Table 4 Summary of Publications Included in the Realist Analysis Following a Case-Control Design. Realist Review on “How Do Breastfeeding Workplace Interventions Work?”

Lead Author; Publication Year

Sahip et al. [58]; 2007

 Study Population

Expectant fathers of companies with full-time workplace physician

Cases (N = 80): men’s characteristics: 32.5% < 30 years of age, 67.5% university education, 81.3% first child; wife’s characteristics: 60.0% < 30 years of age, 60.0% university education, 53.8% working outside the home

Controls (N = 80): men’s characteristics: 31.3% < 30 years of age, 67.5% university education, 70.0% first child; wife’s characteristics: 60.0% < 30 years of age, 45.0% university education, 48.8% working outside the home

NS differences between cases and controls

 Country

Turkey

 Intervention

6 education sessions each 3–4 h for expectant fathers: health during pregnancy, pregnancy nutrition + birth, communication techniques, infant health care and feeding, fatherhood, family health after birth

 Outcomes

BF initiation within 1 h after birth: OR = 2.38, 95% CI: 1.24–4.61, p < 0.01

EBF at 3 months: OR = 3.44, 95% CI: 1.74–6.82, p < 0.01

BF at 9 months: OR = 2.64, 95% CI: 1.36–5.09, p < 0.01

Supplementary feeding before 6 months: OR = 0.19, 95% CI: 0.09–0.37, p < 0.01

Lead Author; Publication Year

Waite et al. [22]; 2015

 Study Population

Women with children and employed with same employer after return to work;

Case company (N = 131): Large corporation in the US Southeast with lactation program; mean age 33.2 ± 3.8 years; 81.8% White, 8.1% Asian, 2.5% Black or African American, 7.6% other; 96.3% married or living with partner; 15.9% less than college graduate, 50.4% 4-year college, 33.7% advanced degree;

Control company (N = 420): Seattle Children’s Hospital; mean age 34.5 ± 2.9 years; 81.3% White, 8.6% Asian, 4.7% Black or African American, 5.4% other; 96.9% married or living with partner; 3.9% less than college graduate, 53.5% 4-year college, 42.6% advanced degree

 Country

USA

 Intervention

N/A

 Outcomes

BF initiation: 100% (case) vs. 98% (control)

Mean BF duration: 38.8 ± 34.1 weeks (case) vs. 41.8 ± 24.0 weeks (control)

BF at 6 months: 60% (case) vs. 79% (control)

Mean total support score: 137.7 ± 15.1 (case) vs. 124.5 ± 14.9 (control)

NS association between support scores and breastfeeding durations

Lead Author; Publication Year

Lin et al. [41]; 2020

 Study Population

Case companies (N = 1089): Companies accredited as healthy workplaces under Tobacco Control and/or Occupational health Promotion legislation from 2007 to 2008;

Control companies (N = 526): Companies without accreditation, randomly selected from the National Business Directory;

For breastfeeding outcome: women who returned to work;

N = 477

 Country

Taiwan

 Intervention

Lactation break times

Availability of lactation policy or documentation

BF promotion

Provision of lactation rooms

Provision of refrigerator to store expressed BM

Provision of child-care facility

 Outcomes

Continuing BF after 1 year:

 • AOR = 3.32, 95% CI:1.90–5.77 if break times are provided

 • AOR = 2.50, 95% CI:1.59–3.92 if BF policy or documentation is available

 • AOR = 2.25, 95% CI: 1.45–3.48 if BF is promoted

 • AOR = 3.00, 95% CI: 1.89–4.76 if lactation rooms are provided

 • AOR = 2.35, 95% CI: 1.23–4.45 if refrigerators are provided

 • AOR = 2.58, 95% CI: 1.40–4.75 if child-care facility is available

Lead Author; Publication Year

Hilliard et al. [32]; 2020

 Study Population

Working women in North Dakota who attempted to continue BF after returning to work outside the home following a birth of a child between 2014 and 2016;

Mean maternal age: 30.8 ± 4.1 years;

Maternal race: 97.0% White, 0.6% Black, 0.2% Asian/Pacific Islander, 1% Native American/Alaskan Native, 0.6% mixed race, 0.6% declined;

Marital status: 94.0% married, 4.3% cohabitating, 1.0% single, 0.7% other;

Income: 0.3% < USD 15,000, 1.1% USD 15,000-24,999, 3.1% USD 25,000-34,999, 6.8% USD 35,000-49,999, 18.0% USD 50,000-74,999, 29.9% USD 75,000-99,999, 40.8% ≥ USD 100,000;

Maternal education level: 1.6% high school, 9.1% some college, 12.2% associate degree, 42.0% Bachelor’s degree, 6.1% some graduate, 29.0% graduate degree;

N = 392

 Country

USA

 Intervention

Infant-friendly business designation incl.:

 • Workplace lactation policy

 • Allowance of flexible break times

 • Provision of private space (other than bathroom) with a source of clean water to wash hands

Provision of refrigerator for BM storage

 Outcomes

BF duration according to designation status:

 • Total mean duration: 8.62 ± 4.89 months

 • Designation in 2011 or 2012 and recent recertification: 7.97 ± 5.60 months

 • Designation later than 2012: 7.69 ± 4.98 months

 • Designation in 2011 or 2012 but no recertification: 6.07 ± 4.32 months

 • No designation: 9.00 ± 4.68 months

p = 0.30

Lead Author; Publication Year

Cervera-Gasch et al. [57]; 2020

 Study Population

Female teachers/researchers or administration/service staff at either Universitat Jaume (UJI) or Universidad de Sevilla (US) who gave birth in the past 10 years and were employed at either UJI or US at the time of delivery and/or BF;

Universitat Jaume (case): N = 103

Maternal education level: 1% secondary education, 99% university studies

Universidad de Sevilla (control): N = 198

Maternal education level: 1% primary education, 11.1% secondary education, 87.9% university studies

 Country

Spain

 Intervention

Universitat Jaume (UJI)

 • 4 designated BF areas

 • BF education

Universidad de Sevilla (US)

 • No lactation rooms

 • No lactation support program

 Outcomes

Intention to BF: 93.2% (UJI) vs. 88.4% (US), p = 0.051

Intention to continue BF after RTW: 77.7% (UJI) vs. 66.7% (US), p = 0.580

Continued BF after RTW: 71.8% (UJI) vs. 50.5% (US), p = 0.001

BF duration

 • UJI: 15.5% < 6 months, 13.6% 6–12 months, 28.2% 1–2 years, 32.0% > 2 years

 • US: 39.9% < 6 months, 18.2% 6–12 months, 16.7% 1–2 years, 10.6% > 2 years

 • p < 0.001