Review article|Articles in Press

Evidence based workplace interventions to promote breastfeeding practices among Pakistani working mothers

Published:February 06, 2012DOI:


      Background and aim

      Breastfeeding is an essential source of nutrition for young babies; however, it is challenging for employed mothers to continue breastfeeding with employment, especially if workplace support is minimal or missing. In Pakistan, from 1983 to 2008, the prevalence of breastfeeding at 6 months has decreased from 96% to 31%. In this region, workplace barriers have been reported as one of the reasons that result in early cessation of breastfeeding among working mothers. This paper aims at reviewing global literature to explore workplace interventions that can promote the breastfeeding practices among working mothers in Pakistan.


      A literature search of peer reviewed databases, including CINHAL (1980–2009), MEDLINE (1980–2009), Pub Med (1980–2009), Springer Link (1980–2008), and Cochrane Database of Systematic Reviews (3rd quarter, 2008), was undertaken. Considering the pre-set inclusion and exclusion criteria, out of more than 500 literature sources, 50 were shortlisted and reviewed.


      A review of global literature revealed that in order to promote breastfeeding practices among employed mothers, the most powerful workplace interventions include: educating working mothers about management of breastfeeding with employment; enhancing employers’ awareness about benefits of breastfeeding accommodation at workplace; arranging physical facilities for lactating mothers (including privacy, childcare facilities, breast pumps, and breast milk storage facilities); providing job-flexibility to working mothers; and initiating mother friendly policies at workplace that support breastfeeding.


      In Pakistani workplace settings, where little attention is paid to sustain breastfeeding practices among working mothers, there is a need to initiate lactation support programmes. These programmes can be made effective by implementing composite interventions at the level of breastfeeding working mothers, employers, and workplace.


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        • McDade T.W.
        Parent-offspring conflict and the cultural ecology of breast-feeding.
        Human Nature. 2001; 12: 9-25
      1. AAP workgroup on Breastfeeding. Breastfeeding and the use of human milk.
        Pediatrics. 1997; 100: 1035-1039
        • Anderson J.W.
        • Johnstone B.M.
        • Remley D.T.
        Breast-feeding and cognitive development: a meta-analysis.
        The American Journal of Clinical Nutrition. 1999; 70: 525-535
        • Cohen R.
        • Mrtek M.B.
        • Mrtek R.G.
        Comparison of maternal absenteeism and infant illness rates among breast-feeding and formula-feeding women in two corporations.
        American Journal of Health Promotion. 1995; 10: 148-153
        • Raisler J.
        • Alexander C.
        • Campo P.O.
        Breastfeeding and infant illness: a dose–response relationship?.
        American Journal of Public Health. 1999; 89: 25-30
        • World Health Organization
        Infant and young child nutrition: technical consultation on infant and young child feeding.
        WHO, 2000 ([fifty-third world health assembly])
        • World Health Organization and UNICEF
        Baby-friendly hospital initiative: Revised, updated and expanded for integrated care.
        WHO Document Production Services, Geneva, Switzerland2009
        • Barber-Madden R.
        • Petschek M.A.
        • Pakter J.
        Breastfeeding and the working mother: barriers and intervention strategies.
        Journal of Public Health Policy. 1987; 8: 531-541
        • Rojjanasrirat W.
        Working women's breastfeeding experiences.
        MCN: The American Journal of Maternal/Child Nursing. 2004; 29: 222-229
        • Chatterji P.
        • Frick K.D.
        Does returning to work after childbirth affect breastfeeding practices.
        Review of Economic of the Household. 2005; 3: 315-335
        • Johnston M.L.
        • Esposito N.
        Barriers and facilitators for breastfeeding among working women in the United States.
        Journal of Obstetric, Gynecologic and Neonatal Nursing. 2007; 36: 9-20
        • Abdulwadud O.A.
        • Snow M.E.
        Interventions in the workplace to support breastfeeding for women in employment (review).
        Cochrane Database Systematic Reviews. 2008; (Available at) ([accessed October 13, 2008])
        • Hirani S.A.
        • Premji S.S.
        Mother's employment and breastfeeding continuation: global and Pakistani perspectives from the literature.
        Neonatal, Pediatric and Child Health Nursing. 2009; 12: 18-24
        • Yimyam S.
        • Morrow M.
        • Srisuphan W.
        Role conflict and rapid socio-economic change: breastfeeding among employed women in Thailand.
        Social Science & Medicine. 1999; 49: 957-965
        • Cardena R.A.
        • Major D.A.
        Combining employment and breastfeeding: utilizing a work-family conflict framework to understand obstacles and solutions.
        Journal of Business and Psychology. 2005; 20: 31-51
        • Hill P.
        • Humenick S.S.
        • Argubright T.M.
        • Aldag J.C.
        Effects of parity and weaning practices on breastfeeding duration.
        Public Health Nursing. 1997; 14: 227-234
        • Lewallen L.P.
        • Dick M.J.
        • Flower J.
        • Powell W.
        • Zickefoose K.T.
        • Wall Y.G.
        • et al.
        Breastfeeding support and early cessation.
        Journal of Obstetric, Gynecologic and Neonatal Nursing. 2006; 35: 166-172
        • Arlotti J.P.
        • Cottrell B.H.
        • Lee S.H.
        • Curtin J.J.
        Breastfeeding among low-income women with and without peer support.
        Journal of Community Health Nursing. 1998; 15: 163-178
        • Bhutta Z.A.
        • Hyder A.A.
        • Ali N.
        Defining a new challenge for health systems: perinatal health in Pakistan.
        in: Bhutta Z.A. Perinatal and newborn care in South Asia: priorities and action. Oxford University Press, Karachi, Pakistan2007: 1-30
        • World Health Organization
        World health statistics.
        2008 (Available at:) ([accessed May 20, 2008])
        • Morisky D.E.
        • Kar S.B.
        • Chaudry A.A.
        • Chen K.R.
        • Shaheen M.
        • Chickering K.
        Breastfeeding practices in Pakistan.
        Pakistan Journal of Nutrition. 2002; 1: 137-142
      2. Society for the Protection of the Rights of Child. Breastfeeding 2008. Available at: [accessed May 15, 2008].

        • Government of Pakistan
        Labour force survey 2005–2006: twenty fifth issue.
        Statistics Division, Federal Bureau of Statistics; Government of Pakistan, 2006
        • Zafar S.N.
        • Bustamante-Gavino I.
        Breastfeeding and working full time: experiences of nurse mothers in Karachi, Pakistan.
        International Journal of Caring Science. 2008; 1: 132-139
      3. Hirani SA. Experiences of lactating working mothers: a qualitative study at a private tertiary care setting of Karachi, Pakistan. Unpublished Advanced Diploma Thesis. Aga Khan University Human Development Programme. Karachi, Pakistan; 2009.

        • Labour Unity
        Labour laws Pakistan.
        2006 (Available at:) ([accessed February 2, 2011])
        • Dodgson J.E.
        • Chee Y.
        • Yap T.S.
        Workplace breastfeeding support for hospital employees.
        Journal of Advanced Nursing. 2004; 47: 91-100
        • Katcher A.L.
        • Lanese M.G.
        Breast-feeding by employed mothers: a reasonable accommodation in the workplace.
        Pediatrics. 1985; 75: 644-647
        • Bonoan R.
        Breastfeeding support at the workplace.
        Washington Business Group on Health. 2000; 2: 1-8
        • Seijts G.H.
        Coworker perceptions of outcome fairness of breastfeeding accommodation in the workplace.
        Employee Responsibilities and Rights Journal. 2004; 16: 149-166
        • Wright A.L.
        • Schanler R.J.
        The resurgence of breastfeeding at the end of the second millennium.
        Journal of Nutrition. 2001; 131: 421-425
        • Kong S.K.
        • Lee D.T.
        Factors influencing decision to breastfeed.
        Journal of Advanced Nursing. 2004; 46: 369-379
        • Ortiz J.
        • McGilligan K.
        • Kelly P.
        Duration of breast milk expression among working mothers enrolled in an employer-sponsored lactation program.
        Pediatric Nursing. 2004; 30: 111-119
        • Fein S.B.
        • Mandal B.
        • Roe B.R.
        Success of strategies for combining employment and breastfeeding.
        Pediatrics. 2008; 122: 556-562
        • Kosmala-Anderson J.
        • Wallance L.M.
        Breastfeeding works: the role of employers in supporting women who wish to breastfeed and wok in four organizations in England.
        Journal of Public Health. 2006; 28: 183-191
        • Chen Y.C.
        • Wu Y.C.
        • Chie W.C.
        Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: a cross-sectional survey.
        BMC Public Health. 2006; 6 (Available at:) ([accessed November 5, 2008])
        • McIntyre E.
        • Pisaniello D.
        • Gun R.
        • Sanders C.
        • Frith D.
        Balancing breastfeeding and paid employment: a project targeting employers, women and workplaces.
        Health Promotion International. 2002; 17: 215-221
        • Thompson P.E.
        • Bell P.
        Breast-feeding in the workplace: how to succeed.
        Issues in Comprehensive Pediatric Nursing. 1997; 20: 1-9
        • Haider R.
        • Begum S.
        Working women, maternity entitlements, and breastfeeding: a report from Bangladesh.
        Journal of Human Lactation. 1995; 11: 273-277
        • Seijts G.H.
        • Yip J.
        The effect of knowledge accumulation on support for workplace accommodation.
        Journal of Business and Psychology. 2008; 22: 311-321
        • Gatrell C.J.
        Secrets and lies: breastfeeding and professional paid work.
        Social Science & Medicine. 2007; 65: 393-404
        • Burgess J.
        Support must continue beyond hospital [Letter to the editor].
        British Medical Journal. 1998; 317: 1385
        • Seijts G.H.
        Milking the organization? The effect of breastfeeding accommodation on perceived fairness and organizational attractiveness.
        Journal of Business Ethics. 2002; 40: 1-13
        • Kimbro R.T.
        On-the-Job Moms: work and breastfeeding initiation and duration for a sample of low-income women.
        Maternal and Child Health Journal. 2006; 10: 19-26
        • Noble S.
        Team. Maternal employment and the initiation of breastfeeding.
        Acta Paediatrica. 2001; 90: 423-426
        • Libbus M.K.
        • Bullock L.F.
        Breastfeeding and employment: an assessment of employer attitude.
        Journal of Human Lactation. 2002; 18: 247-251
        • Galtry J.
        The impact on breastfeeding of labour market policy and practices in Ireland Sweden, and the USA.
        Social Science & Medicine. 2003; 57: 167-177
        • Kurinij N.
        • Shiono P.H.
        • Exrine S.F.
        • Rhoads G.G.
        Does maternal employment affect breast-feeding?.
        American Journal of Public Health. 1989; 79: 1247-1250
        • Baker M.
        • Milligan K.
        Maternal employment, breastfeeding, and health: evidence from maternity leave.
        Journal of Health Economics. 2008; 27: 871-887
        • Foo L.L
        • Quek S.J.N.G.
        • Lim S.A.
        • Deurenberg-Yap M.T.M.
        Breastfeeding prevalence and practices among Singaporean Chinese, Malay, and Indian mothers.
        Health Promotion International. 2005; 20: 229-237
        • Olang B.
        • Farivar K.
        • Heidarzadeh A.
        • Strandvik B.
        • Yngve A.
        Breastfeeding in Iran: prevalence, duration and current recommendations.
        International Breastfeeding Journal. 2009; 4
        • Sarwar T.
        Infant feeding practices of Pakistani mothers in England and Pakistan.
        Journal of Human Nutrition & Dietetics. 2002; 15: 419-428
        • Wooten L.P.
        What makes women-friendly public accounting firms tick? The diffusion of human resource management knowledge through institutional and resource pressures.
        Sex Roles. 2001; 45: 277-297