Implementation of Breastfeeding Policies at Workplace in Mexico: Analysis of Context Using a Realist Approach

Sonia Hernández-Cordero,Matthias Sachse-Aguilera,Mónica Ancira-Moreno,Natalia Rovelo-Velázquez,Kathrin Litwan,Fernanda Cobo-Armijo,Mireya Vilar-Compte,Vania Lara-Mejía

doi:10.3390/ijerph19042315

Abstract

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.

Highlights

Fourteen workplaces from four cities, settled in four different Mexican states participated in the study, including Chihuahua (n = 6), Mérida (n = 4), Guadalajara (n = 3) and Monterrey (n = 1)
“ . . . Once they come off maternity leave, we are aware of when they return because at that time we contact them and talk to them about breastfeeding, we give them a talk on breastfeeding, benefits for them, for the baby, etc., and we provide follow-up, we explain to them what the breastfeeding period is and after that period, if they need more days, how they should request it, because they can request more days than the period that is normally given in the workplace
As for the contextual factors, we identified, on the one hand, workplaces where neither working women, male collaborators nor the managers and supervisors were aware of the Mexican maternity protection legislation, or the actions implemented in their workplace to support women to continue BF

Summary

Introduction

Improving nutrition globally is a matter of social justice and public health. The promotion, protection, and support of breastfeeding (BF) is a proven cost-effective intervention and one of the most promising alternatives to combat malnutrition throughout life, as well as to prevent it from continuing through the intergenerational cycle of families, communities, and nations [1]. Knowledge of all the health and economic benefits that BF brings to children, mothers, families, and society at large, calls for the protection, promotion, and support of BF to be seen as fundamental to equity and social justice [2].

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Conclusion