Employed mothers’ breastfeeding: Exploring breastfeeding experience of employed mothers in different work environments in Ethiopia

Background One of the most cost-effective interventions to enhance child health with the potential to reach families of all economic backgrounds is breastfeeding. Despite the many benefits optimal breastfeeding has, its practice is low due to various barriers among which maternal employment is mentioned repeatedly. Accordingly, this study has explored the experience of employed mothers with regards to breastfeeding, employment, and work environment in Addis Ababa Ethiopia. Methods and findings A descriptive Phenomenology strategy was employed among 17 mothers drawn from different organizations, conveniently, that offer accommodation of six months maternity leave or onsite child care center or had only three months maternity leave. Data were collected through in-depth interviews until information saturation was reached. Recorded interviews were transcribed and translated and the information obtained was then organized and coded to generate overarching themes. Two themes on facilitators and barriers, and addressing barriers were generated after analysis. Mothers recognize the importance of breastfeeding for children but returning to work at three months is expressed as a major barrier to continuous breastfeeding. Mothers who have access to supporting conditions at their workplace expressed better breastfeeding practice and better satisfaction with their job. Conclusions Providing employed mothers with a supporting environment helps them work with better stability, motivation, and satisfaction. This however requires a suitable accommodation with a focus on the different kinds of work environments of the mothers and the different risks related to each respective environment via scaling up and monitoring breastfeeding interventions and calling upon institutions to remove structural and societal barriers to breastfeeding. The study received ethical approval from the Research Ethical Committee of the School of Public Health, Addis Ababa University. Following this, written informed consent was obtained from the participants after the explanation of the purpose, procedures, benefits, and risks of the study were made. All the interviews were done with strict privacy. This study had two main research questions which are: (1) what does the experience of breastfeeding for employed mothers look like? (2) How does the breastfeeding experience differ between employed mothers who have six months of maternity leave or access to an onsite childcare center or have neither of the two? Accordingly, the specific objectives of this study were exploring the breastfeeding experiences of employed mothers in different working environments with different supporting arrangements, and identifying and understanding motivations, barriers, and mechanisms of addressing challenges to breastfeed while employed in different working environments. A descriptive Phenomenology strategy was employed in this study where understanding the lived experience is marked as a philosophy as well as a method. This procedure involves studying a small number of subjects through extensive engagement to develop patterns and relationships of meaning as described in Creswell’s research design 3rd edition [31]. This strategy is used in this study to address the objectives of the study by helping explore and understand the lived experience of mothers related to breastfeeding and employment. Furthermore, the application of this design helps to apprehend the subjective experience of employed mothers and to gain insight into their perception, emotion, thought, and action giving chance to development of better recommendations. The study population in this study included full-time women employees working in any position and have a currently breastfeeding child of two years or younger. These women were employed in an institution that offers a six months maternity leave, or in an institution that has an onsite childcare center, or in an institution that has neither. All participants were from urban areas and lived in a highly crowded city. A purposive selection was used to choose institutions in Addis Ababa city taking their provision of the different supporting environment, operationally defined in this study as institutions that have six months of maternity leave and an onsite childcare center in the work environment, for breastfeeding employees and those with only three months maternity leave into consideration. The representation of private, governmental, and non-governmental organizations was also considered in the selection. Eligible participants were identified purposively using predefined inclusion criteria where responsible personals, mostly HR officers, in each organization helped to identify participants in each institution. After identification, eligible participants were contacted by researchers if only they have expressed their willingness to be approached. Data were collected between Dec 2016-May 2017 in Addis Ababa, the capital city of Ethiopia, in governmental, private, and non-governmental organizations. The included organizations had three months of maternity leave or six months of maternity leave or an onsite childcare center. Data were from women who met the inclusion criteria and were collected until information saturation was attained which was determined by the repetition of information and lack of newly emerging information. Data collection was carried out by adapting a national breastfeeding study in Pakistan which has a section of interviews for employed breastfeeding mothers and is used in countries like Uganda, Malawi, and Senegal [32]. This protocol was edited to fit into this study considering the objective and the study population. The interview guide contains semi-structured and a few open-ended questions to have a high degree of flexibility. The demographic data on the age of the mother, marital status, working position, Years of schooling, the total number of children, and the gender of the youngest child, and the age of the child were collected. Additionally, each interview guide had core questions that did not direct the participants and permitted them to express what they felt was important while maintaining a central frame of inquiry. The interview also included questions regarding general knowledge on breastfeeding, breastfeeding experience of mothers concerning employment, and experience of breastfeeding with regards to supporting conditions in the workplace. Some are: All interviews were conducted by the principal investigator (FB) who is a public health professional by training and worked in a governmental organization where she has worked with employed mothers but did not have experience of her own on breastfeeding and was not particularly very knowledgeable on the issue. The date, time, and place of each interview were arranged following what was most favorable and comfortable for the subjects. Accordingly, interviews were conducted in the mothers’ offices. All the interviews were audiotaped with the participant’s consent and the interviews took from 40 to 60 minutes. Informed consent was taken before each interview where participants were informed about the purpose, procedures, benefits, risks, and the right of the respondents to refuse to answer a few or all of the questions. Thematic data analysis was performed to describe and compare general statements as relationships and themes present on the data according to the method of analysis described by Kleiman (2004). All three authors were involved in the preparation of this study where FB was involved starting from the conception of the idea of the study and original article write-up to collecting data and analysis to final write-up. JH has been involved as a senior researcher starting from guiding the study conduction and supervision to involving in the analysis of the study from coding to writing up of the study and the third author YG has been involved in conception and analysis from coding to writing up and editing of the study. All interview transcripts were read and counter-checked with the transcripts, and emerging themes were agreed upon after coding. The interviews of this study were digitally recorded, transcribed verbatim, and translated to English from the local dialect of Amharic. The first stage of data analysis involved closely reading and re-reading each transcript and listening to the audio recording to become familiar with the data. The second stage involved initial coding by reading the transcript in-depth and making a note of anything important or interesting and paying attention to where and how patterns occurred. The third stage was categorizing codes into themes directed by the content of the data. In the fourth stage searching for connections across emergent themes and checking if the themes make sense and account for all the coded extracts and the entire data set was done. The fifth stage involved generating clear definitions and names for each theme and describing which aspects of data are being captured in them and that they had meaningful contributions to answering the research question by systematically going through the transcripts of each one of the 17 participants. During data collection member checking was done by restating and paraphrasing information for respondents to determine the accuracy and participants were revisited one more time for clarity of information and accuracy of meaning before data analysis. Reliability was ensured by trying to avoid leading questions and all Amharic transcripts were cross-checked with the oral discourse for consistency and completeness of data and interview transcripts and codes were constantly compared with the data to prevent drift of definition of codes (Gibbs 2017). The analysis was done manually and rigor was enhanced through regular discussions between all three authors.