Supporting Exclusive Breastfeeding Among Factory Workers and Their Unemployed Neighbors: Peer Counseling in Bangladesh

Abstract

Background

Thirty-six percent of females are employed in Bangladesh, many in the readymade garments manufacturing industry. Inadequate access to health information, care, and long working hours makes exclusive breastfeeding particularly challenging for these employed mothers.

Research aim

To describe the influence of a breastfeeding education and support program on breastfeeding patterns of mothers working in garment and other factories in Bangladesh.

Methods

A descriptive two-group prospective, mixed methods, longitudinal prospective study was conducted from May 2015 to March 2017. Peer counselors were trained to provide home-based counseling from 6 months of pregnancy until infants completed 6 months for pregnant and lactating factory workers and neighboring unemployed women. The total evaluation sample (N = 304) consisted of participants still employed (n = 190) and unemployed (n = 144). Peer counselors recorded socioeconomic information, weights, and infant feeding patterns. Descriptive statistical analyses examined the peer counselors’ influence on breastfeeding practices.

Results

Initiation of breastfeeding within 1 hr was high in both groups, 173 (91%) among the employed, and 101 (89%) among the unemployed participants. Exclusive breastfeeding at 6 months was reported by 107 out of 125 (86%) of the employed participants versus 72 out of 76 (95%) of those unemployed.

Conclusions

Community-based peer counselors can help to inform, encourage, and support both factory workers and unemployed women with optimal breastfeeding patterns. Factories who have female workers should consider employing outreach peer counselors as part of their community social responsibility, and as a way to contribute to the sustainability of these programs.

Keywords

breastfeeding breastfeeding support exclusive breastfeeding human milk expression peer counselors

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References

Akhter

Rutherford

Chu

(2017). What makes pregnant workers sick: Why, when, where and how? An exploratory study in the readymade garment industry in Bangladesh. Reproductive Health, 14(142), 1–9.

Bangladesh Bureau of Statistics, Statistics and Informatics Division, Ministry of Planning. (2017). Bangladesh statistics, Dhaka. Retrieved from http://bbs.portal.gov.bd/sites/default/files/files/bbs.portal.gov.bd/page/b2db8758_8497_412c_a9ec_6bb299f8b3ab/S_Y_B2017.pdf

Berger

(2015). Now I see it, now I don’t: Researcher’s position and reflexivity in qualitative research. Qualitative Research, 15(2), 219–234. doi:10.1177/1468794112468475

Billah

M. M.

Manik

M. R. I.

(2017). Readymade garments (RMG) contribution in women empowerment: A study on Bangladesh perspective. European Scientific Journal, 13(29), 1857–7881.

Continuous Update Project. (2018). Analysing research on cancer prevention and survival: Diet, nutrition, physical activity and breast cancer, 2017. World Cancer Research Fund and American Institute for Cancer Research. Retrieved from http://www.aicr.org/continuous-update-project/reports/breast-cancer-report-2017.pdf

Dinour

L. M.

Szaro

J. M.

(2017). Employer-based programs to support breastfeeding among working participants: A systematic review. Breastfeeding Medicine, 12, 131–141. doi:10.1089/bfm.2016.0182

Dodgson

(2019). Reflexivity in qualitative research. Journal of Human Lactation, 35(2), 220–222. doi:10.1177/0890334419830990

The Global Economy.com. (2018). Bangladesh: Female labor force participation. Retrieved from https://www.theglobaleconomy.com/Bangladesh/Female_labor_force_participation/

Haider

Saha

K. K.

(2016). Breastfeeding and infant growth outcomes in the context of intense peer counseling support in two communities in Bangladesh. International Breastfeeding Journal, 11, 18. doi:10.1186/s13006-016-0077-6.

10.

Haider

M. R.

Rahman

M. M.

Moinuddin

Rahman

A. E

Ahmed

Khan

M. M.

(2018). Ever-increasing caesarean section and its economic burden in Bangladesh. PLoS ONE,13(12): e0208623. doi:10.1371/journal.pone.0208623

11.

Haviland

James

Killman

Trbovich

(2015). Supporting breastfeeding in the workplace. Retrieved from https://www.asphn.org/resource_files/657/657_resource_file2.pdf

12.

Hobbs

A. J.

Mannion

C. A.

McDonald

S. W.

Brockway

Tough

S. C.

(2016). The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy and Childbirth, 16, 90. doi:10.1186/s12884-016-0876-1

13.

Horta

B. L.

Loret

D. M. C.

Victora

C. G.

(2015). Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and Type 2 diabetes: A systematic review and meta-analysis. Acta Paediatrica, 104(467), 30–37. doi:10.1111/apa.13133

14.

International Labor Organization. (2017). Better work supports maternity rights and breastfeeding in Bangladesh RMG sector. Retrieved from http://www.ilo.org/dhaka/Informationresources/Publicinformation/Pressreleases/WCMS_573867/lang–en/index.htm

15.

Islam

M. J.

Baird

Mazerrole

Braidy

(2017). Exploring the influence of psychosocial factors on exclusive breastfeeding in Bangladesh. Archives of Women’s Mental Health, 20, 173–188. Retrieved from https://link-springer-com-443.web.bisu.edu.cn/article/10.1007/s00737-016-0692-7

16.

Johnson

A. M.

Kirk

Muzik

(2015). Overcoming workplace barriers: A focus group study exploring African American mothers’ needs for workplace breastfeeding support. Journal of Human Lactation, 31(3) 425–433.

17.

Karim

Billah

S. M.

Chowdhury

M. A. K.

Zaka

Manu

Arifeen

S. E.

Khan

A. N. S.

(2018). Initiation of breastfeeding within one hour of birth and its determinants among normal vaginal deliveries at primary and secondary health facilities in Bangladesh: A case observation study. PLosONE, 13(8):e0202508. doi:10.1371/journalpone.0202508

18.

Kavle

A .J.

LaCroix

Dau

Engmann

(2017). Addressing barriers to exclusive breast-feeding in low and middle-income countries: A systematic review and programmatic implications. Public Health Nutrition, 20(17), 3120–3134.

19.

Khatun

(2018, March 8). Women’s participation in the job market. The Daily Star. Retrieved from https://cpd.org.bd/womens-participation-job-market-dr-fahmida-khatun/

20.

Khatun

Comins

C. A.

Shah

Islam

M. M.

Choudhury

Ahmed

(2018). Uncovering the barriers to exclusive breastfeeding for participants living in Dhaka’s slums: A mixed method study. International Breastfeeding Journal, 13, 44.

21.

Kozhimannil

K. B.

Jou

Gjerdingen

D. K.

McGovern

P. M.

(2016). Access to workplace accommodations to support breastfeeding after passage of the Affordable Care Act. Women’s Health Issues 26(1), 6–13.

22.

Lewis

(2015). Qualitative enquiry and research design: Choosing among five approaches. Health Promotion Practice, 16(4), 473–475. doi:10.1177/1524839115580941.

23.

Mahmud

M. S.

Rajath

Mahmud

Jahan

M. N.

(2018). Health issues of female garment workers: evidence from Bangladesh. Journal of Population and Social Studies 26(3), 181–194.

24.

Menon

Nguyen

P. H.

Saha

K. K.

Khaled

Kennedy

Tran

L. M.

Sanghvi

(2016). Impacts on breastfeeding practices of at-scale strategies that combine intensive interpersonal counseling, mass media, and community mobilization: Results of cluster-randomized program evaluations in Bangladesh and Viet Nam. PLoS Med, 13, e1002159.

25.

Ministry of Health and Family Welfare. (2015). Training guidelines for Infant and Young Child Feeding (IYCF). Ministry of Health and Family Welfare, Dhaka.

26.

Ministry of Health and Family Welfare, Bangladesh, Partnership for Maternal, Newborn & Child Health, World Health Organization, World Bank, & Alliance for Health Policy and Systems Research. (2015). Success factor for women’s and children’s health, Dhaka. Retrieved from https://www.who.int/pmnch/knowledge/publications/successfactors/en/index2.html

27.

Moazzem

K. G.

Arfanuzzaman

(2018, August 20). RMG workers: Minimum livelihood needs. The Financial Express. Retrieved from http://www.thefinancialexpress.com.bd/views/rmg-workers-minimum-livelihood-needs-1534781373

28.

National Institute of Population Research and Training, Mitra and Associates, and ICF International. (2016). Bangladesh Demographic and Health Survey 2014. Dhaka, Bangladesh and Rockville, Maryland, USA: NIPORT, Mitra and Associates, and ICF International. Retrieved from https://dhsprogram.com/pubs/pdf/FR311/FR311.pdf

29.

Negin

Coffman

Vizintin

Raynes-Greenow

(2016). The influence of grandparticipants on breastfeeding rates: A systematic review. BMC Pregnancy and Childbirth, 16(91). doi:10.1186/s12884-016-0880-5

30.

Nkrumah

(2016). Maternal work and exclusive breastfeeding practice: A community based cross-sectional study in Efutu Municipal, Ghana. International Breastfeeding Journal, 12(10). doi:10.1186/s13006-017-0100-6

31.

Okonya

J. N.

Nabimba

Richard

Ombeva

A. E.

(2017). Perceptions of mother’s own milk expression practices among working participants. African Journal of Midwifery and Women’s Health, 11(4), 169. doi:10.12968/ajmw.2017.11.4.169

32.

Palla

Kitsantas

(2017). Mode of delivery and breastfeeding practices. International Journal of Pregnancy & Childbirth, 2(6),167–172.

33.

Parashmanti

B. A.

Hadi

Gunawan

I. M.

(2016). Timely initiation of breastfeeding is associated with the practice of exclusive breastfeeding in Indonesia. Asia Pacific Journal of Clinical Nutrition, 25 (Supplement 1), S52–56.

34.

Paul

G. K.

Sarker

D. C.

Naznin

(2016). Present situation of women empowerment in Bangladesh. International Journal of Mathematics and Statistics Intervention 4(8), 31–38.

35.

Pelto

Lee

Akter

Porqueddu

Thuy-Co Hoang

Anwar

Akhter

(2015). Summary report: Infant and young child feeding and home fortification in rural Bangladesh—perspectives from a focused ethnographic study. Global Alliance for Improved Nutrition (GAIN), International Centre for Diarrhoeal Disease research, Bangladesh (icddr,b), & Valid International.

36.

Phukan

Ranjan

Dwivedi

L. K.

(2018). Impact of timing of breastfeeding initiation on neonatal mortality in India. International Breastfeeding Journal, 13(27). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029033/pdf/13006_2018_Article_162.pdf

37.

Rahman

J. B. A.

(2015). Brief guidelines for methods and statistics in medical research. Singapore: Springer.

38.

Rahman

M. H.

Siddiqui

S. A.

(2015). Female RMG worker: Economic contribution in Bangladesh. International Journal of Scientific and Research Publications, 5(9), 1–8.

39.

Rai

(2017). Expressed mother’s own milk: A less used option by working participants of India. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 6(7): 2867–2873.

40.

Ratnasari

Paramashanti

B. A.

Hadi

Yugistyowati

Astiti

Nurhayati

(2017). Family support and exclusive breastfeeding among Yogyakarta participants in employment. Asia Pacific Journal of Clinical Nutrition, 26(Suppl), S31–35.

41.

Samad

Haque

M. M.

Sultana

(2017). Pattern of delivery and early initiation of breastfeeding: An urban slum based cross cut study. Journal of Nutrition Health Food Engineering, 7(4), 332‒335. doi:10.15406/jnhfe.2017.07.00244

42.

Sarker

B. I.

Rahman

Hossain

Reichenbach

Mitra

D. K.

(2016). Reasons for preference of home delivery with traditional birth attendants (TBAs) in Rural Bangladesh: A qualitative exploration. PLoS ONE, 11(1), e0146161. doi:10.1371/journal.pone.0146161

43.

Shakya

Kunieda

M. K.

Koyama

Rai

S. S.

Miyaguchi

Dhakal

Sandy

Sunguya

B. F.

Jimba

(2017). Effectiveness of community-based peer support for mothers to improve their breastfeeding practices: A systematic review and meta-analysis. PLoS ONE, 12(5): e0177434. doi:10.1371/journal.pone.0177434

44.

Sharma

(2014). Sample size calculations for research studies in ophthalmology. Current Indian Eye Research 1(2), 78–80

45.

Sharmin

Chowdhury

M. A. K.

Khatun

Ahmed

(2016). Barriers to exclusive breastfeeding among urban participants. Journal of Enam Medical College, 6(2). doi:10.3329/jemc.v6i2.27763

46.

Smith

E. R.

Lisa

Chowdhury

Sinha

Fawzi

Edmond

K. L

., on behalf of the Neovita Study Group. (2017). Delayed breastfeeding initiation and infant survival: A systematic review and meta-analysis. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0180722

47.

Sung

H. K.

S. H.

Choi

Ji-Y

Hwang

Ahn

Kim

B-G.

Kim

Y-M.

Kim

J.W.

Kang

Kim

T.J.

Yoo

K-Y.

Kang

Park

(2016). The effect of breastfeeding duration and parity on the risk of epithelial ovarian cancer: A systematic review and meta-analysis. Journal of Preventive Medicine & Public Health, 49:349–366. doi:10.3961/jpmph.16.066

48.

Taddele

Abebe

Fentahun.

. (2014). Exclusive breastfeeding and maternal employment in Ethiopia: A comparative cross-sectional study. International Journal of Nutrition and Food Sciences, 3(6), 497–503.

49.

Takahashi

Ganchimeg

Ota

Vogel.

J. P.

Souza

J. P.

Laopaiboon

Castro

C. P.

Jayaratne

Ortiz-Panozo

Pisake Lumbiganon

Moriet

(2017). Prevalence of early initiation of breastfeeding and determinants of delayed initiation of breastfeeding: Secondary analysis of the WHO Global Survey. Scientific Reports, 7, 448688. doi:10.1038/srep44868.

50.

Tariku

Alemu

Gizaw

Muchie

K. F.

Derso

Abebe

S. M.

Yitayal

Fekadu

Ayele

T. A.

Alemayehu

G. A.

Tsegaye

A. T.

Shimeka

Biks

G. A.

(2017). Participants’ education and ANC visit improved exclusive breastfeeding in Dabat Health and Demographic Surveillance Site, northwest Ethiopia. PLoS ONE, 12(6): e0179056. doi:10.1371/journal.pone.0179056.

51.

UNESCO (2017). Education and literacy. Retrieved from uis.unesco.org/country/BD

52.

UNICEF & ILO (2015). Healthy beginnings for a better society. Breastfeeding in the workplace is possible: A toolkit. Inter-national Labour Organization, ILO Country Office for the Philippines. Makati City: ILO. Retrieved from https://www.ilo.org/wcmsp5/groups/public/—asia/—ro-bangkok/—ilo-manila/documents/publication/wcms_493121.pdf

53.

United Nations Children’s Fund Bangladesh (2016, November). Workshop report on maternity protection and promotion at the workplace. National Programme for the formal sector. An initiative of the Institute of Public Health and Nutrition, Ministry of Health and Family Welfare, ILO, WABA and UNICEF. (draft).

54.

United Nations Children’s Fund (2018). Let’s make it work!: Breastfeeding in the workplace—Using communication for development to make breastfeeding possible among working participants. New York: UNICEF. https://www.healthynewbornnetwork.org/resource/lets-make-it-work-breastfeeding-in-the-workplace-using-communication-for-development-to-make-breastfeeding-possible-among-working-mothers/

55.

U.S. Department of Health & Human Services (2018). What employers need to know. Why should businesses support breastfeeding moms at work? Washington, DC: Office on Women’s Health. Retrieved from https://www.womenshealth.gov/supporting-nursing-moms-work/what-law-says-about-breastfeeding-and-work/what-employers-need-to-know

56.

USAID (2017). MCSP Nutrition Brief. Addressing barriers to exclusive breastfeeding: Evidence and program considerations for low- and middle-income countries. Retrieved from http://www.mcsprogram.org

57.

Victora

Bahl

Barros

Franca

G. V. A.

Horton

Krasevec

Murch

Sankar

M. J.

Walker

Rollins

N. C.

(2016). Breastfeeding in the 21st century: Epidemiology, mechanisms and lifelong effect. The Lancet 387(10017), 475–490.

58.

World Bank Group (2017). Bangladesh continues to reduce poverty but at slower pace. Retrieved from https://www.worldbank.org/en/news/feature/2017/10/24/bangladesh-continues-to-reduce-poverty-but-at-slower-pace

59.

World Health Organization and Unicef (1993). Breastfeeding counselling: A training course. Retrieved from http://www.who.int/maternal_child_adolescent/documents/who_cdr_93_3/en/

60.

World Health Organization (2008). Indicators for assessing infant and young child feeding practices. Part 2: Measurements. Geneva, Switzerland. Retrieved from http://www.who.int/nutrition/publications/infantfeeding/9789241599290/en/

61.

World Health Organization (2016). New guidelines on antenatal care for a positive pregnancy experience. Retrieved from http://www.who.int/reproductivehealth/news/antenatal-care/en/

62.

World Health Organization (2018a). Exclusive breastfeeding for optimal growth and development of infants. Retrieved from http://www.who.int/elena/titles/exclusive_breastfeeding/en/

63.

World Health Organization. (2018b). Health Topics: Breastfeeding. Retrieved from http://www.who.int/topics/breastfeeding/en

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