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Mgongo M, Ickes SB, Leyaro BJ, Mboya IB, Grounds S, Seiger ER, Hashim TH, Conklin JL, Kimani-Murage EW, Martin SL. Early Infant Feeding Practices among Women Engaged in Paid Work in Africa: A Systematic Scoping Review. Adv Nutr 2024; 15:100179. [PMID: 38246350 PMCID: PMC10877690 DOI: 10.1016/j.advnut.2024.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 01/05/2024] [Accepted: 01/14/2024] [Indexed: 01/23/2024] Open
Abstract
Around the world, paid work without appropriate structural support is a key barrier to optimal breastfeeding practices. To better protect, promote, and support optimal breastfeeding practices among working women in Africa, this scoping review sought to understand how paid work influences infant feeding practices in the first 6 mo of life and what support women need to manage work and optimal infant feeding practices. We systematically searched PubMed, Scopus, Global Health, and CINAHL Plus, screened 2436 abstracts, and reviewed 322 full-text articles using Covidence for review and charting. We identified 203 articles that met the inclusion criteria. We identified 32 quantitative, 10 qualitative, 3 mixed-methods, and 2 review articles that focused on examining the relationship between work and breastfeeding, and 109 quantitative, 22 qualitative, 21 mixed-methods, and 4 review articles that included work as part of broader breastfeeding research but did not focus on work. Most studies reported a significant negative association between work and exclusive breastfeeding. Three major domains were reported in the qualitative studies: challenges to managing work and infant feeding, receiving support from employers and family members/caregivers, and strategies for feeding infants when the mother is working. Reviewed studies proposed recommendations to increase support for breastfeeding through changes to policies and support within worksites, the health system, and childcare; however, evidence of previously implemented policies or programs is limited. We recommend more consistent definitions and measurement of women's work. Future research is needed on the impact of implementing various strategies and benefits for breastfeeding at workplaces, as well as efforts to support breastfeeding among informal workers.
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Affiliation(s)
- Melina Mgongo
- Institute of Public Health, Department of Community and Global Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania; Better Health for the African Mother and Child, Moshi, Tanzania.
| | - Scott B Ickes
- Department of Biological and Health Sciences, Wheaton College, Wheaton, IL, United States; Kenya Medical Research Institute, Nairobi, Kenya; Program in Nutritional Sciences, and Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States; Department of Kinesiology and Health Sciences, William and Mary, WIlliamsburg, VA, United States
| | - Beatrice J Leyaro
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Innocent B Mboya
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania; Department of Translational Medicine, Lund University, Malmo, Sweden
| | - Samantha Grounds
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Emily R Seiger
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tamara H Hashim
- Institute of Public Health, Department of Community and Global Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Jamie L Conklin
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Ickes SB, Lemein HS, McKay A, Arensen K, Singa B, Kinyua J, Nduati R, Walson J, Denno DM. Mothers' Willingness to Use Workplace Lactation Supports: Evidence from Formally Employed Mothers in Central Kenya. Curr Dev Nutr 2023; 7:102032. [PMID: 38130332 PMCID: PMC10733674 DOI: 10.1016/j.cdnut.2023.102032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 12/23/2023] Open
Abstract
Background Formally employed mothers are vulnerable to early cessation of exclusive breastfeeding. Kenyan national policy requires employer-provided maternity benefits and workplace lactation supports. Objective The objective of this study was to evaluate willingness to use nationally mandated workplace lactation supports among formally employed women in Kenya. Methods We conducted a cross-sectional survey among 304 mothers of children ages ≤12 mo in Naivasha, Kenya, who were currently formally employed and employed before delivery of the most recent child to assess availability of and willingness to use current and potential future workplace lactation supports. Results The most available reported workplace lactation supports were schedule flexibility to arrive late or leave early (87.8%) or visit a child to nurse during lunch (24.7%), followed by company-funded community-based daycare (7.6%). Few (<4.0%) reported the availability of lactation rooms, on-site daycares, transportation to breastfeed during lunch, refrigerators for expressed milk, or manual or electric breastmilk pumps. If made available, >80% of mothers reported moderate or strong willingness to use flexible schedules to arrive late or leave early, break during lunch, and transportation to visit a child to nurse. A moderate proportion reported strong willingness to use on-site daycares (63.8%), company-funded community-based daycare (56.9%), on-site lactation rooms (60.5%), refrigeration for expressed milk (49.3%), manual (40.5%), and electric pumps (27.6%). Mothers expressed fear of missing production targets and reported more willingness to use on-site compared with off-site daycare to save transportation time but noted concerns about chemical exposures and early arrival times with young infants. Hesitations regarding the use of on-site lactation rooms included concerns about privacy, milk identification and storage, and use and sharing of pumps. Conclusions Flexible schedules were the workplace lactation supports in highest demand among formally employed mothers. Maternal willingness to use lactation rooms, refrigeration, and pumping equipment was moderate to low, suggesting sensitization may help to increase demand as the implementation of Kenyan policies moves forward.
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Affiliation(s)
- Scott B. Ickes
- Department of Biological and Health Sciences, Wheaton College, Wheaton, IL, United States
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
- Departments of Medicine (Allergy and Infectious Disease) and Epidemiology, University of Washington, Washington, DC, United States
- Department of Kinesiology, William and Mary, Williamsburg, VA, United States
| | - Hellen Sankaine Lemein
- Departments of Medicine (Allergy and Infectious Disease) and Epidemiology, University of Washington, Washington, DC, United States
| | - Anna McKay
- Department of Biological and Health Sciences, Wheaton College, Wheaton, IL, United States
| | - Kelly Arensen
- Department of Biological and Health Sciences, Wheaton College, Wheaton, IL, United States
| | - Benson Singa
- Departments of Medicine (Allergy and Infectious Disease) and Epidemiology, University of Washington, Washington, DC, United States
| | - Joyceline Kinyua
- Departments of Medicine (Allergy and Infectious Disease) and Epidemiology, University of Washington, Washington, DC, United States
| | - Ruth Nduati
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Judd Walson
- Departments of Medicine (Allergy and Infectious Disease) and Epidemiology, University of Washington, Washington, DC, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Donna M. Denno
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
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