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

Food-Derived Compounds Extend the Shelf-Life of Frozen Human Milk

Breastmilk is known to provide optimal nutrition for infant growth and development. A cross-sectional analysis of nationally representative US data from 2016 to 2021 revealed that >90% of lactating mothers reported using breast pumps to express milk.1 We conducted a survey of n = 1,049 lactating or recently lactating individuals from a US nationally representative population to explore breastmilk storage practices among this group. The data revealed that 83% of respondents store breastmilk in their homes, with 68% using freezers to do so for >1 month. The lowest available temperature in most household freezers is -20 °C, a temperature that is inadequate to maintain human milk's emulsified structure, leading to separation, degradation of fats, loss of key vitamins, and changes in palatability. We developed a first-of-its-kind high-throughput screening platform to identify food-derived compounds and combinations of compounds that, when added to human breastmilk, preserve fat content, retain antioxidant capacity, and reduce production of rancid-associated free fatty acids during extended freezer storage. These formulations represent leads for the development of safe and affordable frozen breastmilk shelf-life extenders for easy at-home use to increase the longevity of stored breastmilk.

Challenges, experiences, and potential supports for East and Southeast Asian mothers in the workforce: a systematic review

OBJECTIVE

To examine the challenges faced by Asian working mothers with a focus on re-entry to the workplace. In addition, we highlight potential supports that retain women in the workforce.

DESIGN

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and registered with PROSPERO database (CRD42022341130).

METHODS

Three independent reviewers were involved in the study selection to screen the search results sequentially by title, abstract, and full text using predefined inclusion and exclusion criteria. The methodological quality of each article was assessed via the Critical Appraisal Skills Programme (CASP) tool.

RESULTS

We analysed a total of 36 studies conducted across different regions: 30 from the East and 6 from Southeast Asia. Among these studies, 20 were quantitative in nature, 15 were qualitative, and one intervention. The 36 studies cover five themes: 1) policies, 2) external support sources, 3) external pressure, 4) breastfeeding and 5) health status. Within each theme the same factor can have a positive or negative impact on the mother depending on her having a pro-career or pro-family mindset. Companies can take various initiatives to support working mothers, such as providing facilities for expressing breast milk at the workplace, educating staff to promote breastfeeding and accommodate childcare needs, and extending maternity leaves. However, there is a lack of literature that directly addresses the barriers and concrete support available to working mothers in Asia, beyond the scope of breastfeeding.

CONCLUSIONS

Our findings underscore several obstacles that can impede a woman's seamless return to work. Pro-family and pro-career mothers have differing needs that cannot be addressed at the same time. There is a lack of comprehensive understanding regarding effective strategies or interventions that can support a positive reintegration into the workforce.

Factors associated with breastfeeding abandonment in the first month after the mother's return to work

The return to work of lactating mothers has been identified as an important risk factor for breastfeeding interruption. We proposed to identify factors associated with breastfeeding abandonment in the first month after return. 252 women working at a hospital who had children aged 12 to 36 months and who were still breastfeeding when returned to work answered a questionnaire containing questions on sociodemographic characteristics, pregnancy, childbirth, breastfeeding and work-related factors. The associations were estimated using adjusted prevalence ratio (aPR), calculated with the hierarchical Poisson multivariable regression model. The following factors showed a significant association with breastfeeding abandonment: using a pacifier (aPR 4.58), cohabiting with someone other than partner (aPR 3.77), having no intention or having doubts about maintaining breastfeeding after returning (aPR 3.39), having a college degree (aPR 2.66), having no support from the infant's caregiver (aPR 2.26), and infant being older when the woman returned to work (PR 1.16 for each additional month of infant age). Longer duration of exclusive breastfeeding was a protective factor (aPR 0.990). Most of the factors associated with discontinuation of breastfeeding in the first month after the mother's return to work are not directly related to the woman's work.

Promotion, protection, and support of breastfeeding at work, and achieving sustainable development: a scoping review

This article aims to map promotion, protection, and support strategies aimed at working women who breastfeed and their potential impact on achieving the Sustainable Development Goals (SDGs), in particular SDGs 5 (gender equality and women's empowerment) and 8 (decent work and economic growth). This study is a scoping review based on the Joanna Briggs Institute (JBI) framework, whose searches were performed in PubMed, Web of Science, Scopus, Social Science Research Network, and Open Knowledge Repository databases. This study's search obtained 576 publications, of which 33 were included in the study. The narrative synthesis was organized into three axes: 1) promotion; 2) protection, and 3) support for breastfeeding in the work context. Actions aimed at women who breastfeed at work have the potential to directly achieve SDGs 5 and 8, and indirectly achieve SDGs 1 and 10. Increased breastfeeding rates also help to achieve another four SDGs (2, 3, 4, 12). Actions aimed at working women who breastfeed can contribute directly and indirectly to the achievement of eight of the 17 SDGs, and should therefore be encouraged and reinforced.

Breastfeeding Support Rooms and Their Contribution to Sustainable Development Goals: A Qualitative Study

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.

Exclusive breastfeeding among working mothers in Kenya: Perspectives from women, families and employers

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.

Breastfeeding after Returning to Work: A Systematic Review and Meta-Analysis

BACKGROUND

The benefits of breastfeeding are widely known; however, continuation after returning to work (RTW) is not. We aimed to conduct a systematic review and meta-analysis to assess the prevalence of breastfeeding after RTW. The secondary objectives were to compare the economic statuses between continents.

METHOD

PubMed, Cochrane Library, Base, and Embase were searched until 1 September 2020, and two independent reviewers selected the studies and collated the data. To be included, articles needed to describe our primary outcome, i.e., prevalence of breastfeeding after RTW.

RESULTS

We included 14 studies, analyzing 42,820 women. The overall prevalence of breastfeeding after RTW was 25% (95% CI, 21% to 29%), with an important heterogeneity (I² = 98.6%)-prevalence ranging from 2% to 61%. Stratification by continents and by GDP per capita also showed huge heterogeneity. The Middle East had the weakest total prevalence with 10% (6% to 14%), and Oceania the strongest with 35% (21% to 50%). Despite the prevalence of breastfeeding in general increasing with GDP per capita (<US$5000: 19%, US$5000-30,000: 22%; US$30,000 to 50,000: 25%, >US$50,000 42%), the prevalence of non-exclusive breastfeeding follows more of a U-curve with the lowest and highest GDP per capita having the highest percentages of breastfeeding (<US$5000: 47% and >US$50,000: 50%, versus <28% for all other categories).

CONCLUSION

Breastfeeding after RTW is widely heterogeneous across the world. Despite economic status playing a role in breastfeeding after RTW, cultural aspects seem influential. The lack of data regarding breastfeeding after RTW in most countries demonstrates the strong need of data to inform effective preventive strategies.

How do breastfeeding workplace interventions work?: a realist review

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.

Integrating motherhood and employment: A 22-year analysis investigating impacts of US workplace breastfeeding policy

The United States has one of the lowest exclusive breastfeeding rates among high-income countries. Most experts agree that there is a lack of mother-friendly workplace policies compared to other countries. Since 1995, 25 states have implemented workplace breastfeeding legislation allowing mothers to express and store breast milk in the workplace. There is heterogeneity in policy enforceability where 17 states have weak enforceability while eight states have strict enforceability and require employers to offer provisions to breastfeed at the workplace. Using difference-in-differences methods, we examine the impact of this policy on state-level breastfeeding rates and assess how that impact differs with policy enforceability. We use data from the Centers for Disease Control on breastfeeding, supplementing with socio-economic data from the Panel Study of Income Dynamics, Current Population Survey, the US Census Bureau and several other datasets over 22 years from 1990 to 2011. We find that states with legislation experienced a 2.3-percentage point increase in breastfeeding rates compared to states without legislation while states with weak enforceability experienced a 3.1-percentage point increase compared to states without legislation. We also find that policies do not start to have an impact until 1-2 years after they were signed into law. Considering the recent assault on breastfeeding from the current administration, our study is a timely and important contribution that strengthens the evidence base for the health benefits of workplace breastfeeding policies.

[Impact of institutional aspects on breastfeeding for working women: a systematic review]

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.

Exclusive breastfeeding cessation and associated factors among employed mothers in Dukem town, Central Ethiopia

BACKGROUND

Employed women tend to exclusively breastfeed less than non-employed women. Early returning to work has been major reason why employed women stop exclusive breastfeeding. The aim of this study was to investigate exclusive breastfeeding (EBF) cessation and associated factors among employed mothers in Dukem town, Central Ethiopia.

METHODS

A cross-sectional study was conducted from February to March 2015 using total sample of 313 randomly selected permanently employed women. Information regarding participants' work-related factors, health service and sociodemographic factors were collected by face to face interview using structured questionnaire. Data were checked for completeness, entered and analyzed by SPSS version 20. Binary logistic regression was done to identify factors associated with exclusive breastfeeding cessation. The strength of association was measured using odds ratio with 95% confidence intervals.

RESULTS

Prevalence of exclusive breastfeeding cessation was 75.7% (95% CI 71.0, 80.5%). Having a short duration of maternity leave (AOR 9.3; 95% CI 3.8, 23), being a full time employee (AOR 3.5; 95% CI 1.7, 11), being private organization employee (AOR=2.1, 95% CI(1, 4.3)), lack of flexible work time (AOR 3.0; 95% CI 1.2, 7.5), not pumping breast milk (AOR 4.3; 95% CI 1.7, 11), lack of a lactation break (AOR 6.7; 95% CI 3,14.5) and work place far away from her child (AOR 3.1; 95% CI 3.1, 6.3), were significantly associated with cessation of EBF among employed mothers.

CONCLUSION

Prevalence of exclusive breastfeeding cessation was much higher than the international and national expectation. The concerned governmental bodies should consider improving the legislation of the 3 months postpartum maternity leave to reduce employed mother's exclusive breastfeeding cessation.

Breastfeeding Knowledge, Attitude, and Practice among White-Collar and Blue-Collar Workers in Indonesia

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.

Breastfeeding Discontinuation Not Associated with Maternal Pregravid BMI But Associated with Native Hawaiian or Other Pacific Islander Race in Hawaii and Puerto Rico WIC Participants

Objectives This study investigated the association between maternal pregravid body mass index (BMI) and breastfeeding discontinuation at 4-6 months postpartum in Hawaii and Puerto Rico participants from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods A secondary data analysis was conducted from a text message-based intervention in WIC participants in Hawaii and Puerto Rico. The analysis included 87 women from the control group who initiated breastfeeding and whose breastfeeding status was known at the end of the study when infants were 4-6 months old. Pregravid BMI and breastfeeding discontinuation were assessed using questionnaires. Results The association between pregravid BMI and breastfeeding discontinuation was not significant in the unadjusted model or in the adjusted model. Native Hawaiian or Other Pacific Islander (NHOPI) participants showed significantly increased odds of discontinuing breastfeeding (adjusted odds ratio [AOR] 7.12; 95% CI 1.34, 37.97; p = .02) compared to all the other racial/ethnic participants, as did older women ages 32-39 years versus women who were 25-31 years old (AOR 4.21; 95% CI 1.13, 15.72; p = .03). Women who took vitamins while breastfeeding had decreased odds of discontinuing breastfeeding (AOR 0.15; 95% CI 0.05, 0.46; p = .0009). Conclusions for Practice Pregravid BMI was not significantly associated with breastfeeding discontinuation at 4-6 months postpartum in women from Hawaii and Puerto Rico WIC, but NHOPIs and women who were older had higher odds of discontinuing breastfeeding. The results of this study may inform strategies for breastfeeding promotion and childhood obesity prevention but should be further investigated in larger studies. ClinicalTrials.gov Identifier: NCT02903186.

Impact of Key Workplace Breastfeeding Support Characteristics on Job Satisfaction, Breastfeeding Duration, and Exclusive Breastfeeding Among Health Care Employees

Background: Although national breastfeeding rates have improved across recent decades, women continue to face barriers to achieving recommended breastfeeding targets. Returning to work presents a unique set of challenges for breastfeeding continuation, even in health care settings tasked with promoting breastfeeding among patients. This study examined the association between key workplace breastfeeding support characteristics, job satisfaction, and breastfeeding outcomes among health care employees. Materials and Methods: We used data from a cross-sectional survey of employees in a large integrated health care system. The study sample included female employees who had breastfed in the past 3 years (n = 165). The Employee Perceptions of Breastfeeding Support Questionnaire (EPBS-Q) measured organization, manager, and coworker support for breastfeeding. Regression analyses tested the association between workplace support factors and breastfeeding duration, breastfeeding exclusivity, and job satisfaction. Results: Managerial support increased median job satisfaction by 0.39 standard deviations (p < 0.001), and increased the odds of prolonging exclusive breastfeeding (odds ratio [OR] 1.47; confidence interval [CI] 1.03-2.09). Organizational support increased median job satisfaction by 0.27 standard deviations (p < 0.001), and increased the odds of exclusive breastfeeding by nearly twofold (OR 1.80; CI 1.05-3.09). No significant associations were found between workplace support factors (organizational, managerial, and co-worker support) and overall breastfeeding duration. Conclusions: Organizational and managerial support are key aspects of workplace lactation support, which may positively impact job satisfaction, rates of exclusive breastfeeding, and duration of exclusive breastfeeding among female health care employees. This intersection of outcomes salient for the business community and public health practitioners highlights opportunities for collaborations to improve workplace and breastfeeding outcomes.

Breastfeeding experiences of female physicians and the impact of the law change on breastfeeding

Aim

A recent improvement was made on the law regulating maternity leave in 2011 in Turkey. The leave without pay period was increased, the right to stop working on night shifts was granted, and work hours were improved. It is a known fact that returning to work is a barrier against exclusive and total breastfeeding duration. Legal regulations have crucial importance on the ability of working mothers to breastfeed their infants. The aim of this study was to calculate the effect of the improved law on breastfeeding rates among female physicians. Moreover, the difference in the duration of exclusive breastfeeding and total breastfeeding were evaluated in relation to the new law.

Material and Methods

Three of the major hospitals in Istanbul were included in the study. A pilot study was planned and our questionnaire was tried. The actual study included 40 female physicians from each hospital. Mothers who went through antenatal or postnatal complications were excluded from the study. Infants who required intensive care after birth or were never breastfed were similarly excluded. A total of 109 female physician resident mothers' questionnaires were included in the study.

Results

The effects of the improvement in the law were statistically significant on the duration of maternity leave and improved working hours after returning to work (OR: 2.74 and OR: 2.52). Exclusive breastfeeding rates and total breastfeeding for more than 12 months significantly increased after the new law (OR: 4.47 and OR: 2.56).

Conclusions

This study showed that legal improvements did reflect on positive outcomes. There is more to be done, especially with condition of the work places and distributing rights equally to women practicing in surgical disciplines as well. If the physicians can breastfeed after they become mothers, their experience may affect their breastfeeding advocacy and the guidance they will provide for their patients.

Does extending the duration of legislated paid maternity leave improve breastfeeding practices? Evidence from 38 low-income and middle-income countries

Introduction

Among all barriers to breastfeeding, the need to work has been cited as one of the top reasons for not breastfeeding overall and for early weaning among mothers who seek to breastfeed. We aimed to examine whether extending the duration of paid maternity leave available to new mothers affected early initiation of breastfeeding, exclusive breastfeeding under 6  months and breastfeeding duration in low-income and middle-income countries (LMICs).

Methods

We merged longitudinal data measuring national maternity leave policies with information on breastfeeding related to 992 419 live births occurring between 1996 and 2014 in 38 LMICs that participated in the Demographic and Health Surveys. We used a difference-in-differences approach to compare changes in the prevalence of early initiation and exclusive breastfeeding, as well as the duration of breastfeeding, among treated countries that lengthened their paid maternity leave policy between 1995 and 2013 versus control countries that did not. Regression models included country and year fixed effects, as well as measured individual-level, household-level and country-level covariates. All models incorporated robust SEs and respondent-level sampling weights.

Results

A 1-month increase in the legislated duration of paid maternity leave was associated with a 7.4 percentage point increase (95%  CI 3.2 to 11.7) in the prevalence of early initiation of breastfeeding, a 5.9 percentage point increase (95%  CI 2.0 to 9.8) in the prevalence of exclusive breastfeeding and a 2.2- month increase (95%  CI 1.1 to 3.4) in breastfeeding duration.

Conclusion

Extending the duration of legislated paid maternity leave appears to promote breastfeeding practices in LMICs. Our findings suggest a potential mechanism to reduce barriers to breastfeeding for working mothers.

Challenges and Supports of Breastfeeding at Workplace in Indonesia

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.

Knowledge, attitude and support for exclusive breastfeeding among bankers in Mainland Local Government in Lagos State, Nigeria

Background

Breastfeeding is a recognized means of ensuring optimal nutrition for the infant. Exclusive breastfeeding is defined as feeding an infant child breast milk only, and for optimal nutrition it is recommended that infants be exclusively breastfed for the first 6 months of life. Without workplace support, exclusive breastfeeding is difficult for working mothers who return to work. The aim of this study was to examine the knowledge, attitude, and support for exclusive breastfeeding among female bank workers in Lagos, Nigeria.

Methods

This was a cross-sectional descriptive study. A total of 210 mothers from all banks in Mainland Local Government, Lagos State were selected using systematic sampling, with a response rate of 95%, so we had 200 respondents. A pretested, structured, self-administered questionnaire adapted from previous studies was used for data collection.

Results

The mean age of the respondents in this study was 33 years (range 21- 50 years). Of the 200 respondents 188 (94%) had a good knowledge of exclusive breastfeeding and 173 (86.5%) of them reported that the hospital was their source of information. More than 180 (90%) respondents had a positive attitude towards exclusive breastfeeding. Exclusive breastfeeding was practiced by 112 (56%) of the respondents, however, only 57 (28.5%) practiced exclusive breastfeeding for up to 6 months postdelivery. The major source of breastfeeding support came from the baby’s father for 88 (44%) respondents while the least breastfeeding support came from the workplace for three (1.5%) respondents. The duration of maternity leave was mostly 3 months, and less than 20 (10%) respondents reported having support for breastfeeding at the workplace.

Conclusions

In spite of the good knowledge of exclusive breastfeeding among the respondents as well as their positive attitude, the exclusive breastfeeding rate up to 6 months postpartum was very low. This may be related to the inadequate breastfeeding support from the various support systems especially in the workplace, as demonstrated in this survey. There should be advocacy for a government policy for a mandatory 6 month maternity leave for all working mothers.

Breastfeeding rates and barriers: a report from the state of Qatar

Objective

The aim of the study was to outline breastfeeding barriers faced by women residing in the State of Qatar.

Methods

A cross-sectional study through a telephone interview was conducted at Hamad Medical Corporation, the only tertiary care and accredited academic institution in the State of Qatar. Mothers of children born between the period of January 1, 2012 and December 31, 2012 in the State of Qatar were contacted.

Results

Of the total 840 mothers who were contacted for the telephone survey, 453 mothers agreed to be interviewed (response rate 53.9%), while 364 (43.3%) did not answer the phone, and 21 (2.5%) answered the phone but refused to participate in the study. The overall breastfeeding initiation rate among the mothers was 96.2%, with 3.8% mothers reporting that they had never breastfed their baby. The percentage of mothers who exclusively breastfed their children in the first 6 months was 24.3%. The most common barriers to breastfeeding as perceived by our participants were the following: perception of lack of sufficient breast milk after delivery (44%), formula is easy to use and more available soon after birth (17.8%), mom had to return to work (16.3%), lack of adequate knowledge about breastfeeding (6.5%), and the concept that the infant did not tolerate breast milk (4.9%).

Conclusion

Exclusive breastfeeding barriers as perceived by women residing in the State of Qatar, a wealthy rapidly developing country, do not differ much from those in other nations. What varies are the tremendous medical resources and the easy and comfortable access to health care in our community. We plan to implement a nationwide campaign to establish a prenatal breastfeeding counseling visit for all expecting mothers.

Perceptions of northeast Thai breastfeeding mothers regarding facilitators and barriers to six-month exclusive breastfeeding: focus group discussions

Background

The 6-month exclusive breastfeeding rate in the Northeast region of Thailand has recently significantly decreased in contrast to all other regions in Thailand. The factors that have influenced this decrease remain unknown. Hence, it is suggested that an investigation into factors that could improve or hinder EBF for 6 months in Northeast Thailand may be required to inform the development of relevant interventions to improve this situation. This study aimed to identify perceived facilitators and barriers to providing exclusive breastfeeding for 6 months in Northeast Thailand among breastfeeding mothers.

Methods

Six focus group discussions were conducted with a total of 30 mothers aged 20 to 40 years who had children aged between 4 and 6 months and were currently breastfeeding or had breastfeeding experience. Participants were recruited through self-selection sampling from Khonkaen hospital (urban), Numphong hospital (peri-urban) and private hospitals (urban) in Khonkaen, Thailand. Thematic analysis was employed to analyse the data.

Results

Five main themes, with 10 sub-themes, were identified as either facilitators (+) or barriers (−), or in some cases, as both (+/−). Breastfeeding knowledge, perceptions, maternal circumstances, support, and traditional food were the main identified themes. Mother’s breastfeeding knowledge, intention to breastfeed, and social media were perceived as facilitators. Perceptions, employment, and formula milk promotion were perceived as barriers. Family, healthcare, and traditional food were perceived as both facilitators and barriers. The perception that social media was a way to access breastfeeding knowledge and support mothers in Northeast Thailand emerged as a new facilitating factor that had not previously been identified in Thai literature relating to facilitators and barriers to exclusive breastfeeding. Intention to breastfeed, family support, healthcare support and traditional food were mentioned by all groups, whereas mothers from urban areas specifically mentioned mother’s breastfeeding knowledge, social media and employment sub-themes. Only mothers from the peri-urban area mentioned formula milk promotion and only mothers who had delivered in public hospitals mentioned the perceptions sub-theme.

Conclusions

Knowledge about these facilitators and barriers may inform the design and development of specific and relevant interventions to improve the 6-month exclusive breastfeeding rate in the Northeast region of Thailand and be useful in other contexts. Social media emerged as a newly perceived facilitator in the Thai context and may be a useful inclusion in a 6-month exclusive breastfeeding intervention model.

Electronic supplementary material

The online version of this article (10.1186/s13006-018-0148-y) contains supplementary material, which is available to authorized users.

[Assessment of employment's impact on breastfeeding practices]

OBJECTIVE

Employment is recognized as a weaning factor in many studies. Our aim was to evaluate the impact of employment on women's breastfeeding (BF) with a duration longer than 6 months in a Moroccan population.

METHOD

A cross-sectional study was conducted between November 2015 and April 2016 in four hospitals in the region of Rabat-Salé, Morocco. All ages were included with the condition that the woman had at least one living child. A questionnaire-based interview collected data on the duration of BF for each child, breast milk storage practices, woman's opinion on BF, and the perception of work conditions during BF. Factors associated with BF lasting longer than 6 months were analyzed using logistic regression carried out in SPSS 13.0 software.

RESULTS

A total of 502 surveyed women were analyzed. The median duration of breastfeeding (exclusive or mixed) in working women was 8 months versus 15 months for those without employment (P<0.001). Only 26 % stored breast milk. For working women, BF practiced due to religious conviction or perceived as mandatory were higher than for unemployed women (18% vs 15% and 11% vs. 7%, respectively; P<0.001). Working conditions during BF were perceived as daunting in 61% of cases. In multivariate analysis, factors correlated with prolonged BF longer than 6 months were: (i) early baby initiation to BF (OR=3; 95% CI [1.9-4.6]), (ii) education level: middle and high school (OR=0.1; 95% CI [0.01-0.5]), and (iii) the social status of working women (OR=0.3; 95% CI [0.1-0.6]).

CONCLUSION

Employment has a negative impact on the duration of breastfeeding, work perception, and practices of breastfeeding women.

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.

Childcare workers' experiences of supporting exclusive breastfeeding in Kuala Muda District, Malaysia: a qualitative study

Background

The role of childcare workers at registered nurseries in supporting exclusive breastfeeding practice is important, as many newborn babies are placed in nurseries during working hours. To increase exclusive breastfeeding rates among working mothers, understanding childcare workers’ experiences and needs relating to supporting these mothers is crucial. This study aimed to explore childcare workers’ experiences of supporting breastfeeding at registered nurseries.

Methods

We used a qualitative design to conduct in-depth, semi-structured interviews with ten childcare workers at seven registered nursery centres in Kuala Muda District, Malaysia. Attitudes towards exclusive breastfeeding practice, experiences of breastfeeding training and information, and experiences supporting exclusive breastfeeding at the nursery were explored. Participants were asked to suggest improvements for exclusive breastfeeding practice at their nursery. All interviews were audio recorded, transcribed verbatim, and translated before analysis.

Results

All participants demonstrated a positive attitude in supporting and promoting exclusive breastfeeding practice, mainly centred on the advantages of breastfeeding. Various supports have been found such as labelling bottled breastmilk, allowing the mother to come to the nursery during breaks, and providing reading materials. However, several issues emerged that include parents’ choice on infant feeding practice, insufficient content on breastfeeding topics during training, and adherence to the (not recommended) practice of bottle feeding expressed breastmilk. Recommendations to enhance breastfeeding were also suggested by participants.

Conclusion

Childcare workers may serve as another potential resource for sustaining exclusive breastfeeding at registered nurseries.

Electronic supplementary material

The online version of this article (doi:10.1186/s13006-016-0095-4) contains supplementary material, which is available to authorized users.

Exclusive breastfeeding among city-dwelling professional working mothers in Ghana

BACKGROUND

In Ghana, periodic national surveys report the practice of exclusive breastfeeding (EBF) in the general population to be over 50 %. However, little is known about EBF among professional working mothers, particularly its duration after maternity leave. Female workers are entitled to 12 weeks (84 days) of maternity leave with full pay in Ghana, and this can be extended by two additional weeks in case of a caesarean or abnormal delivery. This study assessed the prevalence of EBF, as well as factors associated with the practice among professional working mothers in one of the ten regional capitals of Ghana.

METHODS

The study was descriptive cross-sectional in design and employed a multi-stage sampling technique to sample 369 professional working mothers. The study was planned and implemented between January to July 2015. Study-specific structured questionnaires were used in the data collection over a period of one month. Some factors including demographic characteristics, types of facilities available at workplace to support breastfeeding, challenges to exclusive breastfeeding at the workplace and mother's knowledge base on EBF, were assessed. Exclusive breastfeeding is defined as feeding infants with only breast milk, without supplemental liquids or solids except for liquid medicine and vitamin or mineral supplements.

RESULTS

There was a near universal awareness of exclusive breastfeeding among respondents (99 %). Even though most mothers initiated breastfeeding within an hour of delivery (91 %), the EBF rate at six months was low (10.3 %). The study identified three elements as determinants of EBF; Those who did not receive infant feeding recommendation from health workers were less likely to practice exclusive breastfeeding (Adjusted Odds Ratio [AOR] 0.45; 95 % Confidence Interval [CI] 0.27, 0.77), mothers who had shorter duration of maternity leave were less likely to practice exclusive breastfeeding (AOR 0.09; 95 % CI 0.02, 0.45), and those who had a normal delivery were almost 10 times as likely to practice exclusive breastfeeding (AOR 9.02; 95 % CI 2.85, 28.53).

CONCLUSION

Given the high breastfeeding initiation, but low EBF continuation rate among professional working mothers, improved policies around maternity leave and breastfeeding friendly work environments are needed.

Factors associated with breastfeeding duration and exclusivity in mothers returning to paid employment postpartum

Mothers who are employed postpartum are less likely to continue breastfeeding than mothers who are not formally employed. However, as postpartum employment is increasingly necessary for the majority of new mothers, it is important to investigate factors that influence the continuation of breastfeeding in employed mothers. A sample of 1,738 mothers who returned to paid employment postpartum were recruited from the obstetric units of four public hospitals in Hong Kong, and prospectively followed for 12 months or until their infant was weaned. More than 85 % of participants returned to formal employment within 10 weeks postpartum, with over 90 % of these employed full-time. About one-third of the participants (32 %) were able to combine breastfeeding and employment, with breastfeeding defined as continuing for more than 2 weeks after returning to work postpartum. Later return to work and higher maternal education were associated with new mothers being able to combine breastfeeding and employment. Later return to work, shorter working hours, parental childcare, and higher maternal education were also associated with less likelihood of weaning from any or exclusive breastfeeding. Improvements in employment-related conditions for mothers and additional support for lower educated mothers may be effective strategies to enable employed women to continue breastfeeding after their return to work.

Breastfeeding Initiation and Continuation by Employment Status among Korean Women

PURPOSE

The objective of this study was to examine the factors associated with initiation and continuation of breastfeeding among Korean women in relation to their employment status.

METHODS

Data were collected using a web-based self-administered questionnaire from 1,031 Korean mothers living in Seoul with babies younger than 24 months. Demographic characteristics, education on breastfeeding, rooming in, breastfeeding during hospital stay, and breastfeeding knowledge were examined. Multivariate logistic regression analyses were performed to identify factors associated with initiation and continuation at 1, 6 and 12 months according to mothers' employment status.

RESULTS

Breastfeeding initiation rates were similar regardless of mothers' employment status. Continuation rates decreased for both groups of mothers, but were significantly lower among employed mothers at all duration points. Unemployed mothers who were able to keep their babies in the same room during the hospital stay were more likely to initiate breastfeeding. The factor that was consistently associated with breastfeeding continuation for all duration points among unemployed mothers was whether the mother breastfed during the hospital stay. Higher knowledge scores and having an infant with atopic dermatitis were also associated with breastfeeding continuation at 6 months and 12 months, respectively for unemployed mothers, and receiving education on breastfeeding was associated with 12-month continuation for employed mothers.

CONCLUSION

These results emphasize the significant roles of hospitals for breastfeeding initiation and continuation, with rooming-in, initial breastfeeding practice and education during hospital stay as important practices. In addition, for working mothers to continue their breastfeeding, significant support from the workplace is crucial.

Facilitating working mothers' ability to breastfeed: global trends in guaranteeing breastfeeding breaks at work, 1995-2014

BACKGROUND

Mothers who work away from home tend to stop breastfeeding earlier than their nonworking counterparts due to workplace barriers. Barriers to breastfeeding discriminate against women and may lead to inequities in children's health outcomes. Guaranteeing paid breastfeeding breaks at work is 1 mechanism that can improve mothers' opportunity to breastfeed in the workplace.

OBJECTIVE

This study aimed to assess the trends in the share of countries guaranteeing breastfeeding breaks in the workplace and paid maternal leave that lasts until the infant is 6 months old (the World Health Organization recommended duration for exclusive breastfeeding), between 1995 and 2014.

METHODS

Legislation and secondary source data were collected and reviewed for 193 United Nations member states. Legislation was analyzed for content on breastfeeding breaks and maternal leave guarantees.

RESULTS

Fifty-one countries (26.7%) in 2014 did not guarantee breastfeeding breaks in any form and 4 countries provided only unpaid breaks or breaks that did not cover the first 6 months of life; since 1995, around 15 countries (10.2%) legislated for such a policy. In 2014, out of 55 countries that did not guarantee paid breastfeeding breaks for the first 6 months after birth, 7 countries guaranteed paid maternal leave for the same duration; 48 countries (25.1%) provided neither paid maternal leave nor paid breastfeeding breaks.

CONCLUSION

Progress in the number of countries guaranteeing breastfeeding breaks at work is modest. Adopting measures to facilitate breastfeeding at work can be a critical opportunity for countries to increase breastfeeding rates among the growing number of women in the labor force.

Outcomes of a hospital-based employee lactation program

BACKGROUND

Little has been published about employee lactation support in hospitals and other healthcare facilities. The Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, has a comprehensive employee lactation program. The objective of this study was to describe the breastfeeding practices of our employees and compare these results with national Centers for Disease Control and Prevention (CDC) data.

MATERIALS AND METHODS

The human resources department generated a list of all employees who filed for maternity leave between 2007 and 2011. These employees were contacted confidentially via e-mail to complete an electronic-based (SurveyMonkey.com) questionnaire. An initial message and three reminder messages were sent over a 3-month period during the last quarter of 2012, with 545 women completing the survey (response rate, 40%).

RESULTS

Women who responded to the survey had significantly higher breastfeeding initiation rates compared with national CDC data (94.5% vs. 76.9%; p<0.0001). At 6 months, significantly more CHOP employees were breastfeeding (78.6% vs. 47.2%; p<0.0001). At 12 months 32.4% of CHOP employees were still breastfeeding compared with CDC data of 25.5% (p=0.0003). Additionally, over 20% of CHOP employees breastfed their infants for over 12 months (no national data for comparison).

CONCLUSIONS

Within CHOP's comprehensive employee lactation program, women achieved breastfeeding milestones that well exceeded national data and the Healthy People 2020 targets for breastfeeding initiation and duration. CHOP's employee lactation program can serve as a model for other institutions.

Influence of partner support on an employed mother's intention to breastfeed after returning to work

BACKGROUND

Despite the increasing number of large companies complying with the demands for a breastfeeding-friendly workplace, providing on-site lactation support, some mothers still find continuing to breastfeed a challenge. We postulated that greater support and encouragement from the partner would be independently predictive of whether the mother would take advantage of workplace milk expression breaks and lactation rooms and continue to breastfeed after returning to work. To evaluate this hypothesis, we conducted a survey at a female labor-intensive electronics manufacturer in Taiwan.

SUBJECTS AND METHODS

Six hundred eight working mothers in an electronics manufacturing plant in Tainan Science Park in Southern Taiwan who had access to dedicated lactation rooms at the workplace were interviewed. Questionnaire content included female employee demographics, employment characteristics, partner-related characteristics, and breastfeeding behavior after returning to work following the birth of their most recently born child.

RESULTS

The partner's initial support of the choice to breastfeed and encouragement to use the lactation room and milk expression breaks and the mother's perception of the partner's support for baby care were significant predictors of the intention to continue to breastfeed after returning to work, after adjusting for the employed mother's demographics and employment characteristics, supporting our hypothesis.

CONCLUSIONS

These findings suggest that antenatal education or activities provided by the workplace should include the partner, which may improve workplace breastfeeding rates.

Breastfeeding knowledge among working pregnant women in Turkey

The purpose of this study was to examine the breastfeeding knowledge of pregnant working women and explore factors that affected their knowledge. This Turkish study included 260 healthy, working women in the last trimester of pregnancy. Two separate questionnaires developed by the researcher were used to collect data. The average knowledge score of pregnant women respondents for all questions were 6.03 ± 2.99 (range: 0 to 14). Pregnant women had the least knowledge about duration of expressing breast milk (21.9%) and safe storage conditions for breast milk (27.2%). They knew the most about methods to express breast milk (87.3%) and features of containers used to store expressed milk (80%). Study results indicated that working pregnant women need better prenatal education to continue safe breastfeeding after returning to work. Occupational health nurses should inform working pregnant women about expression and storage of breast milk during prenatal education.

Breastfeeding policy: a globally comparative analysis

OBJECTIVE

To explore the extent to which national policies guaranteeing breastfeeding breaks to working women may facilitate breastfeeding.

METHODS

An analysis was conducted of the number of countries that guarantee breastfeeding breaks, the daily number of hours guaranteed, and the duration of guarantees. To obtain current, detailed information on national policies, original legislation as well as secondary sources on 182 of the 193 Member States of the United Nations were examined. Regression analyses were conducted to test the association between national policy and rates of exclusive breastfeeding while controlling for national income level, level of urbanization, female percentage of the labour force and female literacy rate.

FINDINGS

Breastfeeding breaks with pay are guaranteed in 130 countries (71%) and unpaid breaks are guaranteed in seven (4%). No policy on breastfeeding breaks exists in 45 countries (25%). In multivariate models, the guarantee of paid breastfeeding breaks for at least 6 months was associated with an increase of 8.86 percentage points in the rate of exclusive breastfeeding (P < 0.05).

CONCLUSION

A greater percentage of women practise exclusive breastfeeding in countries where laws guarantee breastfeeding breaks at work. If these findings are confirmed in longitudinal studies, health outcomes could be improved by passing legislation on breastfeeding breaks in countries that do not yet ensure the right to breastfeed.

Impact of a breastfeeding-friendly workplace on an employed mother's intention to continue breastfeeding after returning to work

BACKGROUND

Ever-increasing populations of women in their childbearing years are choosing to become employed. Breastfeeding provides unique health advantages to both the infant and mother. A breastfeeding-friendly workplace might be an important factor for predicting breastfeeding rates among working women. To explore the impact of breastfeeding-friendly support on the intention of working mothers to continue breastfeeding, we conducted a survey at a female labor-intensive electronics manufacturer in Taiwan.

SUBJECTS AND METHODS

A structured questionnaire survey was administered to 715 working mothers employed in an electronics manufacturing plant in Tainan Science Park in Southern Taiwan. Questionnaire content included female employee demographics, employment characteristics, continued breastfeeding behavior after returning to work, access to lactation rooms, and employee perception of the breastfeeding policy and support when raising their most recently born child.

RESULTS

A higher education level (odds ratio [OR]=2.66), lower work load (8 work hours/day) (OR=2.66), lactation room with dedicated space (OR=2.38), use of breast pumping breaks (OR=61.6), and encouragement from colleagues (OR=2.78) and supervisors (OR=2.44) to use breast pumping breaks were significant predictors of continued breastfeeding for more than 6 months after returning to work.

CONCLUSIONS

The findings of the present study suggest that to encourage and increase the rate of continued breastfeeding, workplaces should establish dedicated breastfeeding rooms and maintain a comfortable and clean environment. Furthermore, employers should provide encouragement and support for working mothers to continue breastfeeding after returning to work.

Breastfeeding support for mothers in workplace employment or educational settings: summary statement

The Academy of Breastfeeding Medicine is a worldwide organization of physicians dedicated to the promotion, protection, and support of breastfeeding and human lactation. Our mission is to unite into one association members of the various medical specialties with this common purpose.

Maternal return to paid work and breastfeeding practices in Bangkok, Thailand

This study explored the association between mothers' work-related factors and breastfeeding practices in Bangkok, Thailand. Data were collected from 84 working mothers with a child aged 6 to 24 months who visited the breastfeeding mobile clinic at a nursery goods exhibition. Thai interviewers collected data using a structured questionnaire. Analysis of the data showed that exclusive breastfeeding for 3 months was 78.6%, and for 6 months it was 38.1%. Mothers who returned to work 3 months or more after giving birth exclusively breastfed more than the mothers who returned to work in less than 3 months (crude odds ratio [OR] = 4.26, 95% confidence interval [CI] = 1.39-13.05; adjusted OR = 4.15, 95% CI = 1.15-14.95). Moreover, mothers who worked at self-employed or family-owned businesses and some mothers working at private companies showed tendencies of returning to work in less than 3 months. Results suggest that longer maternity leave would help extend the duration of exclusive breastfeeding. In addition, the improvement of a breastfeeding supportive environment in the workplace would be valuable and may be an effective means to improve breastfeeding practices and infant health.

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.

Continuous exclusive breastfeeding and some related factors in the selected hospitals of Isfahan

BACKGROUND

Exclusive nutrition with breastfeeding is the health provider of the infant and mothers and its continuing would provide more advantages. Exclusive nutrition on different communities is affected by different factors. This study aimed to determine continuous exclusive breastfeeding and some of the related factors.

METHODS

This was a descriptive-analysis prospective study. The study population included all the breastfed mothers admitted in the obstetrics wards of the selected hospitals. Selecting the hospitals also was done randomly. Data collection tools included a questionnaire completed by 291 mothers. To obtain the data about breastfeeding duration, mothers were phone called at the first and sixth postpartum months. The collected data were analyzed using descriptive and analytical statistics and software SPSS.

RESULTS

Estimation of mean and standard deviation of exclusive breastfeeding duration at the first and sixth months after the delivery, respectively, were 3.86 (0.55) and 23.67 (6.63) weeks. One month after the delivery, 93.1%, 6.2% and 0.7% of the mothers, respectively, had exclusive breastfeeding, breastfeeding with formula milk or other ingredients and discontinuation of breastfeeding; 6 months after the delivery, these values changed to 86.3, 12 and 1.7%, respectively. The most frequent period of breastfeeding discontinuation (6.9%) was related to 1-4 weeks. The results indicated that statistically there was a significant correlation between breastfeeding duration and age and the birth hospital. While the results of the study showed no association between breastfeeding duration and number of the children, duration of marriage, educational level and mothers' occupation.

CONCLUSIONS

The findings of the present study represented a high continuous exclusive breastfeeding which perhaps was due to applied baby-friendly hospitals strategies. Furthermore, to prevent from discontinuation of exclusive breastfeeding, knowing the discontinuation time and its related factors, particularly the first four postpartum weeks, can increase the knowledge of the health staff about counseling and education.

Public policy and breast-feeding: a straightforward and significant solution

Ensuring working mothers' ability to breast-feed is crucial given that breast-feeding substantially reduces infant morbidity and mortality while promoting maternal health. Working conditions, rules on the job, supervisors and co-workers can all raise or lower barriers to breast-feeding. Around the world, 127 countries guarantee working women the right to breast-feed. Canada does not provide this assurance, despite the fact that the majority of infants are born to women in the labour force. This has profound implications for the health of infants and mothers alike. Solutions exist: extending current policies to ensure adequate maternity leave is available for all Canadians, legislating a right to breast-feed while working, and adapting workplaces to make this practical.

Maternal return to work and breastfeeding: a population-based cohort study

BACKGROUND

In recent decades there has been a marked rise in the participation of women with infants in the labour market, while there has been a decline in the prevalence rate of breastfeeding.

OBJECTIVE

To explore the relationship between maternal return to work and breastfeeding.

DESIGN

An on-going prospective longitudinal study.

SETTING AND PARTICIPANTS

Multistage stratified systematic sampling was designed to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. Participating women underwent two home interviews at 6 and 18 months after giving birth, following structured questionnaires. A total of 21,248 and 20,172 women were interviewed, and the completed interview rate was thus 87.8% and 83.4% at 6 and 18 months, respectively. All study participants provided informed consent as approved by the Ethics Review Board of the National Taiwan College of Public Health.

RESULTS

The overall prevalence of initial breastfeeding was 83.7%. Postpartum women returning to work less than or equal to 1 month had the lowest initiation of breastfeeding rate (77.5%), but had a higher prevalence of breastfeeding duration less than or equal to 1 month (34.9%) than the overall population (26.8%). Overall 67.9%, 39.4%, 25.4%, and 12.7% mothers who started breastfeeding still breastfed their infants at the age of 1, 3, 6 and 12 months, respectively. Women with maternal leave of less than or equal to 6 months ceased breastfeeding earlier than those with maternal leave beyond 6 months and those who did not return to work up to 18 months after birth. After adjustment for potential confounders, odds ratios of initial breastfeeding seemed no different, except those for postpartum women who returned to work less than or equal to 1 month and those who did not return to work. Mothers returning to work within 1 year after giving birth were significantly earlier in weaning than those without return to work.

CONCLUSION

In our study, an early maternal return to work, especial within 6 months after giving birth, was a barrier to the initiation and continuation of breastfeeding. Thus, a comprehensive strategy is required to encourage the practice of breastfeeding in working women from pregnancy to the return to work, and nurses should work to promote breastfeeding in the different occasion.

Public policy and breast-feeding: a straightforward and significant solution

Ensuring working mothers' ability to breast-feed is crucial given that breast-feeding substantially reduces infant morbidity and mortality while promoting maternal health. Working conditions, rules on the job, supervisors and co-workers can all raise or lower barriers to breast-feeding. Around the world, 127 countries guarantee working women the right to breast-feed. Canada does not provide this assurance, despite the fact that the majority of infants are born to women in the labour force. This has profound implications for the health of infants and mothers alike. Solutions exist: extending current policies to ensure adequate maternity leave is available for all Canadians, legislating a right to breast-feed while working, and adapting workplaces to make this practical.

Factors associated with exclusive breastfeeding at 3 months postpartum in Valdivia, Chile

A prospective cohort study was conducted in 315 mother-newborn dyads from Valdivia, Chile. A questionnaire was administered to mothers before 48 hours postpartum, and sociodemographic, obstetric, and neonatal data were collected. At 3 months postpartum, a follow-up by telephone interview or home visit was made, determining the proportion of mothers providing exclusive breastfeeding. Multivariate logistic regression was carried out to identify variables significantly associated with exclusive breastfeeding. Follow-up data showed 98.1% were breastfeeding, and exclusive breastfeeding reached 69.5%. Withdrawal of exclusive breastfeeding was positively associated with single marital status (odds ratio, 2.49; 95% confidence interval: 1.48-4.20) and smoking during pregnancy (odds ratio, 2.61; 95% confidence interval: 1.48-4.60), while maternal education greater than 8 years was associated with continuation of exclusive breastfeeding (odds ratio, 0.45; 95% confidence interval: 0.24-0.84). Breastfeeding education strategies addressed to high-risk pregnant women (single with a low education level) must be emphasized in addition to prevention of nonhealthy habits, such as tobacco and alcohol consumption during gestation.