Three main themes emerged from the interviews conducted to explore the extent to which health facilities in the study provided breastfeeding workplace environment, comprising: 1). Standpoints on workplace breastfeeding support. 2). Breastfeeding support and 3). Suggested future directions. Standpoints on workplace breastfeeding support had three sub-themes, namely, backings for workplace breastfeeding support, perceived benefits of breastfeeding support and factors of poor breastfeeding workplace support. Breastfeeding support also had three sub-themes, including maternity protection benefits, workplace support gaps and awareness creation on benefits. Verbatim quotations were used to support the themes and provide evidence. Details of the main themes and sub-themes are discussed followed by the quantitative results.
Characteristics of Participants
Table 1 presents the characteristics of the study participants. All 50 questionnaires were completed and returned giving a response rate of 100%. Fifty-four (54) respondents participated in the study, four out of them were representatives of healthcare facilities in the study. The mean age of participants was 32. All participants were females, the majority of whom were married with children between the ages of 4-21months. The mean age of babies of mothers in the study was 11 months with a good number (30%) of the babies at 4 months. Sixty-one percent (61%) of breastfeeding frontline health workers interviewed were clinical staff and 39% were support staff.
Standpoints on workplace support for Breastfeeding
Representatives of health facilities interviewed shared their facilities’ perceived positions on workplace breastfeeding support and accentuated the importance of providing such support for frontline health workers. The three sub-themes that follow presents the details.
Backings for Workplace Breastfeeding Support
Respondents in this study had extensive knowledge of workplace support for breastfeeding and shared some views on workplace support for breastfeeding. Breastfeeding workplace support such as the creation of breastfeeding rooms where breastfeeding frontline health workers can keep their babies while working was emphasized by all the respondents. The need for a national policy on a breastfeeding-friendly workplace environment was also mentioned. Respondents believed this would help provide a standardized workplace support culture across industries and workplaces. The representative of hospital 3 shared her views on the need for a breastfeeding-friendly work environment in the following statement:
Workplaces must have very very well-equipped places for breastfeeding. For instance, in this hospital, there should be a place where working mothers can go and breastfeed. Possibly, there should be a nurse at the place to take care of the babies so that even if the mother is not visiting… and there is bottle feeding, it would be expressed breast milk. It should be a very hygienic place that can take care of babies.
Table 1: Demographic characteristics of respondents
Description
|
Freq.
|
%
|
Description
|
Freq.
|
%
|
Age Respondents
|
|
|
parity
|
|
|
Mean age
|
32±5
|
|
1
|
17
|
34
|
24 – 28
|
14
|
26
|
2
|
13
|
26
|
29 – 33
|
17
|
31
|
3
|
12
|
24
|
34 – 38
|
9
|
17
|
4
|
6
|
12
|
39 – 43
|
9
|
17
|
5
|
2
|
4
|
44+
|
5
|
9
|
Total
|
50
|
100
|
Total
|
54
|
100
|
Work experience
|
|
|
Marital Status
|
|
|
1 – 4
|
30
|
60
|
Married
|
43
|
79
|
5 – 8
|
14
|
28
|
Single
|
8
|
15
|
9+
|
6
|
12
|
Divorced
|
2
|
3
|
Age of Baby (in Months)
|
Widowed
|
2
|
3
|
Mean age of babies
|
11±5
|
|
Total
|
54
|
100
|
4 – 6
|
15
|
30
|
Religion
|
|
|
7 – 9
|
6
|
12
|
Christian
|
32
|
58
|
10 – 12
|
11
|
22
|
Muslim
|
23
|
42
|
13 – 15
|
7
|
14
|
Total
|
54
|
100
|
16 – 18
|
5
|
10
|
Staff Category
|
|
|
19 – 21
|
6
|
12
|
Clinical staff
|
33
|
61
|
Total
|
50
|
100
|
Support staff
|
21
|
39
|
|
|
Total
|
54
|
100
|
|
|
|
|
|
|
|
|
|
Source: constructed by authors using data from the field
The Perceived benefits of breastfeeding Workplace Support
The representative of hospital 4 shared the benefits employers stand to gain when they implement breastfeeding workplace support and said:
If we have healthy children…. I mean, if a mother can breastfeed so that the child does not have diarrhea and other illnesses, then the mother will not lose working days to go and take care of a sick baby. Once a child is healthy on breast milk, the employee saves money and time for work. So, it is good for mothers in employment and employers as well.
It is clear from the above statement that creating a breastfeeding-friendly workplace can be thought of as a good business or an aspect of hospitals’ corporate social responsibility. Most respondents were of the view that breastfeeding workplace support has triple benefits that may outweigh the cost involved in providing the support, particularly, loss of man-hours that may arise from the indisposition of infants because of inappropriate feeding practice. The representative of hospital 2 shared this with us.
Breast milk has nutrients that protect the child from illness, so employers must support it. In this way, working mothers will not need to take days off work to care for their babies because of illness. Mothers will always be present at work to discharge their duties. I believe employers stand to benefit if their employees are always present work.
Factors of Poor Breastfeeding Workplace Support
In this study, an array of factors was outlined by respondents to limit efforts in providing breastfeeding support for breastfeeding frontline health workers. They included lack of funding to create breastfeeding friendly workplace environment, limited office space, and inadequate staff. Two of the respondents retorted that it is difficult to promote breastfeeding supportive work culture, particularly when more frontline health workers have to be provided with such support at the same time. The representative of hospital 2 shared this with us:
Hmm…it is quite difficult. Sometimes we have issues of limited staff. Supposing you are on a ward which requires ten (10) staff but only eight (8) are on duty and you have some of the staff taking off two (2) hours to breastfeed.…. this situation puts pressure on the other remaining staff if the workplace is busy, they are forced to do the work of those breastfeeding in addition to theirs. especially when the breastfeeding mothers decide to take some time off their schedules to breastfeed. Other times too, you may have situations where more than three mothers would be on maternity leave at the same time in a unit. This gives more work and stress to the other staff who may be at work.
Breastfeeding Support
All health facilities in the study had some form of breastfeeding support in place for frontline health workers, predominantly, those that are guaranteed by the maternity protection provision of the Labor Act of Ghana. The details are discussed in the sub-themes below.
Maternity Protection Benefits
As part of the conditions of work of frontline health workers, breastfeeding mothers are granted 12 weeks paid maternity leave in the case of spontaneous vagina delivery (SVD) and 24 weeks for those with assisted delivery such as cesarean section. Breastfeed frontline health workers also enjoy paid breastfeeding breaks. Respondents from both private and public hospitals mentioned that the conditions of work capture all the maternity protection provisions provided by the labor laws of Ghana. Further, breastfeeding frontline health workers are placed on morning shift only until the baby is 26 weeks and morning and afternoon shifts until the baby is 52 weeks old, as well as casual leave where necessary.
Workplace support Gaps
The gaps in breastfeeding workplace support identified in the health facilities studied are summed up in the statements of the representatives of hospital 1 and three as follows:
Our clients breastfeed in the wards…………. I mean our postnatal inpatients are entitled to breastfeed on the ward. For our staff, we do not have a lactating site for them. A breastfeeding staff must leave her baby at home and when it is time to breastfeed, she goes home to breastfeed. If they are fortunate to have a babysitter who will come to work with them, then they can bring their babies along to breastfeed at work…… maybe sit under the tree where they believe would be comfortable for them. But as to getting a place that is so conducive for breastfeeding, no, not at all.
When they come to work, depending on the workload for the day… you know, there are days that the workplace is very busy and there are days that the workplace is less busy. On out busy days, when we monitor and realize that the tension has reduced, we give them the time to go and breastfeed. Sometimes, when the workplace is busy, they communicate with their babysitters and ask, ‘is the baby in need of breast milk?’, ‘is it time for breastfeeding?’ ‘is baby showing any signs of lactating?’ If it comes out like that then the person goes and then breastfeeds.
This statement highlights the plight of breastfeeding frontline health workers and the work-breastfeeding discrepancies that are likely to result from it. Almost all hospitals in the study did not have breastfeeding facilities or an on-site creche for kids of frontline health workers. Only one out of the four hospitals was constructing an onsite creche at the of the study.
Awareness Creation on Breastfeeding Workplace Support
Even though healthcare facilities in the study did not have most of the essential breastfeeding friendly workplace environment, those provided in the condition of services of frontline health workers, such as maternity leave, casual leave, working half-day, and other staff welfare packages were disseminated among frontline health workers through staff orientation, memos, website, and staff meetings. Also, respondents assumed that breastfeeding frontline health workers are well informed of issues related to optimal breastfeeding practice due to the breastfeeding education they received as part of maternity care during pregnancy.
Suggested Future Direction
Respondents were united in their views regarding the way forward. They called for a revision of the Labor Act, Act 651 of 2003 to define the essentials of the workplace breastfeeding policy. On the flipside, representatives of the mission-based and private hospitals expressed a preference for a policy guideline that would leave details of action for promoting a breastfeeding friendly workplace environment to employers to formulate and implement based on organization-specific circumstances. The representative of hospital 4 explained further and said.
A national policy would be helpful. Yes, they would guide the hospitals to formulate their action plans. I think a policy framework must come from the top and then translated down to all healthcare facilities. Individual hospitals can have their strategic plans which will have considerations for specific needs related to breastfeeding mothers.
To obtain a balanced view of the extent of support for workplace breastfeeding, front-line health workers were interviewed. Table 2 presents breastfeeding frontline health workers views of breastfeeding workplace support and breastfeeding practice. Participants’ views on breastfeeding workplace support were consistent with Responses from the interviews. Ninty-six percent (96%) of the participants said they went on 12 weeks maternity leave, breastfeeding break (80%), and 70% indicated that they enjoyed five-day 20-hour work week (5/20) (i.e. half-day) after returning to work instead of the usual five-day 40-hour work week (5/40). Participants specified staff orientation (44%) and workshops (16%) as the main sources of maternity protection benefits information.
The results also established several shortfalls in the breastfeeding workplace support of the hospitals. Ninety-six percent (96%) of breastfeeding frontline health workers indicated a lack of breastfeeding policy and breastfeeding facilities (94%) in their hospitals. Even though 90% said their workplace policy allows them to go to work along with baby, only 14% go to work with their babies possibly due to the lack of breastfeeding facility or creche at the hospitals. However, reasons offered for not going to work with baby were no place to keep baby (28%) and to concentrate on work (16%). A little above half of the participants failed to provide reasons. All (100%) breastfeeding frontline health workers in the study had knowledge about the benefits of breastfeeding and did initiate breastfeeding. Yet, about 34% of them supplemented breastfeeding with artificial milk (4%), water (18%), and porridge and water (12%). Averagely, participants indicated that they reported to work at 8:00am and closed at 3:00pm each day. Feeding strategies upon return to work included expressed breast milk (34%), breastfeed only when at home (40%) and expressed breast milk and porridge (26%). Twenty percent of the participants indicated that their closing and reporting time affected breastfeeding and 96% said that they will prioritize work over breastfeeding in circumstance of work-breastfeeding tension. A good number (34%) of breastfeeding frontline workers also indicated the sustained separation between them and their baby can make them wean baby earlier than planned.
Table 3 presents the mothers’ evaluation of coping strategies adopted to manage breastfeeding-work tension. Breastfeeding mothers in organizations where no breastfeeding support is available are likely to experience stress and burnout from demands of work, breastfeeding, and childcare. In such a situation, distinct interventions are required to support mothers to navigate daily challenges related to work, breastfeeding, and childcare. The results of this study identified social support such as support from husbands and relatives (median = 3) as highly supportive in mitigating the inconsistencies between work and childcare. Flexible work arrangement (median = 2) and support from coworkers (median = 2) were deemed by breastfeeding frontline health workers as moderately supportive for coping with the challenges of work breastfeeding, and childcare. Regarding the challenges of work and breastfeeding, undue stress resulting from conflicts between work and breastfeeding (median = 3) was extremely challenging. Insufficient breast milk arising from the separation between mother and baby (median = 2), difficulties in expressing milk (median = 2), work overload (median = 2), and work duration (median = 2) were considered moderately challenging.
Table 2.0: Mothers’ Views on Workplace Support.
Breastfeeding Policy at Workplace
|
Freq.
|
%
|
Mothers’ Feeding Strategies
|
|
%
|
Yes
|
0
|
0
|
Expressed breast milk
|
17
|
34
|
No.
|
48
|
96
|
Breastfeed when at home
|
20
|
40
|
No response
|
2
|
4
|
Breast milk and porridge
|
13
|
26
|
Paid Maternity Leave
|
|
|
Feeding Strategy below 6 Months
|
|
Yes
|
48
|
96
|
Expressed breast milk
|
18
|
36
|
No.
|
2
|
4
|
Artificial milk
|
2
|
4
|
Paid Breastfeeding Break
|
|
|
Breast milk and water
|
9
|
18
|
Yes
|
40
|
80
|
porridge, water and breast milk
|
6
|
12
|
No.
|
10
|
20
|
No response
|
15
|
30
|
Worked Half-Day
|
|
|
Had Breastfeeding Education when Pregnant
|
Yes
|
35
|
70
|
Yes
|
47
|
94
|
No
|
5
|
10
|
No
|
3
|
6
|
No response
|
10
|
20
|
Aware of Breastfeeding Benefits
|
Sources of Maternity Benefits Information
|
|
Yes
|
50
|
100
|
HR handbook
|
3
|
6
|
No.
|
0
|
0
|
Facility’s website
|
3
|
6
|
Initiated Breastfeeding
|
|
|
Orientation
|
22
|
44
|
Yes
|
50
|
100
|
Workshop
|
8
|
16
|
No
|
0
|
0
|
Memos/circulars
|
4
|
8
|
Reporting/Closing Time Affected Breastfeeding
|
No. response
|
10
|
20
|
Yes
|
20
|
40
|
Policy Allows Going to Work with Baby
|
No
|
30
|
60
|
Yes
|
45
|
90
|
Would sacrifice work to breastfeed
|
No
|
5
|
10
|
Yes
|
48
|
96
|
Go to Work Along with Baby
|
|
|
No
|
2
|
4
|
Yes
|
7
|
14
|
Possible effect of effect of separation on breastfeeding
|
No.
|
43
|
86
|
Insufficient breast milk
|
8
|
16
|
Breastfeeding Facility at Workplace
|
|
Early winning
|
17
|
34
|
Yes
|
3
|
6
|
Decision not to breastfeed
|
4
|
8
|
No.
|
47
|
96
|
No response
|
21
|
42
|
Reasons for Leaving Baby at Home
|
|
|
Common breastfeeding Challenges
|
To concentrate at work
|
8
|
16
|
Work overload
|
19
|
38
|
No place to keep baby
|
14
|
28
|
Insufficient breastmilk
|
11
|
22
|
wants baby to be at creche
|
2
|
4
|
Breast milk contamination
|
10
|
20
|
No response
|
26
|
52
|
Breast milk expression
|
10
|
20 20
|
Mean reporting time to work
|
8:00am
|
|
Common Copping Strategies
|
|
|
Mean closing time from work
|
3:00pm
|
|
Husband/relatives support
|
35
|
70
|
|
|
|
Colleagues support
|
9
|
18
|
|
|
|
Closing at unapproved time
|
7
|
12
|
Source: constructed by authors using field data.
Table 3: Mothers’ Evaluation of Copping Strategies of Childcare, Work and Challenges
Description
|
Frequency
|
|
|
|
|
|
Challenges
|
Least Challenging (1)
|
Most Challenging (2)
|
Highly Challenging (3)
|
NR
|
Total
|
Median
|
Difficulties in expressing milk
|
12
|
17
|
5
|
16
|
50
|
2.0
|
Inadequate breast milk due to infrequent feeding
|
9
|
16
|
10
|
15
|
50
|
2.0
|
Breastmilk contamination
|
14
|
10
|
9
|
17
|
50
|
2.0
|
Work overload
|
7
|
15
|
21
|
7
|
50
|
2.0
|
Work duration
|
12
|
15
|
9
|
14
|
50
|
2.0
|
Conflicting responsibilities
|
11
|
12
|
15
|
12
|
50
|
2.0
|
Stress and burnout
|
5
|
15
|
21
|
9
|
50
|
3.0
|
Poor concentration at work
|
6
|
14
|
17
|
13
|
50
|
2.0
|
Difficulties in meeting timelines
|
10
|
12
|
11
|
17
|
50
|
2.0
|
Copping Strategies
|
Least Supportive (1)
|
Moderately Support (2)
|
Highly Supportive (3)
|
No Response
|
Total
|
Median
|
Avoiding workplace responsibilities
|
18
|
13
|
2
|
17
|
50
|
1.0
|
Reporting to work late
|
15
|
10
|
4
|
21
|
50
|
1.0
|
Leaving workplace before approved closing time
|
17
|
8
|
4
|
21
|
50
|
1.0
|
Support from husband and relatives
|
3
|
7
|
34
|
6
|
50
|
3.0
|
Flexible work arrangement
|
6
|
22
|
9
|
13
|
50
|
2.0
|
Breast milk expression
|
7
|
10
|
19
|
14
|
50
|
3.0
|
Support from colleagues
|
2
|
18
|
11
|
19
|
50
|
2.0
|
Source: constructed by authors using field data.