Abstract

This article aims to map promotion, protection, and support strategies aimed at working women who breastfeed and their potential impact on achieving the Sustainable Development Goals (SDGs), in particular SDGs 5 (gender equality and women’s empowerment) and 8 (decent work and economic growth). This study is a scoping review based on the Joanna Briggs Institute (JBI) framework, whose searches were performed in PubMed, Web of Science, Scopus, Social Science Research Network, and Open Knowledge Repository databases. This study’s search obtained 576 publications, of which 33 were included in the study. The narrative synthesis was organized into three axes: 1) promotion; 2) protection, and 3) support for breastfeeding in the work context. Actions aimed at women who breastfeed at work have the potential to directly achieve SDGs 5 and 8, and indirectly achieve SDGs 1 and 10. Increased breastfeeding rates also help to achieve another four SDGs (2, 3, 4, 12). Actions aimed at working women who breastfeed can contribute directly and indirectly to the achievement of eight of the 17 SDGs, and should therefore be encouraged and reinforced.

Key words:
Breastfeeding; Sustainable Development Goals; Women working; Gender equality; Health promotion

Introduction

Good practices of breastfeeding have a positive impact on survival, nutrition and food safety, and the development of small children, as well as bring benefits to the mothers’ health¹1 Victora CG, Barros AJD, França GVA, Bahl R, Rollins NC, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N. Amamentação no século 21: epidemiologia, mecanismos e efeitos ao longo da vida. Epidemiol Serv Saude 2016; 16:1-24.^,22 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.. However, globally, only 14% of babies under six months of age receive exclusive breastfeeding. Thus, efforts need to be made to achieve the goal of 70% established by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) for 2030³3 World Health Organization (WHO), United Nations Children's Fund (UNICEF). Global breastfeeding scorecard, 2019: increasing commitment to breastfeeding through funding and improved policies and programmes. Geneva: WHO; 2019.. A barrier to the improvement in breastfeeding rates is the increase in the participation of women in the work market, since conciliating maternity and work is a major challenge⁴4 Dagher RK, McGovern PM, Schold JD, Randall XJ. Determinants of breastfeeding initiation and cessation among employed mothers: a prospective cohort study. BMC Pregnancy Childbirth 2016; 16(1):194.^,55 Monteiro FR, Buccini GDS, Venâncio SI, Costa THM. Influence of maternity leave on exclusive breastfeeding. J Pediatr (Rio J) 2017; 93(5):475-481.. When the work environment is not favorable, women do not feel encouraged to continue breastfeeding, one of the main underlying reasons for early weaning⁴4 Dagher RK, McGovern PM, Schold JD, Randall XJ. Determinants of breastfeeding initiation and cessation among employed mothers: a prospective cohort study. BMC Pregnancy Childbirth 2016; 16(1):194.

5 Monteiro FR, Buccini GDS, Venâncio SI, Costa THM. Influence of maternity leave on exclusive breastfeeding. J Pediatr (Rio J) 2017; 93(5):475-481.^-66 Souza CB, Venancio SI, Silva RPGVC. Breastfeeding support rooms and their contribution to sustainable development goals: a qualitative study. Front Public Health 2021; 9:732061.. Moreover, the efforts and concerns of women about how to continue breastfeeding, associated with difficulties to safely express and store milk in the workplace, can cause stress and a lack of concentration within professional activities, thus impacting one’s efficiency and productivity at work⁶6 Souza CB, Venancio SI, Silva RPGVC. Breastfeeding support rooms and their contribution to sustainable development goals: a qualitative study. Front Public Health 2021; 9:732061..

In this sense, it is important for companies to provide support to women to exercise their right to breastfeed²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,77 Bai YK, Dinour LM, Pope GA. Determinants of the intention to pump breast milk on a university campus. J Midwifery Womens Health 2016; 61(5):563-570.. Support for breastfeeding in the workplace is encouraged by the International Labor Organization (ILO), which proposes the implementation of conventions no. 183 and no. 191 to guarantee maternity and labor protection, including paid maternity leave for a minimum of 14 weeks and breaks during working hours to breastfeed, or a reduction in working hours to breastfeed⁸8 Addati L, Cassirer N, Gilchrist K. Maternity and paternity at work: law and practice across the world International Labour Office. Geneva: ILO; 2014..

The promotion, protection, and support strategies for breastfeeding in the workplace, such as campaigns, maternity leave (preferably of six months), and the providing of support rooms for breastfeeding, contribute to the increase in breastfeeding indexes, as well as diminish absenteeism and improve performance, commitment, and maintenance of the work force²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.. These strategies are essential for women to dedicate themselves to their professional activities more easily, alleviating physical and emotional discomfort while maintaining their productivity⁶6 Souza CB, Venancio SI, Silva RPGVC. Breastfeeding support rooms and their contribution to sustainable development goals: a qualitative study. Front Public Health 2021; 9:732061.. Therefore, it can be inferred that the promotion, protection, and support strategies for breastfeeding in the work context have a great potential to foster the achievement of the Sustainable Development Goals (SDGs) related to health and well-being, gender equality, women’s empowerment, and decent and productive work⁶6 Souza CB, Venancio SI, Silva RPGVC. Breastfeeding support rooms and their contribution to sustainable development goals: a qualitative study. Front Public Health 2021; 9:732061..

One form of decent work is defined by the ILO as the promotion of and compliance with fundamental rights at work, with decent pay and employment, in the social and legal protection, as well as in the adequate dialogue between business leaders and their workers. Productivity is related to the efficiency and efficacy of the work. In this sense, full and productive employment benefits the workers, business leaders, and their countries. Gender equality seeks to provide the same opportunities to all, and their existence in the work environment have an impact upon the physical and mental disposition of the women⁹9 United Nations (UN). Resolution adopted by the General Assembly on 25 September 2015 [Internet]. 2015. [cited 2022 ago 27]. Available from: https://www.eea.europa.eu/policy-documents/resolution-adopted-by-the-general
https://www.eea.europa.eu/policy-documen... ^,1010 ODS Brasil. Indicadores Brasileiros para os Objetivos de Desenvolvimento Sustentável [Internet]. 2022. [acessado 2022 ago 27]. Disponível em: https://odsbrasil.gov.br/home/videos
https://odsbrasil.gov.br/home/videos... .

Considering the relevance of breastfeeding for maternal-child health and nutrition and of the recent debate over the influences of the work context in the protection and support for breastfeeding, this study aims to map the strategies geared toward working women who breastfeed and discuss their potential to help to achieve the SDGs, especially SDGs 5 (gender equality and women’s empowerment) and 8 (decent work and economic growth).

Methods

This study performed a scoping review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) approach¹¹11 Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, McInerney P, Godfrey CM, Khalil H. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth 2020; 18(10):2119-2126..

Identification of research questions and eligibility criteria

The acronym “PCC” (population, concept, and context) was used to guide the core research question: “What are the promotion, protection, and support strategies for maternal breastfeeding in the work context, and how can these help to achieve the SDGs, especially SDGs 5 (gender equality and women’s empowerment) and 8 (decent work and economic growth)?” The inclusion criteria were: Population: women who breastfeed, mothers of children under two years of age; Concept: promotion, protection, and support strategies for maternal breastfeeding; Context: strategies related to the work context and to the working woman who breastfeeds.

Data source

This study included primary studies and reviews in the English, Portuguese, and Spanish languages, with no restrictions concerning the approach (quantitative, qualitative) or the year of publication, as well as technical notes. Excluded from this study were publications in the form of books, book chapters, and program implementation guides.

Search strategies

The search was conducted in April 2021 in the Medline, Web of Science, and Scopus databases and in two repositories: Scopus, Social Science Research Network (SSRN) and Open Knowledge Repository. The following descriptors, in the English language, were used: Breastfeeding; Intervention; Equity, Gender; Workplaces; Legislation; Woman, Working; Living Cost; Economic Conditions; Household Consumption; Public Expenditures; Health Expenditures; Public Policies; Income; Employment; Women; Empowerment; Economy. In the search conducted in the “Social Science Research Network” repository, only the descriptors “Breastfeeding AND Intervention” were used, since the search models with the combination of other descriptors did not produce results. The complete model of the searches combining the descriptors is presented in Supplementary Material A (available at: https://doi.org/10.48331/scielodata.1WZKVJ).

Study selection and data extraction

The Rayyan QCRI 0.0.1 software was used to screen the records by titles and abstracts. Three authors screened the records in an interactive manner, and the conflicts were resolved by consensus. After reading the full texts for eligibility assessment, the data were registered in an extraction spreadsheet, including the following information: author, year of publication, country, type of study, type of strategy (promotion/protection/support), relation of the strategies and/or outcomes with SDGs 5 and 8.

Data analysis

A narrative synthesis was produced¹²12 Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, Britten N, Roen K, Duffy S. Guidance on the conduct of narrative synthesis in systematic reviews. Plymouth: Peninsular Medical School; 2006., and the information was grouped to describe the characteristics of the studies. The classification of the economies of the countries of this study, according to the World Bank 2020-2021¹³13 The World Bank Group. World Bank Country and Lending Groups [Internet]. 2021. [cited 2022 ago 8]. Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups
https://datahelpdesk.worldbank.org/knowl... , was identified. The strategies identified in the studies were classified in three axes, based on the reference from the Brazilian Ministry of Health¹⁴14 Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Bases para a discussão da Política Nacional de Promoção, Proteção e Apoio ao Aleitamento Materno. Brasília: MS; 2017.:

Promotion: publicity actions in companies and informative materials to promote breastfeeding in the workplace; includes the disclosure of declarations and guidelines that encourage the implementation of support programs for breastfeeding in companies.

Protection: public policies at the federal, state, and municipal government levels, especially with laws to protect breastfeeding; includes paid maternity leave and the right to take breaks during working hours to breastfeed or to express breastmilk.

Support: support actions to institutionalize breastfeeding within the company environment; local policies from the companies themselves; providing of daycare centers; and support provided by supervisors, workmates, and family members.

Analysis of the potential of the strategies to achieve the SDGs

This study identified the impacts of the strategies on the working conditions of the mothers and on the practices of breastfeeding and/or on the mothers’ health and well-being. Using the SDGs from the United Nations Agenda 2030 as the core reference, our study analyzed the potential to achieve the SDGs through the strategies of promotion, protection, and support for breastfeeding in the work context⁹9 United Nations (UN). Resolution adopted by the General Assembly on 25 September 2015 [Internet]. 2015. [cited 2022 ago 27]. Available from: https://www.eea.europa.eu/policy-documents/resolution-adopted-by-the-general
https://www.eea.europa.eu/policy-documen... . To support the analysis, evidence concerning the influences of good working conditions and practices of breastfeeding upon well-being, health, and prosperity of the mothers and children was investigated in the literature.

Results

Figure 1 presents the results of the searches, inclusions, and exclusions with justifications. The list of references of the excluded reports and reasons for exclusion are presented in Supplementary Material B (available at: https://doi.org/10.48331/scielodata.1WZKVJ).

Characteristics of the study

The 33 selected reports were published between 1990 and 2021, with the majority (28) published between 2011 and 2021. Most of the studies were conducted in high-income countries (n = 23; 69.7%), mainly in the USA (n = 15; 45.5%)¹⁵15 Abdulloeva S, Eyler AA. Policies on worksite lactation support within states and organizations. J Womens Health (Larchmt) 2013; 22(9):769-774.

16 Barber-Madden R. Design and implementation of a citywide breastfeeding promotion program: the New York City approach. Fam Community Health 1990; 12(4):71-78.

17 Bradford VA, Walkinshaw LP, Steinman L, Otten JJ, Fisher K, Ellings A, O'Leary J, Johnson DB. Creating environments to support breastfeeding: the challenges and facilitators of policy development in hospitals, clinics, early care and education, and worksites. Matern Child Health J 2017; 21(12):2188-2198.

18 Dozier AM, McKee KS. State breastfeeding worksite statutes...breastfeeding rates...and... Breastfeed Med 2011; 6(5):319-324.

19 Grummer-Strawn LM, Shealy KR. Progress in protecting, promoting, and supporting breastfeeding: 1984-2009. Breastfeed Med 2009; 4(Suppl. 1):S31-S39.

20 Hilliard E, Brunt A. Impact of an infant friendly business designation. Health Promot Prac 2020; 21(4):642-653.

21 Jacknowitz A. The role of workplace characteristics in breastfeeding practices. Women Health 2008; 47(2):87-111.

22 Kozhimannil KB, Jou J, Gjerdingen DK, McGovern PM. Access to workplace accommodations to support breastfeeding after passage of the affordable care. Act Womens Health Issues 2016; 26(1):6-13.

23 Mirkovic KR, Perrine CG, Scanlon KS. Paid maternity leave and breastfeeding outcomes. Birth 2016; 43(3):233-239.

24 Murtagh L, Moulton AD. Working mothers, breastfeeding, and the law. Am J Public Health 2011; 101(2):217-23.

25 Ogbuanu C, Glover S, Probst J, Liu J, Hussey J. The effect of maternity leave length and time of return to work on breastfeeding. Pediatrics 2011; 127(6):e1414-e1427.

26 Ruhm CJ. Policies to assist parents with young children. Future Child 2011; 21(2):37-68.

27 Taylor YJ, Scott VC, Danielle Connor C. Perceptions, Experiences, and Outcomes of Lactation Support in the Workplace: A Systematic Literature Review. J Hum Lact 2020; 36(4):657-672.^-2828 Alb CH, Theall K, Jacobs MB, Bales A. Awareness of United States' Law for Nursing Mothers among Employers in New Orleans, Louisiana. Womens Health Issues 2017; 27(1):14-20., and six multicenter studies (18.2%) involved studies from more than 140 countries²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,2929 Heymann J, Raub A, Earle A. Creating and using new data sources to analyze the relationship between social policy and global health: the case of maternal leave. Public Health Rep 2011; 126(Suppl. 3):127-134.

30 Heymann J, Earle A, McNeill K. The impact of labor policies on the health of young children in the context of economic globalization. Annu Rev Public Health 2013; 34:355-372.

31 Nandi A, Jahagirdar D, Dimitris MC, Labrecque JA, Strumpf EC, Kaufman JS, Vincent I, Atabay E, Harper S, Earle A, Heymann SJ. The impact of parental and medical leave policies on socioeconomic and health outcomes in OECD countries: a systematic review of the empirical literature. Milbank Q 2018; 96(3):434-471.

32 Stumbitz B, Lewis S, Rouse J. Maternity management in SMEs: a transdisciplinary review and research agenda. Int J Management Rev 2018; 20(2):500-522.^-3333 Marinelli KA, Moren K, Taylor JS, Ademy of Breastfeeding Medicine. Breastfeeding support for mothers in workplace employment or educational settings: summary statement. Breastfeed Med 2013; 8(1):137-142.. Two studies were carried out in upper middle-income countries (6.1%)^{34, 35} and another two in lower middle-income countries (6.1%)³⁶36 Febrianingtyas Y, Februhartanty J, Hadihardjono DN. Workplace support and exclusive breastfeeding practice: a qualitative study in Jakarta, Indonesia. Mal J Nutr 2019; 25(1):129-142^,3737 Soomro JA, Shaikh ZN, Saheer TB, Bijarani SA. Employers' perspective of workplace breastfeeding support in Karachi, Pakistan: a cross-sectional study. Int Breastfeed J 2016; 11(1):24..

The study designs were mainly observational and analytical (n=16; 47.5%)¹⁵15 Abdulloeva S, Eyler AA. Policies on worksite lactation support within states and organizations. J Womens Health (Larchmt) 2013; 22(9):769-774.^,1818 Dozier AM, McKee KS. State breastfeeding worksite statutes...breastfeeding rates...and... Breastfeed Med 2011; 6(5):319-324.^,2020 Hilliard E, Brunt A. Impact of an infant friendly business designation. Health Promot Prac 2020; 21(4):642-653.

21 Jacknowitz A. The role of workplace characteristics in breastfeeding practices. Women Health 2008; 47(2):87-111.

22 Kozhimannil KB, Jou J, Gjerdingen DK, McGovern PM. Access to workplace accommodations to support breastfeeding after passage of the affordable care. Act Womens Health Issues 2016; 26(1):6-13.^-2323 Mirkovic KR, Perrine CG, Scanlon KS. Paid maternity leave and breastfeeding outcomes. Birth 2016; 43(3):233-239.^,2525 Ogbuanu C, Glover S, Probst J, Liu J, Hussey J. The effect of maternity leave length and time of return to work on breastfeeding. Pediatrics 2011; 127(6):e1414-e1427.^,2828 Alb CH, Theall K, Jacobs MB, Bales A. Awareness of United States' Law for Nursing Mothers among Employers in New Orleans, Louisiana. Womens Health Issues 2017; 27(1):14-20.^,2929 Heymann J, Raub A, Earle A. Creating and using new data sources to analyze the relationship between social policy and global health: the case of maternal leave. Public Health Rep 2011; 126(Suppl. 3):127-134.^,3535 The World Bank Group (WBG). Mauritius early childhood development: SABER Country Report 2012. Washington, DC: WBG; 2012., followed by qualitative approaches (n = 6; 18.2%)¹⁷17 Bradford VA, Walkinshaw LP, Steinman L, Otten JJ, Fisher K, Ellings A, O'Leary J, Johnson DB. Creating environments to support breastfeeding: the challenges and facilitators of policy development in hospitals, clinics, early care and education, and worksites. Matern Child Health J 2017; 21(12):2188-2198.^,3434 Fernandes VMB, Santos EKA, Zampieri MFM, Gregório VRP, Hernandes MJ, Ribeiro LC. Condutas de gestores relacionadas ao apoio ao aleitamento materno nos locais de trabalho. Texto Contexto - Enferm 2018; 27(3):e2560016.^,3636 Febrianingtyas Y, Februhartanty J, Hadihardjono DN. Workplace support and exclusive breastfeeding practice: a qualitative study in Jakarta, Indonesia. Mal J Nutr 2019; 25(1):129-142^,4343 Burns E, Triandafilidis Z. Taking the path of least resistance: a qualitative analysis of return to work or study while breastfeeding. Int Breastfeed J 2019; 14:15.

44 Rowbotham S, Marks L, Tawia S, Woolley E, Rooney J, Kiggins E, Healey D, Wardle K, Campbell V, Bridges N, Hawe P. Using citizen science to engage the public in monitoring workplace breastfeeding support in Australia. Health Promot J Austr 2021; 33(1):151-161.^-4545 Chen YC, Wu YC, Chie WC. Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: a cross-sectional survey. BMC Public Health 2006; 6:160.. Other types of designs included reviews (n = 9; 27.3%)²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,1616 Barber-Madden R. Design and implementation of a citywide breastfeeding promotion program: the New York City approach. Fam Community Health 1990; 12(4):71-78.^,1919 Grummer-Strawn LM, Shealy KR. Progress in protecting, promoting, and supporting breastfeeding: 1984-2009. Breastfeed Med 2009; 4(Suppl. 1):S31-S39.^,2424 Murtagh L, Moulton AD. Working mothers, breastfeeding, and the law. Am J Public Health 2011; 101(2):217-23.^,2626 Ruhm CJ. Policies to assist parents with young children. Future Child 2011; 21(2):37-68.^,2727 Taylor YJ, Scott VC, Danielle Connor C. Perceptions, Experiences, and Outcomes of Lactation Support in the Workplace: A Systematic Literature Review. J Hum Lact 2020; 36(4):657-672.^,2929 Heymann J, Raub A, Earle A. Creating and using new data sources to analyze the relationship between social policy and global health: the case of maternal leave. Public Health Rep 2011; 126(Suppl. 3):127-134.

30 Heymann J, Earle A, McNeill K. The impact of labor policies on the health of young children in the context of economic globalization. Annu Rev Public Health 2013; 34:355-372.^-3131 Nandi A, Jahagirdar D, Dimitris MC, Labrecque JA, Strumpf EC, Kaufman JS, Vincent I, Atabay E, Harper S, Earle A, Heymann SJ. The impact of parental and medical leave policies on socioeconomic and health outcomes in OECD countries: a systematic review of the empirical literature. Milbank Q 2018; 96(3):434-471., technical notes (n = 1; 3.7%)³³33 Marinelli KA, Moren K, Taylor JS, Ademy of Breastfeeding Medicine. Breastfeeding support for mothers in workplace employment or educational settings: summary statement. Breastfeed Med 2013; 8(1):137-142., and other analytical methods (n = 1; 3.7%)⁴⁶46 Hauck K, Miraldo M, Singh S. Integrating motherhood and employment: a 22-year analysis investigating impacts of US workplace breastfeeding policy. SSM Popul Health 2020; 11:100580..

The promotion strategies for breastfeeding in the work context have been described in only a few reports (n = 2; 6.1%)¹⁶16 Barber-Madden R. Design and implementation of a citywide breastfeeding promotion program: the New York City approach. Fam Community Health 1990; 12(4):71-78.^,3333 Marinelli KA, Moren K, Taylor JS, Ademy of Breastfeeding Medicine. Breastfeeding support for mothers in workplace employment or educational settings: summary statement. Breastfeed Med 2013; 8(1):137-142., while most reports described protection strategies (n = 27; 81.8%)²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,1515 Abdulloeva S, Eyler AA. Policies on worksite lactation support within states and organizations. J Womens Health (Larchmt) 2013; 22(9):769-774.^,1717 Bradford VA, Walkinshaw LP, Steinman L, Otten JJ, Fisher K, Ellings A, O'Leary J, Johnson DB. Creating environments to support breastfeeding: the challenges and facilitators of policy development in hospitals, clinics, early care and education, and worksites. Matern Child Health J 2017; 21(12):2188-2198.

18 Dozier AM, McKee KS. State breastfeeding worksite statutes...breastfeeding rates...and... Breastfeed Med 2011; 6(5):319-324.

19 Grummer-Strawn LM, Shealy KR. Progress in protecting, promoting, and supporting breastfeeding: 1984-2009. Breastfeed Med 2009; 4(Suppl. 1):S31-S39.

20 Hilliard E, Brunt A. Impact of an infant friendly business designation. Health Promot Prac 2020; 21(4):642-653.

21 Jacknowitz A. The role of workplace characteristics in breastfeeding practices. Women Health 2008; 47(2):87-111.

22 Kozhimannil KB, Jou J, Gjerdingen DK, McGovern PM. Access to workplace accommodations to support breastfeeding after passage of the affordable care. Act Womens Health Issues 2016; 26(1):6-13.

23 Mirkovic KR, Perrine CG, Scanlon KS. Paid maternity leave and breastfeeding outcomes. Birth 2016; 43(3):233-239.

24 Murtagh L, Moulton AD. Working mothers, breastfeeding, and the law. Am J Public Health 2011; 101(2):217-23.

25 Ogbuanu C, Glover S, Probst J, Liu J, Hussey J. The effect of maternity leave length and time of return to work on breastfeeding. Pediatrics 2011; 127(6):e1414-e1427.

26 Ruhm CJ. Policies to assist parents with young children. Future Child 2011; 21(2):37-68.

27 Taylor YJ, Scott VC, Danielle Connor C. Perceptions, Experiences, and Outcomes of Lactation Support in the Workplace: A Systematic Literature Review. J Hum Lact 2020; 36(4):657-672.

28 Alb CH, Theall K, Jacobs MB, Bales A. Awareness of United States' Law for Nursing Mothers among Employers in New Orleans, Louisiana. Womens Health Issues 2017; 27(1):14-20.

29 Heymann J, Raub A, Earle A. Creating and using new data sources to analyze the relationship between social policy and global health: the case of maternal leave. Public Health Rep 2011; 126(Suppl. 3):127-134.

30 Heymann J, Earle A, McNeill K. The impact of labor policies on the health of young children in the context of economic globalization. Annu Rev Public Health 2013; 34:355-372.

31 Nandi A, Jahagirdar D, Dimitris MC, Labrecque JA, Strumpf EC, Kaufman JS, Vincent I, Atabay E, Harper S, Earle A, Heymann SJ. The impact of parental and medical leave policies on socioeconomic and health outcomes in OECD countries: a systematic review of the empirical literature. Milbank Q 2018; 96(3):434-471.

32 Stumbitz B, Lewis S, Rouse J. Maternity management in SMEs: a transdisciplinary review and research agenda. Int J Management Rev 2018; 20(2):500-522.^-3333 Marinelli KA, Moren K, Taylor JS, Ademy of Breastfeeding Medicine. Breastfeeding support for mothers in workplace employment or educational settings: summary statement. Breastfeed Med 2013; 8(1):137-142.^,3737 Soomro JA, Shaikh ZN, Saheer TB, Bijarani SA. Employers' perspective of workplace breastfeeding support in Karachi, Pakistan: a cross-sectional study. Int Breastfeed J 2016; 11(1):24.^,3939 Lee CC, Chiou ST, Chen LC, Chien LY. Breastfeeding-friendly environmental factors and continuing breastfeeding until 6 months postpartum: 2008-2011 national surveys in Taiwan. Birth 2015; 42(3):242-248.

40 Tsai SY. Employee perception of breastfeeding-friendly support and benefits of breastfeeding as a predictor of intention to use breast-pumping breaks after returning to work among employed mothers. Breastfeed Med 2014; 9(1):16-23.^-4141 Tsai SY. Influence of partner support on an employed mother's intention to breastfeed after returning to work. Breastfeed Med 2014; 9(4):222-30.^,4444 Rowbotham S, Marks L, Tawia S, Woolley E, Rooney J, Kiggins E, Healey D, Wardle K, Campbell V, Bridges N, Hawe P. Using citizen science to engage the public in monitoring workplace breastfeeding support in Australia. Health Promot J Austr 2021; 33(1):151-161.

45 Chen YC, Wu YC, Chie WC. Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: a cross-sectional survey. BMC Public Health 2006; 6:160.^-4646 Hauck K, Miraldo M, Singh S. Integrating motherhood and employment: a 22-year analysis investigating impacts of US workplace breastfeeding policy. SSM Popul Health 2020; 11:100580., followed by support strategies (n = 18; 54.5%)²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,1919 Grummer-Strawn LM, Shealy KR. Progress in protecting, promoting, and supporting breastfeeding: 1984-2009. Breastfeed Med 2009; 4(Suppl. 1):S31-S39.

20 Hilliard E, Brunt A. Impact of an infant friendly business designation. Health Promot Prac 2020; 21(4):642-653.

21 Jacknowitz A. The role of workplace characteristics in breastfeeding practices. Women Health 2008; 47(2):87-111.^-2222 Kozhimannil KB, Jou J, Gjerdingen DK, McGovern PM. Access to workplace accommodations to support breastfeeding after passage of the affordable care. Act Womens Health Issues 2016; 26(1):6-13.^,2727 Taylor YJ, Scott VC, Danielle Connor C. Perceptions, Experiences, and Outcomes of Lactation Support in the Workplace: A Systematic Literature Review. J Hum Lact 2020; 36(4):657-672.^,3232 Stumbitz B, Lewis S, Rouse J. Maternity management in SMEs: a transdisciplinary review and research agenda. Int J Management Rev 2018; 20(2):500-522.^,3434 Fernandes VMB, Santos EKA, Zampieri MFM, Gregório VRP, Hernandes MJ, Ribeiro LC. Condutas de gestores relacionadas ao apoio ao aleitamento materno nos locais de trabalho. Texto Contexto - Enferm 2018; 27(3):e2560016.^,3636 Febrianingtyas Y, Februhartanty J, Hadihardjono DN. Workplace support and exclusive breastfeeding practice: a qualitative study in Jakarta, Indonesia. Mal J Nutr 2019; 25(1):129-142

37 Soomro JA, Shaikh ZN, Saheer TB, Bijarani SA. Employers' perspective of workplace breastfeeding support in Karachi, Pakistan: a cross-sectional study. Int Breastfeed J 2016; 11(1):24.

38 Cervera-Gasch A, Mena-Tudela D, Leon-Larios F, Felip-Galvan N, Rochdi-Lahniche S, Andreu-Pejó L, González-Chordá VM. Female employees' perception of breastfeeding support in the workplace, public universities in Spain: a multicentric comparative study. Int J Environ Res Public Health 2020; 17(17):6402.

39 Lee CC, Chiou ST, Chen LC, Chien LY. Breastfeeding-friendly environmental factors and continuing breastfeeding until 6 months postpartum: 2008-2011 national surveys in Taiwan. Birth 2015; 42(3):242-248.

40 Tsai SY. Employee perception of breastfeeding-friendly support and benefits of breastfeeding as a predictor of intention to use breast-pumping breaks after returning to work among employed mothers. Breastfeed Med 2014; 9(1):16-23.

41 Tsai SY. Influence of partner support on an employed mother's intention to breastfeed after returning to work. Breastfeed Med 2014; 9(4):222-30.

42 Kosmala-Anderson J, Wallace LM. Breastfeeding works: the role of employers in supporting women who wish to breastfeed and work in four organizations in England. J Public Health (Oxf) 2006; 28(3):183-191.

43 Burns E, Triandafilidis Z. Taking the path of least resistance: a qualitative analysis of return to work or study while breastfeeding. Int Breastfeed J 2019; 14:15.

44 Rowbotham S, Marks L, Tawia S, Woolley E, Rooney J, Kiggins E, Healey D, Wardle K, Campbell V, Bridges N, Hawe P. Using citizen science to engage the public in monitoring workplace breastfeeding support in Australia. Health Promot J Austr 2021; 33(1):151-161.^-4545 Chen YC, Wu YC, Chie WC. Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: a cross-sectional survey. BMC Public Health 2006; 6:160.. Some studies treated more than one type of strategy, for example, protection and support. A synthesis of the characteristics of the strategies cited in the reports is presented in the three charts below (Charts 1, 2, and 3).

Promotion strategies for breastfeeding

In one study, the strategy cited was that of the creation of guidelines for health and nutrition promotion programs in the workplace for pregnant and breastfeeding women, attempting to overcome the shortcomings and challenges faced regarding improvements in the prevalence of breastfeeding in the 1990s in the USA. These actions were successful for the promotion of maternal breastfeeding in large urban areas¹⁶16 Barber-Madden R. Design and implementation of a citywide breastfeeding promotion program: the New York City approach. Fam Community Health 1990; 12(4):71-78.. Findings from Marinelli et al. (2013)³³33 Marinelli KA, Moren K, Taylor JS, Ademy of Breastfeeding Medicine. Breastfeeding support for mothers in workplace employment or educational settings: summary statement. Breastfeed Med 2013; 8(1):137-142. presented a Declaration based on evidence regarding medical, legal, and political challenges faced by mothers who breastfeed and are separated from their children in the workplace or educational environments. The Declaration presents recommendations for doctors and employers concerning how to: avoid the separation of the mother from the child because of work responsibilities, offer adequate maternity leave, reduce the work load of the job/study, and implement formalized breastfeeding programs and physical installations in schools and workplaces.

Protection strategies for breastfeeding

The most frequent protection strategy for breastfeeding in the work context (n = 16; 59.5%) was the right to breaks during working hours to express breastmilk or to breastfeed²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,1515 Abdulloeva S, Eyler AA. Policies on worksite lactation support within states and organizations. J Womens Health (Larchmt) 2013; 22(9):769-774.^,1818 Dozier AM, McKee KS. State breastfeeding worksite statutes...breastfeeding rates...and... Breastfeed Med 2011; 6(5):319-324.

19 Grummer-Strawn LM, Shealy KR. Progress in protecting, promoting, and supporting breastfeeding: 1984-2009. Breastfeed Med 2009; 4(Suppl. 1):S31-S39.^-2020 Hilliard E, Brunt A. Impact of an infant friendly business designation. Health Promot Prac 2020; 21(4):642-653.^,2222 Kozhimannil KB, Jou J, Gjerdingen DK, McGovern PM. Access to workplace accommodations to support breastfeeding after passage of the affordable care. Act Womens Health Issues 2016; 26(1):6-13.^,2424 Murtagh L, Moulton AD. Working mothers, breastfeeding, and the law. Am J Public Health 2011; 101(2):217-23.^,2626 Ruhm CJ. Policies to assist parents with young children. Future Child 2011; 21(2):37-68.^,2828 Alb CH, Theall K, Jacobs MB, Bales A. Awareness of United States' Law for Nursing Mothers among Employers in New Orleans, Louisiana. Womens Health Issues 2017; 27(1):14-20.

29 Heymann J, Raub A, Earle A. Creating and using new data sources to analyze the relationship between social policy and global health: the case of maternal leave. Public Health Rep 2011; 126(Suppl. 3):127-134.^-3030 Heymann J, Earle A, McNeill K. The impact of labor policies on the health of young children in the context of economic globalization. Annu Rev Public Health 2013; 34:355-372.^,3232 Stumbitz B, Lewis S, Rouse J. Maternity management in SMEs: a transdisciplinary review and research agenda. Int J Management Rev 2018; 20(2):500-522.^,3737 Soomro JA, Shaikh ZN, Saheer TB, Bijarani SA. Employers' perspective of workplace breastfeeding support in Karachi, Pakistan: a cross-sectional study. Int Breastfeed J 2016; 11(1):24.^,4040 Tsai SY. Employee perception of breastfeeding-friendly support and benefits of breastfeeding as a predictor of intention to use breast-pumping breaks after returning to work among employed mothers. Breastfeed Med 2014; 9(1):16-23.^,4141 Tsai SY. Influence of partner support on an employed mother's intention to breastfeed after returning to work. Breastfeed Med 2014; 9(4):222-30.^,4545 Chen YC, Wu YC, Chie WC. Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: a cross-sectional survey. BMC Public Health 2006; 6:160.. Some studies described the right to adjust work duties, flexible working hours at home or at work, or the reduction in the workload of the job as ways to protect the mother’s right to breastfeed²⁰20 Hilliard E, Brunt A. Impact of an infant friendly business designation. Health Promot Prac 2020; 21(4):642-653.^,2121 Jacknowitz A. The role of workplace characteristics in breastfeeding practices. Women Health 2008; 47(2):87-111.^,3737 Soomro JA, Shaikh ZN, Saheer TB, Bijarani SA. Employers' perspective of workplace breastfeeding support in Karachi, Pakistan: a cross-sectional study. Int Breastfeed J 2016; 11(1):24.^,4444 Rowbotham S, Marks L, Tawia S, Woolley E, Rooney J, Kiggins E, Healey D, Wardle K, Campbell V, Bridges N, Hawe P. Using citizen science to engage the public in monitoring workplace breastfeeding support in Australia. Health Promot J Austr 2021; 33(1):151-161.. The execution of the right to maternity leave was also a common strategy among the studies (n = 11; 33.3%)²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,2323 Mirkovic KR, Perrine CG, Scanlon KS. Paid maternity leave and breastfeeding outcomes. Birth 2016; 43(3):233-239.^,2525 Ogbuanu C, Glover S, Probst J, Liu J, Hussey J. The effect of maternity leave length and time of return to work on breastfeeding. Pediatrics 2011; 127(6):e1414-e1427.^,2626 Ruhm CJ. Policies to assist parents with young children. Future Child 2011; 21(2):37-68.^,2929 Heymann J, Raub A, Earle A. Creating and using new data sources to analyze the relationship between social policy and global health: the case of maternal leave. Public Health Rep 2011; 126(Suppl. 3):127-134.

30 Heymann J, Earle A, McNeill K. The impact of labor policies on the health of young children in the context of economic globalization. Annu Rev Public Health 2013; 34:355-372.^-3131 Nandi A, Jahagirdar D, Dimitris MC, Labrecque JA, Strumpf EC, Kaufman JS, Vincent I, Atabay E, Harper S, Earle A, Heymann SJ. The impact of parental and medical leave policies on socioeconomic and health outcomes in OECD countries: a systematic review of the empirical literature. Milbank Q 2018; 96(3):434-471.^,3535 The World Bank Group (WBG). Mauritius early childhood development: SABER Country Report 2012. Washington, DC: WBG; 2012.^,3737 Soomro JA, Shaikh ZN, Saheer TB, Bijarani SA. Employers' perspective of workplace breastfeeding support in Karachi, Pakistan: a cross-sectional study. Int Breastfeed J 2016; 11(1):24.^,3939 Lee CC, Chiou ST, Chen LC, Chien LY. Breastfeeding-friendly environmental factors and continuing breastfeeding until 6 months postpartum: 2008-2011 national surveys in Taiwan. Birth 2015; 42(3):242-248.^,4545 Chen YC, Wu YC, Chie WC. Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: a cross-sectional survey. BMC Public Health 2006; 6:160., considering that two of these cited parental leave as a strategy³²32 Stumbitz B, Lewis S, Rouse J. Maternity management in SMEs: a transdisciplinary review and research agenda. Int J Management Rev 2018; 20(2):500-522.^,3535 The World Bank Group (WBG). Mauritius early childhood development: SABER Country Report 2012. Washington, DC: WBG; 2012.. Other examples of legislative strategies were the existence of laws and federal and state statutes that forced companies to provide support to their workers who breastfeed by making breastfeeding accommodations available and by offering flexibility in working hours¹⁵15 Abdulloeva S, Eyler AA. Policies on worksite lactation support within states and organizations. J Womens Health (Larchmt) 2013; 22(9):769-774.^,1818 Dozier AM, McKee KS. State breastfeeding worksite statutes...breastfeeding rates...and... Breastfeed Med 2011; 6(5):319-324.^,1919 Grummer-Strawn LM, Shealy KR. Progress in protecting, promoting, and supporting breastfeeding: 1984-2009. Breastfeed Med 2009; 4(Suppl. 1):S31-S39.^,2424 Murtagh L, Moulton AD. Working mothers, breastfeeding, and the law. Am J Public Health 2011; 101(2):217-23.^,4646 Hauck K, Miraldo M, Singh S. Integrating motherhood and employment: a 22-year analysis investigating impacts of US workplace breastfeeding policy. SSM Popul Health 2020; 11:100580..

The studies showed that the federal and state laws and policies allow for an increase in the participation of the women and mothers in paid work, improving the household income and general equity, both also associated with improvements in health results for women and children²⁶26 Ruhm CJ. Policies to assist parents with young children. Future Child 2011; 21(2):37-68.^,2929 Heymann J, Raub A, Earle A. Creating and using new data sources to analyze the relationship between social policy and global health: the case of maternal leave. Public Health Rep 2011; 126(Suppl. 3):127-134.^,3131 Nandi A, Jahagirdar D, Dimitris MC, Labrecque JA, Strumpf EC, Kaufman JS, Vincent I, Atabay E, Harper S, Earle A, Heymann SJ. The impact of parental and medical leave policies on socioeconomic and health outcomes in OECD countries: a systematic review of the empirical literature. Milbank Q 2018; 96(3):434-471.. Some European countries use political policies in an attempt to boost gender equity and fertility²⁶26 Ruhm CJ. Policies to assist parents with young children. Future Child 2011; 21(2):37-68.^,3535 The World Bank Group (WBG). Mauritius early childhood development: SABER Country Report 2012. Washington, DC: WBG; 2012.. The right to breaks and flexible working hours are low-cost interventions that can reduce absenteeism and improve worker performance and commitment, as well as secure the workforce²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.. Maternity leave was considered to be an important mediator in diminishing “household shortcomings” in terms of income and promotors of economic growth, given that the parents tend not to quit their jobs so that they can take care of their children²⁶26 Ruhm CJ. Policies to assist parents with young children. Future Child 2011; 21(2):37-68..

Concerning the positive impacts of the laws and/or policies in the breastfeeding practices, one study demonstrated that working at home (> 8 hours/week) presented an 8% increase in the probability of breastfeeding at birth and a 16.8% increase at six months²¹21 Jacknowitz A. The role of workplace characteristics in breastfeeding practices. Women Health 2008; 47(2):87-111.. The right to breaks during working hours and breastfeeding accommodations improved the exclusive maternal breastfeeding rates at six months¹⁵15 Abdulloeva S, Eyler AA. Policies on worksite lactation support within states and organizations. J Womens Health (Larchmt) 2013; 22(9):769-774.. Demanding a location and/or break to breastfeed by means of a state statute increased the probability of breastfeeding to six months¹⁸18 Dozier AM, McKee KS. State breastfeeding worksite statutes...breastfeeding rates...and... Breastfeed Med 2011; 6(5):319-324.. The execution of the state law was highlighted as being effective in increasing maternal breastfeeding rates by 2.3 percentage points when compared to states without this type of law, although this impact can only be observed one to two years after the law has been signed⁴⁶46 Hauck K, Miraldo M, Singh S. Integrating motherhood and employment: a 22-year analysis investigating impacts of US workplace breastfeeding policy. SSM Popul Health 2020; 11:100580.. The mothers were more prone to breastfeeding for a longer period of time when they received maternity leave for at least 12 weeks²³23 Mirkovic KR, Perrine CG, Scanlon KS. Paid maternity leave and breastfeeding outcomes. Birth 2016; 43(3):233-239.^,2525 Ogbuanu C, Glover S, Probst J, Liu J, Hussey J. The effect of maternity leave length and time of return to work on breastfeeding. Pediatrics 2011; 127(6):e1414-e1427.^,3939 Lee CC, Chiou ST, Chen LC, Chien LY. Breastfeeding-friendly environmental factors and continuing breastfeeding until 6 months postpartum: 2008-2011 national surveys in Taiwan. Birth 2015; 42(3):242-248.^,4545 Chen YC, Wu YC, Chie WC. Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: a cross-sectional survey. BMC Public Health 2006; 6:160.. The prevalence of continuing to breastfeed after six months further improved when the maternity leave was paid²³23 Mirkovic KR, Perrine CG, Scanlon KS. Paid maternity leave and breastfeeding outcomes. Birth 2016; 43(3):233-239.^,3939 Lee CC, Chiou ST, Chen LC, Chien LY. Breastfeeding-friendly environmental factors and continuing breastfeeding until 6 months postpartum: 2008-2011 national surveys in Taiwan. Birth 2015; 42(3):242-248., and served to diminish the neonatal and infant mortality rates by 10%²⁹29 Heymann J, Raub A, Earle A. Creating and using new data sources to analyze the relationship between social policy and global health: the case of maternal leave. Public Health Rep 2011; 126(Suppl. 3):127-134..

Some challenges in the execution of protection strategies were described: many employers do not offer decent working conditions for breastfeeding women and the periods of paid maternity leave fall short of that recommended by the ILO²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,2323 Mirkovic KR, Perrine CG, Scanlon KS. Paid maternity leave and breastfeeding outcomes. Birth 2016; 43(3):233-239.^,3131 Nandi A, Jahagirdar D, Dimitris MC, Labrecque JA, Strumpf EC, Kaufman JS, Vincent I, Atabay E, Harper S, Earle A, Heymann SJ. The impact of parental and medical leave policies on socioeconomic and health outcomes in OECD countries: a systematic review of the empirical literature. Milbank Q 2018; 96(3):434-471.^,3737 Soomro JA, Shaikh ZN, Saheer TB, Bijarani SA. Employers' perspective of workplace breastfeeding support in Karachi, Pakistan: a cross-sectional study. Int Breastfeed J 2016; 11(1):24.^,3939 Lee CC, Chiou ST, Chen LC, Chien LY. Breastfeeding-friendly environmental factors and continuing breastfeeding until 6 months postpartum: 2008-2011 national surveys in Taiwan. Birth 2015; 42(3):242-248.. In Pakistan, only 45% of the countries offered any type of adjustment in job functions for the mothers during the breastfeeding period and only 15% offered breaks to breastfeed and no more than three months of paid maternity leave³⁷37 Soomro JA, Shaikh ZN, Saheer TB, Bijarani SA. Employers' perspective of workplace breastfeeding support in Karachi, Pakistan: a cross-sectional study. Int Breastfeed J 2016; 11(1):24.. In Taiwan, paid maternity leave lasted for only two months for most mothers, and it was not common for women to opt for longer periods, possibly due to the fear of losing their jobs and income³⁹39 Lee CC, Chiou ST, Chen LC, Chien LY. Breastfeeding-friendly environmental factors and continuing breastfeeding until 6 months postpartum: 2008-2011 national surveys in Taiwan. Birth 2015; 42(3):242-248.. Another study used data from a nationwide American study and revealed that 28% of the employed women between 2006 and 2010 did not receive any type of paid maternity leave²³23 Mirkovic KR, Perrine CG, Scanlon KS. Paid maternity leave and breastfeeding outcomes. Birth 2016; 43(3):233-239.. Systematic reviews¹1 Victora CG, Barros AJD, França GVA, Bahl R, Rollins NC, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N. Amamentação no século 21: epidemiologia, mecanismos e efeitos ao longo da vida. Epidemiol Serv Saude 2016; 16:1-24.^,22 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504. showed short spans of maternity leave in a number of countries, not reaching the minimum standard of 14 weeks established by the ILO²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504..

Support strategies for breastfeeding

Among the 18 reports that cited support strategies, 16 mentioned the availability of a room in the workplace for the mothers to breastfeed and/or express breastmilk and store it in a secure manner (described in this study as support rooms for breastfeeding)²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,1919 Grummer-Strawn LM, Shealy KR. Progress in protecting, promoting, and supporting breastfeeding: 1984-2009. Breastfeed Med 2009; 4(Suppl. 1):S31-S39.^,2020 Hilliard E, Brunt A. Impact of an infant friendly business designation. Health Promot Prac 2020; 21(4):642-653.^,2222 Kozhimannil KB, Jou J, Gjerdingen DK, McGovern PM. Access to workplace accommodations to support breastfeeding after passage of the affordable care. Act Womens Health Issues 2016; 26(1):6-13.^,2727 Taylor YJ, Scott VC, Danielle Connor C. Perceptions, Experiences, and Outcomes of Lactation Support in the Workplace: A Systematic Literature Review. J Hum Lact 2020; 36(4):657-672.^,3232 Stumbitz B, Lewis S, Rouse J. Maternity management in SMEs: a transdisciplinary review and research agenda. Int J Management Rev 2018; 20(2):500-522.^,3636 Febrianingtyas Y, Februhartanty J, Hadihardjono DN. Workplace support and exclusive breastfeeding practice: a qualitative study in Jakarta, Indonesia. Mal J Nutr 2019; 25(1):129-142

37 Soomro JA, Shaikh ZN, Saheer TB, Bijarani SA. Employers' perspective of workplace breastfeeding support in Karachi, Pakistan: a cross-sectional study. Int Breastfeed J 2016; 11(1):24.

38 Cervera-Gasch A, Mena-Tudela D, Leon-Larios F, Felip-Galvan N, Rochdi-Lahniche S, Andreu-Pejó L, González-Chordá VM. Female employees' perception of breastfeeding support in the workplace, public universities in Spain: a multicentric comparative study. Int J Environ Res Public Health 2020; 17(17):6402.

39 Lee CC, Chiou ST, Chen LC, Chien LY. Breastfeeding-friendly environmental factors and continuing breastfeeding until 6 months postpartum: 2008-2011 national surveys in Taiwan. Birth 2015; 42(3):242-248.

40 Tsai SY. Employee perception of breastfeeding-friendly support and benefits of breastfeeding as a predictor of intention to use breast-pumping breaks after returning to work among employed mothers. Breastfeed Med 2014; 9(1):16-23.

41 Tsai SY. Influence of partner support on an employed mother's intention to breastfeed after returning to work. Breastfeed Med 2014; 9(4):222-30.^-4242 Kosmala-Anderson J, Wallace LM. Breastfeeding works: the role of employers in supporting women who wish to breastfeed and work in four organizations in England. J Public Health (Oxf) 2006; 28(3):183-191.^,4343 Burns E, Triandafilidis Z. Taking the path of least resistance: a qualitative analysis of return to work or study while breastfeeding. Int Breastfeed J 2019; 14:15.

44 Rowbotham S, Marks L, Tawia S, Woolley E, Rooney J, Kiggins E, Healey D, Wardle K, Campbell V, Bridges N, Hawe P. Using citizen science to engage the public in monitoring workplace breastfeeding support in Australia. Health Promot J Austr 2021; 33(1):151-161.^-4545 Chen YC, Wu YC, Chie WC. Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: a cross-sectional survey. BMC Public Health 2006; 6:160.. Our study also considered as support strategies the existence of companies’ internal policies, which mainly encouraged the installation of support rooms for breastfeeding, breaks to express breastmilk³⁸38 Cervera-Gasch A, Mena-Tudela D, Leon-Larios F, Felip-Galvan N, Rochdi-Lahniche S, Andreu-Pejó L, González-Chordá VM. Female employees' perception of breastfeeding support in the workplace, public universities in Spain: a multicentric comparative study. Int J Environ Res Public Health 2020; 17(17):6402.^,4242 Kosmala-Anderson J, Wallace LM. Breastfeeding works: the role of employers in supporting women who wish to breastfeed and work in four organizations in England. J Public Health (Oxf) 2006; 28(3):183-191.^,4545 Chen YC, Wu YC, Chie WC. Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: a cross-sectional survey. BMC Public Health 2006; 6:160., daycare center subsidies for the workers’ children⁴³43 Burns E, Triandafilidis Z. Taking the path of least resistance: a qualitative analysis of return to work or study while breastfeeding. Int Breastfeed J 2019; 14:15., or the availability of daycare centers in workplace⁴²42 Kosmala-Anderson J, Wallace LM. Breastfeeding works: the role of employers in supporting women who wish to breastfeed and work in four organizations in England. J Public Health (Oxf) 2006; 28(3):183-191.. Four reports highlighted the importance of support from the managers and workmates to create a friendly work environment for breastfeeding and to make resources available that would allow for women to exercise their right to breastfeed³⁴34 Fernandes VMB, Santos EKA, Zampieri MFM, Gregório VRP, Hernandes MJ, Ribeiro LC. Condutas de gestores relacionadas ao apoio ao aleitamento materno nos locais de trabalho. Texto Contexto - Enferm 2018; 27(3):e2560016.^,3636 Febrianingtyas Y, Februhartanty J, Hadihardjono DN. Workplace support and exclusive breastfeeding practice: a qualitative study in Jakarta, Indonesia. Mal J Nutr 2019; 25(1):129-142^,4242 Kosmala-Anderson J, Wallace LM. Breastfeeding works: the role of employers in supporting women who wish to breastfeed and work in four organizations in England. J Public Health (Oxf) 2006; 28(3):183-191.^,4444 Rowbotham S, Marks L, Tawia S, Woolley E, Rooney J, Kiggins E, Healey D, Wardle K, Campbell V, Bridges N, Hawe P. Using citizen science to engage the public in monitoring workplace breastfeeding support in Australia. Health Promot J Austr 2021; 33(1):151-161.. Educational activities were also carried out in combination with other support actions mentioned above³⁸38 Cervera-Gasch A, Mena-Tudela D, Leon-Larios F, Felip-Galvan N, Rochdi-Lahniche S, Andreu-Pejó L, González-Chordá VM. Female employees' perception of breastfeeding support in the workplace, public universities in Spain: a multicentric comparative study. Int J Environ Res Public Health 2020; 17(17):6402.^,4141 Tsai SY. Influence of partner support on an employed mother's intention to breastfeed after returning to work. Breastfeed Med 2014; 9(4):222-30..

Support rooms also showed benefits in the work context, including an infrastructure to better promote worker performance, as well as improvements in satisfaction with their work and reduced absenteeism^2,3232 Stumbitz B, Lewis S, Rouse J. Maternity management in SMEs: a transdisciplinary review and research agenda. Int J Management Rev 2018; 20(2):500-522.. The use of support rooms in the workplace has grown over the years in Taiwan, from 51.1% in 2008 to 64.1% in 2011³⁹39 Lee CC, Chiou ST, Chen LC, Chien LY. Breastfeeding-friendly environmental factors and continuing breastfeeding until 6 months postpartum: 2008-2011 national surveys in Taiwan. Birth 2015; 42(3):242-248., and the availability of these rooms can boost the mothers’ intention to take breaks to express breastmilk and then return to work⁴⁰40 Tsai SY. Employee perception of breastfeeding-friendly support and benefits of breastfeeding as a predictor of intention to use breast-pumping breaks after returning to work among employed mothers. Breastfeed Med 2014; 9(1):16-23.^,4141 Tsai SY. Influence of partner support on an employed mother's intention to breastfeed after returning to work. Breastfeed Med 2014; 9(4):222-30.. Regarding the impacts on breastfeeding practices, the adequate supply of support rooms for breastfeeding was associated with a longer duration of breastfeeding after returning to the work³⁸38 Cervera-Gasch A, Mena-Tudela D, Leon-Larios F, Felip-Galvan N, Rochdi-Lahniche S, Andreu-Pejó L, González-Chordá VM. Female employees' perception of breastfeeding support in the workplace, public universities in Spain: a multicentric comparative study. Int J Environ Res Public Health 2020; 17(17):6402.^,2020 Hilliard E, Brunt A. Impact of an infant friendly business designation. Health Promot Prac 2020; 21(4):642-653.. Between 2011 and 2012, in the USA, 40% of the women had access to both breaks and private spaces. These women had a 2.3 times greater probability of breastfeeding exclusively at six months (95% CI, 1.03-4.95) and a 1.5 greater probability of continuing to breastfeed exclusively each month thereafter (95% CI, 1.08-2.06), when compared to women without access to these accommodations²²22 Kozhimannil KB, Jou J, Gjerdingen DK, McGovern PM. Access to workplace accommodations to support breastfeeding after passage of the affordable care. Act Womens Health Issues 2016; 26(1):6-13..

There is still a low supply of these rooms for breastfeeding, and the access to these rooms depends on the organization’s size, in which it is more likely that larger companies would be able to provide instrumental support, including rooms to breastfeed or to express and store their breastmilk³⁶36 Febrianingtyas Y, Februhartanty J, Hadihardjono DN. Workplace support and exclusive breastfeeding practice: a qualitative study in Jakarta, Indonesia. Mal J Nutr 2019; 25(1):129-142. The availability of rooms was less common (9%) in small businesses (< 100 employees) when compared to large-scale companies (42%)¹⁹19 Grummer-Strawn LM, Shealy KR. Progress in protecting, promoting, and supporting breastfeeding: 1984-2009. Breastfeed Med 2009; 4(Suppl. 1):S31-S39.. One of the factors that makes it challenging to revert this scenario, especially among small businesses, is the lack of mandatory requirements for the employers to provide adequate rooms for breastfeeding³⁷37 Soomro JA, Shaikh ZN, Saheer TB, Bijarani SA. Employers' perspective of workplace breastfeeding support in Karachi, Pakistan: a cross-sectional study. Int Breastfeed J 2016; 11(1):24.^,4444 Rowbotham S, Marks L, Tawia S, Woolley E, Rooney J, Kiggins E, Healey D, Wardle K, Campbell V, Bridges N, Hawe P. Using citizen science to engage the public in monitoring workplace breastfeeding support in Australia. Health Promot J Austr 2021; 33(1):151-161.. Even in studies conducted in high-income countries, such as Australia and England, in some companies, the rooms available for women to express and store breastmilk were found to be kept in unhealthy conditions⁴²42 Kosmala-Anderson J, Wallace LM. Breastfeeding works: the role of employers in supporting women who wish to breastfeed and work in four organizations in England. J Public Health (Oxf) 2006; 28(3):183-191.^,4343 Burns E, Triandafilidis Z. Taking the path of least resistance: a qualitative analysis of return to work or study while breastfeeding. Int Breastfeed J 2019; 14:15..

The existence of a company policy to support breastfeeding, which implements the support rooms for breastfeeding, was one factor associated with mothers continuing to breastfeed (p = 0.009)³⁸38 Cervera-Gasch A, Mena-Tudela D, Leon-Larios F, Felip-Galvan N, Rochdi-Lahniche S, Andreu-Pejó L, González-Chordá VM. Female employees' perception of breastfeeding support in the workplace, public universities in Spain: a multicentric comparative study. Int J Environ Res Public Health 2020; 17(17):6402.. However, two studies emphasized a low use of the rooms because the mothers did not know of the policy or of their worker rights in maternity⁴²42 Kosmala-Anderson J, Wallace LM. Breastfeeding works: the role of employers in supporting women who wish to breastfeed and work in four organizations in England. J Public Health (Oxf) 2006; 28(3):183-191.^,4545 Chen YC, Wu YC, Chie WC. Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: a cross-sectional survey. BMC Public Health 2006; 6:160.. One company policy that makes daycare centers available showed a 47% rise in the probability of breastfeeding for six months after birth, according to data from the national studies in the USA in 1979²¹21 Jacknowitz A. The role of workplace characteristics in breastfeeding practices. Women Health 2008; 47(2):87-111.. In one study conducted in England, access to daycare centers in the workplace was available only for a few workers⁴²42 Kosmala-Anderson J, Wallace LM. Breastfeeding works: the role of employers in supporting women who wish to breastfeed and work in four organizations in England. J Public Health (Oxf) 2006; 28(3):183-191..

With regard to the support provided by employers and workmates, these attitudes promote the protection and dissemination of the rights of mothers who breastfeed to return to work³⁶36 Febrianingtyas Y, Februhartanty J, Hadihardjono DN. Workplace support and exclusive breastfeeding practice: a qualitative study in Jakarta, Indonesia. Mal J Nutr 2019; 25(1):129-142^,4444 Rowbotham S, Marks L, Tawia S, Woolley E, Rooney J, Kiggins E, Healey D, Wardle K, Campbell V, Bridges N, Hawe P. Using citizen science to engage the public in monitoring workplace breastfeeding support in Australia. Health Promot J Austr 2021; 33(1):151-161.. A study conducted in Brazil pointed out that the managers show a positive behavior to support and promote breastfeeding when they understand the positive impacts in worker efficiency that can result from maternity support. The opposite was observed when the managers had a negative view in relation to the implementation of rooms for breastfeeding, they did not understand the laws and the workers’ needs, or they simply exempted themselves of the responsibility³⁴34 Fernandes VMB, Santos EKA, Zampieri MFM, Gregório VRP, Hernandes MJ, Ribeiro LC. Condutas de gestores relacionadas ao apoio ao aleitamento materno nos locais de trabalho. Texto Contexto - Enferm 2018; 27(3):e2560016.. In a study conducted in England, the lack of support from the employer was seen as a major source of dissatisfaction among working women. This, in fact, was the underlying reason why some stayed on leave for longer periods of time than they wanted or why they resigned after their maternity leave⁴²42 Kosmala-Anderson J, Wallace LM. Breastfeeding works: the role of employers in supporting women who wish to breastfeed and work in four organizations in England. J Public Health (Oxf) 2006; 28(3):183-191..

Educational activities were carried out, in general, in combination with other support actions. Support groups were created in a Spanish university for their workers, and special accommodations were made available for women to express and store their breastmilk. A support policy for breastfeeding was also put into practice at the university. The set of strategies was associated with a longer duration of breastfeeding when returning to work (p < 0.001)³⁸38 Cervera-Gasch A, Mena-Tudela D, Leon-Larios F, Felip-Galvan N, Rochdi-Lahniche S, Andreu-Pejó L, González-Chordá VM. Female employees' perception of breastfeeding support in the workplace, public universities in Spain: a multicentric comparative study. Int J Environ Res Public Health 2020; 17(17):6402.. In Indonesia, the researchers provided information to pregnant women in the workplace, encouraging breastfeeding, and provided installations where they could express their breastmilk³⁶36 Febrianingtyas Y, Februhartanty J, Hadihardjono DN. Workplace support and exclusive breastfeeding practice: a qualitative study in Jakarta, Indonesia. Mal J Nutr 2019; 25(1):129-142. In Taiwan, educational actions or pre-natal activities were developed in the workplace, which included the partner of the working women. The initial support of the partner to choose breastfeeding, the company’s encouragement for women to use the rooms set up for breastfeeding, and breaks during working hours to express breastmilk led to an increase in breastfeeding rates⁴¹41 Tsai SY. Influence of partner support on an employed mother's intention to breastfeed after returning to work. Breastfeed Med 2014; 9(4):222-30..

Potential of the strategies to achieve SDGs

Figure 2 synthesizes the impacts of the promotion, protection, and support strategies for breastfeeding in the work context in better working conditions for women who breastfeed and who receive the positive results in the breastfeeding practices. These outcomes show connections with the achievement of the SDGs. The impacts of the strategies on women’s work has the potential to achieve SDG 5 (gender equality and women’s empowerment) and SDG 8 (decent work and economic growth), which increases the possibility of achieving SDG 10 (reduce inequalities) and SDG 1 (no poverty). Concerning the SDG 5, the strategies impact three targets ​​(5.1, 5.6, and 5c) related to eliminating all forms of discrimination against women, thus guaranteeing reproductive rights, in turn adopting and strengthening solid policies and laws to promote gender equality and the empowerment of all women²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,2626 Ruhm CJ. Policies to assist parents with young children. Future Child 2011; 21(2):37-68.^,2929 Heymann J, Raub A, Earle A. Creating and using new data sources to analyze the relationship between social policy and global health: the case of maternal leave. Public Health Rep 2011; 126(Suppl. 3):127-134.^,3131 Nandi A, Jahagirdar D, Dimitris MC, Labrecque JA, Strumpf EC, Kaufman JS, Vincent I, Atabay E, Harper S, Earle A, Heymann SJ. The impact of parental and medical leave policies on socioeconomic and health outcomes in OECD countries: a systematic review of the empirical literature. Milbank Q 2018; 96(3):434-471.^,3535 The World Bank Group (WBG). Mauritius early childhood development: SABER Country Report 2012. Washington, DC: WBG; 2012.^,4747 United Nations (UN). Global indicator framework for the Sustainable Development Goals and targets of the 2030 Agenda for Sustainable Development [Internet]. 2021. [cited 2022 ago 3]. Available from: https://unstats.un.org/sdgs/indicators/Global%20Indicator%20Framework%20after%202020%20review_Eng.pdf
https://unstats.un.org/sdgs/indicators/G... . As regards SDG 8, the strategies have the potential to achieve two targets (8.5 and 8.8) concerning full and productive employment and decent work for all women and men as well as protect worker rights and promote safe and protected work environments for all workers²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,2626 Ruhm CJ. Policies to assist parents with young children. Future Child 2011; 21(2):37-68.^,2929 Heymann J, Raub A, Earle A. Creating and using new data sources to analyze the relationship between social policy and global health: the case of maternal leave. Public Health Rep 2011; 126(Suppl. 3):127-134.^,3131 Nandi A, Jahagirdar D, Dimitris MC, Labrecque JA, Strumpf EC, Kaufman JS, Vincent I, Atabay E, Harper S, Earle A, Heymann SJ. The impact of parental and medical leave policies on socioeconomic and health outcomes in OECD countries: a systematic review of the empirical literature. Milbank Q 2018; 96(3):434-471.^,3535 The World Bank Group (WBG). Mauritius early childhood development: SABER Country Report 2012. Washington, DC: WBG; 2012.^,4747 United Nations (UN). Global indicator framework for the Sustainable Development Goals and targets of the 2030 Agenda for Sustainable Development [Internet]. 2021. [cited 2022 ago 3]. Available from: https://unstats.un.org/sdgs/indicators/Global%20Indicator%20Framework%20after%202020%20review_Eng.pdf
https://unstats.un.org/sdgs/indicators/G... . Two targets of SDG 10 (10.1 and 10.2) are achieved indirectly through the impacts of the strategies, which seek to progressively achieve and sustain income growth, and to strengthen and promote social, economic, and political inclusion for all²⁶26 Ruhm CJ. Policies to assist parents with young children. Future Child 2011; 21(2):37-68.^,2929 Heymann J, Raub A, Earle A. Creating and using new data sources to analyze the relationship between social policy and global health: the case of maternal leave. Public Health Rep 2011; 126(Suppl. 3):127-134.^,3131 Nandi A, Jahagirdar D, Dimitris MC, Labrecque JA, Strumpf EC, Kaufman JS, Vincent I, Atabay E, Harper S, Earle A, Heymann SJ. The impact of parental and medical leave policies on socioeconomic and health outcomes in OECD countries: a systematic review of the empirical literature. Milbank Q 2018; 96(3):434-471.^,4747 United Nations (UN). Global indicator framework for the Sustainable Development Goals and targets of the 2030 Agenda for Sustainable Development [Internet]. 2021. [cited 2022 ago 3]. Available from: https://unstats.un.org/sdgs/indicators/Global%20Indicator%20Framework%20after%202020%20review_Eng.pdf
https://unstats.un.org/sdgs/indicators/G... . These actions influence the achievement of two targets (1.2 and 1.3) of SDG 1, since they promote the reduction of poverty and encourage the implementation of social protection systems²⁶26 Ruhm CJ. Policies to assist parents with young children. Future Child 2011; 21(2):37-68.^,2929 Heymann J, Raub A, Earle A. Creating and using new data sources to analyze the relationship between social policy and global health: the case of maternal leave. Public Health Rep 2011; 126(Suppl. 3):127-134.^,3131 Nandi A, Jahagirdar D, Dimitris MC, Labrecque JA, Strumpf EC, Kaufman JS, Vincent I, Atabay E, Harper S, Earle A, Heymann SJ. The impact of parental and medical leave policies on socioeconomic and health outcomes in OECD countries: a systematic review of the empirical literature. Milbank Q 2018; 96(3):434-471.^,4747 United Nations (UN). Global indicator framework for the Sustainable Development Goals and targets of the 2030 Agenda for Sustainable Development [Internet]. 2021. [cited 2022 ago 3]. Available from: https://unstats.un.org/sdgs/indicators/Global%20Indicator%20Framework%20after%202020%20review_Eng.pdf
https://unstats.un.org/sdgs/indicators/G... .

The increase in exclusive and continued breastfeeding practices after women return to work increases the potential to achieve SDG 2 (zero hunger), SDG 3 (good health and well-being), and SDG 12 (responsible consumption and production). These results enhance the possibility of achieving SDGs 1, 4, and 10. Concerning SDG 2, a better prevalence of maternal breastfeeding can help to achieve two targets (2.1 and 2.2), since breastfeeding is a means through which to end hunger and guarantee access to safe and nutritional foods for babies. Moreover, good breastfeeding practices are a path toward ending all forms of malnutrition¹1 Victora CG, Barros AJD, França GVA, Bahl R, Rollins NC, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N. Amamentação no século 21: epidemiologia, mecanismos e efeitos ao longo da vida. Epidemiol Serv Saude 2016; 16:1-24.^,22 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,4747 United Nations (UN). Global indicator framework for the Sustainable Development Goals and targets of the 2030 Agenda for Sustainable Development [Internet]. 2021. [cited 2022 ago 3]. Available from: https://unstats.un.org/sdgs/indicators/Global%20Indicator%20Framework%20after%202020%20review_Eng.pdf
https://unstats.un.org/sdgs/indicators/G... . In relation to SDG 3, the strategies that increase the number of breastfed children also promote specific targets (3.1 and 3.2), as it has been proven that breastfeeding leads to a reduction in the chances of contracting cancer in women who breastfeed and a decline in neonatal mortality¹1 Victora CG, Barros AJD, França GVA, Bahl R, Rollins NC, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N. Amamentação no século 21: epidemiologia, mecanismos e efeitos ao longo da vida. Epidemiol Serv Saude 2016; 16:1-24.^,22 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,4747 United Nations (UN). Global indicator framework for the Sustainable Development Goals and targets of the 2030 Agenda for Sustainable Development [Internet]. 2021. [cited 2022 ago 3]. Available from: https://unstats.un.org/sdgs/indicators/Global%20Indicator%20Framework%20after%202020%20review_Eng.pdf
https://unstats.un.org/sdgs/indicators/G... . As the breastmilk is a natural food source, breastfeeding can also help to achieve a target from SDG 12 (12.3), as it served to diminish food waste and diminish food loss along the food and supply chains¹1 Victora CG, Barros AJD, França GVA, Bahl R, Rollins NC, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N. Amamentação no século 21: epidemiologia, mecanismos e efeitos ao longo da vida. Epidemiol Serv Saude 2016; 16:1-24.^,22 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,4747 United Nations (UN). Global indicator framework for the Sustainable Development Goals and targets of the 2030 Agenda for Sustainable Development [Internet]. 2021. [cited 2022 ago 3]. Available from: https://unstats.un.org/sdgs/indicators/Global%20Indicator%20Framework%20after%202020%20review_Eng.pdf
https://unstats.un.org/sdgs/indicators/G... . Good nutrition and health among children promoted by breastfeeding in the two first years of life is essential for a more complete child development, which is one of the targets to be achieved in SDG 4 (4.2: quality education)¹1 Victora CG, Barros AJD, França GVA, Bahl R, Rollins NC, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N. Amamentação no século 21: epidemiologia, mecanismos e efeitos ao longo da vida. Epidemiol Serv Saude 2016; 16:1-24.^,22 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,4747 United Nations (UN). Global indicator framework for the Sustainable Development Goals and targets of the 2030 Agenda for Sustainable Development [Internet]. 2021. [cited 2022 ago 3]. Available from: https://unstats.un.org/sdgs/indicators/Global%20Indicator%20Framework%20after%202020%20review_Eng.pdf
https://unstats.un.org/sdgs/indicators/G... . The promotion of high-quality child development promotes the growth of healthier and more prosperous populations, an effect that positively impacts a decline in poverty (SDG 1) and promotes SDG 10 to progressively achieve and sustain income growth¹1 Victora CG, Barros AJD, França GVA, Bahl R, Rollins NC, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N. Amamentação no século 21: epidemiologia, mecanismos e efeitos ao longo da vida. Epidemiol Serv Saude 2016; 16:1-24.^,22 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,4747 United Nations (UN). Global indicator framework for the Sustainable Development Goals and targets of the 2030 Agenda for Sustainable Development [Internet]. 2021. [cited 2022 ago 3]. Available from: https://unstats.un.org/sdgs/indicators/Global%20Indicator%20Framework%20after%202020%20review_Eng.pdf
https://unstats.un.org/sdgs/indicators/G... .

Discussion

The present study mapped the promotion, protection, and support strategies geared toward working women who breastfeed and demonstrated the potential of these results to achieve SDGs, a theme that is rarely treated in the literature. The results revealed the potential of these strategies to contribute to the achievement of the SDG 5 (gender equality and women’s empowerment) and SDG 8 (decent work and economic growth) in a more direct manner, and SDG 1 (no poverty) and SDG 10 (reduce inequalities) in a more indirect manner. The positive impacts of the strategies on the breastfeeding indexes have the potential to achieve SDG 2 (zero hunger), SDG 3 (good health and well-being), and SDG 12 (responsible consumption and production) more directly, as well as SDG 4 (quality education), and SDGs 1 and 10 indirectly.

Most of the studies were conducted in high-income countries, especially in the USA⁴⁶46 Hauck K, Miraldo M, Singh S. Integrating motherhood and employment: a 22-year analysis investigating impacts of US workplace breastfeeding policy. SSM Popul Health 2020; 11:100580., where, although there have been advances to protect and support working women who breastfeed¹⁹19 Grummer-Strawn LM, Shealy KR. Progress in protecting, promoting, and supporting breastfeeding: 1984-2009. Breastfeed Med 2009; 4(Suppl. 1):S31-S39.^,2020 Hilliard E, Brunt A. Impact of an infant friendly business designation. Health Promot Prac 2020; 21(4):642-653., the most of the women did not receive paid maternity leave²⁵25 Ogbuanu C, Glover S, Probst J, Liu J, Hussey J. The effect of maternity leave length and time of return to work on breastfeeding. Pediatrics 2011; 127(6):e1414-e1427. nor breaks during working hours or rooms to breastfeed or to express breastmilk in the workplace¹⁹19 Grummer-Strawn LM, Shealy KR. Progress in protecting, promoting, and supporting breastfeeding: 1984-2009. Breastfeed Med 2009; 4(Suppl. 1):S31-S39.^,2222 Kozhimannil KB, Jou J, Gjerdingen DK, McGovern PM. Access to workplace accommodations to support breastfeeding after passage of the affordable care. Act Womens Health Issues 2016; 26(1):6-13.. According to UNICEF, the richest countries in the world do not offer broad solutions to all families in relation to the duration of paid leave for mothers and fathers⁴⁶46 Hauck K, Miraldo M, Singh S. Integrating motherhood and employment: a 22-year analysis investigating impacts of US workplace breastfeeding policy. SSM Popul Health 2020; 11:100580.. Moreover, it is important to enhance the research agenda on the theme of working women who breast feed in lower-income countries, where the children are at imminent risk of a less than optimum development and where there is also a lack of labor laws and social support during maternity⁴⁸48 World Health Organization (WHO), United Nations Children's Fund (UNICEF), World Bank Group (WBG). Nurturing care for early childhood development: a framework for helping children survive and thrive to transform health and human potential. Geneva: WHO; 2018..

It was observed that the strategies of axis 1 (promotion) were implemented in only two studies, a much lower frequency when compared to protection and support actions. The interventions for the promotion of breastfeeding include the creation of guidelines for health and nutrition programs in the workplace and campaigns to inform the employers about the potential benefits if they provide support to their workers who breastfeed²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,1616 Barber-Madden R. Design and implementation of a citywide breastfeeding promotion program: the New York City approach. Fam Community Health 1990; 12(4):71-78.. However, data about the effects of these interventions are rarely reported²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.. Hence, it is clearly important to encourage the scientific disclosure of methods and results of this type of intervention.

In relation to the second axis of strategies (protection), the right to breaks during working hours to express their breastmilk was the most frequent. Expressing breastmilk during working hours, in addition to helping to maintain the production of breastmilk, also alleviates the woman’s physical discomfort, allowing for better conditions in which to perform professional activities. The institutions that generally follow this law have rooms reserved for breastfeeding, that is, they also implement support strategies in the company environment³⁴34 Fernandes VMB, Santos EKA, Zampieri MFM, Gregório VRP, Hernandes MJ, Ribeiro LC. Condutas de gestores relacionadas ao apoio ao aleitamento materno nos locais de trabalho. Texto Contexto - Enferm 2018; 27(3):e2560016.^,3636 Febrianingtyas Y, Februhartanty J, Hadihardjono DN. Workplace support and exclusive breastfeeding practice: a qualitative study in Jakarta, Indonesia. Mal J Nutr 2019; 25(1):129-142^,3838 Cervera-Gasch A, Mena-Tudela D, Leon-Larios F, Felip-Galvan N, Rochdi-Lahniche S, Andreu-Pejó L, González-Chordá VM. Female employees' perception of breastfeeding support in the workplace, public universities in Spain: a multicentric comparative study. Int J Environ Res Public Health 2020; 17(17):6402.^,4141 Tsai SY. Influence of partner support on an employed mother's intention to breastfeed after returning to work. Breastfeed Med 2014; 9(4):222-30.^,4444 Rowbotham S, Marks L, Tawia S, Woolley E, Rooney J, Kiggins E, Healey D, Wardle K, Campbell V, Bridges N, Hawe P. Using citizen science to engage the public in monitoring workplace breastfeeding support in Australia. Health Promot J Austr 2021; 33(1):151-161.. These actions can contribute to the promotion of decent work (SDG 8) and to the equity of working conditions for both men and women (SDG 5). Regarding the existence of laws that protect the right to maternity leave, it is understood that these contribute to gender equality and women’s empowerment (SDG 5), as they provide the women with the right to receive a source of income while they exercise their reproductive rights⁴⁵45 Chen YC, Wu YC, Chie WC. Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: a cross-sectional survey. BMC Public Health 2006; 6:160.. Maternity leave also has the potential to increase employment stability, potentially boosting productivity and resulting in better gains over the long term and in one’s career path, which is related to SDG 8. Furthermore, the equity of access to income can contribute to combat poverty (SDG 1) and promote socioeconomic equality (SDG 10) by diminishing unemployment and providing legal social protection²⁶26 Ruhm CJ. Policies to assist parents with young children. Future Child 2011; 21(2):37-68.^,3535 The World Bank Group (WBG). Mauritius early childhood development: SABER Country Report 2012. Washington, DC: WBG; 2012.^,4242 Kosmala-Anderson J, Wallace LM. Breastfeeding works: the role of employers in supporting women who wish to breastfeed and work in four organizations in England. J Public Health (Oxf) 2006; 28(3):183-191.. In Brazil, the Corporate Citizenship Program, which is a non-mandatory mechanism that concedes fiscal incentives to companies, allows for an expansion of maternity leave from four to six months and of paternal leave from five to 20 days⁴⁹49 Brasil. Ministério da Saúde (MS). Lei nº 11.770, de 9 de setembro de 2008. Cria o Programa Empresa Cidadã, destinado à prorrogação da licença-maternidade mediante concessão de incentivo fiscal, e altera a Lei no 8.212, de 24 de julho de 1991. Diário Oficial da União 2008; 9 set..

As regards the third axis (support), studies affirm that when managers and companies adopt strategies, such as providing rooms to express and store breastmilk, or to breastfeed during working hours, this can help to reduce situations of discrimination against working mothers²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,3232 Stumbitz B, Lewis S, Rouse J. Maternity management in SMEs: a transdisciplinary review and research agenda. Int J Management Rev 2018; 20(2):500-522.^,3434 Fernandes VMB, Santos EKA, Zampieri MFM, Gregório VRP, Hernandes MJ, Ribeiro LC. Condutas de gestores relacionadas ao apoio ao aleitamento materno nos locais de trabalho. Texto Contexto - Enferm 2018; 27(3):e2560016.. Support groups and other educational actions further contribute to improving the support provided by managers and workmates to mothers who breastfeed²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,3232 Stumbitz B, Lewis S, Rouse J. Maternity management in SMEs: a transdisciplinary review and research agenda. Int J Management Rev 2018; 20(2):500-522.^,3434 Fernandes VMB, Santos EKA, Zampieri MFM, Gregório VRP, Hernandes MJ, Ribeiro LC. Condutas de gestores relacionadas ao apoio ao aleitamento materno nos locais de trabalho. Texto Contexto - Enferm 2018; 27(3):e2560016.. These actions can include the women’s partners and significantly influence incentives for breastfeeding⁴¹41 Tsai SY. Influence of partner support on an employed mother's intention to breastfeed after returning to work. Breastfeed Med 2014; 9(4):222-30.. In Brazil, the Primary Health Care (PHC) services receive fathers/partners during pre-natal care and include advice on how to encourage and favor breastfeeding, as well as how to share domestic activities and take care of the child⁵⁰50 Herrmann A, Silva ML, Chakora ES, Lima DC. Guia do pré-natal do parceiro para profissionais de saúde. Rio de Janeiro: MS; 2016.. However, the inclusion of information concerning rights related to breaks and the expression of breastmilk during working hours would also be valid.

Recently, one study analyzed the perception of registered working women in Brazil regarding support rooms for breastfeeding. A favorable relation was found between the rooms and SDGs 5 and 8. The relation between gender equality and women’s empowerment (SDG 5) and the support rooms for breastfeeding has been established due to the fact that they help women perform their professional activities without physical and emotional stress, in turn feeling more valued and recognized professionally, allowing them to dedicate themselves to their professional activities, maintaining a certain equality in the workplace when compared to men who do not have these concerns⁶6 Souza CB, Venancio SI, Silva RPGVC. Breastfeeding support rooms and their contribution to sustainable development goals: a qualitative study. Front Public Health 2021; 9:732061.. In relation to decent work (SDG 8), access to rooms provides comfort and well-being, both physical and emotional, for the women to exercise their activities. In addition, it contributes to a good work relationship between employee and employers, given that the women recognize the importance of the rooms in their own performance of work activities, as well as recognize and value the company that meets their needs as a woman, a mother, and a professional⁶6 Souza CB, Venancio SI, Silva RPGVC. Breastfeeding support rooms and their contribution to sustainable development goals: a qualitative study. Front Public Health 2021; 9:732061..

It can therefore be seen that the positive changes in the work context are in line with helping to achieve SDGs 5 and 8. A work environment with these positive changes is friendlier for women who breastfeed, which can be considered decent and safe work. This support can also impact productivity and, consequently, economic growth⁶6 Souza CB, Venancio SI, Silva RPGVC. Breastfeeding support rooms and their contribution to sustainable development goals: a qualitative study. Front Public Health 2021; 9:732061..

As regards the positive impacts of the strategies of the three axes in the increase of the practices of breastfeeding, the evidence is consistent. Many authors have identified the benefits of paid maternity leave in relation to the increase in breastfeeding²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,2323 Mirkovic KR, Perrine CG, Scanlon KS. Paid maternity leave and breastfeeding outcomes. Birth 2016; 43(3):233-239.^,2525 Ogbuanu C, Glover S, Probst J, Liu J, Hussey J. The effect of maternity leave length and time of return to work on breastfeeding. Pediatrics 2011; 127(6):e1414-e1427.. Initiatives of support to maternal breastfeeding, such as the providing of special accommodations to express and store breastmilk, the incentives from workmates and supervisors, and educational actions conducted with the mother and partners are associated with a longer duration of maternal breastfeeding among working women³⁸38 Cervera-Gasch A, Mena-Tudela D, Leon-Larios F, Felip-Galvan N, Rochdi-Lahniche S, Andreu-Pejó L, González-Chordá VM. Female employees' perception of breastfeeding support in the workplace, public universities in Spain: a multicentric comparative study. Int J Environ Res Public Health 2020; 17(17):6402. and to the continuity of breastfeeding⁴¹41 Tsai SY. Influence of partner support on an employed mother's intention to breastfeed after returning to work. Breastfeed Med 2014; 9(4):222-30.. A good amount of evidence reinforces the important role of breastfeeding to achieve the SDG 2 (zero hunger). Maternal breastfeeding is considered the primary protection of a child against hunger, and it does not generate costs for the household budget. Breastfeeding is a long-lasting investment in physical, cognitive, and social aspects⁵¹51 Hansen, K. Breastfeeding: a smart investment in people and in economies. Lancet 2016; 387(10017):416., thus helping to guarantee nutrition and food safety, as well as the child’s full growth and development⁶6 Souza CB, Venancio SI, Silva RPGVC. Breastfeeding support rooms and their contribution to sustainable development goals: a qualitative study. Front Public Health 2021; 9:732061.. Many authors have shown the relation between breastfeeding and maternal-child health, a theme from SDG 3 (good health and well-being), given that breastfeeding provides numerous benefits both to the health of the children¹1 Victora CG, Barros AJD, França GVA, Bahl R, Rollins NC, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N. Amamentação no século 21: epidemiologia, mecanismos e efeitos ao longo da vida. Epidemiol Serv Saude 2016; 16:1-24.^,22 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,5151 Hansen, K. Breastfeeding: a smart investment in people and in economies. Lancet 2016; 387(10017):416. and to that of the mothers¹1 Victora CG, Barros AJD, França GVA, Bahl R, Rollins NC, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N. Amamentação no século 21: epidemiologia, mecanismos e efeitos ao longo da vida. Epidemiol Serv Saude 2016; 16:1-24.^,22 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.^,5252 Chowdhury R, Sinha B, Sankar MJ, Taneja S, Bhandari N, Rollins N, Bahl R, Martines J. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr 2015; 104(467):96-113., also helping to strengthen the affective bond between mother and baby⁶6 Souza CB, Venancio SI, Silva RPGVC. Breastfeeding support rooms and their contribution to sustainable development goals: a qualitative study. Front Public Health 2021; 9:732061.. It is well-known that breastfeeding reduces infant mortality¹1 Victora CG, Barros AJD, França GVA, Bahl R, Rollins NC, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N. Amamentação no século 21: epidemiologia, mecanismos e efeitos ao longo da vida. Epidemiol Serv Saude 2016; 16:1-24.^,77 Bai YK, Dinour LM, Pope GA. Determinants of the intention to pump breast milk on a university campus. J Midwifery Womens Health 2016; 61(5):563-570.^,5151 Hansen, K. Breastfeeding: a smart investment in people and in economies. Lancet 2016; 387(10017):416. and can prevent 13% of the deaths in children who are less than 5 years of age worldwide⁷7 Bai YK, Dinour LM, Pope GA. Determinants of the intention to pump breast milk on a university campus. J Midwifery Womens Health 2016; 61(5):563-570..

In relation to SDG 12 (responsible consumption and production), breastfeeding has the potential to achieve SDGs, as it is a sustainable practice. Breastmilk is “a natural and renewable food” of easy access; therefore, it does not cause negative impacts upon the environment²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.. Some workers consider that the use of support rooms for breastfeeding helps to diminish the use of infant formulas⁶6 Souza CB, Venancio SI, Silva RPGVC. Breastfeeding support rooms and their contribution to sustainable development goals: a qualitative study. Front Public Health 2021; 9:732061.. Thus, the higher the breastfeeding rates, the lower the consumption of product packaging to substitute breastmilk, in turn reducing the production of waste and the entire chain of environmental pollution resulting from the production and distribution of these foods²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504..

Achieving SDG 4 (Quality education) can be boosted through the increase of breastfeeding practices, since the good nutrition of the child is essential to the child’s high-quality development, which is one of the targets of this SDG (4.2)⁹9 United Nations (UN). Resolution adopted by the General Assembly on 25 September 2015 [Internet]. 2015. [cited 2022 ago 27]. Available from: https://www.eea.europa.eu/policy-documents/resolution-adopted-by-the-general
https://www.eea.europa.eu/policy-documen... . Moreover, the longer the duration of breastfeeding, the greater the positive impacts upon the intellectual development of the children (average increase of three points in the intelligence coefficient)²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.. These impacts can result in a better performance in school, a better qualification for the work market, a better income in one’s adult life, and the reduction of poverty and social inequalities, all themes from SDGs 1 and 10⁴⁷47 United Nations (UN). Global indicator framework for the Sustainable Development Goals and targets of the 2030 Agenda for Sustainable Development [Internet]. 2021. [cited 2022 ago 3]. Available from: https://unstats.un.org/sdgs/indicators/Global%20Indicator%20Framework%20after%202020%20review_Eng.pdf
https://unstats.un.org/sdgs/indicators/G... .

It is important to highlight that efforts are needed to push countries to include maternity leave in their laws, as well as to have more companies that assume the commitment to provide support rooms for breastfeeding in healthy conditions⁷7 Bai YK, Dinour LM, Pope GA. Determinants of the intention to pump breast milk on a university campus. J Midwifery Womens Health 2016; 61(5):563-570.^,4141 Tsai SY. Influence of partner support on an employed mother's intention to breastfeed after returning to work. Breastfeed Med 2014; 9(4):222-30.^,4545 Chen YC, Wu YC, Chie WC. Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: a cross-sectional survey. BMC Public Health 2006; 6:160.. Small and mid-sized companies employ the majority of women around the work, but maternity is one of the primary causes of gender inequality, and maternity management is a common dilemma for small business owners³²32 Stumbitz B, Lewis S, Rouse J. Maternity management in SMEs: a transdisciplinary review and research agenda. Int J Management Rev 2018; 20(2):500-522.. Thus, it is necessary to encourage and facilitate a friendly work environment for maternal breastfeeding³⁷37 Soomro JA, Shaikh ZN, Saheer TB, Bijarani SA. Employers' perspective of workplace breastfeeding support in Karachi, Pakistan: a cross-sectional study. Int Breastfeed J 2016; 11(1):24., with the institutionalization of a written policy for promotion, protection and support strategies for breastfeeding in the workplace³⁴34 Fernandes VMB, Santos EKA, Zampieri MFM, Gregório VRP, Hernandes MJ, Ribeiro LC. Condutas de gestores relacionadas ao apoio ao aleitamento materno nos locais de trabalho. Texto Contexto - Enferm 2018; 27(3):e2560016.. In this sense, there should be collaborative efforts among managers and employers to guarantee effective strategies, both to improve the outcomes related to decent and productive work for women and gender equality, as well as for the outcomes regarding breastfeeding.

It is understood that the positive results of the strategies to promote breastfeeding to improve one’s work performance should be presented to the managers, thereby increasing their adherence to the implementation of company policies²⁸28 Alb CH, Theall K, Jacobs MB, Bales A. Awareness of United States' Law for Nursing Mothers among Employers in New Orleans, Louisiana. Womens Health Issues 2017; 27(1):14-20.. It is also important to highlight that in the major informal work sectors, there are millions of working women who have no maternity protection or who have an inadequate protection²2 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 30; 387(10017):491-504.. Therefore, the major challenge is to expand promotion, protection, and support strategies for breastfeeding among women who work informally, who are self-employed, and/or who have no specific labor contract.

Final considerations

This critical analysis, based on scientific evidence, allowed us to highlight how the strategies that promote, protect, and support breastfeeding in the work context relate to the promotion of decent work and economic growth (SDG 8) and to gender equality and women’s empowerment (SDG 5), in addition to helping to achieve more than six SDGs, such as the reduction of poverty and of social iniquities (SDGs 1 and 10), the reduction of hunger (SDG 2), the guarantee of health and well-being of the woman and child binomial (SDG 3), the full child development and high-quality education (SDG 4), and the environmental impact (SDG 12).

It can therefore be concluded that the actions geared toward working women who breastfeed contribute both directly and indirectly to achieving eight of the 17 SDGs, and should therefore be encouraged and reinforced.

References

Publication Dates

History