Category: Science

Source: The Conversation – Indonesia – By Andini Pramono, Research officer, Department of Health Economics, Wellbeing and Society, National Centre for Epidemiology and Population Health, Australian National University

Research shows that six months of exclusive breastfeeding, and continuing until two years old or beyond, provide multiple benefits for the baby and mother.

It can prevent deaths both in infants and mothers – including in wealthy nations like the United States. It also benefits the global economy and the enviroment.

However, after maternity leave ends, mothers returning to paid work face many challenges maintaining breastfeeding. This often leads mothers to stop breastfeeding their children before six months – the duration of exclusive breastfeeding recommended by the World Health Organisation (WHO) and others.

According to the WHO, less than half of babies under six months old worldwide are exclusively breastfed.

In Indonesia, research shows 83% of mothers initiate breastfeeding, but only 57% are still breastfeeding at around six months. In Australia, 96% of mothers start breastfeeding, but then there is a rapid fall to only 39% by around three months and only 15% by around five months.

Among the key reasons for low rates of exclusive breastfeeding are the difficult work conditions women face when they return to paid work.

So how can governments and workplaces – especially in countries that have yet to do enough, like Indonesia and Australia – better support breastfeeding mothers, particularly at work?

Half a billion reasons to change

For more than a century, the International Labour Organization (ILO) has set global standards for maternity protection through the Maternity Protection Convention and accompanying recommendations, as well as the ILO Workers with Family Responsibilities Convention, aiming to protect female workers’ rights.

So far, only 66 member states have ratified at least one of the Maternity Protection Conventions, while 43 have ratified the Workers with Family Responsibilities Convention. Unfortunately, Indonesia has not ratified either convention. So far, Australia has only ratified the family responsibilities convention.

In some countries, protections are aligned with the ILO Conventions. For example, in Denmark and Norway, the governments offer maternity leave of at least 14 weeks. During leave, mothers’ earnings are protected at a rate of at least two-thirds of their pre-birth earnings. Public funds ensure this is done in a manner determined by national law and practice, so the employer is not solely responsible for the payment.

A Canadian study highlights the proportion of mothers exclusively breastfeeding to six months increased by almost 40% when paid maternity leave was expanded from six to 12 months. At the same time, average breastfeeding duration increased by one month, from five to six months.

Evidence shows paid maternity leave and providing an adequate lactation room at work both contribute positively to breastfeeding rates.

Despite this, half a billion women globally still lack adequate maternity protections.

For example, welfare reforms in the US encouraging new mothers’ return to work within 12 weeks led to a 16–18% reduction in breastfeeding initiation. It also saw a four to six week reduction in the time babies were breastfed.

Indonesia and Australia aren’t doing enough

Neither Indonesia or Australia are currently doing enough to meet the ILO’s maternity protection standards.

In Indonesia, the 2003 Labour Law urges companies to give 12 weeks of paid maternity leave for women workers to support breastfeeding. Furthermore, the 2012 regulation on exclusive breastfeeding obligates workplace and public space management to provide a space or facility to breastfeed and express breast milk. However, the monitoring of its implementation is weak.

In Australia, paid parental leave (PPL) policy supports parents who take time off from paid work to care for their young children.

Eligible working mothers or primary carers are entitled to up to 20 weeks (or 22 weeks if the child is born or adopted from 1 July 2024) of government paid parental leave within the first two years of the birth or adoption of a child.

In the Federal Budget announced on 15 May 2024, the Australian government has added payment of superannuation contributions to the parental leave package for births and adoptions on or after 1 July 2025. However, the PPL is a low amount, paid at the national minimum wage ($882.80 per week)].

Some mothers can combine the government payment with additional paid leave from their employer. However in 2022-2023, only 63% of Australian employers offered this, leaving nearly half of new mothers with only minimum financial support.

Unlike Indonesia, Australia has no legal requirement for employers to offer paid breastfeeding breaks in their workplace, so mothers can express and take home their breastmilk. This can badly impact women’s and children’s health.

While Australia’s support for breastfeeding mothers is welcome, it’s still inadequate to meet the ILO’s international standard – particularly Australia’s low payment rate of government PPL (at the minimum wage, rather than two-thirds of previous earnings) and the lack of legislation for paid breastfeeding breaks.

How employers and colleagues can help

Globally, the barriers to maintain breastfeeding include not only lack of maternity leave duration and pay, but also unavailability of breastfeeding and breast pumping facilities at workplaces, sometimes unsupportive colleagues and supervisors, and lack of time at work to breastfeed or expressing breastmilk.

Breastfeeding a baby should not preclude women from earning a living. In 2022, female workers were 39.5% of total workers globally, while in Australia and Indonesia they made up 47.4% and 39.5% respectively.

An accessible facility or space for breastfeeding or breast pumping is vital to support breastfeeding working mothers.

In Indonesia, a 2013 Ministry of Health regulation outlines the procedure for an employer to provide a space and facility for mothers to breastfeed and breast pump.

The minimum specifications of this facility are described as a lockable, clean and quiet room, with a sink for washing, suitable temperature, lighting and flooring. While these specifications are technically mandatory, monitoring is weak, meaning if employers fail to meet the requirements there are no specific consequences.

But a breastfeeding space alone is not enough. In many jobs, mothers cannot leave their tasks during working hours, even if there is a lactation room.

Supportive employers need to regulate time and flexibility to breastfeed and express breastmilk, including providing flexible working arrangements and paid breastfeeding breaks during working hours. Supportive attitudes from co-workers and managers are also important.

Suitable staff training on breastfeeding and policies supporting mothers, such as providing time and facility to express breastmilk in work hours, are crucial. Training on how to support co-worker can include anything from basic information breastfeeding, to what to say (or not say) with a breastfeeding co-worker.

Access to supportive childcare is another issue globally.

For those families who can access childcare, childcare centres can also help by:

• encouraging and accommodating mothers to visit for breastfeeding
• having written policies supporting breastfeeding
• providing parents with resources on breastfeeding
• and referring parents to community resources for breastfeeding support.

Practical ways to support more families

The Australian Breastfeeding Association has an accreditation program that helps workplaces to be breastfeeding-friendly. Workplace policies, including adequate time and space for pumping, are positively associated with longer breastfeeding duration.

The program assesses workplaces for three aspects: time, space and supportive culture. This means, workplaces are encouraged to provide a special space and time for breastfeeding and breast pumping in a supportive culture and flexible working hours.

Mothers should consider to prepare how to align breastfeeding with work early – during pregnancy. Start by discussing your breastfeeding goals with healthcare professionals and finding a baby-friendly hospital.

Discuss your breastfeeding plan with your supervisor at work during your pregnancy, including finding out your maternity leave (paid and unpaid) entitlements. Also consider childcare arrangements that will work best for you with breastfeeding.

For further information and support, you can find resources from local breastfeeding support groups, such as the Indonesian Breastfeeding Mothers Association and Australian Breastfeeding Association.

Julie P. Smith is a qualified breastfeeding counselor and honorary member of the Australian Breastfeeding Association.

Andini Pramono dan Liana Leach tidak bekerja, menjadi konsultan, memiliki saham, atau menerima dana dari perusahaan atau organisasi mana pun yang akan mengambil untung dari artikel ini, dan telah mengungkapkan bahwa ia tidak memiliki afiliasi selain yang telah disebut di atas.

– ref. Difficult work arrangements force many women to stop breastfeeding early. Here’s how to prevent this – https://theconversation.com/difficult-work-arrangements-force-many-women-to-stop-breastfeeding-early-heres-how-to-prevent-this-211831