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Introduction: While breastfeeding is recognized as providing optimal nutrition for infants and toddlers, maternal employment is a commonly mentioned barrier to breastfeeding. The goal was to (a) identify key actors participating in the design and implementation of workplace breastfeeding interventions in Mexico, (b) understand the complexity of interactions between the actors, and (c) map the connections and influence between the actors when looking into networks of Advice, Command, Funding, and Information. Method: Following the NetMap methodology, a total of 11 semi-structured interviews with 12 interview partners from 10 organizations were conducted. Interview data were analyzed, and networks were analyzed and visualized, using a social network mapping software. Results: A total of 83 actors from five different actor groups were identified. Four networks were constructed along the four types of connections: Advice, Command, Funding, and Information. The actors were connected by 580 connections with 446 unique links. Based on various network statistics, the Mexican Institute of Social Security, the Mexican Secretary of Labor and Social Welfare, UNICEF, and the Mexican Secretary of Health were identified to be key actors. Conclusion: To increase the likelihood of success of workplace breastfeeding interventions, the role of the actors "Employers" and "Women" needs to expand. They should be actively involved in the decision-making process, together with the identified key actors. It is further recommended to re-introduce a national breastfeeding strategy for Mexico that includes policies for workplace breastfeeding interventions.

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Return to work is one of the most significant barriers to breastfeeding (BF). Family-friendly policies are critical to ensure that BF and maternal work are not mutually exclusive. This study aims to determine contextual factors and underlying mechanisms influencing the implementation of workplace policies in Mexico. Following a qualitative approach, the study was conducted in the following four cities in Mexico: Mérida, Chihuahua, Guadalajara, and Monterrey. Interviews were conducted in 14 workplaces, and included 49 (potential) beneficiaries, 41 male employees, and 21 managers and human resources personnel. The information collected was analyzed through a deductive thematic analysis and mapped against the Context-Mechanism-Outcome framework of Breastfeeding Interventions at the Workplace. Contextual factors influencing a BF-friendly environment in the workplace were as follows: work-schedule flexibility, provision of lactation services (i.e., BF counseling) other than a lactation room, women's previous experience with BF and family-friendly environments in the workplace. The underlying mechanisms enabling/impeding a BF-friendly environment at the workplace were as follows: awareness of Mexican maternity protection legislation, usage of BF interventions in the workplace, culture, supervisor/co-worker support and BF-friendly physical space. To achieve a BF-friendly environment in the workplace, actions at the level of public policy and workplaces must accompany adherence to Mexican legislation.

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Resumo O objetivo deste estudo é identificar fatores associados à continuidade da amamentação por 12 meses ou mais em mulheres trabalhadoras. Estudo transversal realizado por meio de entrevista com 251 trabalhadoras de um hospital, com filhos biológicos entre 12 e 36 meses de idade, não gemelares e sem doença que afetasse a amamentação, e amamentando quando do seu retorno ao trabalho. Para a associação entre a continuidade da amamentação e as variáveis de exposição utilizou-se a regressão multivariável de Poisson. Apenas uma variável relacionada ao local de trabalho da mulher mostrou associação significativa com o desfecho. Trabalhar durante o dia aumentou em 37% a prevalência da amamentação por 12 meses ou mais. Os fatores não relacionados ao trabalho da mulher que mostraram associação positiva com o desfecho: mãe sem curso superior, experiência de amamentação superior a 12 meses; criança não receber outro leite quando a mãe retornou ao trabalho e não ter usado chupeta. Por outro lado, maior idade da mãe, maior idade gestacional, apoio do cuidador da criança e apoio profissional na amamentação associaram-se negativamente ao desfecho. Fatores não relacionados diretamente ao trabalho materno tiveram maior participação na continuidade da amamentação por 12 meses ou mais.

Abstract This article aims to identify factors associated with breastfeeding continuation for at least 12 months among working mothers in a hospital in the south of Brazil. We conducted a cross-sectional study, interviewing 251 women who breastfed after returning to work. Eligibility criteria included non-twin biological children aged between 12 and 36 months and the absence of an illness (mother and/or child) that could affect breastfeeding. The association between breastfeeding continuation and the exposure variables was tested using Poisson multivariate regression. Only one work-related variable showed a significant association with the outcome. Working only during the day increased the prevalence of BF continuation for at least 12 months by 37%. The following non-work-related factors showed a positive association with the outcome: mothers without a college degree; mothers with at least 12 months' prior breastfeeding experience; child not given milks other than breast milk when the mother returned to work, and not using a pacifier. The following variables showed a negative association with the outcome: older maternal age; older gestational age; mother receiving support from the child's caregiver; and mother receiving professional breastfeeding support. Non-work-related factors had a greater influence on breastfeeding continuation for at least 12 months among working mothers.

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BACKGROUND: Breastfeeding can be affected by maternal employment. This is important considering that in 2019, 47.1% of women globally participated in the labor force. The aim of this study was to review workplace interventions to promote, protect and support breastfeeding practices among working mothers globally. METHODS: A systematic review was conducted following the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Observational, experimental and qualitative peer-reviewed studies in English and Spanish, published between 2008 and 2019 were included. The review focused on working women who were pregnant, breastfeeding or who recently had a child, and women's working environments. The outcomes of interest included breastfeeding intentions, initiation, exclusivity and duration, confidence in breastfeeding or breastmilk extraction, and perceived support at workplace. Quality was assessed according to National Institute for Health and Care Excellence (NICE) checklist for systematic reviews. It was registered on PROSPERO (#140624). RESULTS: Data was extracted from 28 quantitative and 9 qualitative studies. The most common interventions were designated spaces for breastfeeding or breastmilk extraction (n = 24), and the support from co-workers (n = 20). The least common interventions were providing breast pumps (n = 4) and giving mothers the flexibility to work from home (n = 3). Studies explored how interventions affected different breastfeeding outcomes including breastfeeding duration, breastfeeding exclusivity, confidence in breastmilk expression, and breastfeeding support. The evidence suggests that workplace interventions help increase the duration of breastfeeding and prevent early introduction of breastmilk substitutes. Having a lactation space, breastmilk extraction breaks, and organizational policies are key strategies. However, to achieve equitable working conditions for breastfeeding mothers, organizational and interpersonal changes need to occur as well. CONCLUSIONS: The systematic review revealed that interventions at the workplace are important in protecting, promoting and supporting breastfeeding among working mothers. To achieve equitable work environments and fair nutritional opportunities for infants of working mothers, interventions should focus at the three ecological layers - individual, interpersonal, and organizational. The quality of studies can be improved. There is a need for studies assessing impacts of workplace interventions on infant feeding practices, mothers' self-esteem and outcomes such productivity and abstentionism.

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Introducción: La lactancia materna exclusiva es ideal para el recién nacido por su aporte nutricional, inmunológico y emocional, todos ellos fundamentales para su adecuado crecimiento y desarrollo. Se ha observado que, el trabajo es el factor más influyente que condiciona el abandono. Se hace necesario evaluar el impacto del lactario domiciliario para reducir el abandono de la lactancia materna exclusiva en madres trabajadoras. Métodos: Estudio aplicativo de tipo experimental, prospectivo, transversal analítico realizado en el Servicio de Maternidad del Hospital Central de San Cristóbal. Se seleccionaron aquellas madres trabajadoras de la localidad dispuestas a lactar, aplicándose un programa de creación y funcionamiento del lactario domiciliario. Posteriormente se verificó la continuidad del programa en su domicilio durante dos meses y se compararon los resultados con las madres trabajadoras que no recibieron este entrenamiento. Resultados: Las madres trabajadoras que crearon el lactario domiciliario presentaron un porcentaje de abandono menor (28)% que aquellas que no lo tenían (60%) (p<0,001). Entre las madres que abandonaron la lactancia materna, el trabajo fue la principal causal en el grupo sin lactario (57%) y la hipogalactia en el grupo con lactario (22%). El trabajo como causal de abandono se redujo considerablemente al instaurarse el lactario domiciliario (p <0,001) Discusión: La creación de lactarios domiciliarios disminuye significativamente el abandono de la lactancia materna en madres trabajadoras. El fomento de este tipo de estrategias es una alternativa para fortalecer la lactancia materna exclusiva por mayor tiempo.

Introduction: Exclusive breastfeeding is ideal for the newborn baby because of its nutritional, immunological and emotional contribution, key elements for adequate growth and development. It is recognized that return to work is the most influential factor for the abandonment of breastfeeding. It is necessary to assess the impact of the home lactary in the reduction of the abandonment of exclusive breastfeeding. Methods: An applicative study of experimental, prospective, cross case and analytical type was conducted in the Maternity Service of the San Cristobal Central Hospital. Working mothers willing to breast-feed were selected and a program for the creation and development of a home lactary was implemented; continuity of the home program was verified during the two subsequent months. Results were compared with mothers who did not receive this training. Results: Working mothers who created the home lactary presented a lower percentage of breast feeding abandonment (28) % in comparison with those who did not (60%). (p<0, 001). Among mothers who gave up breastfeeding, returning to work was the main cause in the group with no lactary (57%) and milk insufficiency was the main cause in the group with a lactary (22%). Returning to work as cause for abandonment dropped significantly with the creation of a lactary (p< 0.001) Discussion: The creation of a home lactary decreases significantly the rate of abandonment of breastfeeding in working mothers. The promotion of this type of strategies is an alternative to strengthen the prolongation of exclusive breastfeeding.

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Investigou-se entre mães trabalhadoras aspectos relacionados aos direitos, conjugalidade, apoio social, prevalência de depressão pós-parto e a sua relação com as variáveis pesquisadas. Participaram 30 primigestas com bebês entre dois e seis meses. Os instrumentos utilizados foram: Escala de Depressão Pós-Parto de Edimburgo e um protocolo de entrevista. Os dados apontaram, que durante a fase gestacional, as participantes desconheciam as políticas de proteção maternoinfantil, mas reconheciam a presença do apoio social, principalmente do companheiro e da genitora. Houve prevalência de sintomatologia depressiva entre 13,3% das mães. Confirmaram-se associações entre DPP e saúde emocional na gestação (p=0,008); sentir falta de ajuda (p=0,026) e pretensão de retorno ao trabalho (p=0,001). Verificou-se satisfação com o apoio social disponível e preservação da satisfação conjugal. Os resultados apontam para a importância de atendimento psicológico à mulher na gestação e puerpério, assim como esclarecê-las de seus direitos.(AU)

We investigated, among working mothers, aspects related to rights, relationship between couples, social support, prevalence of postpartum depression and its relationship with the variables studied. A total of 30 first-time-mothers with babies from two to six months took part. The instruments used were: Postpartum Depression Scale of Edinburgh and an interview protocol. Data showed that during the gestational phase, participants were unaware of maternal and child protection policies, but acknowledged the presence of social support, especially the fellow and mother. Depressive symptoms prevailed among 13.3% of mothers. Associations between DPP and emotional health during pregnancy (p = 0.008); lack of assistance (p = 0.026) and intention of returning to work (p = 0.001) were confirmed. Satisfaction with social support available and preservation of marital satisfaction were observed. The results show the importance of psychological care for women during pregnancy and postpartum, as well as information about their rights.(AU)

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Knowledge about mothers' perceptions of food classification and values about complementary feeding is necessary for designing educational and food supply interventions targeted to young children. To determine classification, attributes, and consumption/preparation routines of key complementary foods, 44 mothers of children < 2 y of age in 14 manufacturing businesses were studied. Using 31 key foods, we conducted free-listings, pile-sort, and food attributes exercises. Hierarchical clustering showed that mothers identified nine classes of key foods, including milk derivatives, complements, junk food, infant products, chicken parts, and other meats. From multidimensional scaling, mothers used three primary classification systems: food groups, food introduction stages, and food processing. Secondary classification systems were healthy-junk, heavy-light, hot-cold, good-bad fat, and main dish-complement. Child health and nutrition, particularly vitamin content, were salient attributes. Fruits and vegetables were preferred for initiating complementary feeding on the second month of age. Consumption of guava, mango, and legumes, however, was associated with digestive problems (empacho). Red meats were viewed as cold-type, heavy, and hard, not suitable for young children, but right for toddlers. Chicken liver was considered nutritious but dirty and bitter. Egg and fish were viewed as a vitamin source but potentially allergenic. Mothers valued vitamin content, flavor, and convenience of processed foods, but some were suspicious about expiration date, chemical and excessive sugar content and overall safety of these foods. Mothers' perceptions and values may differ from those of nutritionists and program designers, and should be addressed when promoting opportune introduction of complementary foods in social programs.

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Since the 1960's, work has been a goal for Brazilian middle class women. In contrast, mothers of lower-income groups have always needed to work. This qualitative study investigated the meaning of motherhood, child care and work among 28 working mothers of different social classes. In order to do so, interviews and focus groups were conducted. Results show that women attribute exclusively to mothers the child care function. In addition, being a working woman has different meanings for each of those two social classes. There are voices in the self that represent the positions of mother and worker. They act on the meaning systems and they can lead to contradictory attitudes in a similar context.

El trabajo femenino se convirtió en un objetivo para las mujeres brasileñas de clase media, especialmente a partir de 1960, pero las madres de clase baja siempre necesitaron trabajar. Por medio de entrevistas y grupos focales, el presente estudio cualitativo investigó el significado de la maternidad, de los cuidados infantiles y del trabajo, con 28 madres trabajadoras de diferentes clases sociales. En general, las mujeres atribuyeron la función de cuidar a los hijos únicamente a las madres. Adicionalmente, ser mujer trabajadora tuvo un significado diferente en cada clase social. Existen voces del "self" que representan las posiciones de madre y de trabajadora, que actúan en los sistemas de significación y pueden llevar a actitudes contradictorias para una misma situación.

O trabalho feminino se converteu em um objetivo para as mulheres brasileiras de classe média, especialmente a partir de 1960; no entanto, as mães de classe baixa sempre precisaram trabalhar. Por meio de entrevistas e grupos focais, o presente estudo qualitativo pesquisou o significado da maternidade, dos cuidados infantis e do trabalho, com 28 mães trabalhadoras de diferentes classes sociais. Em geral, as mulheres atribuíram a função de cuidar dos filhos unicamente às mães. Adicionalmente, ser mulher trabalhadora teve um significado diferente em cada classe social. Existem vozes do "self" que representam as posições de mãe e de trabalhadora que atuam nos sistemas de significação e podem levar a atitudes contraditórias para uma mesma situação.