Behavior Outcomes of Breastfeeding-Friendly Policies Among Mothers Working in a Factory in Thailand

Background: The prevalence of exclusive breastfeeding (EBF) in Thailand is the lowest in Asia, at only 12%. Studies show that many factors negatively affect breastfeeding practices in Thailand and impact women’s breastfeeding behaviors. However, returning to work is one such factor. Recently, breastfeeding advocates developed and supported factories as they implemented breastfeeding-friendly policies. We are among the first study to explore the role of policy and breastfeeding behaviors at one of these factories. Methods: A mixed-method study was used in this study. We administered (June-August 2017) a survey study to 216 eligible mothers employed at one factory that implemented a breastfeeding-friendly policy (Bangkok, Thailand) and 30 individual, semi-structured interviews of mother working who were selected from survey participants. Eligibility was determined by date of maternity leave (June-December 2016) so that exclusive breastfeeding practices could be assessed. In addition to breastfeeding practices, demographic, work status, and policy awareness and support data were collected. Results: Women were between 22-46 years old (mean=31 years) and worked 8-12 hours per day (mean=11.4 hours) for 4-6 days per week (mean=5 days) and most worked shifts (96.3%). A large proportion 201/216 (93.1%) intended to breastfeed. All but one woman was aware of the factory’s policy. Women assessed the factory’s level of breastfeeding support and more than a quarter of women rated it as excellent with the majority rating it as very good (59%). Surprisingly, only 32 women actually used the lactation room (supplies provided by the factory), which aligned with EBF patterns. In months 1-3 EBF declined from 76.9% to 46.3% and between months 3-6, it dropped from 16.2%- 7.4%. Several reasons were offered to explain discontinuation of breastfeeding/pumping including: insufficient milk (36%), the baby lived far away (31%), returning to work (12%), and “other” (21%). Five major themes emerged from the interview findings: (1) appreciation of breastfeeding-friendly policies, (2) compatibility of exclusive breastfeeding and work, (3) impact of returning to work, (4) importance of social support during breastfeeding, and (5) win-win situation.In addition, the reported rate of exclusive breastfeeding for 6 or more months among interview participants was higher than the national average. Discussion: Breastfeeding support policies in Thai factories can support positive breastfeeding practices. Rates of EBF for women at this factory were higher than the national average in months 1-3 but quickly dropped in months 3-6. Further exploration of childcare practices is needed as many women indicated being separated from their baby when they returned to work. Further research should examine more diverse groups of Thai working women in a variety of workplaces (both public and private) as well as should compare breastfeeding outcomes in various types of Thai workplaces lacking breastfeeding-friendly policies. In addition, researchers should explore how Thai employers can facilitate and improve breastfeeding-friendly policy implementation across work environments.The results provide baseline data on the role that supportive workplace policies has for breastfeeding and will guide future research workplace policy development about breastfeeding support policies in Thai workplaces as well as extended maternity leave.