JEA Q. 2 2019

Breastfeeding & Work in Latin America: Is There a Role for EAPs?

By Andrea Lardani

Breastfeeding is beneficial to the health of both women and infants. According to the World Health Organization (WHO), women who breastfeed have longer intervals between births and, as a result, a lower risk of maternal morbidity and mortality, as well as lower rates of breast cancer before menopause and potentially lower risks of ovarian cancer, osteoporosis, and coronary heart disease. Because of this data, WHO recommends exclusively breastfeeding for at least the first 6 months of life.
In 2012, the World Health Assembly (WHA) endorsed breastfeeding as one of the key global nutrition targets to foster a healthy, equitable, and sustainable future for individuals and nations. Nevertheless, little progress has been made. Women may avoid or stop breastfeeding for a number of medical, cultural, and psychological reasons.
But most commonly, women stop breastfeeding because of lack of support in the workplace. This article describes a public health problem and describes an important and appropriate role for EAPs to play in supporting breastfeeding at work. 
Breastfeeding is significantly reduced in the workplace when breastfeeding breaks unavailable, if infant care near the workplace is inaccessible or unaffordable, and if no facilities are available for expressing or storing milk.
Legislation guaranteeing breastfeeding breaks could improve a working mother’s ability to continue to breastfeed. However, it might not be enough if organizations do not incorporate a culture of breastfeeding with policies and procedures that support it. 

What Happens in Latin America? 
In Latin America and the Caribbean, it is estimated that 66% of infant deaths due to diarrheal disease and acute respiratory infection occurring between birth and 3 months of age could be prevented by exclusive breastfeeding, nevertheless, according to the Pan American Health Organization (PHO) only 38% of infants receive breastmilk exclusively during their first 6 months of age. There are variations between countries. Breastfeeding rates in the Dominican Republic remain at 8%. 
In Mexico they dropped from 20% to 14.5%. Still other countries have shown progress, such as Colombia where it increased from 15 to 43%. In Brazil they increased between 1986 and 2006, going from 2.9% to 37.1%.
There is strong evidence that returning to work is one of the principal barriers to breastfeeding. In Guatemala, for example, although there is a culture that supports breastfeeding, mothers who work outside the home are significantly less likely than mothers who do not work to exclusively breastfeed (9% vs. 25%, respectively).
In Mexico, a study of mothers from Veracruz, concluded that one of the principal factors of early abandonment of breastfeeding is working outside the home. 
In Argentina, a 2018 study of 1,883 employed women who returned to work with a child below the age of 1 revealed that: 

* Eight out of 10 women said that combining breastfeeding and work is difficult. 
* Women working in factories find it more difficult as well as those who work only for economic reasons. 
* There is a significant belief that employers do not support breastfeeding. One of the employees said: “My boss did not give me time to go to the breastfeeding facilities nor to breastfeed my baby. He claimed to be supportive, but with the daily pressures he imposed on me it was not possible.”
* There is lack of role models: Only 2 out 10 women believed that female leaders in their workplace breastfed and/or expressed milk at work.
* One third said that career opportunities were negatively impacted by breastfeeding or expressing milk at work. One woman stated: “My boss did not support me, and scheduled meetings during the time I was in the breastfeeding room.” 
* Two out of 10 women felt, that in some way, their jobs were at risk if they continued breastfeeding or expressing milk at work. One of the study participants said: “Although it is said that expressing milk at work is permitted, it is badly seen if you leave your position more than once a day.”
* Seventy-three percent felt uncomfortable asking where to breastfeed or express milk – 63% felt uncomfortable talking about the issue with their direct boss, while 43% felt uncomfortable talking with colleagues. One of the participants said: “There was no understanding either from management or Human Resources.” “Companies are not prepared to have a woman use a breast pump, not even their colleagues.”
* Eighty-eight percent said here is lack of information from their employer, and they do not know who to ask when returning to work. “Nobody explained to me how to combine breastfeeding and work so that my milk production would not be interrupted.”
* Six out of 10 could not organize regular and long enough breaks to express milk at work. 
* Four out of 10 considered that the assigned room was not clean.
* Five out of 10 stated the room was not private.
* Eight out of 10 said comfortable seating was not provided...

How could EAPs Intervene to Reduce Workplace-related Barriers to Breastfeeding?
The Employee Assistance Professional Association states: “Employee Assistance Programs (EAPs) serve organizations and their employees in multiple ways, ranging from consultation at the strategic level about issues with organization-wide implications to individual assistance to employees and family members experiencing personal difficulties”.
Taking this definition into account, how could EAPs serve organizations to support both returning to work and breastfeeding? We suggest the following three levels of interventions:

1) At the organizational level
** Collaboration in designing breastfeeding policies and procedures adapted specifically to the company client and its culture. 
** Collaboration in creating procedures and guidelines for managers and breastfeeding employees 
** Providing specialized recommendations regarding adequate maternity and paternity leaves as well as how to support mothers who return to work. 
** Specialized professional recommendations about how to incorporate breastfeeding, pumping and storing facilities and promoting their proper use. 
** Suggesting and designing communications to promote a breastfeeding culture. 

2) At the management level
** Providing face-to-face and/or online trainings for managers, supervisors and Human Resources offering information about the benefits of breastfeeding, how to support mothers who are returning to work after maternity leave, and how breastfeeding/pumping facilities can be used by employees with management support.
** Offering telephonic management consultations about issues related to employees who are breastfeeding. 
** Encouraging managers who breastfeed in the workplace to become mentors, sharing their personal experience with employees who will be in the same situation. These mentors may also become intermediaries between the employee and the company, helping them obtain information and present their needs related to breastfeeding. 

3) At the employee and family level
** Provide telephonic and face-to-face breastfeeding counseling by specialized professionals both during and after maternity leave. 
** Offer a 24/7/365 support line for breastfeeding employees during and after maternity leave. 
** Present telephonic, face-to-face counseling and workshops for family members on how to support the mother who returns to work and wants to continue breastfeeding and/or expressing milk.
** Offer online workshops for breastfeeding employees providing specialized information on how to manage lactation and return to work and resources such as books and targeted reading materials. 

Summary
Overall female participation in the global workforce has fallen 2% since 1990. But this is not the case for Latin America and the Caribbean where it has increased by 14%. This region had women joining the workforce at a faster pace than anywhere else in the world, adding up to 80 million more working women since the 1960s.
For this reason, as EA professionals committed to promoting well-being and health in the workplace, we should pay particular attention to specific issues impacting women such as breastfeeding. This of course benefits the work organization as a whole, and not just the women.
There is no doubt that women who work in an environment where their right to breastfeed is supported are more motivated and engaged. Absenteeism, requests for medical appointments, and medical leaves decrease, as breastfeeding benefits both the mother and the child´s health.
Work abandonment by new mothers, with the related costs of staff turnover, should also decrease. Further research should focus on how breastfeeding impacts work performance and engagement. 

Andrea Lardani is the Director at Grupo Wellness Latina. She has extensive experience in developing and managing EAPs and well-being programs for multinational companies, as well as in training and leading affiliate networks and teams in Latin America. Andrea is a psychologist with post-graduate studies and complementary training, including a solid background in clinical organizational contexts. She may be reached at andreal@grupowellnesslatina.com.

References

Employee Assistance Professionals Association. (2001). Definitions of an Employee Assistance Program (EAP) and EAP core technology. Arlington, VA: Author. Retrieved from: http://www.eapassn.org/About/About-Employee-Assistance/EAP-Definitions-and-Core-Technology

Pan American Health Organization & World Health Organization. (2013). Situación actual y tendencias de la lactancia materna en América Latina y el Caribe: Implicaciones políticas programáticas. Washington, DC: Author.

Voices Research & Consultancy. (2018). Encuesta Nacional de Lactancia y Trabajo preparado para la Liga de la Leche Argentina. Retrieved from: http://www.ligadelaleche.org.ar 

World Health Organization. (2013). Breastfeeding policy: A globally comparative analysis. Bulletin of the World Health Organization, 91, 398-406. doi:http://dx.doi.org/10.2471/BLT.12.109363

Further Reading

Betrán, A.P., de Onis, M., Lauer, J.A., & Villar, J. (2001). Ecological study of effect of breast feeding on infant mortality in Latin America.  British Medical Journal, 323(7308), 303-306.

Boccolini, C.S., Boccolini, P.D.M.M., Monteiro, F.R., Venâncio, S.I., & Giugliani, E.R.J. (2017). Breastfeeding indicators trends in Brazil for three decades. Revista de saude publica, 51,108. doi:10.11606/S1518-8787.2017051000029

Buccini, G., Pérez-Escamilla, R., Giugliani, E.R.J., Benicio, M.H., & Venancio, S.I. (December, 2018). Exclusive breastfeeding changes in Brazil attributable to pacifier use. PLoS ONE. Retrieved from: https://www.researchgate.net/publication/329787663_Exclusive_breastfeeding_changes_in_Brazil_attributable_to_pacifier_use

Chioda, L. (2016). Work and family: Latin American and Caribbean women in search of a new balance. Washington, DC: International Bank for Reconstruction and Development / The World Bank. ISBN (electronic): 978-0-8213-9962-0.  Retrieved from: https://openknowledge.worldbank.org/bitstream/handle/10986/23748/9780821384855.pdf?sequence=3&i

Dearden, K., Altaye, M., Maza, I. D., Oliva, M. D., Stone-Jimenez, M., Morrow, A. L., & Burkhalte, B. R. (2002). Determinants of optimal breast-feeding in peri-urban Guatemala City, Guatemala. Revista Panamericana de Salud Pública, 12(3), 185-192. doi:10.1590/S1020-49892002000900007

Flores-Díaz, A,L,, Bustos-Valdés, M.V., González-Solís, R., & Mendoza-Sánchez, H.F. (2006). Maternal breastfeeding-related factors in a group of Mexican children. Archivos en Medicina Familiar, 8(1), 33-39

Gonzalez, E.  (2017). Weekly chart: Women in the workforce in Latin America and the Caribbean. Retrieved from: https://www.as-coa.org/articles/weekly-chart-women-workforce-latin-america-and-caribbean