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      The association between work related factors and breastfeeding practices among Chinese working mothers: a mixed-method approach

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          Breastfeeding rates remain low in China and some mothers stop breastfeeding shortly after returning to work. Our study aimed to investigate the association between breastfeeding practices of working mothers and their employment status (formal versus informal) and occupational fields (agriculture related, industry related, and business and white collar). We also identified key work-related factors that influence breastfeeding practices in Chinese working mothers.


          This is a mixed-method research consisted of two components. We conducted a cross-sectional study of 10,408 breastfeeding mothers with children under 12 months old from 12 regions in China from July 2017 to January 2018. Multiple logistic regression was used to calculate adjusted odds ratios (AdjORs) and 95% confidence intervals (CIs) for breastfeeding practices. For the qualitative component, semi-structured interviews were conducted with 84 breastfeeding mothers in the study areas from July to December 2017, Content analysis was used for the qualitative component.


          Agriculture related occupations were positively associated with early initiation of breastfeeding (AdjOR 1.32, 95% CI 1.15, 1.51), current breastfeeding (AdjOR 1.76, 95% CI 1.41, 2.20), ever breastfed (AdjOR 1.69, 95% CI 1.09, 2.62), exclusive breastfeeding (AdjOR 1.30, 95% CI: 1.04, 1.62), and predominant breastfeeding (AdjOR 1.72, 95% CI 1.44, 2.05). Business and white collar occupations were positively associated with early initiation (AdjOR1.38, 95% CI 1.23, 1.56) and ever breastfed (AdjOR 1.64, 95% CI 1.12, 2.39), and inversely associated with predominant breastfeeding (AdjOR 0.81, 95% CI 0.68, 0.95). For industry related and business and white collar occupations, informal employment was negatively related to current breastfeeding. In qualitative analysis, four main themes were developed to identify key work-related factors that influence breastfeeding practices: 1) employment benefits; 2) commute time; 3) workplace environment; 4) labor intensity. Mothers who experienced difficulties in one or more of the above would choose to lower breastfeeding frequency or stop breastfeeding.


          Having flexible work schedules and proximity of workplace to home can assist continuance of breastfeeding. Policies promoting supportive breastfeeding environment at work ought to be implemented. Additionally, informally employed mothers require more attention due to limited legal protection.

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          Most cited references 25

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          Factors associated with breastfeeding at discharge and duration of breastfeeding.

          To identify determinants of the initiation and duration of breastfeeding amongst Australian women. A prospective cohort study of 556 women in Perth, Western Australia and 503 women from the Darling Downs area, Queensland, Australia. Breastfeeding at discharge was most strongly associated with perceived paternal support of breastfeeding with an adjusted odds ratio of 9.13 (95% CI 4.83-17.26), using multivariate logistic regression analysis. Duration of breastfeeding was most strongly associated with the length of time a mother intended to breastfeed with an adjusted relative risk of 4.18 (95% CI 2.81-6.22) for > or = 4 months relative to < 4 months. Interventions which aim to increase the length of time a woman intends to breastfeed, and which highlight the role of the father in successful breastfeeding, are recommended to help achieve recommended targets for breastfeeding initiation and duration.
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            The impact of maternal employment on breast-feeding duration in the UK Millennium Cohort Study.

            To examine the relationship of maternal employment characteristics, day care arrangements and the type of maternity leave pay to breast-feeding for at least 4 months. Cohort study. Babies aged 9 months in the Millennium Cohort Study, born between September 2000 and January 2002. A total of 6917 British/Irish white employed mothers with singleton babies. Mothers employed part-time or self-employed were more likely to breast-feed for at least 4 months than those employed full-time (adjusted rate ratio (aRR) and 95% confidence interval (CI) 1.30 (1.17-1.44) and 1.74 (1.46-2.07), respectively). The longer a mother delayed her return to work postpartum, the more likely she was to breast-feed for at least 4 months (P for trend < 0.001). Mothers were less likely to breast-feed for at least 4 months if they returned to work for financial reasons (aRR 0.86, 95% CI 0.80-0.93) or used informal day care arrangements rather than care by themselves or their partner (aRR 0.81, 95% CI 0.71-0.91). Mothers were more likely to breastfeed for at least 4 months if their employer offered family-friendly (aRR 1.14, 95% CI 1.02-1.27) or flexible work arrangements (aRR 1.24, 95% CI 1.00-1.55), or they received Statutory Maternity Pay (SMP) plus additional pay during their maternity leave rather than SMP alone (aRR 1.13, 95% CI 1.02-1.26). These findings were independent of confounding factors, such as socio-economic status and maternal education. Current policies may encourage mothers to enter or return to employment postpartum, but this may result in widening inequalities in breast-feeding and persistence of low rates. Policies should aim to increase financial support and incentives for employers to offer supportive work arrangements.
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              Stress during labor and delivery and early lactation performance.

              The amount of stress experienced by both the mother and fetus during labor and delivery varies considerably and is likely to be different in primiparous and multiparous women. In this study we explored relations between the birth experience and lactation performance of 40 women. Stress hormones were measured in serum or plasma during pregnancy, parturition (cord and maternal blood), and lactation. Milk samples were obtained and breast-feeding frequency was recorded each day during the first 2 wk postpartum. Four outcomes were used as markers of lactogenesis: the time when the subject first felt fullness in the breasts, 24-h milk volume on day 5 postpartum, milk lactose concentration on day 5, and the day of appearance of casein in the milk as determined by gel electrophoresis. There were significant intercorrelations among the outcome variables, except for milk lactose. Compared with multiparous women, primiparous mothers experienced a delay in breast fullness and lower milk volume on day 5. In multiple regression analyses excluding subjects who had cesarean deliveries (n = 5), markers of both fetal and maternal stress during labor and delivery (cord glucose concentration and maternal exhaustion score) were associated with delayed breast fullness and casein appearance; delayed casein appearance was also associated independently with a longer duration of labor. Milk volume on day 5 was lower in women with higher exhaustion scores, and, in multiparous women, those who breast-fed less frequently on day 2. The milk lactose concentration was inversely related to pregnancy weight gain. These results indicate that primiparity, long labor, stress to the mother and fetus during labor and delivery, and elevated cord glucose concentrations are risk factors for delayed lactogenesis.

                Author and article information

                Int Breastfeed J
                Int Breastfeed J
                International Breastfeeding Journal
                BioMed Central (London )
                27 June 2019
                27 June 2019
                : 14
                [1 ]ISNI 0000 0001 2256 9319, GRID grid.11135.37, School of Nursing, , Peking University Health Science Center, ; 38 Xueyuan Road, Haidian District, Beijing, 100191 China
                [2 ]ISNI 0000 0001 2256 9319, GRID grid.11135.37, Department of Global Health, School of Public Health, , Peking University Health Science Center, ; 38 Xueyuan Road, Haidian District, Beijing, 100191 China
                [3 ]United Nations Population Fund China office, 14 Liangmahe Nanlu, Chaoyang District, Beijing, 100600 China
                [4 ]ISNI 0000 0001 2256 9319, GRID grid.11135.37, School of Basic Medical Sciences, , Peking University Health Science Center, ; 38 Xueyuan Road, Haidian District, Beijing, 100191 China
                [5 ]ISNI 0000 0001 2173 3359, GRID grid.261112.7, Department of Psychology, , Northeastern University, ; 360 Huntington Ave, Boston, MA 02115 USA
                [6 ]ISNI 0000 0004 1936 7558, GRID grid.189504.1, Department of Global Health and Population, , Harvard University T. H Chan School of Public Health, ; 677 Huntington Ave, Boston, MA 02115 USA
                [7 ]ISNI 0000 0001 2256 9319, GRID grid.11135.37, Institute for Medical Humanities, , Peking University Health Science Center, ; 38 Xueyuan Road, Haidian District, Beijing, 100191 China
                [8 ]ISNI 0000 0004 0369 153X, GRID grid.24696.3f, Breast Surgery Department, Beijing Shijitan Hospital, , Capital Medical University, ; Chaoyang District, Beijing, 100038 China
                [9 ]ISNI 0000 0004 0632 4559, GRID grid.411634.5, Peking University People’s Hospital, ; No. 11 Xizhimen South Ave., Xicheng District, Beijing, 100044 China
                [10 ]ISNI 0000 0001 0662 3178, GRID grid.12527.33, Research Center for Public Health, , Tsinghua University, ; Haidian District, Beijing, 100084 China
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funded by: China Development Research Foundation
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