Creating Environments to Support Breastfeeding: The Challenges and Facilitators of Policy Development in Hospitals, Clinics, Early Care and Education, and Worksites

Abstract

Objectives Supportive organizational breastfeeding policies can establish enabling environments for breastfeeding. In this qualitative study we identify facilitators and barriers to the development, adoption, and implementation of supportive breastfeeding policies and practices in four influential sectors for breastfeeding women: hospitals, clinics, early care and education settings, and worksites. Methods We interviewed 125 individuals representing 110 organizations in Washington State about their breastfeeding policy development and implementation process between August 2014 and February 2015. Greenhalgh's diffusion of innovations framework guided the interviews and qualitative analysis. Results Breastfeeding policy facilitators across the sectors include national and state laws and regulations, performance tracking requirements, and an increasingly supportive sociopolitical climate; barriers include limited resources and appreciation about the need for breastfeeding policies, and certain organizational characteristics such as workforce age. Despite broad support for breastfeeding, organizations differed on perceptions about the usefulness of written breastfeeding policies. Personal breastfeeding experiences of policy makers and staff affect organizational breastfeeding policies and practices. Conclusions for Practice Supportive organizational systems and environments are built through effective policy development processes; public health can support breastfeeding policy development and assure a coordinated continuum of care by leveraging federal health care policy requirements, building networks to support training and collaboration, and disseminating strategies that reflect the personal nature of breastfeeding.

Promotion, protection, and support of breastfeeding at work, and achieving sustainable development: a scoping review

“…The 33 selected reports were published between 1990 and 2021, with the majority (28) published between 2011 and 2021. Most of the studies were conducted in high-income countries (n = 23; 69.7%), mainly in the USA (n = 15; 45.5%) [15][16][17][18][19][20][21][22][23][24][25][26][27][28] , and six multicenter studies (18.2%) involved studies from more than 140 countries 2,[29][30][31][32][33] . Two studies were carried out in upper middle-income countries (6.1%) 34,35 and another two in lower middle-income countries (6.1%) 36,37 .…”

“…The study designs were mainly observational and analytical (n=16; 47.5%) 15,18,[20][21][22][23]25,28,29,35 , followed by qualitative approaches (n = 6; 18.2%) 17,34,36,[43][44][45] . Other types of designs included reviews (n = 9; 27.3%) 2,16,19,24,26,27,[29][30][31] , technical notes (n = 1; 3.7%) 33 , and other analytical methods (n = 1; 3.7%) 46 .…”

“…The promotion strategies for breastfeeding in the work context have been described in only a few reports (n = 2; 6.1%) 16,33 , while most reports described protection strategies (n = 27; 81.8%) 2,15,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]37,[39][40][41][44][45][46] , followed by support strategies (n = 18; 54.5%) 2,[19][20][21][22]27,32,34,[36][37][38][39][40][41][42][43][44][45] . Some studies treated more than one type of strategy, for example, protection and support.…”

“…The Law requires that the employers provide a break and a private location, other than a bathroom, so that breastfeeding employees are able to express breastmilk for one year after childbirth. Bradford et al, 2017 17 State policies and practices of support for breastfeeding in four areas: hospitals, clinics, care environments and early childhood education, and workplaces. Chen et al, 2006 45 Maternity leave and the right to have breaks to express breastmilk.…”

The Effectiveness of WFH (Work From Home) during the Covid-19 Pandemic to Support the Provision of Exclusive Breastfeeding Practices with Direct Breastfeeding (DBF) for Working Moms

“…Sejalan dengan hal tersebut, penelitian yang dilakukan oleh Bradford et al menunjukkan bahwa pengalaman positif saat menyusui ditempat kerja dan fasilitas serta dukungan kebijakan dan praktik ASI ekslusif bagi ibu menyusui menjadi faktor kunci keberhasilan ibu menyusui yang bekerja. Pada penelitian ini menduga bahwa terdapat pengaruh signifikan antara pola kerja secara WFH saat pandemi covid-19 yang dibagi menjadi dua perlakuan yaitu partial WFH dan full WFH terhadap pemilihan metode menyusui bayi secara DBF 13 Berdasarkan Tabel 4 menunjukkan bahwa terdapat perbedaan signifikan (p=0,000) perlakuan partial WFH terhadap pemilihan metode menyusui ASI eksklusif secara DBF pada bayi. Hal ini berarti pelaksanaan praktek pemberian ASI eksklusif secara DBF bisa terhambat jika ibu bekerja secara partial WFH yang berarti ibu harus bekerja di luar rumah dengan meninggalkan bayi sebanyak 2-3 hari/minggu selama 6 bulan masa pandemi.…”