Addressing barriers to health: Experiences of breastfeeding mothers after returning to work

Challenges for influencing exclusive breastfeeding practice among lactating mothers with infants aged 0-6 months in Borama District, Somaliland: A cross-sectional study

Background and Aims

Exclusive breastfeeding (EBF) has been demonstrated to have positive effects on a child's survival, growth, and development, as well as a mother's health and well-being. The authors aim to examine the barriers to EBF among lactating mothers in Borama town, Somaliland, with infants aged <6 months.

Methods

The authors collected primary data on a sample of 153 lactating mothers in Borama town, Somaliland, for this study. This study used descriptive statistics with frequencies and percentages. Moreover, the multivariable logistic regression model is applied to analyze the data.

Results

Findings revealed that about 28.1% of mothers pointed out that breastfeeding should be the baby's first meal. Surprisingly, 69.3% of the women were unaware that 6 months of EBF may keep a baby healthy. Results depict that EBF was influenced by lack of education (AOR: 0.013; 95% Cl: 0.001, 0.124), marital status (AOR: 0.40; 95% Cl: 0.004, 0.427), employed mothers (AOR: 0.070; 95% Cl: 0.043, 0.94), mothers perception of milk quantity (AOR: 0.033; 95% Cl: 0.001, 0.124), and perceived rejection to breastfeeding by the baby (AOR: 0.043; 95% Cl: 0.021, 0.134). Mothers who had no formal education or a primary level of education have less chance of practicing EBF than higher-educated mothers.

Conclusions

It is observed that the educational level of mothers, marital status (widow), employed mother, perceived insufficient milk, and the perceived rejection of breastfeeding by the baby are the major challenges for enhancing the EBF practice. The authors suggested that the Ministry of Health examine how effectively breastfeeding counseling is implemented in medical facilities. Moreover, the authors suggest that the government, nongovernmental organizations (NGOs), and community associations collaboratively plan and carry out suitable programs focusing on vulnerable groups.

Breastfeeding environment and experiences at the workplace among health workers in the Upper East Region of Ghana

BACKGROUND

Employed mothers have lower rates of breastfeeding, including health workers who are supposed to be advocates for breastfeeding. These working mothers need a supportive workplace environment to breastfeed, yet Ghana's breastfeeding policy neither mentions the workplace breastfeeding environment nor offers any information on it.

METHODS

A convergent parallel mixed-methods design was used in this study to determine: facilities with a complete breastfeeding support environment (BFSE); breastfeeding challenges experienced; coping strategies and motivators for breastfeeding among health workers in the Upper East Region of Ghana; and Management's awareness of the need for an institutional breastfeeding support policy. Quantitative and qualitative data were analyzed using descriptive statistics and thematic analysis respectively. The research was conducted from January to April 2020.

RESULTS

All facilities (39) had incomplete BFSE and management representatives of health facilities (39) did not have and were not aware that their respective facilities needed to have a specific workplace breastfeeding policy that fed into the national policy agenda. Breastfeeding challenges at workplaces included: lack of private space for breastfeeding; inadequate support from co-workers and management; emotional stress; and inadequate breastfeeding breaks and work options. Women adapted to these challenges by employing coping strategies such as: bringing children to work with / without caretakers; leaving children at home; seeking support from co-workers and family members; feeding children with supplementary foods; adding annual leave to maternity leave; breastfeeding in cars / offices; and sending children to daycare. Interestingly, the women were still motivated to breastfeed. Health benefits of breastmilk, the convenience and readily available nature of breastmilk, moral obligation to breastfeed, and cheap cost of breastmilk emerged as key motivators to breastfeed.

CONCLUSION

Our findings suggest that health workers have poor BFSE and are faced with numerous breastfeeding challenges. There is a need for programs that improve BFSE in health facilities.

Employed mothers' breastfeeding: Exploring breastfeeding experience of employed mothers in different work environments in Ethiopia

BACKGROUND

One of the most cost-effective interventions to enhance child health with the potential to reach families of all economic backgrounds is breastfeeding. Despite the many benefits optimal breastfeeding has, its practice is low due to various barriers among which maternal employment is mentioned repeatedly. Accordingly, this study has explored the experience of employed mothers with regards to breastfeeding, employment, and work environment in Addis Ababa Ethiopia.

METHODS AND FINDINGS

A descriptive Phenomenology strategy was employed among 17 mothers drawn from different organizations, conveniently, that offer accommodation of six months maternity leave or onsite child care center or had only three months maternity leave. Data were collected through in-depth interviews until information saturation was reached. Recorded interviews were transcribed and translated and the information obtained was then organized and coded to generate overarching themes. Two themes on facilitators and barriers, and addressing barriers were generated after analysis. Mothers recognize the importance of breastfeeding for children but returning to work at three months is expressed as a major barrier to continuous breastfeeding. Mothers who have access to supporting conditions at their workplace expressed better breastfeeding practice and better satisfaction with their job.

CONCLUSIONS

Providing employed mothers with a supporting environment helps them work with better stability, motivation, and satisfaction. This however requires a suitable accommodation with a focus on the different kinds of work environments of the mothers and the different risks related to each respective environment via scaling up and monitoring breastfeeding interventions and calling upon institutions to remove structural and societal barriers to breastfeeding.

Women's and Employers' Experiences and Views of Combining Breastfeeding with a Return to Paid Employment: A Systematic Review of Qualitative Studies

INTRODUCTION

Returning to paid employment is one of the reasons women stop breastfeeding earlier than they planned to. This systematic review aimed to provide insight into the experiences and views of women and employers on breastfeeding and returning to paid employment, with findings used to inform practice and policy.

METHODS

The review was guided by the Joanna Briggs Institute (JBI) methodology for systematic reviews of qualitative evidence. Medline, CINAHL, PsycINFO, and Web of Science databases were searched for studies published in English. JBI's meta-aggregative approach informed data analysis. The studies in this analysis included women who stopped breastfeeding before, and those who continued breastfeeding after, returning to paid employment and the employers, work managers, or supervisors of women who continued breastfeeding after returning to paid employment.

RESULTS

Twenty-six articles presenting findings from 25 studies were included and critically appraised. Synthesized findings showed that women experienced physical and emotional difficulties and described gender and employment inequalities in accessing and receiving the support they needed. Women reported that the importance of their own motivation and having workplace legislation in place facilitated breastfeeding during employment. Support from employers, colleagues, and family members, as well as access to convenient child care, helped women continue breastfeeding on return to paid employment. Employers' personal experiences influenced their views on breastfeeding and working, and the need for more education and communication between employers and employers on breastfeeding in the workplace was recognized.

DISCUSSION

Support from family, work colleagues, and employers was important to reduce the physical and emotional challenges women experienced when combing breastfeeding with return to paid employment. Gender inequalities, especially in low- and middle-income countries, in accessing support exacerbated the difficulties women experienced. Limited data were identified regarding employers' experiences and views, suggesting an urgent need for further research to explore employers' and work colleagues' experiences and views.

Association between duration of exclusive breastfeeding and nursing mothers' self-efficacy for breastfeeding

OBJECTIVE

To verify the association of nursing mothers' self-efficacy for breastfeeding in the immediate postpartum period and six months after birth and obstetric and sociodemographic variables with the duration of exclusive breastfeeding.

METHOD

Observational, longitudinal, prospective study which followed nursing mothers from the immediate postpartum period to the sixth month postpartum in a municipality in Southern Brazil. For data collection, a questionnaire with sociodemographic and obstetric variables and the scale Breastfeeding Self-Efficacy Scale - short form - were employed in the maternity ward and six months after birth. Inferential and descriptive statistics were employed.

RESULTS

A total of 158 nursing mothers have participated. The prevalence of exclusive breastfeeding in the sixth month was 36.70%, out of which 77.34% have presented a high self-efficacy score. Sociodemographic factors had a negative impact on exclusive breastfeeding.

CONCLUSION

High levels of self-efficacy favor exclusive breastfeeding; however, such factor, in isolation, is not decisive for exclusive breastfeeding. Self-efficacy should be identified during the pre-natal period through mothers' employment and marital status data to promote preventive actions against early weaning.

Description of an mHealth tool for breastfeeding support: LactApp. Analysis of how lactating mothers seek support at critical breastfeeding points and according to their infant's age

Interventions in mHealth have had positive effects on establishing and maintaining breastfeeding, but we still do not know what content women consult when downloading a breastfeeding mobile application. We conducted an observational, descriptive, and retrospective study using the data recorded by LactApp in 2019. The most frequently consulted topics were those related to breastfeeding technique, infant sleep, human milk management and storage, breastfeeding myths, breastfeeding stages, complementary feeding, infant care, and returning to work. Our study results suggest that LactApp's support seems to develop with mothers' needs according to their infant's development stage. The first breastfeeding days include more physiological answers. Between 15 days and 3 months, mothers look for support in topics like breastfeeding crisis/complications and returning to work. At 3 months to 1 year, answers are related to complementary feeding and weaning. When the user's infant is 1 year of age, mothers seek support for weaning, weaning management, and tandem breastfeeding.

Pregnant Women's Experiences of Social Roles: An Ethnophenomenological Study

Background:

The role of women and men is changing across the world, and women, including pregnant women, are adopting newer roles in traditional societies like Iran. This study aimed to explore the meaning of pregnant women's experiences regarding their social roles in the sociocultural context of Iran.

Materials and Methods:

This study was carried out using an ethnophenomenological approach. Participants included 16 pregnant women who attended health centers, hospitals, and private obstetric clinics in Mashhad, Iran, between 2016 and 2017 and were selected based on purposive sampling. In-depth semistructured interviews, vignette interviews, participant observations, and field notes were used to collect data. To analyze data, six-step van Manen's (1997) descriptive-interpretive phenomenological approach was used.

Results:

Through data analysis, the overarching theme of “selection, management, and adjustment of various roles to play social roles” was emerged. This was consisted of four themes: “Mother's perspective regarding out-of-home employment, incompatibility between pregnancy and social roles, mother's management strategies to play different roles, and husband's authority regarding mother's employment.”

Conclusions:

The consequence of reciprocal endeavors of pregnant women along with their husbands as well as their work environment expectations tends to selection, management, and adjustment of feminine roles. Since the employment of pregnant women leads to their more physical and psychological involvement, not only the problems of working women but also the expectations and rules of the workplaces as well as the requests of their husbands should be taken into account.

Keep Doing the Good Work: Impact of Coworker and Community Support on Continuation of Breastfeeding

Returning to work poses a challenge to new mothers' breastfeeding success during the first 6 months postpartum. While previous research has shown that breastfeeding-related workplace policy plays a significant role in women's decision to continue breastfeeding, the extent to which interpersonal factors such as coworkers' (lack of) support and stigma affect women's breastfeeding behavior is less understood. Through a cross-sectional survey with 500 working mothers, this research found that female coworker support of other women played an important role in affecting mothers' decision to continue breastfeeding after returning to work and contributed to breastfeeding self-efficacy. The findings suggest that mothers' perception of supportive coworker communication has an impact on sustained breastfeeding. Workplaces need to enhance the mother-friendly climate by encouraging and rewarding coworkers and providing support necessary for breastfeeding colleagues.

Clinician's Guide to Supporting Women With Breast Milk Pumping

The benefits of breastfeeding and breast milk are well established. Women may intend to exclusively breastfeed their infants, but they often need to provide expressed breast milk upon returning to employment or other activities. Without specialized lactation services, women may turn to health care providers, social media, and Web-based information for support and education. Nurses can support breastfeeding women and help them make informed decisions by providing factual, practical information about breast pumps, expression and storage of breast milk, options for testing breast milk, and available resources.

Maternal challenges of exclusive breastfeeding and complementary feeding in Ghana

Mothers are recommended to exclusively breastfeed their infants for the first six months of their lives. Also, after the sixth month, breastfeeding should continue with added complementary foods to the diets of children. Studies designed to sought the views of mothers on breastfeeding practices are limited. The aim of this study was to explore challenges to breastfeeding practices by considering spatial, societal and maternal characteristics in Ghana. Twenty mothers aged 15–49 years were interviewed purposively in selected communities within two regions of the country. Thematic content analytical procedures were applied to interpret and present findings. Challenges (to both exclusive breastfeeding and complementary feeding) spanned across spatial (home and work places), societal, and maternal characteristics. Key themes identified were in relation to household chores, work schedules, family influence, low breast milk production, swollen breasts or sore nipples, access to food items and preparation or giving foods. Addressing these challenges would require co-creation of supportive environments between couples and significant others as well as tackling institutional barriers that obstruct adequate breastfeeding among mothers. On complementary feeding, there is the need to form community health volunteers help educate mothers more on how to appropriately use local foods to feed their children.

Maternal breastfeeding: indicators and factors associated with exclusive breastfeeding in a subnormal urban cluster assisted by the Family Health Strategy

OBJECTIVE

To describe and analyze indicators of feeding practices related to breastfeeding and factors associated with exclusive breastfeeding (EBF) in a subnormal urban cluster (slums) in Pernambuco, Brazil.

METHODS

Four breastfeeding indicators were used to interview mothers of children under 3 years of age. An inventory of the families' socioeconomic and environmental factors, maternal obstetric history, and basic health care access was undertaken. The sample consisted of all 310 children under the age of 3 years from Coelhos, PE, Brazil. Spearman's correlation was carried out, as well as crude and adjusted prevalence ratios for a final statistical model that showed associated factors with the main outcome at a level of 0.05.

RESULTS

The prevalence of breastfeeding in the first hour of life, exclusive breastfeeding up to 6 months, continued breastfeeding at 1 year, and continued breastfeeding at 2 years were 60.2%, 32.9%, 45.9, and 35.9%, respectively. A correlation was observed between start of pacifier use and duration of either exclusive (r_s=0.358 [p<0.001]) or non-exclusive breastfeeding (r_s=0.248 [p=0.006]). Maternal age over 35 years (p<0.001), home visit in the first week after birth (p=0.003), having had a male baby (p=0.029), and not using a pacifier (p<0.001) remained protective factors in the final model.

CONCLUSION

The prevalence rates of exclusive breastfeeding at 6 months were well above the results obtained by other Brazilian authors. Home visit and maternal age prevailed as protective factors, while pacifier use was shown to be a discouraging practice.