Experiences of workplace breastfeeding in a provincial government setting: a qualitative exploratory study among managers and mothers in South Africa

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.

"I Have to Stand Up on My Own and Do the Best I Can for My Kids"a: Work (Re-)entry Among New Mothers Living with HIV in Cape Town, South Africa

In recent years, significant progress has been made in treatment access for women living with HIV (WLHIV). For example, option B+, which requires that all pregnant persons who test positive for HIV start on antiretroviral treatment, has been instrumental in reducing the risk of vertical transmission. For birthing individuals who have a low HIV viral load, there is a minimized risk of vertical transmission during breastfeeding. However, an alarming rate of WLHIV in South Africa disengage from care during postpartum. Given that work is intricately linked to individuals' socioeconomic status, and thus health outcomes, and their health-seeking ability, it is important to explore the role of work in decisions that impact HIV-related care for the dyad postpartum. Semi-structured interviews were conducted with 26 women living with HIV at 6-8 weeks postpartum in Cape Town, South Africa. A secondary qualitative data analysis was conducted following thematic content analysis. Three themes were identified, spanning participants' financial considerations, navigating childcare needs, and considerations for exclusive breastfeeding. For many participants, there was often a conflict between returning to work, childcare, and the decision whether or not to breastfeed-in addition to their HIV care. This conflict between participants' commitments suggests an increased pressure that WLHIV may face postpartum, which could impact their ability to remain engaged in their healthcare and adherent to medication. Although exclusive breastfeeding is an important recommendation for the baby's health outcomes; there is a need for structural support for WLHIV as they navigate work re-entry during postpartum.

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.

Continuing breastfeeding upon returning to work: feelings, challenges and strategies of breastfeeding nurses

OBJECTIVE

To describe feelings, challenges and strategies related to the continuity of breastfeeding after returning to work in the perception of lactating nurses.

METHOD

Descriptive, exploratory, qualitative study, with snowball sampling. Data collection occurred virtually between August and September 2020 in the State of Rio de Janeiro. Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software and a thematic analysis were used.

RESULTS

42 breastfeeding nurses participated and cited fear, missing the child, anguish, and pleasure in returning to work. Challenges such as lack of infrastructure for pumping the breast in health services, unfavorable scales, and multiple jobs were reported. Support networks, listening spaces, and appropriate times and places for breast milk pumping were mentioned as strategies.

CONCLUSION

Different feelings and challenges for the continuity of breastfeeding upon returning to work were identified; some strategies found were common to other working women while others related to the specific nursing work context.

Maternity protection policies and the enabling environment for breastfeeding in the Philippines: a qualitative study

BACKGROUND

The Philippines has enacted maternity protection policies, such as the 105-Day Expanded Maternity Leave Law and the Expanded Breastfeeding Promotion Act of 2009, to protect, promote, and support breastfeeding. This study aimed to review the content and implementation of maternity protection policies in the Philippines and assess their role in enabling recommended breastfeeding practices. It also identified bottlenecks to successful implementation from the perspectives of mothers and their partners, employers, and authorities from the government and non-government organizations involved in developing, implementing, monitoring, and enforcing maternity protection policies.

METHODS

This study employed a desk review of policies, guidelines, and related documents on maternity protection, and in-depth interviews. Of the 87 in-depth interviews, there were 12 employed pregnant women, 29 mothers of infants, 15 partners of the mothers, 12 employers and 19 key informants from the government and non-government organizations. Respondents for the in-depth interviews were from the Greater Manila Area and were recruited using purposive snowball sampling. Data were collected from December 2020 to April 2021.

RESULTS

The study shows that maternity protection policies in the Philippines are mostly aligned with the maternity protection standards set by the International Labour Organization. However, their role in improving breastfeeding practices is limited because: (1) not all working women have access to maternity protection entitlements; (2) the duration of maternity leave entitlements is inconsistent with the World Health Organization's recommended duration of exclusive breastfeeding; (3) there are gaps in policy implementation including: a lack of monitoring systems to measure the availability, functionality, and usage of lactation spaces; limited workplace support for breastfeeding; poor communication of maternity and paternity entitlements; and limited breastfeeding advocacy and promotion; and (4) there is limited integration between maternity protection and breastfeeding promotion interventions.

CONCLUSIONS

There is a need to (1) strengthen communication about and promotion of maternity and paternity entitlements for mothers, fathers and employers, (2) improve monitoring and enforcement mechanisms to ensure utilization of entitlements among mothers, (3) develop modalities to extend the coverage of maternity entitlements to the informal sector, (4) fully cover paid leave entitlements from social insurance or public funding sources in line with International Labour Organization recommendations, and (5) revisit the limitations on the coverage of paternity entitlement.

Knowledge, understanding and perceptions of key stakeholders on the maternity protection available and accessible to female domestic workers in South Africa

Maternity protection enables women to combine reproductive and productive roles. Domestic workers are a vulnerable group due to heterogeneous non-standard employment relationships and are unlikely to have access to comprehensive maternity protection. This study aimed to explore the knowledge, understanding and perceptions of key stakeholders in government, trade unions, non-governmental organisations and other relevant organisations of the maternity protection entitlements that should be available and accessible to female domestic workers in South Africa. This qualitative cross-sectional study included in-depth interviews with fifteen stakeholders working in different sectors in South Africa and mainly at a national level involved in maternity protection availability and access. Results show that stakeholders appear to have limited understanding of comprehensive maternity protection. Many challenges related to accessing cash payments while on maternity leave were described and suggestions were provided for how this could be improved. Participants described how certain labour-related characteristics unique to the domestic work sector were barriers in accessing maternity protection. Ensuring greater awareness of all components of maternity protection and improving implementation of existing labour legislation intended to guarantee maternity protection for non-standard workers in South Africa is important to improve access to maternity protection for this vulnerable group. Improved access to maternity protection would contribute to optimal maternal and new-born health and ensure economic security for women around the time of childbirth.

A PowerPack of SuperScientists: An innovative concept by African scientists to address gender bias and inequity in science

Underrepresentation of women in scientific leadership is a global problem. To understand and counter narratives that limit gender equity in African science, we conducted a public engagement campaign. Scientists representing six sub-Saharan African countries and multiple career stages used superhero imagery to create a diverse and unified team advocating for gender equity in science. In contrast to many traditional scientific environments and global campaigns, this "PowerPack of SuperScientists" was led by early-career Black female scientists whose perspectives are often under-represented in discussions about gender equity in science. The superhero imagery served as a powerful and fun antidote to imposter syndrome and helped to subvert traditional power structures based on age, race and sex. In an interactive social media campaign, the PowerPack developed insights into three themes: a) cultural stereotypes that limit women's scientific careers, b) the perception of a "conflict" between family and career responsibilities for women scientists, and c) solutions that can be adopted by key stakeholders to promote gender equity in African science. The PowerPack proposed solutions that could be undertaken by women working individually or collectively and interventions that require allyship from men, commitment from scientific institutions, and wider societal change. Further work is required to fully engage African scientists from even more diverse and disadvantaged backgrounds and institutions in these solutions and to enhance commitment by different stakeholders to achieving gender equity in science. Our experience suggests that creative tools should be used to subvert power dynamics and bring fresh perspectives and urgency to this topic.

A PowerPack of SuperScientists: An innovative concept by African scientists to address gender bias and inequity in science

Underrepresentation of women in scientific leadership is a global problem. To understand and counter narratives that limit gender equity in African science, we conducted a public engagement campaign. Scientists representing six sub-Saharan African countries and multiple career stages used superhero imagery to create a diverse and unified team advocating for gender equity in science. In contrast to many traditional scientific environments and global campaigns, this “PowerPack of SuperScientists” was led by early-career Black female scientists whose perspectives are often under-represented in discussions about gender equity in science. The superhero imagery served as a powerful and fun antidote to imposter syndrome and helped to subvert traditional power structures based on age, race and sex. In an interactive social media campaign, the PowerPack developed insights into three themes: a) cultural stereotypes that limit women’s scientific careers, b) the perception of a “conflict” between family and career responsibilities for women scientists, and c) solutions that can be adopted by key stakeholders to promote gender equity in African science. The PowerPack proposed solutions that could be undertaken by women working individually or collectively and interventions that require allyship from men, commitment from scientific institutions, and wider societal change. Further work is required to fully engage African scientists from even more diverse and disadvantaged backgrounds and institutions in these solutions and to enhance commitment by different stakeholders to achieving gender equity in science. Our experience suggests that creative tools should be used to subvert power dynamics and bring fresh perspectives and urgency to this topic.

A influência do retorno ao trabalho no aleitamento materno de trabalhadoras da enfermagem

Resumo Objetivo analisar a influência do retorno ao trabalho de mães trabalhadoras da enfermagem no aleitamento materno. Método pesquisa qualitativa, desenvolvida por meio de formulário semiestruturado, via Google Forms, junto a 49 trabalhadoras de enfermagem do estado do Rio de Janeiro. Os dados foram submetidos à análise lexicográfica, com auxílio do software Interface de R pour Analyses Multidimensionnelles de Textes Et de Questionnaires (IRAMUTEQ), pelo método de Nuvem de Palavras e Classificação Hierárquica Descendente. Resultados o aproveitamento do corpus textual foi de 88,24%, gerando quatro classes de segmentos de texto. As principais influências do retorno ao trabalho na amamentação relatadas pelas participantes foram: a falta de apoio dos chefes e colegas de trabalho, a necessidade de local e tempo adequados para ordenha do leite materno, a diminuição na produção de leite por fatores inerentes ao trabalho e sobrecarga e ambientes insalubres de trabalho na enfermagem. Conclusão e implicações para a prática a identificação desses fatores possibilita a compreensão das demandas das nutrizes participantes e aponta para a necessidade de estratégias inovadoras, que garantam o direito das trabalhadoras, assim como adequações de infraestrutura em seus ambientes laborais.