Participants were diverse in race, level of education, and age. All except one participant had post graduate qualifications and held professional positions. Three of the four managers were male, and all had children (Table 1).
Table 1. Demographic characteristics of study participants
Participant
|
Level of Education
|
Gender
|
Race
|
Age
|
Work Position
|
Mother 1
|
Postgraduate
|
F
|
White
|
38
|
Senior manager
|
Mother 2
|
Postgraduate
|
F
|
Coloured
|
32
|
Project Manager
|
Mother 3
|
High School
|
F
|
Coloured
|
40
|
Admin Clerk
|
Mother 4
|
Postgraduate
|
F
|
Coloured
|
36
|
Supply Chain Officer
|
Mother 5
|
Postgraduate
|
F
|
African
|
36
|
Educator
|
Mother 6
|
Postgraduate
|
F
|
Coloured
|
34
|
Educator
|
Mother 7
|
Postgraduate
|
F
|
Coloured
|
31
|
Educator
|
Mother 8
|
Postgraduate
|
F
|
Coloured
|
31
|
Monitoring Officer
|
Manager 1
|
Postgraduate
|
M
|
Coloured
|
47
|
Senior manager
|
Manager 2
|
Postgraduate
|
M
|
African
|
55
|
Chief Director
|
Manager 3
|
Postgraduate
|
F
|
White
|
59
|
Director
|
Manager 4
|
Postgraduate
|
M
|
Coloured
|
49
|
Director
|
Pregnancy phase
Table 2: Emerging themes and sub-themes on breastfeeding at work experiences across maternity phases in the provincial government sector.
|
Theme 1: Knowledge about the legislation and breastfeeding support benefits
|
Theme 2: Perceptions and experiences of breastfeeding in the workplace
|
Theme 3: Barriers to breastfeeding continuation
|
Theme 4: Recommendations to improve breastfeeding support at work
|
Pregnancy
[sub-themes]
|
- · Knowledge about maternity leave uptake.
- · Poor knowledge about breastfeeding breaks.
- Optimal knowledge about benefits of supporting breastfeeding.
|
- · Breastfeeding considered a private and personal matter.
- Support dependant on managers’ personal values & experiences.
|
- · Absence of conversation about breastfeeding.
- · Confusion on who is responsible for initiating breastfeeding support conversation at work.
- Manager’s gender consideration on breastfeeding support.
- Lack of instrumental support at work.
|
- · Raise awareness about the maternity support legislation.
- · Have a workplace breastfeeding policy.
- Provide instrumental support.
- · Breastfeeding specific social support to be provided.
|
Maternity
[sub-themes]
|
- Optimal knowledge about benefits of supporting breastfeeding.
|
- · Breastfeeding considered a private and personal matter.
- · Early breastfeeding cessation.
|
- Stress associated with transitioning back to employment.
|
- · Raise awareness about the maternity support legislation.
- · Extension of maternity leave.
- Breastfeeding specific social support to be provided.
|
Return to work
[sub-themes]
|
- Poor knowledge about breastfeeding breaks.
- Optimal knowledge about benefits of supporting breastfeeding.
|
- · Difficulty expressing at work.
- · Early breastfeeding cessation.
- · Breastfeeding considered a private and personal matter.
- Support dependant on managers’ personal values & experiences.
|
- · Absence of conversation about breastfeeding.
- · Confusion on who is responsible for initiating breastfeeding support conversation at work.
- Manager’s gender consideration on breastfeeding support.
- Influence of job characteristics.
- Stress associated with transitioning back to employment.
- Lack of instrumental support at work.
|
- · Have a workplace breastfeeding policy.
- Provide instrumental support.
- · Extension of maternity leave.
- Breastfeeding specific social support to be provided.
|
Pregnancy perceived as a mother’s issue
Senior managers and mothers generally perceived pregnancy as private and a mother’s issue, that needed to be concealed from work processes. None of the mothers had any infant feeding related conversation with their managers prior to going on maternity leave. Most mothers did not even consider combining breastfeeding and work, while managers distanced themselves and felt that only if mothers made enough of a demand, would there be a need to address pregnancy and breastfeeding issues at work. Some participant’s views are expressed in the following quotes:
“Actually no [conversation about breastfeeding], the only discussion we have had in terms of that, is okay, what plans and arrangements are you going to make when the maternity leave is [over]…Who is going to look after the baby, and those kind of things. I don’t know if every woman is comfortable discussing their personal matters like that especially with a male manager…but I have never had a discussion, maybe it is something I need to think about going forward.” (Manager 1)
“As long as I told them that I am planning on taking my maternity leave, so I think that was enough for me.” (Mother 3)
“I think the conversation ended there after me telling them I am expecting a baby. There was no conversations about how I am going to handle the pregnancy or whatever or breastfeeding later on, so no conversations like that”. (Mother 5)
Minimal discussion about maternity benefits with pregnant employees
Most mothers did not have knowledge of their full maternity protection rights such as maternity leave extension or breastfeeding breaks (Basic Conditions of Employment Act, Code of Good Practice), but only knew about the legislated four months maternity leave and time off for prenatal visits. Managers were also not aware that breastfeeding breaks were legislated and assumed that mothers were informed of their maternity benefits. One manager said:
“…even the Basic Condition of Employment Act does not have that [breastfeeding breaks]. If it does, I will be surprised because the Basic Condition lays the basic minimum… But, definitely there is no break there, I think it is the tea break…and smoke breaks is there but not breastfeeding.” (Manager 2)
Only a few mothers reported knowledge of the option to apply for a maternity leave extension to six months. Some shared that they did not apply for it in fear of their manager thinking that they were attempting to take advantage of the circumstances, as maternity leave tended to be viewed as a holiday. As one mother mentioned:
“I didn’t [have any conversation about the possibility of extending maternity leave]. I must admit I was actually dying to have that conversation with my boss, but I also didn’t want to give that impression that I am trying to ride this leave out, or take advantage of the situation.” (Mother 5)
Some mothers chose not to apply for maternity leave extension because it was unpaid and there was a financial necessity to return to work. While others described doing their own research, most commonly on the internet, to find out information about their maternity rights, such as breastfeeding breaks:
“I just Googled breastfeeding….I think it was the Basic Conditions of Employment Act where they say you get two sessions [breastfeeding breaks], thirty minutes each….I went and found the policy and so I took it upon myself to educate them [managers] around what the policies are because I did feel conscious that I am going to express and it is going to take time.” (Mother 4)
Maternity leave phase
Preparation for early breastfeeding cessation
Most mothers shared that during their maternity leave they started to become anxious thinking about how to provide optimal nutrition for their infants after returning to work. This anxiety stemmed from several sources including: (1) the lack of decent space to express breast milk at work and adequate storage for mother’s milk, (2) working with painful breasts, and (3) commuting for hours with their expressed milk. Consequently, most mothers decided to wean their infants before or shortly after returning to employment as shared by one mother:
“I just sorted it out myself before I came back to work because I knew I was going to work… I didn’t want to feel uncomfortable and now you are working and suddenly there is a wet patch. I decided to do that [stop breastfeeding and started the baby on infant formula] before I went to work so by the time I returned to work there was nothing [no milk leaking]”. (Mother 7)
A few mothers made plans during their maternity leave to maintain exclusive breastfeeding and started storing milk for when they were back at work:
“So, I started probably two or so weeks before I came back and I started expressing and freezing milk. So, we had a backup supply in the freezer and then obviously I ensured that there was at least four bottles for him in the fridge and then during the day at work I expressed two bottles.” (Mother 8)
Return to work phase
Stress from juggling work and breastfeeding needs
Upon return to employment mothers reported stress dealing with conflict between work demands and their infant’s breastfeeding needs. Here mothers spoke about expectations to be efficient at work whilst experiencing discomfort from full breasts because of a lack of facilities to express mother’s milk:
“I remember also going home every day with really sore breasts because I wasn’t expressing at work and so the milk was building up and building up and it becomes so full and so painful and I also thought this time around [with a new baby] I wouldn’t want to go through that again because it is embarrassing if it breaks through and milk spilling out… you come to work and smile on your face and go on working as normal but you are actually there with full breasts and in pain.” (Mother 5)
Another mother added that there is no recognition that a mother returning to work may be breastfeeding and having both work and breastfeeding duties during her work day. She suggested that support would be welcomed to alleviate this pressure that she faced when returning to work:
“…I will say that the work place must make that provision for a mother when she comes back to have that place or a room where they can [express]. You can’t breastfeed because the baby is not here but just to make that provision that you can do all your things because I don’t think there is any places that you can as a mother go and sit and even if you come back, no one is talking to you to ask if you are breastfeeding or just to assist you when you come back…you just come back in the same situation that you left and so no one is actually talking to you to ask you or even suggest. I will say a person [supervisor] must come to you and say you have a baby now and it is four months, is there certain things that you want or ask you if you are breastfeeding or even ask you if you want to leave earlier but there is no things like that.”. (Mother 4)
Juxtaposing this perspective, managers were not aware of this conflict and the breastfeeding related needs of mothers while at work. They perceived that because mothers had not raised the topic of breastfeeding at work, nor requested support in any form, that it was unlikely to be a real concern. As expressed by one senior manager:
“If women are not putting a request or a demand for breastfeeding facilities it will never see the light of the day because other things that are on the table competing for available resources will get priority…I cannot remember any union having brought this as a request. I cannot remember. I have been here now for 16 years I cannot remember any supervisors bringing this as an issue that needs to be looked at.” (Manager 2)
Workplace supportive breastfeeding facilities
None of the work spaces in the two departments provided supportive infrastructure for mothers to breastfeed or express milk during the workday. One manager shared:
“This is a very unfortunate part because the government doesn’t have [facilities] and in most offices there is no infrastructure for breastfeeding… I think that is the disadvantage for young mothers because we do wonder most of them are highly qualified and they are professional people and that is putting a huge disadvantage, so they must find alternative means [to provide breastmilk] because they just can’t bring babies to work even if they wanted to there are just no facilities.” (Manager 2)
Another manager, while speaking about infrastructure, was also indirectly suggesting that its solely the mother’s responsibility to find a solution to combine breastfeeding and work:
"I think it’s a bit difficult at work remember because we need to keep it [breast milk] here in the freezer and that is not always available and so on. So, when you are back at work it’s more difficult so you [the mother] will have to find the balance..." (Manager 3)
One government department (not part of this study), had a breastfeeding room that was offered to mothers from other departments to use. However, it was often not a logistically viable option to access during the 30 minutes breastfeeding break as it was in a different building. While few mothers could use this facility enabling their continued breastfeeding, other mothers used the bathroom or offices to express:
“I think what motivated me to stop [breastfeeding] besides the fact that I didn’t have much milk was the fact that the toilet I was using, they were renovating them and so I did not have anywhere else to express.” (Mother 3)
Job characteristics and social supportive enablers
Few mothers reported to have continued breastfeeding exclusively after returning to employment and stated that supportive supervisors and co-workers were important enablers:
“The rest of the people [colleagues] were absolutely brilliant and if they knew I was pumping then they would make sure no one would come in and that kind of thing, so they respected that and everything and they were just supportive.” (Mother 1)
“My job requires me to be out in the field and travel a lot and he [supervisor] actually said he understands that and he is limiting my operations to day trips so in the metro and the winelands so I don’t have to sleep over in the west coast and stuff like that. So in terms of his overall [support] he is very accommodating.” (Mother 8)
On the other hand, some mothers shared that co-workers were resentful of mothers who expressed at work, suggesting that they were ‘avoiding work’. Mothers in more senior positions who maintained exclusive breastfeeding reported that their seniority and associated levels of autonomy might have influenced their agency to demand support from their managers.
None of the mothers knew anyone who had breastfed at their workplaces and thus had no positive role models. However, a few managers expressed willingness to offer flexible arrangements to accommodate mothers returning from maternity leave, as captured in the following quotes:
“I am open to the idea of it [providing support to breastfeeding employees] and I don’t have an issue if you need to express…” Manager 1
“…from where I sit, I have now become aware so it is actually a management responsibility…. And then sensitization of managers in particular because I think once managers are sensitized on this then it becomes easier because I for example would prefer working through my managers to say but you must support … it requires an attitude change how this is actually being implemented… I think that can be done through training particularly targeting managers and making sure that they understand the particular needs so is it for example something that can be made available temporarily, what do you need in order for that to happen and so on.” (Manager 4)
“I think if the employers can be more, I don’t know if the word is sensitive but more understanding or accommodating. Yes, if they can be more accommodating in that regard, that would be helpful so providing facilities and obviously be accommodating in terms of allowing you to go and do your expressing at that time …I think if they could be more sensitive or maybe do some research of their own…” (Mother 5)