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

Abstract

Background Breastfeeding can be affected by maternal employment. This is important considering that in 2019, 47.1% of women globally participated in the labor force. The aim of this study was to review workplace interventions to promote, protect and support breastfeeding practices among working mothers globally. Methods A systematic review was conducted following the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Observational, experimental and qualitative peer-reviewed studies in English and Spanish, published between 2008 and 2019 were included. The review focused on working women who were pregnant, breastfeeding or who recently had a child, and women’s working environments. The outcomes of interest included breastfeeding intentions, initiation, exclusivity and duration, confidence in breastfeeding or breastmilk extraction, and perceived support at workplace. Quality was assessed according to National Institute for Health and Care Excellence (NICE) checklist for systematic reviews. It was registered on PROSPERO (#140624). Results Data was extracted from 28 quantitative and 9 qualitative studies. The most common interventions were designated spaces for breastfeeding or breastmilk extraction (n = 24), and the support from co-workers (n = 20). The least common interventions were providing breast pumps (n = 4) and giving mothers the flexibility to work from home (n = 3). Studies explored how interventions affected different breastfeeding outcomes including breastfeeding duration, breastfeeding exclusivity, confidence in breastmilk expression, and breastfeeding support. The evidence suggests that workplace interventions help increase the duration of breastfeeding and prevent early introduction of breastmilk substitutes. Having a lactation space, breastmilk extraction breaks, and organizational policies are key strategies. However, to achieve equitable working conditions for breastfeeding mothers, organizational and interpersonal changes need to occur as well. Conclusions The systematic review revealed that interventions at the workplace are important in protecting, promoting and supporting breastfeeding among working mothers. To achieve equitable work environments and fair nutritional opportunities for infants of working mothers, interventions should focus at the three ecological layers – individual, interpersonal, and organizational. The quality of studies can be improved. There is a need for studies assessing impacts of workplace interventions on infant feeding practices, mothers’ self-esteem and outcomes such productivity and abstentionism.

Implementation of Breastfeeding Policies at Workplace in Mexico: Analysis of Context Using a Realist Approach

“…It is linked to a change in the working culture, including demystifying BF as feminine, and any machoistic view that implies that is incompatible with work and productivity. All of it is consistent with the findings of a recent systematic literature review [ 9 ]. Moreover, the Becoming Breastfeeding-Friendly (BBF) Committee in Mexico recommended that Mexico should work towards having better conditions for BF working mothers including a BF-friendly working environment [ 30 ].…”

“…Both Chang´s systematic review as well as our study show the role of supervisors and colleagues as an important barrier or facilitator for working mothers to continue BF once they return to work. Finally, consistent with a recent systematic review aiming to describe workplace interventions to promote, protect and support BF practices among working mothers globally (which included quantitative and qualitative studies) [ 9 ], the present study identified the poor knowledge on legislation to protect maternal and child health, including BF, among working women, employees, and co-workers. Taken together, all studies highlight the importance of developing written policies at different levels (national, local and within each worksite) as well as educating co-workers, directors, human resources personnel and mothers about the importance of BF and the local maternity protection legislation to promote a BF-friendly environment.…”

“…The return to work is one of the greatest barriers to BF [ 5 ]. Family-friendly policies are critical to ensure that BF and work are not mutually exclusive; however, workplaces often fail to protect, promote, and support BF due to inadequate maternity leaves, flexibility in scheduling to accommodate BF or appropriate breaks and spaces for milk expression and storage after mothers return to work [ 9 ]. In Mexico, women working in the formal (work with social security benefits) or informal (self-employment or non-wage contractual arrangement work without access to social protection, e.g., maternity leave benefits) sector are 20% less likely to ever breastfeed (children < 24 months), 10% less likely to have an early onset of BF (during the first hour of life) and 20% less likely to EBF compared to unemployed women [ 10 ].…”

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

“…On the contrary, part-time work has been found to have a positive impact on breastfeeding duration [86,87]. Flexibility in working schedules may be associated with breastfeeding [88]. Despite no studies, the acceptance of teleworking following the COVID-19 pandemic could also help women to breastfeed [89].…”

Between and Within-Country Variations in Infant and Young Child Feeding Practices in South Asia

“…Excessive workload, caesarean section delivery, discouragement and criticism inadequate creche facilities at the workplace, inadequate caregivers at home, inadequate knowledge about expressed milk are barriers to EBF for employed mothers [ 44 , 45 ]. Evidence suggested a baby-friendly workplace for employed mothers was effective for improving EBF practices [ 46 , 47 ]. Also, better knowledge, education, counselling, home support, six-months maternity leave, and flexibility at work are the enablers of exclusive breastfeeding for employed mothers in LMICs [ 44 , 48 ].…”