Breastfeeding and employment

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.

Personal Attitudes or Structural Factors? A Contextual Analysis of Breastfeeding Duration

A personal attitudes model (i.e., infant feeding choices are based on personal attitudes primarily) and a structural factors model (i.e., feeding choices are shaped by the structural contexts of women's lives, as much as personal attitudes) of women's breastfeeding behavior were tested by surveying a longitudinal sample of 548 mostly European American women recruited for the Wisconsin Maternity Leave and Health Project. Personal attitudes (enjoyment of breastfeeding, gender-role attitudes, and work and family salience) accounted for half as much variance in breastfeeding duration for women who were employed outside the home compared to those who were not. For women employed outside the home, both structural variables (length of maternity leave and workplace flexibility) and personal attitudes predicted duration. These results have implications for how we construct the issue of women's breastfeeding decisions.

Duration of breast feeding and risk of developmental delay in Taiwanese children: a nationwide birth cohort study

The purpose of this study was to examine the relationship between duration of breast feeding and four developmental domains: gross motor, fine motor, language, and personal/social skills. This study included 14,621 infants from birth to 18 months of age. In the Taiwan Birth Cohort Study, four developmental screening items adapted from the Denver Development Screening Test were most appropriate for children aged 15 to 18 months. The proportion of young children who had mastered specific milestones increased consistently with longer duration of breast feeding. The adjusted odds ratios of the risk of developmental delay for the longest duration of breast feeding vs. never breast-fed were 0.69 [95% confidence interval (CI) 0.57, 0.83] for gross motor, 0.64 [95% CI 0.53, 0.77] for fine motor, 0.74 [95% CI 0.60, 0.91] for language, and 0.76 [95% CI 0.64, 0.90] for personal/social skills. Regardless of when the mothers returned to work, duration of breast feeding was found to have an inverse association with developmental delay in young children. The protection against developmental delays remained significant for those children who were breast-fed for more than 6 months. Children who were breast-fed for longer than 6 months had a lower risk of developmental delay than those who were never breast-fed. These data support the hypothesis that duration of breast feeding is positively related to young children's neurodevelopment.

Maternal distress and intended breastfeeding duration

AIM

To evaluate the associations between maternal psychological status and intended breastfeeding duration.

METHODS

A total of 852 pregnant women who attended antenatal care between September 1997 and August 2000 in 12 health units and five hospitals in Jundiaí city, Brazil, were included in the study. Psychological measures (stress and distress) were obtained at a gestational age from 30 to 36 weeks, using standardized scales, questionnaires and inventories. Psychological factors specifically related to breastfeeding assessed their worries, concerns, and support when breastfeeding. Multiple linear regression analysis identified the associations between the outcome "intended duration of breastfeeding" and psychological status of the mothers, controlling for toxic exposure, socioeconomic, demographic, obstetric and nutritional factors.

RESULTS

There were negative associations between the outcome and distress, "concerned about body's changes", and work outside home, and a positive association between the outcome and marital status (p < or = 0.03).

CONCLUSION

Early identification of distress in pregnant women and a more attentive encouragement to breastfeed is probably one of the steps to improve intended breastfeeding duration.

Predictors of preterm infant feeding methods and perceived insufficient milk supply at week 12 postpartum

As part of a large, nonexperimental, prospective, longitudinal study, 94 pump-dependent mothers of a nonnursing preterm infant were queried via telephone at weeks 8 to 12 post-partum about their infant feeding method. At week 12, 44.6% provided own mother's milk, 26.6% provided own mother's milk + artificial milk, and 28.7% provided artificial milk only. Logistic regression analyses identified the following predictors for risk of artificial milk at week 12 postpartum: multiple birth, week 6 inadequate milk supply, maternal age younger than 29 years, and intended length of lactation less than 34 weeks. Predictors for risk of maternal perceived insufficient milk supply for weeks 8 to 12 postpartum included week 6 inadequate milk supply, unemployment, and infant hospital discharge after postpartum day 42. Further research is needed to assist pump-dependent mothers of preterm infants with sustaining their milk supply.

Breastfeeding: factors associated with the continuation of breastfeeding, the current situation in Japan, and recommendations for further research

There are a number of research reports that address the various advantages that breastfeeding brings to mothers and children, as well as to families and society, and in addition to a number of physically positive effects, breastfeeding has an important role in terms of mental and psychological effects.Ninety-five % of mothers desire to breastfeed, which reflects social acceptance, but the actual breastfeeding rate of the first month after childbirth is 42%, which accounts for about a half of all mothers. Breastfeeding is a natural behavior, but it cannot be performed only by instinct, so mothers discontinue breastfeeding for various reasons. While these reasons for the discontinuation of breastfeeding have been studied in many countries, research regarding the usability of care to support breastfeeding is being conducted in other countries at a level that can be considered evidential, but not yet in Japan. In addition, the current situation is that breastfeeding is strongly promoted but the support provided remains inadequate for mothers who cannot breastfeed, regardless of whatever efforts they make. This article will review several factors associated with the continuation of breastfeeding and the current situation in Japan, with the intention of identifying desirable areas for further research.

Factors influencing full breastfeeding in a southwestern ontario community: assessments at 1 week and at 6 months postpartum

Factors associated with full breastfeeding (FBF) at 1 week and at 6 months postpartum were examined in a cohort of 856 mother-infant dyads. Questionnaires were mailed at 4 time points over the first 6 months postpartum. At 1 week, 68% of infants were FBF; at 6 months, 23% were FBF. Factors significantly associated with FBF at 1 week were hospital of delivery, residing with a smoker, maternal shiftwork during pregnancy, and having no prior breast-feeding experience. Cox proportional hazards regression analysis showed that residing with a smoker, having consumed caffeine during pregnancy, reporting elevated maternal trait anxiety at 1 week postpartum, having been employed full-time outside the home prior to delivery, and having received anesthesia/analgesia during labor/delivery were associated with earlier cessation of FBF, whereas not having previous breastfeeding experience predicted its continuation. Although most mothers are breastfeeding early on, a number of factors adversely affect its successful continuation.

Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: a cross-sectional survey

BACKGROUND

In recent years, the creation of supportive environments for encouraging mothers to breastfeed their children has emerged as a key health issue for women and children. The provision of lactation rooms and breast pumping breaks have helped mothers to continue breastfeeding after returning to work, but their effectiveness is uncertain. The aim of this study was to assess the effects of worksite breastfeeding-friendly policies and work-related factors on the behaviour of working mothers.

METHODS

This study was conducted at a large Taiwanese semiconductor manufacturer in August-September 2003. Questionnaires were used to collect data on female employees' breastfeeding behaviour, child rearing and work status when raising their most recently born child. A total of 998 valid questionnaires were collected, giving a response rate of 75.3%.

RESULTS

The results showed that 66.9% of survey respondents breastfed initially during their maternity leave, which averaged 56 days. Despite the provision of lactation rooms and breast pumping breaks, only 10.6% mothers continued to breastfeed after returning to work, primarily office workers and those who were aware of their company's breastfeeding-friendly policies.

CONCLUSION

In conclusion, breastfeeding-friendly policies can significantly affect breastfeeding behaviour. However, an unfavourable working environment, especially for fab workers, can make it difficult to implement breastfeeding measures. With health professionals emphasizing that the importance of breastfeeding for infant health, and as only females can perform lactation, it is vital that women's work "productive role" and family "reproductive role" be respected and accommodated by society.

Protecting, promoting, and supporting breastfeeding among women in the labor force

The need to protect, promote, and support breastfeeding among women in the labor force is an important global issue that requires greater attention. An increasing proportion of women of child-bearing age are employed outside the home. Women who resume full-time work outside the home when their infants are young tend to have shorter durations of breastfeeding and less exclusive breastfeeding. However, evidence indicates that appropriate breastfeeding policy and support programs can help sustain breastfeeding among employed women. Effective strategies include delayed return to work, working part-time, improved conditions at work for breastfeeding, breastfeeding breaks during work hours, milk expression and storage, and access to breastfeeding counseling. In this chapter, we consider the special needs of women working outside the home; provide a brief overview of the literature; and address international policy regarding the protection, promotion, and support of breastfeeding among women who work outside the home.

Breast milk expression in the workplace: a look at frequency and time

The objective of this article is to study a barrier for breastfeeding women working full-time outside the home: breast milk expression in the workplace. Data are from a large corporation that provides employee benefits. Mothers express breast milk about twice a day when infants are 4 months old (x = 2.2 +/- 0.8) and 6 months old (x = 1.9 +/- 0.6), with a significant decline in frequency (P <.05) comparing the 2 age groups. Most mothers spend 1 hour or less expressing breast milk when infants are 3 (82%) or 6 months old (96%), with a significant difference (P <.05) between the 2 age groups. Mothers of younger infants were no more likely to work fewer days per week than were mothers of older infants. Most women can express breast milk for 3- and 6-month-old infants in less than an hour, distributed in about 2 separate portions, in an employment environment supportive of breastfeeding.

A description of a male-focused breastfeeding promotion corporate lactation program

The role of the father has been identified as one of the strongest influences on the initiation and duration of breastfeeding by mothers in the United States. This report describes a corporate lactation program that focuses on promoting breastfeeding through male employees. Since 1990, a full-time on-site lactation program has been offered to male employees at the Los Angeles Department of Water and Power, a public utility company. The male program participants are from diverse backgrounds. Participation in the Fathering Program has grown since 1990 based on word of mouth, fathers' interest in the benefits of breastfeeding for the infant, and the female partners' interest in getting a free pump rental. This report illustrates the viability of a breastfeeding support program that targets male employees and that is offered in a corporate setting.

Breastfeeding initiation and duration: a 1990-2000 literature review

OBJECTIVE

To review the literature on breastfeeding initiation and duration and to delineate effective strategies for promoting positive breastfeeding behaviors.

DATA SOURCES

Computerized searches on MEDLINE, CINAHL, and the Cochrane Library.

STUDY SELECTION

Articles from indexed journals relevant to the objective and published after 1990 (except for classic findings) were reviewed. Although a myriad of pertinent articles was located, referenced citations were limited to three per point. When article selection was required for a specific point, preferences were given to (a) randomized controlled trials; (b) meta-analyses; (c) studies with the largest, most representative samples; and (d) investigations conducted in North America.

DATA EXTRACTION

Data were extracted and organized under the following headings: benefits of breastfeeding, breastfeeding initiation and duration, personal characteristics, attitudinal and intrapersonal characteristics, hospital policies and intrapartum experience, sources of support, breastfeeding interventions, and review implications.

DATA SYNTHESIS

Although the health benefits of breastfeeding are well documented and initiation rates have increased over the past 20 years, most mothers wean before the recommended 6-months postpartum because of perceived difficulties with breastfeeding rather than due to maternal choice. Women least likely to breastfeed are those who are young, have a low income, belong to an ethnic minority, are unsupported, are employed full-time, decided to breastfeed during or late in pregnancy, have negative attitudes toward breastfeeding, and have low confidence in their ability to breastfeed. Support from the mother's partner or a nonprofessional greatly increases the likelihood of positive breastfeeding behaviors. Health care professionals can be a negative source of support if their lack of knowledge results in inaccurate or inconsistent advice. Furthermore, a number of hospital routines are potentially detrimental to breastfeeding. Although professional interventions that enhance the usual care mothers receive increase breastfeeding duration to 2 months, these supportive strategies have limited long-term effects. Peer support interventions also promote positive breastfeeding behaviors and should be considered.

CONCLUSIONS

A promising intervention is the complementation of professional services with peer support from a mother experienced in breastfeeding. This lay support appears to be an effective intervention with socially disadvantaged women.

Breastfeeding knowledge and beliefs among adults in eastern Tobago

Using a cross-sectional survey, the knowledge and beliefs about breastfeeding were evaluated among adults in Eastern Tobago (N = 509). Of the respondents, 95%, 69%, and 48% indicated that a baby should be exclusively breastfed at birth, 3 months, and 6 months, respectively. The baby's mother was thought to have the greatest influence on breastfeeding decisions. Of the respondents, 63% and 80% were unaware of expressed breast milk and cup-feeding a neonate, whereas 82% believed that a solely breastfed baby should receive water. Additionally, 23% and 44% felt that breastfeeding should be terminated before 6 months and between 6 and 12 months, respectively. Inadequate maternal nutrition and employment were reported as the principal factors affecting breastfeeding. There is a lack of knowledge about the anatomy and physiology of lactation and about the benefits of exclusive breastfeeding. These findings are useful for guiding the development and implementation of interventions to promote breast-feeding in Tobago.

Breastfeeding in the workplace

More than 50% of women of reproductive age are employed, and most return to work post partum at a time when exclusive breastfeeding is the ideal. Public health efforts target a goal of increased breastfeeding initiation and duration rates. To be successful at integrating the roles of breastfeeding mother and employee, women need practical advice, the encouragement and support of health care providers, and societal and workplace support. This article discusses the current state of employed breastfeeding women and provides practical guidelines for assisting women to be successful at meeting breastfeeding goals.

The efficacy of the lactational amenorrhea method (LAM) among working women

The purpose of this study was to assess the efficacy of the lactational amenorrhea method (LAM) for family planning among mothers who are separated from their infants by work. The study population, 170 urban middle class women who planned to return to work before 120 days postpartum, were interviewed monthly for 6 months postpartum and contacted at 12 months. The study population received clinical support for expressing their milk and exclusively breast-milk feeding the infants and for the use of LAM for birth spacing. The cumulative life table pregnancy rate by 6-month was 5.2%, with 3 pregnancies, one at each of months 4, 5, and 6. LAM for working women, as described in this article, might be associated with a higher pregnancy risk than LAM use among non-working women. Therefore, women using LAM should be informed that separation from the infant might increase their risk of pregnancy.

Supporting the employed breastfeeding mother

The number of women in the workforce is continuing to increase and surveys suggest that one-fourth of employed women with a child less than 1 year of age will be concurrently breastfeeding and working for at least 1 month. Combining breastfeeding and employment is a complex process in American society. Women will be seeking practical, sound advice on how to be successful in this combination. This article offers suggestions for promoting its success, describes the preplanning that needs to occur, and provides current lactation recommendations and resources. It also offers information about working with employers, the importance of a support network, decisions that each family must make, the use of breast pumps; milk storage, lactation enhancement including the use of herbs, and practical tips for the mother's working day.

Breastfeeding practices among employed Thai women in Chiang Mai

In many developing countries, labor force participation by women in the childbearing years has increased rapidly. Social and economic changes present new challenges for women attempting to combine their roles as workers and mothers. Little is known about how these challenges affect infant feeding choices. This multidisciplinary study investigated work and infant feeding decisions among 313 employed women in Chiang Mai, Thailand. Resumption of employment generally had negative affects on breastfeeding rates and duration. At 6 months postpartum, women who worked inside the home breastfed more than those working in the formal sector at jobs with inflexible hours (home, 80%; public sector, 37%; private sector, 39%). Women who were working outside the home for a long period or had shift jobs encountered many obstacles to maintaining breastfeeding, and most gave it up within 1 month after resuming employment. There is a need for multisectoral policies that address obstacles to breastfeeding among women in the paid labor force in Thailand.

What influences the uptake and early cessation of breast feeding?

OBJECTIVE

To examine obstetric, maternal and social factors associated with the uptake and early cessation of breast feeding and women's reasons for altering from breast to bottle feeding.

DESIGN

Women who responded to a postal questionnaire on long-term postpartum health were contacted and asked to participate in a home-based interview. In addition to health problems, the interview obtained information on baby feeding and a number of social factors. Women were also asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Obstetric and maternal data were obtained from maternity records.

SETTING

Deliveries from a large maternity hospital in Birmingham.

PARTICIPANTS

906 women were interviewed at a mean of 45 weeks after delivery.

FINDINGS

63% of the women said they had breast fed, but 40% of these stopped within three months of delivery. Many of the women gave physical problems with lactation as reasons for stopping. The factors found to be predictors of early cessation were: return to work within three months of birth; regular childcare support from other female relatives, and a high EPDS score. Non-initiation of breast feeding was predicted by a different set of factors: multiparity; general anaesthetic (GA); and unmarried status.

DISCUSSION AND CONCLUSION

Despite evidence of the benefits of breast feeding, this remains an unacceptable long-term option for many women, and for over one-third it is never attempted. Factors within the woman's social environment were found to influence early cessation. Women who had a GA during or immediately following labour and delivery were less likely to initiate breast feeding.

IMPLICATIONS FOR PRACTICE

If breast-feeding incidence and duration are to increase, more attention should be paid to establishing early, successful breast feeding and countering the negative influences of factors within the social environment.

Lactation and the labor market: breastfeeding, labor market changes, and public policy in the United States

Public health authorities in the United States actively promote breast-feeding, with target goals for increased beast-feeding rates by the year 2000. In recent decades, however, there has been an increase in the number of American mothers with infants who are in the labor market. Drawing together research examining the intersection of breast-feeding and women's involvement in paid employment, as well as various labor market analyses, this study explores how national recommendations advocating increased breast-feeding among new mothers in paid work are reconciled with economic pressures to return to the labor force in the early postpartum period. This analysis highlights those employment-related factors that constrain the practice of breast-feeding, thereby impeding "choice" over infant feeding method for many mothers. Finally, there is an attempt to explore various employer and public policies and strategies potentially supportive of breast-feeding among mothers in paid employment.

Breast-feeding in the workplace: how to succeed

As the numbers of women of childbearing age in the workforce continue to increase, some employers and employees have viewed maternal employment to be incompatible with breast-feeding. This qualitative study investigated factors that hindered as well as facilitated breast-feeding in the workplace. Findings suggest breast-feeding and employment can and should be compatible.

The decision to breastfeed. The importance of father's approval

One hundred fifteen postpartum mothers who were within 24 hours of delivery completed a questionnaire to determine factors which may influence a mother's intention to breastfeed and to evaluate specifically the effect of working outside of the home. In our population of mostly middle-class married and insured women, working outside of the home was not significantly related to the decision to breastfeed (67.9% of working mothers, compared to 67.2% of those who did not plan to work postpartum, planned to at least partially breastfeed). The only factors that significantly related to breastfeeding intention pertained to the father's level of education and to his approval of breastfeeding. Strong approval of breastfeeding by the father was associated with a high incidence of breastfeeding (98.1%), compared to only 26.9% breastfeeding when the father was indifferent to feeding choice (P < 0.001).