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Table 3 Workplace breastfeeding interventions and their association with BF1 duration, quantitative studies

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

Author (yr) Country (City) Population (n) Design Type of BF intervention Outcome variable Type of analysis Effects & associations Quality assessment
Ahmadi M, Moosavi SM (2013) [17] Iran (Bandar Abbas) Employed mothers with healthy children 6–12 months (n = 212) Cross-sectional -BF education
-Designated spaces for BF or expressing milk
-Flexible scheduling to support milk expression
Formula use Bivariate Infant formula use was significantly lower among women with access to a lactation space compared to those without access (28% vs 59.3%) Very low
Amin RM, Said ZM, Sutan R, Shah SA, Darus A, Shamsuddin K. (2011) [18] Malaysia (Petaling district in Selangor) Working mothers with children 3–12 months who attended health services from governmental health clinics in Petaling (n = 290) Cross-sectional -Designated spaces for BF or expressing milk Discontinuation of breastfeeding Logistic regression Not having adequate breastfeeding facilities at the workplace was associated with breastfeeding discontinuation (OR2 = 1.8, CI 95% 1.1–3.1) Moderate
Balkam JA, Cadwell K, Fein SB. (2011) [19] USA Women participating in the workplace lactation program (3 previous years) & were still employed in the organization (n = 128) Cross-sectional -BF education
-Designated spaces for BF or expressing milk
-Provision of breast pumps
Duration of any BF and EBF3 Logistic regression EBF at 6 months: Number of program services received AOR = 1.73 (p = 0.003) Any BF at 6 months Return-to-work consultation AOR4 = 3.15 (ref: no serv.) Low
Dagher RK, McGovern PM, Schold JD, Randall XJ. (2016) [20] USA (Minnesota) Employed women + 18 years while hospitalized for childbirth (n = 817). Prospective cohort -Support from colleagues BF cessation at 6 months postpartum Cox proportional hazards analysis No statistically significant results Moderate
Dozier AM, McKee KS.(2011) [21] USA (several states) Infants whose mothers were + 18 years and who had not changed state of residence since birth (n = 16,145) Cross-sectional -Written policies to support BF employees
-Designated spaces for BF or expressing milk
-Flexible scheduling to support milk expression
BF duration (< 6 months or > 6 months) Logistic regression Not statistically significant results Low
Fein SB, Mandal B, Roe BE. (2008) [22] USA Mothers from the Infant Feeding Practices Study II (IFPSII) who concurrently worked and BF at some point during their infant’s first year of life (n = 810) Prospective cohort - Flexible scheduling to support milk expression Duration of BF (weeks) Regression and censored regression models Duration of BF after return to work (weeks): Pump only (Marginal Effect −7.11),
Pump and feed directly (Marginal Effect − 2.94)
Neither pump nor feed during day (Marginal Effect − 11.77)
Feed infant directly (ref.)
Low
Jacknowitz A. (2008) [23] USA Births of women working (1989–1999) from
the National Longitudinal Survey of Youth 1979 and the Children of the
National Longitudinal Survey of Youth 1979 (n = 1506)
Cross-sectional -Work from home (i.e., home-office) or reduced hours BF at 6 months among those who initiated BF Probit model BF at 6 months was not significantly associated with the mother’s perception of flexible work schedule availability Moderate
Kozhimannil KB, Jou J, Gjerdingen DK, McGovern PM (2016) [24] USA Women between 18 and 45 years who gave birth in 2011–2012 and were employed at the time of the Listening to Mothers III survey (n = 550) Cross-sectional -Designated spaces for BF or expressing milk
-Flexible scheduling to support milk expression
BF at 1 week and 6 months (any/exclusive) and BF (months) Logistic regression Women with sufficient break time were 2.6 times more likely to BF exclusively and 3.0 times more likely to BF at all at 6 months than women without access to break time or private space. Women with access to breaks and space were 2.3 times more likely to BF exclusively at 6 months Moderate
Mao ZY, Lin XH, Tai XJ, Wang J. (2018) [25] China (Beijing) Pregnant women residents in Beijing, who participated in Beijing’s two-child women’s maternity survey and were qualified according to the universal two-child policy and have already given birth to the second child and had complete information (n = 247) Cross-sectional -Designated spaces for BF or expressing milk BF duration Cox Proportional Hazards Regression Model Women with an independent breastfeeding room in the workplace were less likely to discontinue breastfeeding HR = 0.371 Moderate
Scott VC, Taylor YJ, Basquin C, Venkitsubramanian K. (2019) [26] USA (North and South Carolina) Adult female employees (+ 18 y) of the health care system who had been employed for > 6 months, who had BF in the past 3 years (n = 165) Cross-sectional -Support from colleagues BF duration (< 6 months, 6–12 months, or > 1 year); EBF; duration of EBF (< 4, 4–5, and 6 months); job satisfaction Linear and quantile regression models, ordinal probit regressions, binary logistic regressions BF duration: Not statistically significant results
EBF: organizational support AOR = 1.81EBF duration: managerial support: AOR1.47
Low
Smith-Gagen J, Hollen R, Tashiro S, Cook DM, Yang W. (2014) [27] USA Data on BF laws enacted by states from the National Council of State Legislatures. Data from NHANES 2003–2010 for BF practices Cross-sectional -Written policies to support BF employees
-BF education
-Designated spaces for BF or expressing milk
-Flexible scheduling to support milk expression
Proxy report of infants being BF for at least 6 months Multivariable logistic regression Infant feeding at 6 months associated with: -Jury duty exemption for BF mothers (AOR = 1.66), having a private area in the workplace to express breastmilk (AOR = 1.34), having break time to BF or pump (AOR = 1.23); Enforcement pumping (AOR: 2.02) Moderate
Spatz DL, Kim GS, Froh EB. (2014) [28] USA (Philadelphia) Employees who had filed for maternity leave between 2007 and 2011 in the Children’s Hospital of Philadelphia (n = 545) Cross-sectional -Written policies to support BF employees
-BF education
-Designated spaces for BF or expressing milk
-Flexible scheduling to support milk expression
-Provision breast pumps
Duration at 6 and 12 months Descriptive Compared to CDC national data, the intervention hospital had a significantly higher BF rate at 6 months (78% at the intervention site vs 42%) and at 12 months (32% vs 25 respectively) Very low
Spitzmueller C, Wang ZX, Zhang J, Thomas CL, Fisher GG, Matthews RA, et al. (2016) [29] USA Subsample of IFPS II of women who returned to paid work within the first year of infant’s life, and women who were BF when they returned to work (n = 859) Longitudinal -Support from colleagues BF goals intentions, BF duration after returning work HLM, Cox proportional hazards regression Perceptions of workplace BF support were associated to prenatal BF goal intentions (ß = .11) and contributed to predict prenatal BF goal intentions by around 10%. BF goal intentions were negatively associated with the hazard rate of cessation of BF after return to work (ß = 0–.16). Low
Tsai SY. (2013) [30] Southern Taiwan Employed mothers at a large electronics manufacturer company in Southern Taiwan (n = 715) Cross-sectional -Designated spaces for BF or expressing milk
-Flexible scheduling to support milk expression
-Support from colleagues
Continuing BF after returning to work (in months) Multiple logistic regression For mother who continued BF for more than 6 months there was an association with less work hours per day (OR = 2.66), access to an independent lactation room (OR = 2.38), using pumping breaks (OR = 61.6) and encouragement by colleagues to use breaks (OR = 2.44) Low
Wallenborn JT, Perera RA, Wheeler DC, Lu J, Masho SW. (2019) [31] USA (Virginia) Nationally representative data of pregnant women and their children until 1 year of age (Infant Feeding Practices Survey (IFPS) II) (n = 1198) Prospective cohort -Support from colleagues BF duration (# of weeks infant was BF) and EBF Structural equation modelling path analysis Direct effect of: workplace support on BF confidence (0.63). Similar effects on EBF. Indirect significant effect: workplace support on BF duration through confidence in BF (0.58) Low
Wambach K, Britt E. (2018) [32] USA (Mid-western region) Registered Nurses employed in a large urban teaching hospital system for children (n = 78) Cross-sectional -Designated spaces for BF or milk expression
-Support from colleagues
BF duration Analysis of variance, Pearson coefficient Perceived support associated with longer BF duration: Pearson coefficient 0.34 Very Low
Waite WM, Christakis D. (2015) [33] USA (Seattle) Female employees of 2 sites – a hospital and a large corporation – who had a child born within the last 5 years (n = 531) Cross-sectional -Designated spaces for BF or expressing milk
-Flexible scheduling to support milk expression
-Support from colleagues
BF duration in weeks. Linear regression models BF duration was not significantly associated with support score or with any specific domain. Low
  1. 1 BF Breastfeeding, 2 OR Odds ratio, 3 EBF Exclusive breastfeeding, 4AOR Adjusted odds ratio