. Participants in the study admitted that they would be open to using or contributing to a bank of breastmilk. Participants also said that if safety precautions are taken, they would urge their customers to give breastmilk and recommend breastmilk from a breastmilk bank to them when the situation calls for it. Health professionals recommended that education be provided prior to the installation of breast milk donor banking to lessen or eliminate any misconceptions people may have about it. The concept of breastmilk donor banking was fairly accepted among health workers. Misconceptions about the safety of breast milk was the main concern. The results emphasize the necessity of greater stakeholder engagement and education prior to the implementation of this policy in order to boost acceptance and uptake.

Breastfeeding Experience among Mothers during the COVID-19 Pandemic

When health experts declared COVID-19 to be a global pandemic, they recognized the virus as a major environmental factor that could affect the practice of breastfeeding. A few studies focused on the effect of COVID-19 on mothers who gave birth during the pandemic. The purpose of this study is to explore the experience of Saudi Arabian breastfeeding mothers during the COVID-19 pandemic. This study used a descriptive phenomenology qualitative design and a convenience sample of 18 mothers who breastfed their children beginning in March 2020. Data were collected through semi-structured, open-ended phone interviews and analyzed using thematic analysis. The mothers were between 27 and 36 years old, and most of them had previous breastfeeding experience. Four main themes emerged regarding breastfeeding experiences during the COVID-19 pandemic: breastfeeding experience (positive and negative), support, facilitators, and challenges. Most mothers felt their experience with breastfeeding during the pandemic encouraged them to continue. It is important to reassure and educate breastfeeding mothers about the nature of COVID-19 and its mode of transmission. The findings from this study lay the foundation for future research to support the practice of breastfeeding and overcome the challenges that arose during the pandemic.