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Daniels LC, Mbhenyane XG, Du Plessis LM. Development of a workplace breastfeeding support practice model in South Africa. Int Breastfeed J 2024; 19:32. [PMID: 38711120 DOI: 10.1186/s13006-024-00638-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/19/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Globally, mothers have identified work as one of the main obstacles to exclusive and continued breastfeeding. The support a woman receives in her workplace in terms of workplace arrangements can be critical to enable women to continue breastfeeding. This study aimed to develop and assess the face validity of a practice model to support exclusive and continued breastfeeding in workplaces in the Western Cape, South Africa. METHODS An explanatory, sequential, mixed-method research design, was conducted (June 2017 to March 2019) in three distinct phases. Phase one employed a quantitative, descriptive, cross-sectional study design. Phase 2 used a qualitative, multiple case study. Phase three involved the development and face validity of a practice model to support exclusive breastfeeding in workplaces. The face validity included two Delphi rounds for experts to provide input on the draft practice model. This paper will only report on phase 3 of the study. The practice model was developed, drawing on the analysis of data from phases one and two and using programme theory approaches and a logic model. RESULTS The practice model was positively perceived. Participants viewed it as informative, well designed and easy to follow, even for those not knowledgeable about the subject. It was viewed as an ideal tool, if accompanied by some training. Participants were positive that the model would be feasible and most commended the tiered approach to implementation. They felt that workplaces would be more open to a step-by-step approach to implementation and if only a few activities are implemented it would be a start to make the work environment more conducive for breastfeeding employees. There were mixed opinions regarding commitment; a few participants mentioned commitment as a challenge they anticipated in the male-dominant environments in which they worked. The provision of space for breastfeeding at the workplace was also highlighted as a potential challenge. CONCLUSIONS Advocacy around creating an enabling workplace environment for breastfeeding is needed. The practice model has the potential to be internationally relevant, locally applied and may be of particular use to workplaces that want to initiate and/or strengthen breastfeeding support.
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Affiliation(s)
- Lynette Carmen Daniels
- Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Xikombiso Gertrude Mbhenyane
- Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lisanne Monica Du Plessis
- Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Ickes SB, Adams JN, Sanders HK, Kinyua J, Lemein HS, Denno DM, Myhre JA, Ithondeka A, Farquhar C, Singa B, Walson JL, Nduati R. Access to Workplace Supports is Positively Associated with Exclusive Breastfeeding among Formally Employed Mothers in Kenya. J Nutr 2023; 152:2888-2897. [PMID: 36040327 PMCID: PMC9839982 DOI: 10.1093/jn/nxac160] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/13/2022] [Accepted: 07/22/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Mothers in low-income settings who work in agricultural employment are challenged to meet breastfeeding (BF) recommendations. Recent legislation in Kenya mandates maternity leave and workplace supports, yet the relation of these benefits with BF practices is poorly understood. OBJECTIVES We evaluated the associations with workplace-provided BF supports and BF practices among formally employed mothers in Kenya. The availability of supports was hypothesized to be associated with a higher prevalence and greater odds of exclusive breastfeeding (EBF). METHODS We conducted repeated cross-sectional surveys among formally employed mothers at 1-4 d and 6, 14, and 36 wk (to estimate 24 wk) postpartum in Naivasha, Kenya. We used logistic regression adjusted for maternal age, education, physical burden of work, HIV status, and income to evaluate associations between workplace supports and EBF practices. RESULTS Among formally employed mothers (n = 564), those who used onsite workplace childcare were more likely to practice EBF than those who used community- or home-based childcare at both 6 wk (95.7% compared with 82.4%, P = 0.030) and 14 wk (60.6% compared with 22.2%, P < 0.001; adjusted OR: 5.11; 95% CI: 2.3, 11.7). Likewise, at 14 wk among mothers who currently used daycare centers, a higher proportion of mothers who visited daycare centers at or near workplaces practiced EBF (70.0%) than of those not visiting daycare centers (34.7%, P = 0.005). EBF prevalence was higher among mothers with access to workplace private lactation spaces than among mothers without such spaces (84.6% compared with 55.6%, P = 0.037), and among mothers who lived in workplace housing than those without onsite housing (adjusted OR: 2.06, 95% CI: 1.25, 3.41). CONCLUSIONS Formally employed mothers in Kenya who have access to and use workplace-provided BF supports were more likely to practice EBF than mothers who lacked these supports. As the Kenya Health Act is implemented, lactation rooms, onsite housing and daycare, and transportation to visit children can all support BF and EBF among employed mothers.
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Affiliation(s)
- S B Ickes
- Department of Biological and Health Sciences, Wheaton College, IL, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine (Allergy and Infectious Disease), University of Washington, Seattle, WA, USA
| | - J N Adams
- Department of Biological and Health Sciences, Wheaton College, IL, USA
| | - H K Sanders
- Department of Biological and Health Sciences, Wheaton College, IL, USA
| | - J Kinyua
- Department of Medicine (Allergy and Infectious Disease), University of Washington, Seattle, WA, USA
| | - H S Lemein
- Department of Medicine (Allergy and Infectious Disease), University of Washington, Seattle, WA, USA
| | - D M Denno
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Deparment of Pediatrics, University of Washington, Seattle, WA, USA
- Childhood Acute Illnesses Network (CHAIN), Nairobi, Kenya
| | - J A Myhre
- Naivasha Sub-County Referral Hospital, Naivasha, Kenya
- Serge, East Africa, Bundibugyo, Uganda
| | - A Ithondeka
- Naivasha Sub-County Referral Hospital, Naivasha, Kenya
| | - C Farquhar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine (Allergy and Infectious Disease), University of Washington, Seattle, WA, USA
| | - B Singa
- Kenya Medical Research Institute, Nairobi, Kenya
| | - J L Walson
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine (Allergy and Infectious Disease), University of Washington, Seattle, WA, USA
- Deparment of Pediatrics, University of Washington, Seattle, WA, USA
- Childhood Acute Illnesses Network (CHAIN), Nairobi, Kenya
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - R Nduati
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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Time to Early Cessation of Exclusive Breast Feeding and Associated Factors among 6-12 months old children: Survival analysis. Clin Nutr ESPEN 2022; 50:283-288. [DOI: 10.1016/j.clnesp.2022.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/09/2022] [Accepted: 04/30/2022] [Indexed: 11/22/2022]
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De Souza CB, Venancio SI, da Silva RPGVC. Breastfeeding Support Rooms and Their Contribution to Sustainable Development Goals: A Qualitative Study. Front Public Health 2022; 9:732061. [PMID: 35004566 PMCID: PMC8733197 DOI: 10.3389/fpubh.2021.732061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Breastfeeding support rooms are low-cost interventions that may prolong breastfeeding and improve work performance. Thus, we sought to understand the experiences and perceptions of working women who use breastfeeding support rooms and the potential contribution to sustainable development goals. Methods: Descriptive and exploratory research was conducted through convenience sampling of women working in companies with breastfeeding support rooms in the state of Paraná, Brazil. A semi-structured questionnaire was applied through interviews and online self-completion. Results: Fifty-three women between 28 and 41 years old participated in the study. In addition, 88.7% had graduated from college, and 96% were married. From the women's experiences and perceptions, we identified that breastfeeding support rooms contribute to prolonged breastfeeding, improve physical and emotional well-being, allow women to exercise their professional activities comfortably, contribute to women's professional appreciation for the excellent relationship between employees and employers. Conclusion: In this novel study, we demonstrate how, from a female point of view, breastfeeding support rooms can contribute to 8 of the 17 sustainable development goals and should therefore be encouraged and promoted.
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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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Litwan K, Tran V, Nyhan K, Pérez-Escamilla R. How do breastfeeding workplace interventions work?: a realist review. Int J Equity Health 2021; 20:148. [PMID: 34172068 PMCID: PMC8234653 DOI: 10.1186/s12939-021-01490-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/02/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Women are representing an increasing share of the labor force, thus, raising the need to accommodate breastfeeding working mothers at the workplace. While there is an emerging body of evidence supporting the positive influence of workplace lactation programs on breastfeeding outcomes, there is a lack of literature on the mechanisms underlying those interventions. Aims of this realist review were three-fold: to uncover underlying mechanisms, determine who benefits the most from such interventions and important contextual factors influencing uptake. METHODS Purposive bibliographic searches on Medline, Web of Science Core Collection, CINAHL, Global Health, LILACS, Global Index Medicus, Business Source Complete, Proquest Dissertations and Theses and Open Access Theses and Dissertations were conducted to identify relevant publications. Included publications (qualitative and quantitative) described interventions aiming to improve the breastfeeding behavior of working mothers, that were initiated by the employer, reported on breastfeeding outcomes and had a clearly defined workplace. Publications only focusing on maternity leave or that were not published in English, Spanish, Portuguese or German were excluded. A realist approach was followed to identify how workplace interventions work, who benefits the most and the important contextual factors. RESULTS The bibliographic search yielded a total of 4985 possible publications of which 37 publications were included in the realist analysis. Effective workplace breastfeeding interventions activate three mechanisms: 1) awareness of the intervention, 2) changes in workplace culture, manager/supervisor support, co-worker support and physical environments, and 3) provision of time. Contextual factors such as the distance between the workplace and the infant and the type of workplace may influence the degree of activation of the underlying mechanisms for programs to positively impact breastfeeding outcomes. CONCLUSIONS In order to be effective, workplace breastfeeding interventions need to: raise awareness of the intervention(s) available among working mothers as well as their work environment, change the workplace culture, foster manager/supervisor support and co-workers support, provide enough time and adequate space and facilities for women to breastfeed or express breastmilk during the workday.
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Affiliation(s)
- Kathrin Litwan
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, 47 College Street, New Haven, CT 06510 USA
| | - Victoria Tran
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, 47 College Street, New Haven, CT 06510 USA
| | - Kate Nyhan
- Harvey Cushing / John Hay Whitney Medical Library, Yale University, New Haven, CT USA
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT USA
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, 47 College Street, New Haven, CT 06510 USA
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Thomas CL, Murphy LD, Mills MJ, Zhang J, Fisher GG, Clancy RL. Employee lactation: A review and recommendations for research, practice, and policy. HUMAN RESOURCE MANAGEMENT REVIEW 2021. [DOI: 10.1016/j.hrmr.2021.100848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Vilar-Compte M, Hernández-Cordero S, Ancira-Moreno M, Burrola-Méndez S, Ferre-Eguiluz I, Omaña I, Pérez Navarro C. Breastfeeding at the workplace: a systematic review of interventions to improve workplace environments to facilitate breastfeeding among working women. Int J Equity Health 2021; 20:110. [PMID: 33926471 PMCID: PMC8082937 DOI: 10.1186/s12939-021-01432-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Breastfeeding can be affected by maternal employment. This is important considering that in 2019, 47.1% of women globally participated in the labor force. The aim of this study was to review workplace interventions to promote, protect and support breastfeeding practices among working mothers globally. METHODS A systematic review was conducted following the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Observational, experimental and qualitative peer-reviewed studies in English and Spanish, published between 2008 and 2019 were included. The review focused on working women who were pregnant, breastfeeding or who recently had a child, and women's working environments. The outcomes of interest included breastfeeding intentions, initiation, exclusivity and duration, confidence in breastfeeding or breastmilk extraction, and perceived support at workplace. Quality was assessed according to National Institute for Health and Care Excellence (NICE) checklist for systematic reviews. It was registered on PROSPERO (#140624). RESULTS Data was extracted from 28 quantitative and 9 qualitative studies. The most common interventions were designated spaces for breastfeeding or breastmilk extraction (n = 24), and the support from co-workers (n = 20). The least common interventions were providing breast pumps (n = 4) and giving mothers the flexibility to work from home (n = 3). Studies explored how interventions affected different breastfeeding outcomes including breastfeeding duration, breastfeeding exclusivity, confidence in breastmilk expression, and breastfeeding support. The evidence suggests that workplace interventions help increase the duration of breastfeeding and prevent early introduction of breastmilk substitutes. Having a lactation space, breastmilk extraction breaks, and organizational policies are key strategies. However, to achieve equitable working conditions for breastfeeding mothers, organizational and interpersonal changes need to occur as well. CONCLUSIONS The systematic review revealed that interventions at the workplace are important in protecting, promoting and supporting breastfeeding among working mothers. To achieve equitable work environments and fair nutritional opportunities for infants of working mothers, interventions should focus at the three ecological layers - individual, interpersonal, and organizational. The quality of studies can be improved. There is a need for studies assessing impacts of workplace interventions on infant feeding practices, mothers' self-esteem and outcomes such productivity and abstentionism.
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Affiliation(s)
- Mireya Vilar-Compte
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Sonia Hernández-Cordero
- Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico.
| | - Mónica Ancira-Moreno
- Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Soraya Burrola-Méndez
- Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Isabel Ferre-Eguiluz
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Isabel Omaña
- Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Cecilia Pérez Navarro
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
- Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
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The yearly financing need of providing paid maternity leave in the informal sector in Indonesia. Int Breastfeed J 2021; 16:17. [PMID: 33588917 PMCID: PMC7885595 DOI: 10.1186/s13006-021-00363-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The economic cost of not breastfeeding in Indonesia is estimated at US$1.5-9.4 billion annually, the highest in South East Asia. Half of the 33.6 million working women of reproductive age (WRA) in Indonesia (15-49 years) are informal employees, meaning they are working as casual workers or they are self-employed (small scale business) and assisted by unpaid/family worker(s). No specific maternity protection entitlements are currently available for WRA working informally in Indonesia. This study aims to estimate the financing need of providing maternity leave cash transfer (MCT) for WRA working in the informal sector in Indonesia. METHOD The costing methodology used is the adapted version of the World Bank methodology by Vilar-Compte et al, following pre-set steps to estimate costs using national secondary data. We used the 2018 Indonesian National Socio-Economic Survey to estimate the number of women working informally who gave birth within the last year. The population covered, potential cash transfer's unitary cost, the incremental coverage of the policy in terms of time and coverage, and the administrative costs were used to estimate the cost of MCT for the informal sector. RESULT At 100% coverage for 13 weeks of leave, the yearly financing need of MCT ranged from US$175million (US$152/woman) to US$669million (US$583/woman). The share of the yearly financing need did not exceed 0.5% of Indonesian Gross Domestic Product (GDP). CONCLUSIONS The yearly financing need of providing MCT for eligible WRA working in the informal sector is economically attractive as it amounts to less than 0.5% of GDP nominal of Indonesia. While such a program would be perceived as a marked increase from current public health spending at the onset, such an investment could substantially contribute to the success of breastfeeding and substantial corresponding public health savings given that more than half of working Indonesian WRA are employed in the informal sector. Such policies should be further explored while taking into consideration realistic budget constraints and implementation capacity.
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Progress towards reducing sociodemographic disparities in breastfeeding outcomes in Indonesia: a trend analysis from 2002 to 2017. BMC Public Health 2020; 20:1112. [PMID: 32669120 PMCID: PMC7362438 DOI: 10.1186/s12889-020-09194-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 07/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background Improving breastfeeding practice is important for reducing child health inequalities and achieving several Sustainable Development Goals. Indonesia has enacted legislation to promote optimal breastfeeding practices in recent years. We examined breastfeeding practices among Indonesian women from 2002 to 2017, comparing trends within and across sociodemographic subgroups. Methods Data from four waves of the Indonesia Demographic and Health Surveys were used to estimate changes in breastfeeding practices among women from selected sociodemographic groups over time. We examined three breastfeeding outcomes: (1) early initiation of breastfeeding; (2) exclusive breastfeeding; and (3) continued breastfeeding at 1 year. Multivariate logistic regression was used to assess changes in time trends of each outcome across population groups. Results The proportion of women reporting early initiation of breastfeeding and exclusive breastfeeding increased significantly between 2002 to 2017 (p < 0.05), with larger increases among women who: were from higher wealth quintiles; worked in professional sectors; and lived in Java and Bali. However, 42.7% of women reported not undertaking early initiation of breastfeeding, and 48.9% of women reported not undertaking exclusive breastfeeding in 2017. Women who were employees had lower exclusive breastfeeding prevalence, compared to unemployed or self-employed women. Women in Java and Bali had higher increase in early initiation of breastfeeding and exclusive breastfeeding compared to women in Sumatra. We did not find statistically significant decline in continued breastfeeding at 1 year over time for the overall population, except among women who: were from the second poorest wealth quintile; lived in rural areas; did not have a health facility birth; and lived in Kalimantan and Sulawesi (p < 0.05). Conclusions There were considerable improvements in breastfeeding practices in Indonesia during a period of sustained policy reform to regulate breastfeeding and community support of breastfeeding, but these were not distributed uniformly across socioeconomic, occupation and geographic subgroups. Concerted efforts are needed to further reduce inequities in breastfeeding practice through both targeted and population-based strategies.
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Nardi AL, Frankenberg ADV, Franzosi OS, Santo LCDE. [Impact of institutional aspects on breastfeeding for working women: a systematic review]. CIENCIA & SAUDE COLETIVA 2020; 25:1445-1462. [PMID: 32267445 DOI: 10.1590/1413-81232020254.20382018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 08/10/2018] [Indexed: 11/22/2022] Open
Abstract
Breastfeeding is considered the ideal feeding method early in life. Despite the scientific evidence, the worldwide prevalence of breastfeeding is low. Maternal work is pointed out as one of the obstacles to maintain this practice. To systematically review studies that evaluated the association between institutional aspects and breastfeeding and exclusive breastfeeding among working women. A literature search until June 2016 was carried out using PubMed, LILACS, and SciELO (MeSH terms: breastfeeding, workplace and observational study). Eighteen observational studies were included. A positive association with breastfeeding were found for later or not return to work, part-time work, availability or the use of lactation room, breast pumping breaks, professional advice on maintaining breastfeeding after returning to work, and attendance at breastfeeding support program. A negative association with breastfeeding was shown for full-time work. Simple interventions in the workplace and some changes in company policy to encourage breastfeeding can positively influence its maintenance after women return to work.
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Affiliation(s)
- Adriana Lüdke Nardi
- Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul. R. São Manoel 963, Santa Cecília. 90620-110 Porto Alegre RS Brasil.
| | | | | | - Lilian Córdova do Espírito Santo
- Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul. R. São Manoel 963, Santa Cecília. 90620-110 Porto Alegre RS Brasil.
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Basrowi RW, Sulistomo AW, Adi NP, Widyahening IS, Vandenplas Y. Breastfeeding Knowledge, Attitude, and Practice among White-Collar and Blue-Collar Workers in Indonesia. J Korean Med Sci 2019; 34:e284. [PMID: 31760710 PMCID: PMC6875433 DOI: 10.3346/jkms.2019.34.e284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 09/05/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Working status is identified as a major risk factor of poor breastfeeding practices among workers. This study aimed to evaluate the knowledge, attitude, and factors associated with breastfeeding practice among white-collar and blue-collar workers in Indonesia. METHODS A cross-sectional study was performed in two factories and three government offices in Jakarta from December 2015 to February 2016. Subjects were woman workers whose children were age 6 to 24 months old and actively working in the factory and/or office. The factors studied were selected socio-demographic and occupational characteristics, score on knowledge and attitude, and breastfeeding practice during working hours. RESULTS From a total of 192 subjects, 73% of white-collar workers had good knowledge on breastfeeding, in contrast with 55% of blue-collar workers who had not good breastfeeding knowledge (P < 0.001). Most of the subjects were conducting breast pumping during working hours, however 15% of white-collar workers and 17% of blue-collar workers never breastfeed nor breast pumped at work. Working status (P = 0.005) and knowledge (P = 0.002) were factors associated with breastfeeding practice among workers. CONCLUSION White-collar workers have a better knowledge, attitude, and practice toward breastfeeding. Knowledge improvement related to breastfeeding benefits and supports to working mothers are a key priority, however advocacy to employers, managers, and supervisors in providing breastfeeding facilitation and program support were also critical to successful breastfeeding practice among workers.
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Affiliation(s)
- Ray Wagiu Basrowi
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Astrid W Sulistomo
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nuri Purwito Adi
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Indah S Widyahening
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
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Predictors of Exclusive Breastfeeding Among Health Care Workers in Urban Kano, Nigeria. J Obstet Gynecol Neonatal Nurs 2019; 48:433-444. [DOI: 10.1016/j.jogn.2019.04.285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 11/19/2022] Open
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Siregar AYM, Pitriyan P, Walters D, Brown M, Phan LTH, Mathisen R. The financing need for expanded maternity protection in Indonesia. Int Breastfeed J 2019; 14:27. [PMID: 31289458 PMCID: PMC6593591 DOI: 10.1186/s13006-019-0221-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/03/2019] [Indexed: 01/01/2023] Open
Abstract
Background Almost half of all Indonesian children under 6 months of age were not exclusive breastfed in 2017. Optimizing maternity protection programs may result in increased breastfeeding rates. This study aims to: estimate the potential cost implications of optimizing the current paid maternity protection program, estimate budgets needed to increase coverage of lactation rooms in mid and large firms, and explore challenges in its implementation in Indonesia. Methods The potential cost implication of the current and increased maternity leave length (three and 6 months) as well as the potential budget impact to the government were estimated for 2020 to 2030. The cost of setting up lactation rooms in formal sector companies was estimated using the Alive & Thrive standards. Interviews were conducted in five different provinces to 29 respondents in 2016 to identify current and potential challenges in implementing both existing and improved maternity protection policies. Results The costs of expanding paid maternity leave from three to 6 months and incorporating standardized lactation rooms in 80% of medium and large size firms in Indonesia was estimated at US$1.0 billion (US$616.4/mother per year) from 2020 to 2030, covering roughly 1.7 million females. The cost of setting up a basic lactation room in 80% of medium and large companies may reach US$18.1 million over 10 years. The three main barriers to increasing breastfeeding rates were: breastmilk substitutes marketing practices, the lack of lactation rooms in workplaces, and local customs that may hamper breastfeeding according to recommendations. Conclusions The cost of expanding paid maternity leave is lower than the potential cost savings of US$ 1.5 billion from decreased child mortality and morbidity, maternal cancer rates and cognitive loss. Sharing the cost of paid maternity leave between government and the private sector may provide a feasible economic solution. The main barriers to increasing breastfeeding need to be overcome to reap the benefits of recommended breastfeeding practices. Electronic supplementary material The online version of this article (10.1186/s13006-019-0221-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adiatma Y M Siregar
- 1Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Jl. Hayam Wuruk 6-8, Bandung, West Java 40115 Indonesia
| | - Pipit Pitriyan
- 1Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Jl. Hayam Wuruk 6-8, Bandung, West Java 40115 Indonesia
| | - Dylan Walters
- 2Canadian Centre for Health Economics, Institute of Health Policy, Management and Evaluation, University of Toronto, and Nutrition International, Ottawa, Ontario Canada
| | - Matthew Brown
- Alive & Thrive, Southeast Asia, 7F, Opera Business Center, 60 Ly Thai To Street, Hanoi, Vietnam
| | - Linh T H Phan
- Alive & Thrive, Southeast Asia, 7F, Opera Business Center, 60 Ly Thai To Street, Hanoi, Vietnam
| | - Roger Mathisen
- Alive & Thrive, Southeast Asia, 7F, Opera Business Center, 60 Ly Thai To Street, Hanoi, Vietnam
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Basrowi RW, Sastroasmoro S, Sulistomo AW, Bardosono S, Hendarto A, Soemarko DS, Sungkar A, Khoe LC, Vandenplas Y. Developing a workplace lactation promotion model in Indonesia using Delphi technique. Arch Public Health 2018; 76:70. [PMID: 30410756 PMCID: PMC6217783 DOI: 10.1186/s13690-018-0312-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/20/2018] [Indexed: 11/13/2022] Open
Abstract
Background Working mothers have a higher risk to terminate breastfeeding earlier than stay-at-home mothers. Researchers reported that support from the workplace by creating lactation facilities and develop supportive programs are necessary to increase the success of exclusive breastfeeding. The aim was to achieve expert consensus on developing a workplace-based lactation promotion model. Methods A three-round online survey using Delphi approach was conducted to reach consensus on to the development of a lactation program at a workplace. Results Twenty-two experts from Indonesian health authority, community medicine, child health and obstetrics were invited to join the Delphi study; 15 (68.2%) enrolled in the first round. The response rate in the second and third round was 80.0% (12/15) and 86.7% (13/15), respectively. The first round categorized the workplace-based promotion model into seven dimensions, i.e. policy and regulation, facility, education material, target participants, promotion approach, human resources, and time. In the final round, “maternity leave of 3-6 months” (median (Q1;Q3):2 (1, 4)) and “employees have the right to breast-pumping every 3 hours” (median (Q1;Q3):3 (2, 4)) ranked as the two most important indicators regarding policy and regulation. A dedicated lactation room (median (Q1;Q3):1 (1)) is the highest ranked indicator regarding facility dimension. Regarding education materials, benefits of breast milk for babies ranked as the highest indicator while for the education and delivering methods dimensions, social media and interactive counseling were two highest ranked indicators. The top management in the company and lactation counselor are the two highest-ranked indicators in human resources dimension. Conclusion In the view of experts, involvement of a dedicated policy maker in the company, a workplace-based lactation counselor, regular promotion with interactive education and dedicated facilities are necessary to develop an effective workplace-based lactation promotion model.
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Affiliation(s)
- Ray Wagiu Basrowi
- 1Doctoral Program Student, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Sudigdo Sastroasmoro
- 2Department of Child Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Astrid W Sulistomo
- 3Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Saptawati Bardosono
- 4Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Aryono Hendarto
- 2Department of Child Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dewi S Soemarko
- 3Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ali Sungkar
- 5Department of Obstetric Gynecology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Levina Chandra Khoe
- 3Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Yvan Vandenplas
- 6KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
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Park HW, Ryu KH, Piao Y, Li P, Hong JS, Kim HB, Chung H, Hoh JK, Kim YJ. Positive Effect of Baby-Friendly Hospital Initiatives on Improving Mothers' Intention for Successful Breastfeeding in Korea. J Korean Med Sci 2018; 33:e272. [PMID: 30344462 PMCID: PMC6193888 DOI: 10.3346/jkms.2018.33.e272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/05/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In Korea, the breastfeeding (BF) rate of infants aged 6 months or more is drastically decreasing, and this phenomenon is particularly worrisome for the future health of the population. The present study aimed to identify an antenatal strategy for initiation and continuation of human BF, and to identify how Baby-Friendly Hospitals (BFHs) may positively influence the intention to breastfeed. METHODS A total of 414 pregnant Korean antenatal women were surveyed using questionnaires to determine current knowledge of the benefits of human breast milk, whether they planned to breastfeed after delivery, to continue BF after reinstatement in the workforce, are willing to abide by rooming-in care for infants, and plan to give birth at BFHs. RESULTS We found that planning room-in care, greater awareness of BF benefits for infant and mother, participation in antenatal education programs, and provision of BF facilities in the workplace were positively associated with plans for exclusive breastfeeding (EBF) and longer BF duration. The mothers who planned to give birth at BFHs also desired to breastfeed immediately after birth, implement in-room care, continue BF at their workplace, participate in antenatal BF educational programs, and were more aware of the benefits of BF. CONCLUSION If the beneficial effects of BFHs were well known to individuals, these would enhance the success rate of BF in Korea. Antenatal education and consequent acquisition of better knowledge of the benefits of BF are important for increasing the rate of BF practices.
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Affiliation(s)
- Hyun Woo Park
- Database and Bioinformatics Laboratory, College of Electrical and Computer Engineering, Chungbuk National University, Cheongju, Korea
| | - Keun Ho Ryu
- Database and Bioinformatics Laboratory, College of Electrical and Computer Engineering, Chungbuk National University, Cheongju, Korea
| | - Yongjun Piao
- Database and Bioinformatics Laboratory, College of Electrical and Computer Engineering, Chungbuk National University, Cheongju, Korea
- The School of Medicine, Nankai University, Tianjin, China
| | - Peipei Li
- Center for Neurodegenerative Science Van Andel Research Institute, Grand Rapids, MI, USA
| | - Jae Shik Hong
- SC Cheil Obstetrics & Gynecology Hospital, Seoul, Korea
| | | | | | - Jeong-Kyu Hoh
- Department of Obstetrics and Gynecology, College of Medicine, Hanyang University, Seoul, Korea
| | - Yong Joo Kim
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea
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Basrowi RW, Sastroasmoro S, Sulistomo AW, Bardosono S, Hendarto A, Soemarko DS, Sungkar A, Khoe LC, Vandenplas Y. Challenges and Supports of Breastfeeding at Workplace in Indonesia. Pediatr Gastroenterol Hepatol Nutr 2018; 21:248-256. [PMID: 30345237 PMCID: PMC6182487 DOI: 10.5223/pghn.2018.21.4.248] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 06/18/2018] [Accepted: 07/09/2018] [Indexed: 01/20/2023] Open
Abstract
Due to increased number of women workers in Indonesia in the last decade, numbers of women living as a worker and a housewife have increased. This also increases the potential risk of breastfeeding discontinuation. Three months of maternal leave policy and inadequate lactation promotion support in workplace have been identified as factors that hinder lactating practices. The World Health Organization recommendation of 6 months of exclusive breastfeeding and joined regulation of three Indonesia ministers (Ministry of Health, Ministry of Labour, and Ministry of Women Empower) have failed to improve the exclusive breastfeeding rate among female workers in Indonesia due to the lack of a standardized guideline on lactation promotion at workplace. In addition, very limited or no studies have been conducted to evaluate the impact of workplace-based lactation intervention programs on exclusive breastfeeding rate among female workers. This is because the relationship of lactation with working performance and productivity could not motivate employer to invest in workplace-based lactation promotion facility or program.
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Affiliation(s)
- Ray Wagiu Basrowi
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Depok City, Indonesia
| | - Sudigdo Sastroasmoro
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Depok City, Indonesia
| | - Astrid W Sulistomo
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Depok City, Indonesia
| | - Saptawati Bardosono
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Depok City, Indonesia
| | - Aryono Hendarto
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Depok City, Indonesia
| | - Dewi S Soemarko
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Depok City, Indonesia
| | - Ali Sungkar
- Department of Obstetric Gynaecology, Faculty of Medicine, Universitas Indonesia, Depok City, Indonesia
| | - Levina Chandra Khoe
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Depok City, Indonesia
| | - Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Barriers to exclusive breast-feeding in Indonesian hospitals: a qualitative study of early infant feeding practices. Public Health Nutr 2018; 21:2689-2697. [PMID: 29973298 DOI: 10.1017/s1368980018001453] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although initiating breast-feeding is common in Indonesia, rates of exclusive breast-feeding are low. Our objective was to identify early barriers to exclusive breast-feeding in Indonesian hospitals. DESIGN Qualitative. Semi-structured interviews were conducted in April-June 2015. The data were analysed using thematic analysis. SETTING Indonesian provinces of Jakarta, Banten and West Java. SUBJECTS Fifty-four participants including public health officials, hospital administrators, health-care professionals and parents. RESULTS Five themes were identified as contributing to low rates of early exclusive breast-feeding in Indonesian hospitals: (i) quality and quantity of breast-feeding education; (ii) marketing and influence of infant formula manufacturers; (iii) hospital infrastructure; (iv) policy, legislation and protocols; and (v) perceived need for infant formula supplementation. Participants noted that providers and mothers receive inadequate or incorrect education regarding breast-feeding; manufacturers promote infant formula use both inside and outside hospitals; constraints in physical space and hospital design interfere with early breast-feeding; legislation and protocols designed to promote breast-feeding are inconsistently enforced and implemented; and providers and mothers often believe infant formula is necessary to promote infant health. All participants identified numerous barriers to early exclusive breast-feeding that related to more than one identified theme. CONCLUSIONS Our study identified important barriers to early exclusive breast-feeding in Indonesian hospitals, finding that participants consistently reported multifaceted barriers to early exclusive breast-feeding. Future research should examine whether system-level interventions such the Baby-Friendly Hospital Initiative might improve rates of exclusive breast-feeding by improving breast-feeding education, reducing manufacturer influence, modifying existing infrastructure and providing tools needed for protocols and counselling.
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Dinour LM, Szaro JM. Employer-Based Programs to Support Breastfeeding Among Working Mothers: A Systematic Review. Breastfeed Med 2017; 12:131-141. [PMID: 28394659 DOI: 10.1089/bfm.2016.0182] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Many mothers experience barriers to maintaining a breastfeeding relationship with their infants upon returning to work and, consequently, terminate breastfeeding earlier than recommended or intended. As such, employers are in a unique position to help further increase breastfeeding rates, durations, and exclusivity. OBJECTIVE The purpose of this review is to examine the literature regarding employer-based programs, policies, and interventions to support breastfeeding among working mothers. MATERIALS AND METHODS A systematic literature search was conducted for peer-reviewed articles published before April 2016. Studies were included if they focused on workplace-based lactation/breastfeeding support programs, policies, or interventions to promote breastfeeding among employees. For inclusion, articles must have measured at least one outcome, such as breastfeeding duration, breastfeeding exclusivity, or employee satisfaction. RESULTS Twenty-two articles were included, representing 10 different countries and both public- and private-sector employers, including governmental offices, schools, hospitals, manufacturing/industrial companies, and financial settings, among others. Providing a lactation space was the most common employer-based support accommodation studied, followed by breastfeeding breaks and comprehensive lactation support programs. The majority of studies analyzing these three support types found at least one positive breastfeeding and/or nonbreastfeeding outcome. CONCLUSIONS This review suggests that maintaining breastfeeding while working is not only possible but also more likely when employers provide the supports that women need to do so. Although some employers may have more extensive breastfeeding support policies and practices than others, all employers can implement a breastfeeding support program that fits their company's budget and resources.
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Affiliation(s)
- Lauren M Dinour
- Department of Nutrition and Food Studies, Montclair State University , Montclair, New Jersey
| | - Jacalyn M Szaro
- Department of Nutrition and Food Studies, Montclair State University , Montclair, New Jersey
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Steurer LM. Maternity Leave Length and Workplace Policies' Impact on the Sustainment of Breastfeeding: Global Perspectives. Public Health Nurs 2017; 34:286-294. [PMID: 28295576 DOI: 10.1111/phn.12321] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Breastfeeding is a global initiative of the World Health Organization and the U.S. domestic health agenda, Healthy People 2020; both recommend exclusive breastfeeding, defined as providing breast milk only via breast or bottle, through the first 6 months of an infant's life. Previous literature has shown the correlation between socioeconomic status and breastfeeding, with higher maternal education and income as predictors of sustained breastfeeding. This same population of women is more likely to be employed outside the home. METHODS PubMed and the Cochrane Database of Systematic Reviews were searched using inclusion and exclusion criteria to identify the effect of maternity leave length and workplace policies on the sustainment of breastfeeding for employed mothers. RESULTS Common facilitators to sustainment of breastfeeding included longer length of maternity leave as well as adequate time and space for the pumping of breast milk once the mother returned to the workplace. Barriers included inconsistency in policy and the lack of enforcement of policies in different countries. CONCLUSIONS There is a lack of consistency globally on maternity leave length and workplace policy as determinants of sustained breastfeeding for employed mothers. A consistent approach is needed to achieve the goal of exclusive breastfeeding for infants.
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Affiliation(s)
- Lisa M Steurer
- School of Nursing and Health Studies, University of Missouri-Kansas City, St. Louis, Missouri
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Violations of the International Code of Marketing of Breast-milk Substitutes: Indonesia context. Public Health Nutr 2016; 20:165-173. [DOI: 10.1017/s1368980016001567] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectivesTo measure compliance with the International Code of Marketing of Breast-milk Substitutes (‘the Code’) in Indonesia.DesignThe study was a cross-sectional survey using the Interagency Group on Breastfeeding Monitoring protocol.SettingPublic and private health facilities in six provinces on Java island in Indonesia.SubjectsA total of 874 women (382 pregnant women and 492 breast-feeding mothers of infants below 6 months) and seventy-seven health workers were recruited from eighteen participating health facilities. The study also analysed a total of forty-four labels of breast-milk substitute products, twenty-seven television commercials for growing-up milk (for children >12 months) of nine brands and thirty-four print advertisements of fourteen brands.ResultsThe study found that 20 % of the women had received advice and information on the use of breast-milk substitutes and 72 % had seen promotional materials for breast-milk substitutes. About 15 % reported receiving free samples and 16 % received gifts. Nearly a quarter of the health workers confirmed receiving visits from representatives of breast-milk substitute companies. Two health workers reported having received gifts from the companies. The most common labelling violations found were statements or visuals that discouraged breast-feeding and the absence of mention about the consideration of local climate in the expiration date.ConclusionsViolations of the Code by health workers, breast-milk substitute companies and their representatives were found in all provinces studied. A regular monitoring system should be in place to ensure improved compliance with and enforcement of the Code.
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