Facilitators and Barriers for Breastfeeding among Working Women in Saudi Arabia

Abstract

Background: Breastfeeding is an essential method of infant feeding that provides many health advantages for both the infant and the mother. Despite the World Health Organization (WHO) and United Nations Children's Fund espousing the benefits of breastfeeding for up to two years of age, returning to paid employment after the baby is born is one of the main reasons that women stop breastfeeding. There are barriers and facilitators for breastfeeding women who return to paid employment in many countries. However, there is scant information about the facilitators and barriers for breastfeeding women returning to work in Saudi Arabia. Furthermore, there is no information from the perspectives of the women, their co-workers and employers, and healthcare providers. Aims: This research explored the facilitators and barriers of breastfeeding as perceived by Saudi women in paid employment. To contextualise Saudi women’s experiences, current workplace policies related to breastfeeding and their operationalisation in the local workplace environment were examined. Also, the experiences of co-workers, line managers and employers have been sought to assess the position of workplace culture in supporting women to continue breastfeeding. Finally, the views of healthcare professionals who work with childbearing women were sought to increase understanding of the roles healthcare workers and healthcare services play in supporting women to initiate and continue breastfeeding after returning to paid employment. Methods: A mixed-methods design was conducted. The qualitative strand of this study explored the facilitators and barriers towards breastfeeding as perceived by women in paid employment, their co-workers, and line managers or employers. Data were collected by oneto-one interviews, transcribed and translated from Arabic to English. Thematic analysis was undertaken through the lens of the theory of planned behaviour to arrive at the themes and subthemes. The quantitative phase has two arms. Arm I examines the resources and spaces available in the workplace to support breastfeeding practices. The settings were in Dammam in the Eastern Province of Saudi Arabia and comprised two government sector locations: Imam Abdulrahman bin Faisal University (IAU) and Maternity and Children Hospital (MCH), and two private sector locations: Alfaisliyah School and Almana General Hospital. Data were collected via direct observation of current workplace policies, and current breastfeeding spaces and resources available to support breastfeeding women in their work environment. Arm II vi explores the role of nurses and midwives in supporting women to initiate and continue breastfeeding after returning to paid employment. A total of 123 nurses and midwives agreed to participate and complete the survey. Data were collected via the participants’ survey completions. Online surveys were conducted using SurveyMonkey and paper surveys were collected by the main researcher. Result: The study showed that immediate family members such as mothers, sisters and grandmothers are important social networks to support breastfeeding women after return to paid employment, and that the woman’s husband plays a critical role in the woman’s continuation of breastfeeding. In addition, healthcare professionals (nurses and midwives) were sources of information for women. However, the perception of breastfeeding support was influenced by aspects such as the knowledge and skills of the healthcare professionals (nurses and midwives). This study showed that workplaces are lacking facilities, such as private rooms with a clean sink and refrigerators, to allow breastfeeding women to express breast milk and to store the milk. In addition, this study found that the 70 days of maternity leave was not enough to achieve the goal of breastfeeding and the WHO recommendation of exclusive breastfeeding for six months. Finally, the findings from this study showed the challenges facing breastfeeding women after return to paid employment due to the fact that the private and government sectors might not have sufficient resources to accommodate the needs of breastfeeding women after return to paid employment. Significance of research: The findings from this research have the potential to increase knowledge regarding the factors that facilitate or hinder Saudi women’s decision to initiate breastfeeding and to continue breastfeeding on return to paid employment. Additionally, understanding of Saudi healthcare workers’ current skills and knowledge base related to breastfeeding may be increased. It is conceivable, therefore, that results from this research can support the development of policies and practices that will facilitate breastfeeding initiation and duration rates among Saudi working women.