Abstract

Background: Not all mothers are able to breastfeed or pump milk. Return-towork has been identified as a major and significant barrier to continue breastfeeding, due to improper lactation facilities at the workplace. This study aimed to explore the implementation of breastfeeding friendly policy at factories, from the perspective of Occupational Health and Safety (OHS) coordinators.

Methods: A qualitative survey conducted in eight factories, using an adjusted openended questionnaire to OHS coordinators in manufacture and garment factories in an industrial area in East Jakarta. The results are presented in a descriptive display matrix and listing, without any statistical analysis. Key and most relevant suggestions and inputs from respondents are presented in the form of quotations to support the pattern found from the survey.

Results: Eight respondents in-charge for the occupational health and safety division participated in this study; all worked in the current factory for more than five years, and four of them were medical doctors. All respondents reported that their factory formally implemented the governmental regulations. However, three respondents reported that their factory provided a multifunctional lactation room, shared with the company’s clinic. All of the factories granted a flexible breast-pumping break time during working hours, but only one respondent reported an annual lactation education class provided in the factory. None of the respondents reported a nutrition intervention and dedicated lactation counselor provided in their factories.

Conclusion: This qualitative study among OHS coordinators in factories revealed that there is still lack of breastfeeding friendly policy implementation in factories.

Keywords: Breastfeeding; Lactation; Occupational Health and Safety; Women Workers

Introduction

Exclusive breastfeeding is the best nutrition source of infants. The World Health Organization (WHO) and the Ministry of Health of Indonesia recommend exclusive breastfeeding for the first 6 months of life which should be continued with complimentary food for two years [1-3]. WHO defines exclusive breastfeeding as an infant that only receives breastmilk without any other foods, including any liquids, water, formula milk, fruit juice, tea, honey, or any solid food except vitamins and medicines [1,4]. Exclusive breastfeeding is not only beneficial for the infants, but also the mothers. Breastfeeding helps to reduce post-partum body weight and the risk for non-communicable diseases, [5-8] cardiovascular disease [9]. Breastfeeding improves the quality of life of the mother and her mental health [10]. Breastfeeding prolongs the amenorrhea period [11]. However, not all mothers are able to breastfeed, especially the working mother population. Return to work after maternal leave has been identified as a major and significant barrier for women workers to continue breastfeeding. Studies show that the breastfeeding rate significantly decreases at the time when mothers return to work [12,13].

The main reasons are related to the distance between home and workplace, improper lactation facilities at the workplace and decreased breastmilk production during working hours [14]. The prevalence of exclusive breastfeeding among factory workers in 2015 was only 19%, significantly lower compared to the national prevalence which was 38% [15]. A study in Taiwan showed that only 10.6% of working mothers continue to breastfeed upon returning to work [14]. An Indonesia study found that 45% of working mothers discontinue breastfeeding because of return-to-work. Inadequate lactation facilities and support programs in workplace are the main reasons of discontinuation [12]. In Indonesia the breastfeeding and lactation competency is not part of the basic and required competency of corporate physicians, company doctors and Occupational Health and Safety (OHS) coordinators, who in fact are responsible for the health promotion program at the workplace [16,17]. According to Cochrane Reviews in 2012, no randomized controlled trial has been performed to evaluate the effectiveness of a workplace lactation intervention program [18]. The present article is a report of a survey of OHS coordinators in eight factories in the East Jakarta region. This qualitative study aimed to identify the OHS coordinator’s perspective about the implementation of national breastfeeding friendly policy and breastfeeding promotion support in their respected factory.

Methods

This is a qualitative survey conducted in eight factories in Jakarta, using an adjusted open-ended questionnaire [19]. The study population were eight OHS coordinators in manufacture and garment factories in an industrial area in East Jakarta. The respondents were asked to fill a questionnaire that consisted of four basic questions, i.e, ‘what is the current situation of breastfeeding policy implementation in your workplace’; ‘what are the current services, program, facilities, and support toward lactating employer in your respected company’; ‘what are the specific internal company’s regulation/policy on breastfeeding promotion’; and ‘what are your practical assessment/evaluation toward breastfeeding promotion support in your respected company’. Since the number of subjects or respondents is too low to perform any statistical test, the result of this survey aimed to list and report the patterns, similarity, and factual findings within the relevant answers of the respondents. Data obtained from the questionnaires were presented in a descriptive display matrix, listing all the information from the respondents coded as subject 1 to subject 8. The key and most relevant suggestions and inputs from respondents are presented in the form of quotations to support the pattern found from the survey. This study was approved by The Ethics Committee of Faculty of Medicine of the authors’ institute, letter number XXX/XXX.F1/XXXX/2016.

Results

Appendix Tables 1-3 shows that all respondents have worked in the current factory for more than five years and 50% of them were medical doctors. All respondents were in the possession of an occupational and workplace health and safety certification required for an OHS coordinator. However, only one respondent obtained a certificate for a specific training in lactation/breastfeeding promotion. The initial response of all respondents mentioned the implementation of the breastfeeding policy formally implemented the government regulation in their factory. However, when it comes to the availability of a dedicated lactation room, three respondents reported that their factory provided a multifunction lactation room, shared with the company’s clinic. Descriptively, three respondents responded affirmatively that providing breastfeeding facility in workplace was mainly determined by the financial assessment and profitable consideration of the factory.

“Breastfeeding facilities provided in the factory based on the standard guideline of the Labor Ministry and Health Ministry regulation, which is also giving the space and opportunity to the company/factory to make the support available at the basic standard, to be fit with the scale and affordability of the company. It is also understandable that providing breastfeeding policy is not considered as profit investment hence fulfilling the breastfeeding support at the minimum required facility is acceptable”

On the maternal leave policy, all respondents reported that their factories implemented the minimum required policy regulated by Labor Ministry of the Republic of Indonesia which is three months leave and the employee should have started to take leave 1.5 month prior to delivery due date. Upon return to work from maternal leave, all factories granted a flexible breast-pumping break time to a lactating employee during working hours with certain conditions such as pumping time break should be authorized by a supervisor. The employee is advised to maximize the lunch break time for pumping. Nevertheless, one respondent admitted that additional pumping break times apart of the lunch break are needed. During the pumping break, the workload should be covered by other colleagues.

“Company guaranteed and committed to provide flexible working hours to the lactating employee and fully understand that this group of employees will require more time to breastfeeding or breast pumping, a part of the lunch time break. This situation is unique and hence the employee will not be sanctioned for leaving the job more often”