The breastfeeding practices of workingmothers and the lactation support that they receive at the formal workplace.

Masters Degree. University of KwaZulu-Natal, Pietermaritzburg

Introduction: The promotion of breastfeeding is a strategy for child health and development. The work environment and the availability of infant formula may hinder exclusive breastfeeding of infants for the recommended six months. In order to promote, protect and support breastfeeding, mothers need detailed education to initiate breastfeeding successfully and to continue breastfeeding successfully with support from healthcare workers, family and the workplace. International studies have reported on the successful implementation of breastfeeding policies and the workplace support thereof that assists mothers to successfully continue breastfeeding once they are back at work. The Tshwane Declaration of Support for Breastfeeding in South Africa (SA) was agreed upon by South African stakeholders and aims to promote, protect and support exclusive breastfeeding. It has been suggested that supporting and empowering mothers to breastfeed within the workplace can be achieved through maternity leave policies and supportive workplace policies. It would be beneficial to determine if mothers know if their workplaces have policies regarding breastfeeding in place and if the workplace implements these policies. Aim: The aim of this study was to determine the breastfeeding practices of working mothers and the lactation support that they receive at the formal workplace, as well as their awareness of the Tshwane Declaration of Support for Breastfeeding in SA. Objectives: i) To determine the demographic characteristics of breastfeeding mothers working in the private and public sectors in the eThekwini Metropolitan, KwaZulu-Natal (KZN), SA: To determine the breastfeeding practices of working mothers while at the workplace and if they lactate during the workday; iii) To determine the support (physical and technical) that breastfeeding mothers receive from their employers to enable them to express breast milk or lactate at work; iv) To determine if working women who are breastfeeding are aware of the Tshwane Declaration of Support for Breastfeeding in SA with regards to continuing breastfeeding when they return to work. Methods: A descriptive cross-sectional study using an interviewer-assisted self-administered questionnaire was conducted using breastfeeding mothers who were employed in the private and public sectors in the eThekwini Metropolitan. Convenience sampling was used to select the study participants. The questionnaire was based on a validated and previously used questionnaire regarding the same topic. The questionnaire developed for the current study was validated by a statistician and an expert in breastfeeding and it consisted of three sections. The first section of the questionnaire collected information regarding demographic characteristics and breastfeeding practices. The second section collected information on the breastfeeding support that working mothers received at work and the third section obtained information on the awareness of mothers regarding the Tshwane Declaration of Support for Breastfeeding in SA. Data were analysed using the International Business Machines Statistical Product and Service Solutions (IBM SPSS) version 25 (IBM Corp, Armonk, NY, USA). Results: The questionnaire was completed by 134 participants. About 65% (n=87) of the participants were aged 31 to 40 years old. The mean age of the infants that accompanied the participants was 5.9 months. About 37% (n=49) of participants had an undergraduate degree, while 66.4% (n=89) were married and 48.5% (n=65) had only one child. Most participants worked full-time (n=122; 91.0%) and 62.7% (n=84) worked in the private sector. A significant number of participants received maternity leave (n=119; 88.8%) (p=0.000) and 47% (n=63) were planning to return to work after maternity leave. Of those who received maternity leave, 52.2% (n=70) were granted four months maternity leave. Of the participants who were on maternity leave, 63.5% (n=40) were exclusively breastfeeding, while 70.4% (n=50) of those who had returned to work were mixed feeding. A significant number of participants were breastfeeding their infants 1-2 times per day (n=30; 25.9%) (p=0.037). Furthermore, 57.6% (n=68) of the participants were not expressing breast milk at all (p=0.000). About 43% (n=57) of the participants received support from their spouse/partner in order to continue breastfeeding successfully. While breastfeeding, some participants experienced problems such as “low milk supply” (n=17; 29.8%) and “cracked nipples” (n=12; 21.1%). At the time of data collection, a significant number of participants (n=44; 77.2%) were still breastfeeding despite the problems that they had experienced (p=0.000). While pregnant, a significant number of participants did not receive any education regarding the support that they would receive at work, upon their return (n=110; 90.2%) (p=0.000). However, they indicated that they would continue breastfeeding once they returned to work (n=63; 51.6%). Furthermore, the participants were not aware that they could request breastfeeding breaks when they returned to work (n=85; 69.7%). Upon returning to work, 53.1% (n=34) of the participants did not receive breastfeeding breaks and 68.8% (n=44) did not receive any support at work. A significant number of workplaces did not have written policies regarding breastfeeding support once mothers returned to work (n=34; 53.1%) (p=0.000). A significant number of participants (n=128; 95.5%) were not aware of the Tshwane Declaration of Support for Breastfeeding in SA (p=0.000). Conclusion: Mothers mostly mixed fed their infants after returning to work as they were unable to sustain exclusive breastfeeding after returning to work. The workplace does not adequately support breastfeeding mothers at the workplace to express breastmilk. This study highlights the need for workplace breastfeeding policies to be in place and communicated in order to support working mothers to sustain breastfeeding after returning to work.