'Negotiating the tensions of having to attach and detach concurrently': a qualitative study on combining breastfeeding and employment in public education and health sectors in New Delhi, India

Workplace Breastfeeding Support and Breastfeeding Practices among Healthcare Professionals

Introduction

Working mothers face striking challenges in breastfeeding. It is important to focus on them to further improve breastfeeding rates.

Aim and Objectives

To assess the workplace breastfeeding support and breastfeeding practices of healthcare professionals.

Methodology

We conducted a cross-sectional study among two hospitals in East Delhi. All mothers having at least one child aged six months to five years and currently employed as healthcare personnel were included. For a sample size of 100, population proportionate to size sampling was done among two hospitals. The participants were randomly selected from a list of healthcare personnel. Employee perception of breastfeeding support questionnaire (EPBS-Q) was used to assess the workplace breastfeeding support. Chi-square test was used to compare proportions, logistic regression, and survival analysis to find the association between workplace breastfeeding support and IYCF parameters.

Results

The proportion of mother who perceived poor workplace breastfeeding support was 37%. The mean (SD) score obtained was 103.48 (8.93). The early initiation of breastfeeding within one hour was practiced by 54%, exclusive breastfeeding for at least six months by 60%, and timely initiation of complementary feeding for six to eight months by 64% mothers. Workplace breastfeeding support was significantly associated with exclusively breastfeeding for at least six months.

Conclusions

More than one-third of mothers perceived poor workplace breastfeeding, and it was associated with exclusive breastfeeding.

Access to Workplace Supports is Positively Associated with Exclusive Breastfeeding among Formally Employed Mothers in Kenya

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.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

DISCUSSION

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

Exclusive breastfeeding continuation and associated factors among employed women in North Ethiopia: A cross-sectional study

Background

Exclusive Breastfeeding (EBF) can prevent up to 13% of under-five mortality in developing countries. In Sub-Saharan Africa the rate of EBF at six months remains very low at 36%. Different types of factors such as maternal, family and work-related factors are responsible for the low rate of EBF among employed women. This study aimed to assess the prevalence of EBF continuation and associated factors among employed women in North Ethiopia.

Materials and methods

A community-based, cross-sectional study was conducted in two towns of Tigray region, North Ethiopia. Employed women who had children between six months and two years were surveyed using multistage, convenience sampling. Women filled in a paper based validated questionnaire adopted from the Breastfeeding and Employment Study toolkit (BESt). The questions were grouped into four parts of sociodemographic characteristics, maternal characteristics, family support and work-related factors. Factors associated with EBF continuation as a binary outcome (yes/no) were determined using multivariable logistic regression.

Results

Four-hundred and forty-nine women participated in this study with a mean (SD) age 30.4 (4.2) years. Two hundred and fifty-four (56.4%) participants exclusively breastfed their children for six months or more. The main reason for discontinuation of EBF was the requirement of women to return to paid employment (31.5%). Four-hundred and forty (98.2%) participants believed that breastfeeding has benefits either to the infant or to the mother. Three hundred and seventy-one (82.8%) of the participants received support from their family at home to assist with EBF, most commonly from their husbands and mothers. Having family support (adjusted odds ratio [AOR] = 2.1, 95%, CI 1.2–3.6; P = 0.005), having frequent breaks at work (AOR = 2.6, 95% CI, 1.4–4.8; P = 0.002) and the possibility of buying or borrowing required equipment for expressing breast milk (AOR = 1.7, 95% CI, 1.0–3.0; P = 0.033) were statistically associated with an increased chance of EBF.

Conclusion

Although returning to work was reported by the study participants as the main reason for discontinuation of EBF, families and managers’ support play significant roles in EBF continuation, which in the absence of six-month’s maternity leave for employed women in Ethiopia would be of benefit to both mothers and children.

Attitudes and experiences of employed women when combining exclusive breastfeeding and work: A qualitative study among office workers in Northern Ethiopia

Evidence from different countries shows that the level of support given to mothers who return to paid employment can significantly determine the duration of exclusive breastfeeding (EBF). However, little is known about how returning to work impacts Ethiopian women's EBF practice. The aim of this study was to explore women's attitudes and experiences of EBF when they returned to work. Mothers who had an infant of less than 12 months, working in government institutions in Tigray region, Ethiopia, were invited to participate in this study. Semi‐structured, face‐to‐face interviews were used to explore mothers' perspectives of the factors that influenced EBF when they returned to work. The interview data were transcribed verbatim and thematically analysed. Twenty mothers were interviewed from 10 organizations. Three themes were identified from their accounts: mother's knowledge, attitudes and practice towards breastfeeding; workplace context and employment conditions; and support received at home. Most participants were familiar with the benefits of EBF. Most participants reported that their colleagues had more positive attitudes towards breastfeeding than their managers. In almost all the workplaces, there was no specific designated breastfeeding space. Participants reported that close family members including husbands and mothers were supportive. Mothers' knowledge and attitude towards breastfeeding, workplace and employment conditions and support received at home were found to be the main factors determining the duration of EBF among employed women. Participants reported that the overall support given to breastfeeding women from their employers was insufficient to promote EBF.

Exploring the breastfeeding knowledge level and its influencing factors of pregnant women with gestational diabetes mellitus

Background

Studies reveal that promoting the breastfeeding knowledge level help to improve breastfeeding behaviors. Promoting breastfeeding knowledge is a simple and economical way to increase breastfeeding rates. However, there are no studies focus on the level of breastfeeding knowledge and factors influencing the knowledge in women with gestational diabetes mellitus (GDM), which is defined as any degree of glucose tolerance impairment first diagnosed during pregnancy. Thus, the objectives of this study were to investigate the breastfeeding knowledge level of GDM pregnant women and explore factors influencing the knowledge level.

Methods

Cross-sectional survey and convenience sampling were conducted in this study. The sociodemographic characteristics, caregivers in pregnancy, knowledge source, breastfeeding status and breast status information of participants were collected. Breastfeeding Knowledge Scale was used to assess the breastfeeding knowledge level of pregnant women with GDM. Multiple linear regression was used to analyze the influence factors of breastfeeding knowledge level in this study.

Results

A total of 226 questionnaires were issued and finally 212 valid questionnaires were collected. Some misconceptions still existed (e.g. ‘breastfeeding cannot prevent your baby from being overweight’ and ‘it is advisable to breastfeed 3-4 times per day within 2-3 days after delivery’), although women with GDM had a good score of breastfeeding knowledge (mean score: 103.5 ± 10.4). Multiple linear regression analysis found that gestational age, family per capita monthly income, educational level, knowledge source were the independent protective factors for breastfeeding knowledge and minority nationality was the independent risk factor. The educational level had the greatest influence on the breastfeeding knowledge level of GDM pregnant women (β = 0.210, t = 2.978, P = 0.003).

Conclusion

GDM pregnant women with insufficient gestational age, low educational level, low family per capita monthly income and single access to knowledge should be included in the focus of health education on breastfeeding. In-depth and systematic health education should be conducted for pregnant women with GDM to improve their breastfeeding rate.

Female hospital workers in Morocco: factors influencing breastfeeding duration with self-reported experiences

Health workers (HW) could be at risk of early weaning because of working conditions. Our aim was to determine factors influencing the duration of breastfeeding among Moroccan hospital workers, and to explore their breastfeeding (BF) experiences. A cross-sectional study was conducted in four hospitals in Rabat/Morocco (from November 2015 to April 2016), including each woman working in the hospital, with at least one living child and who accepted to be interviewed. Data of 203 hospital workers were analyzed. The median age was 39. The median duration of any breastfeeding was 8 months. Among different categories of HW, physicians had the lowest duration of breastfeeding. Factors significantly correlated to longer duration of breastfeeding were infant rank (p = 0.003), early initiation of breastfeeding (p < 0.001), access to milk storage generally (p = 0.04), husband's opinion on breastfeeding (p < 0.001) and category of hospital worker (p = 0.01). Three central themes emerged from the analysis of qualitative data: "Breastfeeding health worker has to assume her work duties as any other health worker", "the expression of need for support", and "the lack of knowledge on breastfeeding". In light of these results, we believe that physicians are a high-risk group of premature complete weaning; many actions should be taken for all HW to enhance their knowledge and giving them support.

Exclusive breastfeeding village program increased the role of health cadres

Background: Exclusive Breastfeeding Village Program was launched by Government in 2016 to increase public awareness on the need to feed babies exclusively with breast milk. The purpose of this study was to determine the effect of the exclusive breastfeeding village program in increasing the role of health cadres to promote breastfeeding practices.

Design and Methods: The design of this study was pre experimental with one group pre-post design with 102 cadres chosen by simple random sampling techniques. A Wilcoxon signed rank test with a significance level α=0.05 was used to measure the effectiveness of the program.

Results: The results showed that the value of P<0.05, it means that exclusive breastfeeding village program increased the role of health cadres and this is expected to be reflected in the improvement of the health of mothers and babies. The program has a strategic role to increase the knowledge and skills of support groups, make mothers understand the benefits of proper breastfeeding, and encourage eating good foods in order to maintain adequate nutrition.

Conclusions: The breastfeeding village program has the ability to improve the knowledge and skills of health cadres.

Work-Related Factors Affecting Exclusive Breastfeeding Among Employed Women in Ethiopia: Managers' Perspective Using a Qualitative Approach

Background

Only 21% of employed mothers in Ethiopia breastfeed exclusively until six months. Evidence from other countries has shown that support from managers encourages mothers to continue breastfeeding. Whereas lack of physical resources, time for breastfeeding and supportive policies adversely impact the continuation of breastfeeding. The aim of this study was to explore the perspective of managers regarding breastfeeding in the Ethiopian context.

Methods

Managers of district level, government institutions were interviewed in the Tigray region of North Ethiopia. Semi-structured, face to face interviews were used to explore managers’ perspectives and views about breastfeeding, the level of support they provide to breastfeeding mothers, and the challenges they faced. The data were transcribed verbatim and thematically analysed.

Results

Fifteen managers were interviewed from 12 organizations. The data were categorized into three themes. The first theme related to the attitudes and preference of managers and revealed that overall participants had positive views towards breastfeeding. The second theme highlighted managers’ concern about the impact of breastfeeding on staffing and workplace productivity. The third theme focused on managers’ assertions that, despite improvements, there were still inadequate policies and government strategies to support employed breastfeeding women in North Ethiopia.

Conclusion

It is promising that managers in North Ethiopia expressed a positive attitude towards supporting breastfeeding mothers. Managers raised concern about the impact of breastfeeding on work performance, as well as the lack of physical facilities and government resources that affects the level of support they can provide.

Hidden Realities of Infant Feeding: Systematic Review of Qualitative Findings from Parents

A growing, global conversation, regarding realities and challenges that parents experience today is ever-present. To understand recent parent's attitudes, beliefs, and perceptions regarding infant feeding, we sought to systematically identify and synthesize original qualitative research findings. Following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) framework, electronic databases were searched with a priori terms applied to title/abstract fields and limited to studies published in English from 2015 to 2019, inclusive. Study quality assessment was conducted using the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed. Of 73 studies meeting inclusion criteria, four major themes emerged. (1) Breastfeeding is best for an infant; (2) Distinct attitudes, beliefs, and perceptions of mothers that breastfeed, and those that could not or chose not to breastfeed, are evident; (3) Infant feeding behaviors are influenced by the socio-cultural environment of the family, and (4) Parent's expectations of education and support addressing personal infant feeding choices from health care providers are not always met. This systematic review, guided by constructs within behavioral models and theories, provides updated findings to help inform the development of nutrition education curricula and public policy programs. Results can be applied within scale-up nutrition and behavioral education interventions that support parents during infant feeding.

Enablers and barriers of exclusive breastfeeding among employed women in low and lower middle-income countries

OBJECTIVE

This systematic review and narrative synthesis aims to explore the specific facilitators and barriers of exclusive breastfeeding (EBF) among employed mothers in low and lower middle-income countries.

METHODS

Primary quantitative and qualitative studies undertaken in low and lower middle-income countries published from 2003 to 2019 were included in the review. Two reviewers independently assessed each article for eligibility using standardized critical appraisal instruments from the Joanna Briggs Institute.

RESULTS

Seven papers were included in this review. The enabler and barrier factors to EBF are summarized into three categories including maternal factors (such as mode of delivery, number of children, knowledge and attitude on breastfeeding), social factors (such as support from husband, family and child day care), and work-related factors (such as duration of maternal leave, flexibility of work, and availability of physical facilities).

CONCLUSION

To increase EBF among employed women, employers should support them by offering flexible working hours, a minimum of six months maternity leave and providing breastfeeding facilities. Support from family and maternal factors were important factors that could positively affect EBF. Identification of modifiable barrier and facilitator factors may contribute to successful EBF in employed women thereby reducing mortality and morbidity in countries with limited resources.

An Exploratory Thematic Analysis of the Breastfeeding Experience of Students at a Canadian University

BACKGROUND

The demographic of today's university student includes breastfeeding mothers. Few studies have examined the breastfeeding experience that women face upon their return to school. Research aim: The purpose of this research was to explore the breastfeeding experience of students on a university campus.

METHODS

This qualitative study used semistructured interviews. Responses were audiotaped, transcribed, and coded according to common themes using MAXQDA software.

RESULTS

A total of eight women were interviewed for the study. All women reported "feelings of isolation" and expressed concern over "what will others think." In addition, "nowhere to breastfeed" and "challenges of pumping" emerged as common barriers to breastfeeding. Regrettably, "forced decisions" emerged as a major theme, with four out of eight women reporting having to supplement with formula because they returned to school.

CONCLUSION

Student breastfeeding mothers are faced with emotional and physical challenges upon their return to school. Lack of space to breastfeed or pump as well as lack of support on campus are the main reasons that students stop breastfeeding prematurely. A day care facility on campus that accepts young infants, a Baby-Friendly space, and enhanced education are required to support student mothers in their choice to breastfeed.