Early Infant Feeding Practices among Women Engaged in Paid Work in Africa: A Systematic Scoping Review

Abstract

Early Infant Feeding Practices among Women Engaged in Paid Work in Africa: A Systematic Scoping Review Melina Mgongo 1,2,*, Scott B Ickes 3,4,5,12, Beatrice J Leyaro 6, Innocent B Mboya 6,7, Samantha Grounds 8, Emily R Seiger 8, Tamara H Hashim 1, Jamie L Conklin 9, Elizabeth W Kimani-Murage 10, Stephanie L Martin 8,11 1 Institute of Public Health, Department of Community and Global Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania; 2 Better Health for the African Mother and Child, Moshi, Tanzania; 3 Department of Biological and Health Sciences, Wheaton College, Wheaton, IL, United States; 4 Kenya Medical Research Institute, Nairobi, Kenya; 5 Program in Nutritional Sciences, and Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States; 6 Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania; 7 Department of Translational Medicine, Lund University, Malmo, Sweden; 8 Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; 9 Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; 10 African Population and Health Research Center, Nairobi, Kenya; 11 Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; 12 Department of Kinesiology and Health Sciences, William and Mary, WIlliamsburg, VA, United States A B S T R A C T Around the world, paid work without appropriate structural support is a key barrier to optimal breastfeeding practices. To better protect, promote, and support optimal breastfeeding practices among working women in Africa, this scoping review sought to understand how paid work influences infant feeding practices in the first 6 mo of life and what support women need to manage work and optimal infant feeding practices. We systematically searched PubMed, Scopus, Global Health, and CINAHL Plus, screened 2436 abstracts, and reviewed 322 fulltext articles using Covidence for review and charting. We identified 203 articles that met the inclusion criteria. We identified 32 quantitative, 10 qualitative, 3 mixed-methods, and 2 review articles that focused on examining the relationship between work and breastfeeding, and 109 quantitative, 22 qualitative, 21 mixed-methods, and 4 review articles that included work as part of broader breastfeeding research but did not focus on work. Most studies reported a significant negative association between work and exclusive breastfeeding. Three major domains were reported in the qualitative studies: challenges to managing work and infant feeding, receiving support from employers and family members/caregivers, and strategies for feeding infants when the mother is working. Reviewed studies proposed recommendations to increase support for breastfeeding through changes to policies and support within worksites, the health system, and childcare; however, evidence of previously implemented policies or programs is limited. We recommend more consistent definitions and measurement of women’s work. Future research is needed on the impact of implementing various strategies and benefits for breastfeeding at workplaces, as well as efforts to support breastfeeding among informal workers. Keywords: breastfeeding, maternal employment, informal work, Africa, lactation support, baby-friendly workplace