Evaluation of occupational factors on continuation of breastfeeding and formula initiation in employed mothers

Occupational Factors Associated With Time to Breastfeeding Discontinuation After Return to Work Among Female Anesthesiologists in China: A Nationwide Survey

BACKGROUND

Breast milk is of great benefit to both infants and mothers. Due to occupational barriers, female physicians are at high risk of unintentionally discontinuing breastfeeding. However, evidence among anesthesiologists was limited. The purpose of this study was to investigate occupational factors associated with time to breastfeeding discontinuation among female anesthesiologists following maternity leave in China.

METHODS

We conducted a nationwide survey of female anesthesiologists who had given birth since January 1, 2015. A 60-item anonymous questionnaire was developed to collect information regarding breastfeeding practices and related factors. The questionnaire was revised based on the recommendations of 15 experts and feedback from the pilot survey. The survey was distributed by the Chinese Society of Anesthesiology.

RESULTS

The completion rate was 57.9%. In total, 1364 responders were analyzed from all 31 provinces of Mainland China. In total, 1311 (96.1%) responders reported a reduction in breast milk supply on returning to work. Among the 1161 responders who discontinued breastfeeding, 836 (72.0%) did not achieve desired goals due to occupational factors. The median [interquartile range] of maternity leave length and breastfeeding duration were 5 [4-6] months and 10 [7-12] months, respectively. The following occupational factors were associated with longer time to breastfeeding discontinuation after adjusting for confounding effects of personal factors: length of maternity leave (hazard ratio [HR] per month 0.44; 95% confidence interval [CI], 0.36-0.54; P < .001), pumping breast milk during work time (HR, 0.04; 95% CI, 0.02-0.08; P < .001), support from colleagues (HR, 0.92; 95% CI, 0.86-0.99; P = .032), and additional nonclinical activities (HR, 0.87; 95% CI, 0.77-0.98; P = .022). Trainees under supervision (HR, 1.20; 95% CI, 1.06-1.43; P = .005) and the need to remain in the operating room during cases (HR, 2.59; 95% CI, 1.09-6.12; P = .031) were associated with shorter time to breastfeeding discontinuation. Approximately 899 (65.9%) responders pumped breast milk during work time. Among them, reduction in pumping frequency (HR, 1.17; 95% CI, 1.00-1.36; P = .049) and difficulty in finding opportunities for pumping (HR, 2.34; 95% CI, 1.36-4.03; P = .002) were associated with shorter time to breastfeeding discontinuation.

CONCLUSIONS

We identified modifiable occupational factors associated with time to breastfeeding discontinuation. These findings underscored the necessity of facilitating breastfeeding in the workplace, including encouraging longer maternity leave and breastfeeding breaks, considering the feasibility of pumping in daily case assignments, establishing supportive culture, providing lactation rooms, and offering nonclinical activities.

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.

Risk factors for discontinuation of exclusive breast feeding within 1month: a retrospective cohort study in Japan

Background

While breastfeeding provides benefits for infants and the mother, many women either do not breastfeed or terminate breastfeeding earlier than recommended. The aim of this analysis was to identify factors associated with early discontinuation of breastfeeding in Japanese women.

Methods

This study used data from medical records of women delivering a singleton live birth between March 2017 and August 2019 in Iwase General Hospital, Fukushima Prefecture, Japan to assess cessation of breastfeeding by the 1-month postpartum appointment. Demographic (age at birth, and employment status), medical (parity, and physical and mental condition of the mother; and infant medical factors, such as sex, Apgar score, and jaundice, among other), and family factors (husband/partner, family members living at the same house, among others) in 734 women who had initiated breastfeeding during their delivery hospital stay were examined, and multiple logistic regression was used to determine significant predictors of early cessation of exclusive breastfeeding.

Results

Bivariate analysis revealed that women who were primipara, unmarried, exposed to secondhand smoke, and employed; those who smoked before pregnancy; and those who had asthma were more likely to discontinue exclusive breastfeeding than other women. Infant factors associated with discontinuation were lower birthweight, earlier gestational age, neonatal intensive care unit admission, treatment for jaundice, or lower weight gain. Multivariable analysis revealed that primiparity, passive smoking before pregnancy, maternal employment, and neonatal jaundice therapy were associated with discontinuation of breastfeeding.

Conclusions

In particular, women whose partners smoked before pregnancy may need to be targeted for additional support for breastfeeding.

Exclusive Breastfeeding Practice in Indonesia: A Population-Based Study

BACKGROUND

It is a well-known fact that exclusive breastfeeding benefits both mothers and their babies. The aim of this study is to assess the associated factors influencing exclusive breastfeeding of babies until 6 months of age.

METHODS

The study used data from the 2017 Indonesia Demographic and Health Survey. Overall, 1,542 women who had infants aged below 6 months were included in the study. Sociodemographic and maternal health service utilization factors were examined for association with exclusive breastfeeding, using logistic regression for a complex sample design.

RESULTS

The proportion of exclusive breastfeeding was 52.3% (95% confidence interval [CI], 0.498-0.548). Parity, antenatal care visits, early initiation of breastfeeding, low-income households, and rural areas were significant factors associated with the increased likelihood of exclusive breastfeeding. However, working status (adjusted odds ratio [aOR], 0.70; 95% CI, 0.57-0.86) and caesarean delivery or C-section (aOR, 0.75; 95% CI, 0.57-0.99) were factors for a lower likelihood of exclusive breastfeeding.

CONCLUSION

Working women are at risk of discontinuation of exclusive breastfeeding. Mothers who had a normal vaginal delivery and practiced early initiation of breastfeeding had a higher rate of exclusive breastfeeding. These findings have important implications for developing comprehensive guidance and resources for women regarding the importance of exclusive breastfeeding during the early postpartum period.

Breastfeeding at the workplace: a systematic review of interventions to improve workplace environments to facilitate breastfeeding among working women

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.

Prevalence of 'Mother/Infant Friendly Worksite Designations' and state laws regulating workplace breastfeeding support in the United States

Human milk is the normative infant feeding standard. Yet breastfeeding rates in the United States are suboptimal as many women discontinue breastfeeding upon return to work. As a result, the Unites States Congress included the Break time for Nursing Mothers law in the Patient Protection and Affordable Care Act of 2010 (ACA). The law mandates that employers provide break time and a private space for employees to express breastmilk. This federal legislation does not cover all employees. The purpose of this project was to identify state legislation and Mother/Infant Friendly Worksite Designations (MIFWD) that provide additional protections to working, breastfeeding mothers. We reviewed websites from the United States Breastfeeding Committee and state health departments, and found 27 states have legislation related to breastfeeding in the workplace, and eight states have active MIFWD program. State laws and designation programs are important additions to federal legislation to support employees not covered by the ACA provision.

Employer-Based Programs to Support Breastfeeding Among Working Mothers: A Systematic Review

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.

Maternity Leave Length and Workplace Policies' Impact on the Sustainment of Breastfeeding: Global Perspectives

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.

Employers' perspective of workplace breastfeeding support in Karachi, Pakistan: a cross-sectional study

Background

Breastfeeding is considered to be an important measure to achieve optimum health outcomes for children, women’s return to work has frequently been found to be a main contributor to the early discontinuation of breastfeeding. The aim of the study is to assess workplace breastfeeding support provided to working mothers in Pakistan.

Method

A workplace based cross-sectional survey was conducted from April through December 2014. Employers from a representative sample of 297 workplaces were interviewed on pre-tested and structured questionnaire. The response rate was 93.7 %. Prevalence of workplace breastfeeding facilities were assessed in the light of World Alliance for Breastfeeding Action (WABA) guidelines.

Results

Among non-physical facilities, all workplaces offered 3 months paid maternity leave, 45 % of the sites were offering task adjustment to mothers during lactation period. Only 15 % of the sites were offering breastfeeding breaks to working mothers. Physical facilities that include a breastfeeding corner, refrigerator for storing breast milk, breast milk pump and nursery for childcare were provided in less than 7 % of the sites. Multinational organizations provided better support compared to national organizations.

Conclusion

Support for continuation of breastfeeding by working women at workplaces is inadequate; hence, women discontinue breastfeeding earlier than planned. Policies need to be developed and enforced, employers and employees need to be educated and supportive environment needs to be created to encourage and facilitate breastfeeding friendly worksite environment.