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Table 7 Workplace breastfeeding interventions assed through qualitative designs

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 Data Collection Type of analysis Findings Quality assessment
Abdulloeva S, Eyler AA. (2013) [35] USA State and university employees (n = 50. Policies of all 50 states) Investigation-action -Written policies to support BF employees Documentary review of written policies or policy statements & state breastfeeding rates from breastfeeding
report card
Content analysis −11 states had lactation policies with a detailed description of time and space to express milk.
-Significant correlation between State law and 6 months EBF rates.1
Low
Anderson J, Kuehl RA, Drury SA, Tschetter L, Schwaegerl M, Hildreth M, Bachman C, Gullickson H, Yoder J, Lamp J. (2015) [36] USA Business representatives in a rural Midwestern city (n = 32) Phenomenological -Support from colleagues Three focus groups Thematic analysis - Interpersonal communication is important to enhance workplace BF support.
- Multiple factors like age and the position of the BF employee can affect interpersonal communication about workplace BFsupport.
Low
Baeza WB., Henríquez KF, Prieto GR (2016) [34] Region on Araucania, Chile Working mothers using the public health system & had breastfed at least 1 month and were or are in maternity leave (n = 65) Grounded Theory -BF education
-Designated space for BF or expressing milk
-Other
Five focus groups, five in-deep interviews and 30 telephonic interviews Thematic analysis -Mothers recognize lack of knowledge of BF law, policies and rights, lack of the technique of breastmilk extraction, and storage inside the worksite
-Returning to work is one of the reasons mentioned by mothers for early weaning, especially when there are no lactation spaces at the worksite.
Low
Bai YK, Wunderlich SM, Weinstock M. (2012) [37] USA (New York) Managers and representatives from human resources at companies with 500 or more employees (n = 20) Phenomenological - Support from colleagues
-Other
Phone or in-person interviews Content analysis -BF support can be helpful to recruit and hold employees. But, the ‘encouragement not to give up breastfeeding early’ was less appreciated as a benefit to the company.
-Men, single women or mothers that decided not to breastfeed are unsupportive of a mother-friendly environment.
-Space limitation for nursing and pumping rooms, and negative employee dynamics are barriers of workplace BF support. There is also a perception of decreased productivity.
Moderate
Bradford VA, Walkinshaw LP, Steinman L, Otten JJ, Fisher K, Ellings A, O’Leary J, Johnson DB. (2017) [38] USA (Washington) Women and men of 110 organizations of four targeted sectors: hospitals, clinics, early care and education settings, and worksites (n = 125) Investigation-action - Written policies to support BF employees
- Support from colleagues
Semi-structured interviews Thematic analysis -Federal and states laws, policies and performance bring awareness and motivates action.
-Organizations have limited financial resources for the development and implementation of supportive breastfeeding policies.
-Organization structure affects the ability to develop and implement supportive breastfeeding policies.
-Positive experiences facilitate supportive policies and practices.
Moderate
Froh EB, Spatz DL (2016) [12] USA (Philadelphia) Female employees of The Children’s Hospital of Philadelphia (n = 410) No design (two open questions were added to a survey of a quantitative study - cohort model) -Written policies to support BF employees
- BF education
- Support from colleagues
A quantitative survey was deployed to all women (1362), the survey included two qualitative questions. It was optional to answer them. Content analysis -Supporting BF mothers after returning to work is key to enable them meeting their BF goals, but even when an institution has a strong lactation policy, mothers may be unaware of the policy, feel internal pressure to avoid frequent pumping breaks, and possibly feel unsupported by both peers and supervisors. Very low
Majee W, Jefferson UT, Goodman LR, Olsberg JE. (2016) [39] USA (Missouri) Low-income employed and unemployed breastfeeding mothers and key employers of rural area (n = 10 / 7) Phenomenological -BF education
-Flexible scheduling to support milk expression
- Support from colleagues
One focus group and individual interviews and document review Content analysis - Workplace milk expression must shift from a reactive stance to regular education for mothers and employees, to allow creating a supportive environment enabling mothers’ BF goals. Low
Payne D, James L (2008) [40] New Zealand Working mothers of different ethnicities (n = 34) Phenomenological - Designated space for BF or expressing milk
-Flexible scheduling to support milk expression
- Support from colleagues
Semi-structured, open-ended, in-depth and interactive interviews Thematic analysis -Implementation of a BF intervention depends on superior’s and colleague’s attitudes towards breastfeeding. Males were less supportive.
-Lack of access to a lactation space and limited time to pump influenced women’s decision either not to return to paid employment or to discontinue breastfeeding
Very low
Spagnoletti BRM, Bennett LR, Kermode M, Wilopo SA, Spagnoletti B (2017) [41] Indonesia (Yogykarta) Working women who had given birth in the last 2 years (n = 20) Ethnography - Designated space for BF or expressing milk
-Flexible scheduling to support milk expression
-Work from home (i.e., home-office) or reduced hours
In-depth interviews, focus groups, semi-structured interviews and participant observation Descriptive analysis -Majority of women did not have access to a space designated for breastfeeding. Among those who had it, feeling comfortable was imperative to their ability to express breastmilk. Very low
  1. 1 Study with mixed methods, explored correlation between status of legislation at State level and Exclusive breastfeeding (EBF) rate