Browsing by Author "Daniels, Lynette Carmen"

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    Support for exclusive breastfeeding in the workplace : development of a practice model for designated workplaces in the Breede Valley sub-district, Western Cape Province, South Africa
    (Stellenbosch : Stellenbosch University, 2020-03) Daniels, Lynette Carmen; Mbhenyane, Xikombiso; du Plessis, Lisanne Monica; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
    ENGLISH SUMMARY: Globally, mothers have identified employment as one of the leading barriers to exclusive and continued breastfeeding. This study aimed to develop a practice model to support exclusive breastfeeding for working mothers. The study was conducted with participants from designated workplaces in the Breede Valley sub-district, Western Cape, South Africa. An explanatory, sequential, mixed methods research design was employed, comprising a quantitative, descriptive, cross-sectional study (phase one), followed by a qualitative, multiple case study (phase two), and the development and validation of a practice model (phase three). In phase one an online survey was conducted to assess current breastfeeding support practices. In phase two, data was collected at nine purposively selected workplaces, using focus group discussions (FGDs) and in-depth interviews. FGDs were also conducted with employed breastfeeding mothers from designated workplaces who exclusively or predominantly breastfed their children for any period up to six months. In phase three, the practice model was developed, drawing on the analysis of data from phases one and two and making use of programme theory approaches and logic models. The draft model was sent to 11 experts. After input from the two modified Delphi rounds had been received and amendments to the model had been made, it was presented for feedback to the nine participating workplaces during four FGDs and one in-depth interview. A response rate of 36.8% (14/38) was achieved for the online survey. The results revealed that arrangements surrounding breastfeeding in designated workplaces were limited and inadequate, with few support practices. Onsite or nearby crèche facilities (n=2, 14.3%), breastfeeding counsellors (n=1, 7.1%), promotion of the benefits of breastfeeding to employees (n=2, 14.3%) and provision of private space for expressing (n=2, 14.3%) were not common practice. Workplace breastfeeding policies (n=4, 28.6%) were not readily available, and were mostly found in the public sector. Forty-three percent of workplaces (n=6, 42.9%) did not allocate time for expressing breastmilk at work. Phase two revealed that employees viewed their workplaces as unsupportive in terms of providing breastfeeding time and designated spaces for expressing breastmilk. Returning to work was viewed as challenging, mainly because of the unsupportive attitudes of co–workers and supervisors and a lack of space and time to express breastmilk. The challenges reported by managers related to the absence of appropriate space and infrastructure, as well as the resources to finance what was needed. The majority of managers claimed that they valued a supportive workplace environment and a culture of caring focusing on staff wellness. They regarded themselves as flexible (including in respect of allowing employees personal time). This was in conflict with employees’ views. Employees felt that their employers were unsupportive, strict and un-accommodating with regard to the provision of time for expressing, mentioning that they mostly used their lunch and tea breaks. Participants were positive about the final practice model and viewed it as informative and well designed. They were positive that the model would be feasible and commended the tiered approach to implementation. The model was perceived as an ideal tool to use, if accompanied by some training. The study showed that legislated breastfeeding breaks are poorly implemented or mostly absent, mainly due to widespread ignorance of breastfeeding rights in the formal sector. There is an urgent need for advocacy around creating an enabling workplace environment for breastfeeding. The practice model has the potential to be locally applied and will be of particular use to workplaces that want to initiate and/or strengthen breastfeeding support.