Make or break. Mothers' experiences of returning to paid employment and breastfeeding: a New Zealand study.
When mothers return to paid employment, which more and more are doing, they often give up breastfeeding. This qualitative study aims to describe New Zealand mothers' experiences of returning to paid employment and infant feeding. Thirty-four mothers who had given birth between 2003 and 2005 were interviewed regarding their experiences and decisions about returning to paid employment following the birth of their child. The presence or absence of the factors of space, time, and support emerged as key factors in the mothers' perception of their ability to continue to breastfeed on their return to paid employment. Employers need to make changes to the workplace environment to encourage and support breastfeeding. But societal attitudes also need to change to become more supportive and positive of breastfeeding workers.
Keywords: breastfeeding, infant feeding, New Zealand, work
|Publication:||Name: Breastfeeding Review Publisher: Australian Breastfeeding Association Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2008 Australian Breastfeeding Association ISSN: 0729-2759|
|Issue:||Date: July, 2008 Source Volume: 16 Source Issue: 2|
Combining breastfeeding and paid employment is an important health issue. Breastfeeding is known to have short-term and longterm benefits not just for the mother and her infant but also for the wider society (Chezem, Friesen & Boettcher 2003; Dubois & Girard 2005; Horta et al 2007; Ip et al 2007). The health benefits of breastfeeding also flow on to economic benefits in that breastfeeding can contribute to reduced health care costs and parental absenteeism (American Academy of Pediatrics 1997; Galtry 1997).
However, in New Zealand, while a large majority of mothers exclusively breastfeed their infants at birth, data collected in 000 indicate that the percentage of mothers fully breastfeeding decreases significantly from 65.1% at six weeks to 50.7% at three months (Ministry of Health 2002). The Ministry of Health (MOH) identifies mothers returning to paid employment as one of the barriers to continuing breastfeeding. In analysing New Zealand statistics, Galtry and Annandale (2003) found that between 1991 and2001 the percentage of women returning to the paid work force within a year of having a baby had increased from 3 to 34%.
Research carried out in places which do not, as yet, have paid breastfeeding breaks, for example, the United States of America and New Zealand, identifies returning to paid employment as a factor that shortens the duration of breastfeeding (Dennis 2002; Fein & Roe 1998; Glover, Manaena-Biddle & Waldon 2007; Lennan 1997; McIntyre et al 2002; McKinley & Hyde 2004; Vogel & Mitchell 1998a; Wallace & Chason 2007). For example, McIntyre and colleagues (2002) found that returning to paid employment within the first year of having a baby influenced mothers' decision to give up breastfeeding within the first six to twelve months. A prospective quantitative study by Hills-Bonczyk and colleagues (1993) reported the experiences of first time mothers who chose to combine breastfeeding and paid employment. At six months, 50 of these 619 women had returned to paid employment and only 1% of the infants were exclusively breastfed. The researchers found that there was a positive correlation between the length of maternity leave and the length of exclusive breastfeeding (Hills-Bonczyk et al 1993). Schmied and Lupton (2001) carried out a three-year longitudinal qualitative study of 5 Australian women and their partners' experiences of parenthood. Four of these women returned to paid employment within the first six months; two of the mothers weaned their babies before returning to paid employment and the other two gave up breastfeeding because they found expressing breastmilk was difficult.
In New Zealand incremental policy changes have been made to support working mothers. The changes both directly and indirectly also support breastfeeding. In2005 paid parental leave entitlement was increased from six to fourteen weeks, and in2006 the entitlement was amended to include women who were self-employed. Both the government's MOH (2001) and Department of Labour (2005) have produced educational pamphlets addressing breastfeeding and paid employment for both employers and employees (Department of Labour 2005; Ministry of Health 2001). Furthermore, New Zealand human rights legislation protects the choice to breastfeed in that prohibiting a mother from breastfeeding at work could be viewed as discrimination on the basis of one's sex (Human Rights Commission 2002). However New Zealand has not yet adopted the International Labour Organization's (2000) recommendation that mothers in paid employment who are breastfeeding get paid breaks to either express breastmilk or breastfeed.
In New Zealand the issue of breastfeeding and paid employment is contradictory and contested, as highlighted in an online survey carried out by the New Zealand Equal Employment Opportunities Trust which asked parents about their family and work situation (McPherson 2005). Over a three week period 4,475 parents, predominantly female, responded. The report states Breastfeeding facilities emerged as a controversial issue, with some respondents saying mothers should not return to paid employment while they are breastfeeding and others reporting their positive experiences of continuing to breastfeed while working (2005 p.8). Only a quarter of the male respondents believed that having breastfeeding facilities in the workplace was important.
Another example of societal attitudes towards breastfeeding that may operate against the combination of breastfeeding and paid employment was shown by a survey of Colorado businesses (Dunn et al 2004). Dunn and colleagues (2004) found that breastfeeding was viewed by respondents as a personal choice, which they suggest reflected a prevalent view that bottle feeding and breastfeeding are considered equally suitable options for infant feeding. In this way, artificial infant milk is supported as the cultural norm for what infants should be fed. Wallace and Chason (2007) also suggest that breastfeeding is still not regarded as the norm. They interpreted their participating mothers' unwillingness to ask their workplaces to accommodate breastfeeding as signifying breastfeeding was seen as a deviant activity.
While there have been studies into breastfeeding and paid employment, little qualitative research has been carried out, particularly in the New Zealand context. This collaborative study involving Auckland University of Technology's (AUT) Centre for Midwifery and Women's Health Research, Women's Health Action and La Leche League aimed to contribute to the body of knowledge pertaining to breastfeeding and work, and to use a qualitative method to capture New Zealand women's decision making and experiences of factors that enabled or discouraged them from returning to paid employment and breastfeeding (Ritchie 2001; Tolich & Davidson 2003).
A convenience sample of women was examined in this study, with two inclusion criteria: that the women were able to converse in English; and had had a baby within two years prior to the interview, that is, between July 2003 and July 2005. In order to gather participants from a range of ethnicities, occupational backgrounds, and infant feeding choices, several recruitment strategies were carried out. Flyers and posters, both hard and electronic versions, advertising the study were sent to six different workplaces, which were listed as being members of the Equal Employment Opportunity Trust (EEO Trust). These organisations included accountancy, banking, legal, food processing, and production and retail companies. In addition, women who had heard about the study, either from friends or in local community newspapers, directly contacted the principal researcher to express an interest in participating in the study. Recruitment continued until data saturation occurred (Streubert 1999).
Participants were interviewed at a place of their choosing, usually their own homes or, on one occasion, on AUT premises. The interviews, which lasted an average of 90 minutes, were unstructured, open-ended, in-depth and interactive. The mothers were asked to talk about their experiences and decisions regarding infant feeding, and returning to paid employment, and the factors that influenced their decisions.
To guarantee consistency in their interviewing technique, each of the four interviewers attended training and a pilot interview session. An open-ended question interview guide was used to ensure that the following key areas were addressed: the mother's plans during pregnancy regarding managing breastfeeding and work; what decisions they then made; when they returned to work; the advice they got from colleagues, family and health professionals; and, for those who returned to work and breastfed, how they managed .
With the participants' permission, all the interviews and focus groups were audiotaped, and transcribed. Emerging themes that either enabled or hindered the women's breastfeeding and return to paid employment were then identified (Streubert 1999). An overview of preliminary findings was sent to those participants whom we were able to contact.
Ethical approval for the study was gained from the AUT ethics committee. Every woman who met the study's inclusion criteria was sent an information sheet about the study prior to her agreeing to participate. Each participant was asked to sign a consent form before the interview commenced. Participants' rights were stated on both the information sheet and consent forms, and were reiterated by the interviewer at the beginning of the interview. The women were asked to provide a pseudonym by which they would be known in the study. Transcripts were only seen by the members of the research team, and by the transcriber who had signed a confidentiality form.
Limitations of the study
The study has several limitations. The participants were a selfselected and not random sample; they came predominantly from professional occupations; and the majority were women who continued to breastfeed on their return to paid employment. Attempts were made to recruit women into the study who did not breastfeed and who came from non-professional occupations. However, it is important to note that two of the women gave up breastfeeding because they were returning to paid employment, and five of the women who chose not to return to paid employment cited lack of workplace support for breastfeeding as their reason for not going back to work. Their experiences provide important insights into the factors that can act as barriers to women combining work and breastfeeding.
A total of 34 women participated in this study and their ages ranged from early 20s to late 30s. Twenty three women identified as European, four as Maori, two as Tongan, two as Samoan, and the remaining three as Nuiean, Rarotongan and Malaysian, respectively. Their occupations included accountancy, banking, bar work, clerical, commerce, dental nursing, design, education, fitness industry, journalism, law, midwifery, nursing, physiotherapy and sales. Almost one-third of the women (n = 11) chose not to return to paid employment, whilst the remainder decided to return, predominantly for economic reasons. Over half of the women returning to paid employment (14 of 3) returned to work fulltime.
Of the 3 women who returned to paid employment, nine did so before their babies were three months old, seven by the time their babies were 4-6 months old, four when their babies were 7-9 months old, and two after their babies were one year old. While all the participants breastfed their babies from birth, three of the women who returned to paid employment gave up breastfeeding within seven months.
The overarching theme that emerged from all the transcripts was the importance of support for breastfeeding from partners, other family members and the workplace. The support of the workplace was made apparent by the provision of suitable space, and the acceptance of the mothers taking time away from their worksite to either breastfeed their baby or express breastmilk.
The support of others was significant to all the mothers who continued to breastfeed on their return to paid employment, particularly support from their partners and colleagues. For six women who were the main income earners, their partners assumed the role of primary caregiver for the baby and supported the mother by either bringing the baby to the mother during her meal break, or preparing and feeding the baby the expressed breastmilk in her absence:
My husband picks me up from work and we either come back here [home] or if it's a wee bit nicer we can go back out in the back yard, or there's a local park down by work. [...] But we just try and do some relaxing, and I get back to work afterwards. (Marion)
Other women (n = 2) reported that other family members such as a parent or older sibling would bring the baby to them so that they could continue to breastfeed.
The support of co-workers was also recognised by fourteen of the mothers who decided to continue breastfeeding on their return to paid employment. For example, one woman spoke of her co-workers thus:
My workplace, they're very pro breastfeeding and I have a wonderful team of nurses of whom a lot of them have been breastfeeding mothers, all very understanding and incredibly supportive. So I feel very lucky. My manager is also very supportive. So I work in a great team really. (Dianne)
The women found that the shared experience of other female co-workers who had continued to breastfeed had created a kind of norm, which allowed them to combine breastfeeding and work. The women's needs of flexibility, in terms of time away to express breastmilk, were accepted. Such support was valued and spoken of positively by these participants.
While some women spoke of workplace support, others (n = 9) who either decided not to return to paid employment or who stopped breastfeeding prior to returning to paid employment, perceived their workplace as unsupportive. One woman felt that her co-workers would be saying:
"Who does she think she is, going off and feeding her baby?" It's not like you are going to be five minutes, is it? It takes a bit of time. Just feeling that you are not really entitled to have that time to do it. (Janice)
In my work position I am not able to create a time to be able to breastfeed. If I was to return to work I am totally at the bottom of the ranks, and I am reporting to my boss and there're three or four other people above me who watch my every move. Everything I do is time allocated. I think that if I was in a position where I just did my own thing and wasn't so reliant upon my superiors then I could do it [breastfeeding] more discreetly. (Charmaine)
The physical structure and operation of work made these mothers' absences highly visible to all around them, particularly their superiors. They perceived that their commitment to continue to breastfeed was not valued but seen as detracting from their overall work. When their colleagues and superiors did not seem supportive, the decision by these women to continue to breastfeed on return to paid employment became more difficult.
Several women noted that when their colleagues were predominantly male, the support for breastfeeding seemed less. One woman worked for a large company that was recognised as an equal rights employer which had multiple worksites and occupations. She noted that the support for breastfeeding depended on the location and how many women were at the site:
Our company is very different. It has totally different values, totally different environments. Most of the guys have come from the military. They are very military and it has been male orientated, which is totally different from my area which is very female orientated. It is very corporate, very professional, very different. So you have got your different worksites. Every area has its own culture, its own environment. And while the company has set values as in overall, it is very hard, I suppose, to have the same feeling within a huge company when there are so many different areas which are spread out, in location as well. So everyone is so far apart from each other as well, and that means that in some areas it is very easy for breastfeeding and parental leave and anything like that. And they would be very welcoming of it. In other areas it is a lot harder. (Eve)
Her experience highlights that, while a company might have a breastfeeding policy, the implementation of that policy may vary from place to place, and is dependent on superior's and colleague's attitudes towards breastfeeding in the workplace.
The presence or absence of space
Few of the participants (n = 2) were able to take their infants to work with them. One mother who returned to paid employment when her baby was six weeks old and had her own office, said:
We had set up the cot, behind me, and had the buggy ready as she got a little bit more interactive, with her toys all ready. [...] So throughout the day, when I knew when the timing was right for her and that she was looking for a feed, I would basically just close the door and take care of what she needed. (Anita)
Ten women had access to their infants during their time at work. They either had a creche nearby or their baby was brought to them by their partner, a family member or, in one case, a nanny.
A few women (n = 6) had access to a worksite room that was made available to them to use to breastfeed or express breast milk. For example, one woman who returned to paid employment when her baby was three months old and she was fully breastfeeding, said:
There's a first aid room which is quite private. It doesn't have a lock on the door because it's a first aid room and people might be sick. But when I mentioned it, the properties manager said, "Look, just put a chair against the door or something". I noticed that after I'd been doing it for a week they'd got a green light on it, so that you could flick the switch and could see the room was in use, which was very nice. (Marion)
The remaining women had to find appropriate spaces within and without their workplaces. A variety of sites were used such as vacant staff rooms, spare offices or meeting rooms, shower cubicles and at times their own car:
I have to express milk in a shower cubicle, there's no toilet in there, I wouldn't express milk if there was a toilet in there but that's it. My office really isn't, well it's not appropriate because there's a telephone there and people come and go and it's a patient area. (Annabelle)
With my youngest, the physio department has curtained spaces, so I just pull the curtains around and quickly feed her there. So it wasn't an issue not having place to go, I didn't have to go to the toilet or something like that. (Nicola)
In their determination to continue breastfeeding, the women showed a resourcefulness and making do with the facilities that were ready to hand.
In New Zealand, there are no legislated breaks for women in paid employment to breastfeed, thus the employed women who continued to breastfeed had to either express or breastfeed their baby during their tea or meal breaks. For example:
So I did express at morning tea, lunch and afternoon tea and that just meant I didn't have a morning tea and an afternoon tea and it meant that I probably ate my lunch as fast as I possibly could. (Alison)
Most of the women felt pressure to fit their activities of breastfeeding or expressing into scheduled work breaks. For these women, the notion of tea breaks being a time of relaxation, and socialising with one's colleagues was replaced with that of tea breaks being a time of isolation and another kind of work.
Having to fit breastfeeding into the constrained fixed break times influenced some of the women's decision either not to return to paid employment or to discontinue breastfeeding. One woman, who stopped breastfeeding because she planned to return to paid employment when her infant was seven months old, said:
Putting the two together, feeding and working...there would've had to be a lot of factors working right in order for me to continue to breastfeed. Work was one, having the breast-milk, the ample supply of breastmilk, and also having the confidence in myself would've been another factor there. [...] It [bottle feeding] was a known thing and I knew that it worked [...] and it meant that I didn't feel guilty about having to leave the office to breastfeed. (Janice)
This mother's baby was a slow feeder. Furthermore, she believed that she had an insufficient milk supply. These two factors when combined with the discomfort she felt about taking time away from her workplace shaped her decision to give up breastfeeding. Her experience draws to light the many factors that are required for successful breastfeeding and how return to paid employment may complicate and erode a mother's ability to continue breastfeeding.
The husband's attitudes towards breastfeeding has been identified as a highly significant factor in a woman's decision-making regarding infant feeding (Draper 1996) and may reduce the mother's stress in managing paid employment and breastfeeding (Fein & Roe 1998). Partners' support was a significant factor for many of our participants returning to paid employment, particularly when the mothers were the main income earners. The partners' willingness and ability to either bring the infant to the mother and/or feed the infant in their absence was recognised and valued by the mothers.
Breastfeeding and expressing of breastmilk are still regarded as intimate activities, not to be carried out in public (Earle 2002; Gatrell 2007). This necessitated our participants who returned to paid employment, particularly while their baby was being exclusively breastfed, to find a suitable private space that they could access two to three times a day. Having an appropriate place to either express breastmilk or breastfeed is an important factor for mothers deciding to establish and continue breastfeeding (Wallace & Chason2007). For our participants, particularly for the eleven who returned to work while exclusively breastfeeding, an appropriate space was one that was conducive to stimulating the flow of breastmilk. It had to be a space that they could control entry to and not be interrupted by colleagues; and where, if they were using a breast pump, the sound of their machine could not be heard by their colleagues. While some women managed to continue breastfeeding without a set space in their workplace, others either were not able to, or chose not to return to paid employment.
Workplace support is critical for mothers returning to paid employment to successfully continue to breastfeed (Fein & Roe 1998). Furthermore, workplace support normalises the practice of breastfeeding in a societal context that may not be supportive of breastfeeding. The availability of physical time and space communicates support (James2004). While Hills Bonczyk and colleagues (1993) suggest that women can combine breastfeeding and paid employment, they note that it is not without its difficulties. Continuing to breastfeed upon return to work shifts what is 'an intimate interpersonal relationship into a broader sociophysical ecosystem' (Johnston & Esposito 2007 p.18). Moreover, breastfeeding has the potential to put women in the spotlight, to make them highly visible, to mark them as different. In this way mothers and their practice of breastfeeding become both visible and vulnerable to the scrutiny and influence of others Galtry (2000). Thus the opinions of other people can influence a mother's decision regarding breastfeeding.
Workplace support for breastfeeding was made visible to our participants in a variety of ways: by allowing the infant to be brought to work; by permitting other worksite spaces to be used for breastfeeding and expressing; and allowing mothers the time to carry out these activities. When workplaces supported the mothers, they felt valued as employees. When workplaces did not offer such support, the mothers felt discouraged from either returning to work while their baby was still breastfeeding or continuing to breastfeed on their return to work.
We concur with the recommendations of Galtry and Annandale (2003), Gatrell (2007) and McKinley and Hyde (2004). In order for workplaces to become routinely supportive, structural strategies need to be implemented, such as Sweden's paid breastfeeding breaks and parental leave allowances (Galtry 1998), and the Australian Breastfeeding Associations' Breastfeeding-Friendly Workplace Accreditation scheme (Eldridge & Croker2005). Societal attitudes and cultural norms also need to change. Instead of mothers having to find ways of being resourceful and individually responsible, breastfeeding support needs to be seen to be in the public's interests and thus recognised as a social responsibility. Research into the long-term effects of breastfeeding, such as the systematic review by Horta and colleagues (2007), need to be widely publicised.
Economic necessity was the main reason for returning to paid employment for the majority of our participants; it was not necessarily a choice. Breastfeeding is increasingly being constructed as a health promotion practice to reduce the incidence of disease in both the short term and the long term. If breastfeeding is a social responsibility, then structural measures and societal attitudinal changes to supporting breastfeeding need to be implemented.
We are grateful to the women who participated in our study and so generously gave their time and shared their experiences. Thanks too to Sue Berman, research officer; Barbara Sturmfels, La Leche League; Mele Siulolo Siakumi, Pacifica advisor; and Beatrice Leatham, Maori advisor. The study was made possible by grants from AUT's Division of Health Care Practice and Faculty of Health and Environmental Sciences Contestable Research Grants Fund.
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Deborah Payne RN BA MA PhD Louise James Bed(EC) Dip CBE
Correspondence to: Deborah Payne Centre for Midwifery & Women's Health Research. Faculty of Health & Environmental Sciences AUT University Private Bag 92006 Auckland 1020 New Zealand Telephone: +64 9 921 9999 ext 711 Email: email@example.com
Deborah Payne is the Director of the Centre for Midwifery and Women's Health Research at the Auckland University of Technology. Her research, in the area of women's health, aims to contribute to women's wellbeing and improve health outcomes.
Louise James is the Breastfeeding Advocate at Women's Health Action. A major stream of work at Women's Health Action is to promote breastfeeding friendly workplaces. She works on other key breastfeeding issues in New Zealand, for example, the 'Big Latch On' during the World Breastfeeding Week.
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