1. 1 Dr Lorna Watson Consultant in Public Health Dr Julia Neufeind Researcher Ms Irene Fenske Infant Feeding Adviser How does the NHS support employees who wish to breastfeed on return to work?

2. 2 Background Breastfeeding rates comparatively low in Scotland WHO ‘up to 2 years’ Public sector workforce Health Promoting Health Services Women returning earlier, anecdotally poor experiences Reduction in absenteeism due to illness in child

3. 3 Method Questionnaire survey of employers of NHS Fife who had gone on maternity leave 2007-09 HR support Exclusions Ethics Information Governance Piloting

4. 4 Results 651 eligible, 87 undelivered 336/564 (60%) completion rate Return to work 267 (82%) 6 months-1 year 151 (46%) 1 child only

5. 5

6. 6

7. 7 Work Hours/Environment 76% part-time 153 (45%) hospital ward/theatre 17% full-time92 (27%) office 9% shift 75 (22%) community Other – health centre/lab/ambulance/A&E, kitchens

8. 8 Important factors on return to work 277 (82%) flexible hours for childcare 24 (7%) break to express milk 9 (2.7%) break to breastfeed Awareness of policies 225 (69%) Carer Leave Policy 175 (53%) Childcare Voucher Scheme 203 (62%) Breastfeeding and return to work

9. 9 Support and Confidence Offered information about breastfeeding on return to work 80.5% No Offered support 25 (8%) leaflet 16 (5%) appropriate areas to express 15 (5%) flexible hours 12 (4%) designated fridge Confidence 146 (59%) very or somewhat confident to approach employer regarding breastfeeding

10. 10 Confidence significantly related to awareness of policies (p<0.0001) 7 (2%) decision to return affected by support offered by employer regarding breastfeeding 165 (57%) employer should do more to support employees with respect to breastfeeding

11. 11 Breastfeeding Intentions and behaviour Length of TimeIntentionActual Not at all 14.0%15.0% < 6 weeks 5%22.1% 6 weeks – 6 months 35.4%23.4% 6 months – 1 year 37.2%24.3% 1 year + 9%15.3% 42 (13%) stopped because they returned to work 31 (9%) would have breastfed longer with better healthcare support 17 (5%) would have breastfed longer if employer was more supportive

12. 12 Breastfeeding and returning to work 152/280 (54%) important or very important to continue after return to work 62/280 – did continue to breastfeed on return did not vary with work setting did vary with age most without support from employer 3/280 – suitable area to express plus designated fridge

13. 13 Qualitative element Perceived that co-workers/managers grudged extra time for expressing Lack of space Tired Continuing optimal nutrition and bonding

14. 14 Legal Context EU Directive 921/85/EEC – Public Sector Management of Health & safety at Work Regulations 1999 Employers should take account of any risk to mother or baby. Control Measures include: altering work conditions and/or hours of work offering alternative work in some cases suspension from work on full pay Sex Discrimination Act 1975 Equalities Act 2010

15. 15 Recommendations Information from employer Line Managers obliged to conduct risk assessment Protect facilities Monitoring feedback on women’s experiences to promote good practice Maternity/health visiting staff provide supportive information

16. 16 Any Questions? lwatson@nhs.net