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Moulton KL, Izuno SA, Prendergast N, Battaglioli N, Sebok‐Syer SS. Alleviating stressfeeding in the emergency department: Elucidating the tensions induced by workplace lactation space issues. J Am Coll Emerg Physicians Open 2024; 5:e13226. [PMID: 39045487 PMCID: PMC11264252 DOI: 10.1002/emp2.13226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/10/2024] [Accepted: 06/06/2024] [Indexed: 07/25/2024] Open
Abstract
Objectives Women remain underrepresented in the emergency medicine (EM) workforce, academic EM, and institutional leadership. In order to support women physicians in EM, we must explore factors that contribute to attrition and workplace satisfaction. For example, tensions between workplace and familial roles are important to consider as women navigate careers in EM. The logistics and stressors of workplace lactation pose a particular challenge during an already stressful time for a new mother returning to work in a busy emergency department (ED), but limited empirical data exist regarding this experience. We aimed to explore the stressors associated with workplace lactation spaces in order to better inform the creation of lactation spaces for individuals working in EDs. Methods Our team used an exploratory qualitative design to investigate lactation-specific stressors and understand their relationship to individuals' needs when lactating in EM workplace environments. A total of 40 individuals were interviewed, highlighting post-pregnancy return-to-work (RTW) experiences of medical students, residents, advanced practice professionals, nurses, fellows, and faculty. Interviews were coded and analyzed using thematic analysis. Results We identified both tangible and intangible characteristics of lactation spaces that contribute to stress for lactating individuals. Additionally, we discovered that participants frequently noted a desire to work simultaneously while pumping in order to feel they were self-actualizing in their dual roles of parent and clinician. Among tangible items, access to a computer within lactation space was a key driver of ability to fulfill dual roles. Among intangible characteristics, we identified three distinct, yet interrelated, subthemes, including the need for lactation spaces to be respectful of individuals' time, privacy, and general health and well-being. Conclusions This study suggests that meeting basic lactation needs with thoughtfully designed lactation spaces can empower individuals in their roles both as a lactating parent and a clinician. EM leadership can evaluate existing lactation spaces to ensure they meet the tangible and intangible needs of lactating physicians, trainees, advanced practice professionals, and nurses.
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Affiliation(s)
| | - Samantha A. Izuno
- Department of Emergency MedicineStanford UniversityPalo AltoCaliforniaUSA
| | - Nicole Prendergast
- Department of Emergency MedicineWake Forest UniversityWinston‐SalemNorth CarolinaUSA
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Lowenfels A, Murphy M, Archibald A, Avellino S, Potestio K. Implementing Policy and Practice Changes to Support Breastfeeding Duration in New York State Communities. Prev Chronic Dis 2024; 21:E50. [PMID: 38991534 PMCID: PMC11262138 DOI: 10.5888/pcd21.240003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
The health benefits of breastfeeding are well-documented, but rates of breastfeeding duration in the US fall below national targets - especially when mothers have less education, have lower incomes, are non-Hispanic Black, or live in nonmetropolitan areas. The Creating Breastfeeding Friendly Communities program was designed to promote breastfeeding and reduce disparities by implementing policy and practice changes in worksites from 2017 through 2023. The purpose of this evaluation was to determine whether the program was effective in increasing breastfeeding supports and addressing disparities. We used a 14-item tool to assess breastfeeding policies and practices at baseline and follow-up at each worksite. We used number of employees to determine worksite size, and we used worksite address to calculate social vulnerability of the community where each site was located and to classify rurality of the county where sites were located. We found significant improvements in the number and quality of breastfeeding supports available at participating worksites (N = 292 at baseline and follow-up). The program successfully reached worksites in socially vulnerable communities. Supports for breastfeeding increased in all worksite subgroups, but they increased less at worksites that were small or rural. The evaluation supports the effectiveness of worksite lactation programs and protective labor laws. Findings suggest that special attention must be given to worksites that are small, located in socially vulnerable communities, or rural counties, to support implementation and reduce disparities.
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Affiliation(s)
- Ann Lowenfels
- Bureau of Chronic Disease Evaluation and Research, New York State Department of Health, 1084 Corning Tower, Empire State Plaza, Albany, NY 12237
| | - Megan Murphy
- Bureau of Chronic Disease Evaluation and Research, New York State Department of Health, Albany
| | - Abbie Archibald
- Bureau of Chronic Disease Evaluation and Research, New York State Department of Health, Albany
| | - Sarah Avellino
- Bureau of Chronic Disease Evaluation and Research, New York State Department of Health, Albany
| | - Katie Potestio
- Bureau of Community Chronic Disease Prevention, New York State Department of Health, Albany
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Ryan RA, Hepworth AD, Bihuniak JD, Lyndon A. A Qualitative Study of Breastfeeding Experiences Among Mothers Who Used Galactagogues to Increase Their Milk Supply. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:122-132. [PMID: 38159094 DOI: 10.1016/j.jneb.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To qualitatively describe breastfeeding experiences among mothers who used galactagogues to increase their milk supply. DESIGN One-time, semistructured phone interviews. SETTING US. PARTICIPANTS Breastfeeding mothers (n = 19) who reported ever consuming foods, beverages, or herbal supplements to increase their milk supply in a cross-sectional online survey were purposefully sampled to participate in this qualitative study. Participants were diverse in terms of race and ethnicity, education, income, infant age (0-18 months), and prior breastfeeding experience (32% first-time breastfeeding). PHENOMENON OF INTEREST Reasons for trying to increase milk supply, sources of information about increasing milk supply, and strategies tried to increase milk supply. ANALYSIS Interviews were transcribed verbatim and analyzed using reflexive thematic analysis. RESULTS Participants expressed determination and commitment to breastfeeding but unexpectedly struggled to breastfeed and increase their milk supply. They sought information from multiple sources and used individualized approaches to address milk supply concerns on the basis of recommendations from others, as well as the perceived convenience, cost, palatability, and safety of potential strategies. CONCLUSIONS AND IMPLICATIONS Results suggest a need to expand breastfeeding education and support so that lactating parents anticipate common breastfeeding challenges and are aware of evidence-based strategies for increasing their milk supply.
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Affiliation(s)
- Rachel A Ryan
- Department of Nutrition and Food Studies, New York University, New York, NY; Public Health Nutrition, School of Global Public Health, New York University, New York, NY.
| | | | | | - Audrey Lyndon
- Rory Meyers College of Nursing, New York University, New York, NY
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Berical KA, Vogel TS, Robinson JM, Ward AM, Wiener-Kronish J. Championing the Mom: The Role of a Mother's Support Group in Academic Anesthesia Practice. Anesth Analg 2023; 137:777-781. [PMID: 37712469 DOI: 10.1213/ane.0000000000006575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Affiliation(s)
- Kinza A Berical
- From the Harvard Medical School, Boston, Massachusetts
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Talia S Vogel
- From the Harvard Medical School, Boston, Massachusetts
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jill M Robinson
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Anna M Ward
- Mayo Clinic College of Medicine and Science, Phoenix, Arizona
- Department of Anesthesiology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Jeanine Wiener-Kronish
- From the Harvard Medical School, Boston, Massachusetts
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Nyhus Dhillon C, Ortenzi F. Assessing the Impact of Workforce Nutrition Programmes on Nutrition, Health and Business Outcomes: A Review of the Global Evidence and Future Research Agenda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095733. [PMID: 37174251 PMCID: PMC10178561 DOI: 10.3390/ijerph20095733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
One in three people globally suffers from at least one form of malnutrition, leading to poor health outcomes and low productivity in the workplace. The workplace offers an important, relatively unexploited opportunity to address malnutrition in all its forms. This narrative literature review aims to understand the impact of workforce nutrition programmes on nutrition, health, and business outcomes, based on high-strength-of-evidence studies. We used PubMed as our primary research database, complemented by Google Scholar, to identify systematic reviews, meta-analyses, and randomised controlled trials published between January 2010 and October 2021. In total, 26 records were included. We found that comprehensive workforce nutrition programmes, including a variety of intervention areas, and/or programmes targeting high-risk categories of workers (overweight/obese or (pre-)diabetic) were more likely to be effective on nutrition, health, and business outcomes. Within comprehensive and targeted programmes, individualised counselling and worksite environmental modifications were often mentioned as the most effective components. However, a high degree of heterogeneity in outcome measures and programme designs made it difficult to draw strong conclusions on the impact of workforce nutrition interventions. Limited evidence was found on business outcomes, longer-term effects of interventions, and programme implementation in LMICs. Therefore, further research is needed to address these evidence gaps.
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Affiliation(s)
| | - Flaminia Ortenzi
- The Global Alliance for Improved Nutrition (GAIN), 1202 Geneva, Switzerland
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Souza CBD, Melo DS, Relvas GRB, Venancio SI, Silva RPGVCD. Promotion, protection, and support of breastfeeding at work, and achieving sustainable development: a scoping review. CIENCIA & SAUDE COLETIVA 2023; 28:1059-1072. [PMID: 37042888 DOI: 10.1590/1413-81232023284.14242022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/28/2022] [Indexed: 04/13/2023] Open
Abstract
This article aims to map promotion, protection, and support strategies aimed at working women who breastfeed and their potential impact on achieving the Sustainable Development Goals (SDGs), in particular SDGs 5 (gender equality and women's empowerment) and 8 (decent work and economic growth). This study is a scoping review based on the Joanna Briggs Institute (JBI) framework, whose searches were performed in PubMed, Web of Science, Scopus, Social Science Research Network, and Open Knowledge Repository databases. This study's search obtained 576 publications, of which 33 were included in the study. The narrative synthesis was organized into three axes: 1) promotion; 2) protection, and 3) support for breastfeeding in the work context. Actions aimed at women who breastfeed at work have the potential to directly achieve SDGs 5 and 8, and indirectly achieve SDGs 1 and 10. Increased breastfeeding rates also help to achieve another four SDGs (2, 3, 4, 12). Actions aimed at working women who breastfeed can contribute directly and indirectly to the achievement of eight of the 17 SDGs, and should therefore be encouraged and reinforced.
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Affiliation(s)
- Carolina Belomo de Souza
- Departamento de Pediatria, Universidade Federal do Paraná. R. General Carneiro 181, 14º andar, Alto da Glória. 80060-900 Curitiba PR Brasil.
| | - Daiane Sousa Melo
- Faculdade de Saúde Pública, Universidade de São Paulo. São Paulo SP Brasil
| | - Gláubia Rocha Barbosa Relvas
- Escritório Regional de Saúde de Barra do Garças, Secretaria de Estado de Saúde de Mato Grosso. Barra do Garças MT Brasil
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Roig-Romero RM, Livingston TA, Schafer EJ, Reyes Martinez E, Wachira M, Marhefka S. The State of our Breastfeeding Friendly Childcare Programs: Ten Years After the 2011 Surgeon General's Call to Action to Support Breastfeeding. J Hum Lact 2022; 38:477-486. [PMID: 35587182 DOI: 10.1177/08903344221097321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Ten years ago, the U.S. Surgeon General's Call to Action to Support Breastfeeding made recommendations for childcare settings, including: (1) accommodating and supporting breastfeeding families; and (2) adopting national guidelines on breastfeeding support in childcare settings. RESEARCH AIMS To (1) describe the existing breastfeeding friendly childcare designation programs in the United States; and (2) describe how states are accommodating breastfeeding families in childcare settings. METHOD The study design was cross-sectional, prospective thematic description of existing publicly available documents. A search of state breastfeeding coalitions was conducted to assess the number of states with breastfeeding friendly childcare designation programs. A definitive yes-or-no answer regarding whether each state had a program was obtained from all 50 states. For states with programs, designation materials were analyzed using thematic analysis and the framework method to compare designation components. RESULTS Fifteen states had evidence of breastfeeding friendly childcare designation programs and similarities exist across designation program components. Four standards were common to all 15 programs: written policy on breastfeeding, suitable space within the center where mothers can breastfeed or express their milk, educational materials, and resources on breastfeeding available to parents. Most states required self-assessment to achieve designation status. CONCLUSION Research is needed to enable evidence-based programs and decision-making regarding components and processes. Federal funding should support these programs' mission, including funding research to assess how and in what circumstances these programs are improving breastfeeding-related outcomes and supporting breastfeeding families.
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Affiliation(s)
| | - Taylor A Livingston
- School of Global Integrative Studies, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Ellen J Schafer
- Department of Public Health & Population Science, Boise State University College of Health Sciences, Boise, ID, USA
| | | | - Maret Wachira
- Florida Department of Health in Citrus County, Tallahassee, FL, USA
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Affiliation(s)
- Leah S Aldridge
- National Lactation Consultant Alliance, Inc., Atlanta, GA, USA
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Ickes SB, Sanders H, Denno DM, Myhre JA, Kinyua J, Singa B, Lemein HS, Iannotti LL, Farquhar C, Walson JL, Nduati R. Exclusive breastfeeding among working mothers in Kenya: Perspectives from women, families and employers. MATERNAL & CHILD NUTRITION 2021; 17:e13194. [PMID: 33949782 PMCID: PMC8476403 DOI: 10.1111/mcn.13194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/22/2021] [Accepted: 03/26/2021] [Indexed: 12/01/2022]
Abstract
Exclusive breastfeeding (EBF) for the first 6 months of life improves survival, growth and development. In Kenya, recent legislation and policies advocate for maternity leave and workplace support for breastfeeding and breast milk expression. We conducted a qualitative study to describe factors influencing EBF for 6 months among mothers employed in commercial agriculture and tourism. We interviewed employed mothers (n = 42), alternate caregivers and employed mothers' husbands (n = 20), healthcare providers (n = 21), daycare directors (n = 22) and commercial flower farm and hotel managers (n = 16) in Naivasha, Kenya. Despite recognizing the recommended duration for EBF, employed mothers describe the early cessation of EBF in preparation for their return to work. Managers reported supporting mothers through flexible work hours and duties. Yet, few workplaces have lactation spaces, and most considered adjusting schedules more feasible than breastfeeding during work. Managers and healthcare providers believed milk expression could prolong EBF but thought mothers lack experience with pumping. The most frequently suggested interventions for improving EBF duration were to expand schedule flexibility (100% of groups), provide on-site daycare (80% of groups) and workplace lactation rooms (60% of groups), improve milk expression education and increase maternity leave length (60% of groups). Returning to work corresponds with numerous challenges including lack of proximate or on-site childcare and low support for and experience with milk expression. These factors currently make EBF for 6 months unattainable for most mothers in these industries. Interventions and supports to improve breastfeeding upon return to work are recommended to strengthen employed mothers' opportunity for EBF.
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Affiliation(s)
- Scott B. Ickes
- Department of Applied Health ScienceWheaton CollegeWheatonIllinoisUSA
- Department of Health ServicesUniversity of WashingtonSeattleWashingtonUSA
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Kenya Medical Research InstituteNairobiKenya
| | - Hannah Sanders
- Department of Applied Health ScienceWheaton CollegeWheatonIllinoisUSA
| | - Donna M. Denno
- Department of Health ServicesUniversity of WashingtonSeattleWashingtonUSA
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
- Childhood Acute Illnesses Network (CHAIN)NairobiKenya
| | - Jennifer A. Myhre
- Naivasha Sub‐County Referral Hospital, Serge East AfricaNaivashaKenya
| | | | | | | | - Lora L. Iannotti
- Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
| | - Carey Farquhar
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Departments of Medicine (Allergy and Infectious Disease) and EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Judd L. Walson
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
- Childhood Acute Illnesses Network (CHAIN)NairobiKenya
- Departments of Medicine (Allergy and Infectious Disease) and EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Ruth Nduati
- Department of Pediatrics and Child HealthUniversity of NairobiNairobiKenya
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Chang YS, Harger L, Beake S, Bick D. Women's and Employers' Experiences and Views of Combining Breastfeeding with a Return to Paid Employment: A Systematic Review of Qualitative Studies. J Midwifery Womens Health 2021; 66:641-655. [PMID: 34423557 DOI: 10.1111/jmwh.13243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Yan-Shing Chang
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Laura Harger
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.,Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Sarah Beake
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Warwick, United Kingdom
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Female Employees' Perception of Breastfeeding Support in the Workplace, Public Universities in Spain: A Multicentric Comparative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176402. [PMID: 32887489 PMCID: PMC7504108 DOI: 10.3390/ijerph17176402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite scientific recommendations for exclusive breastfeeding until 6 months of age and complementary breastfeeding to 2 years of age, breastfeeding abandonment rates increase with time, and one of the main reasons is that women go back to work. AIM To analyze the perception of support of breastfeeding workers to continue breastfeeding at two Spanish universities, and associated factors. METHODS A multicenter retrospective cross-sectional comparative study conducted in a population of 777 female workers at the Universidad de Sevilla (US) and the Universitat Jaume I (UJI) in Spain using an online questionnaire. RESULTS The response rate was 38.74% (n = 301). Of all the participants, 57.8% continued breastfeeding after returning to work. The factors associated with continuing breastfeeding for longer were the university having a breastfeeding support policy and special accommodation (p < 0.001); participating in breastfeeding support groups (p < 0.001); intending to continue breastfeeding after returning to work (p < 0.001); knowing the occupational legislation in force (p = 0.009); having a female supervisor (p = 0.04). CONCLUSION Breastfeeding support initiatives and having special accommodation to pump and preserve breast milk after returning to work are associated with a longer duration of female workers' breastfeeding.
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