Workplace Programs for Supporting Breastfeeding: A Systematic Review and Meta-Analysis.

OBJECTIVE To critically review the literature regarding workplace breastfeeding interventions, and to assess their impact on breastfeeding indicators. DESIGN A systematic review and meta-analysis was conducted. Electronic searches for workplace intervention studies to support breastfeeding, without restriction on language or study design, were performed in PubMed, CENTRAL, CINAHL, Embase, Web of Science, Business Source Complete, ProQuest-Sociology, and ProQuest-Social Science to 13th April 2020. A meta-analysis of the pooled effect of the programs on breastfeeding indicators was conducted. RESULTS The search identified 10,215 articles; 14 studies across 18 publications met eligibility criteria. Programs were delivered in the U.S.A (n=10), Turkey (n=2), Thailand (n=1) and Taiwan (n=1). There were no randomised controlled trials. The pooled odds ratio for exclusive breastfeeding at 3 or 6 months for participants vs. non-participants of three non-randomised controlled studies was 3.21 (95% CI 1.70, 6.06, I2=22%). Despite high heterogeneity, other pooled outcomes were consistently in a positive direction with acceptable confidence intervals. Pooled mean duration of breastfeeding for five single-armed studies was 9.16 months (95% CI 8.25, 10.07). Pooled proportion of breastfeeding at 6 months for six single-armed studies was 0.76 (95% CI 0.66, 0.84) and breastfeeding at 12 months for three single-armed studies was 0.41 (95% CI 0.22, 0.62). Most programs were targeted at mothers; two were targeted at expectant fathers. CONCLUSIONS Workplace programs may be effective in promoting breastfeeding among employed mothers and partners of employed fathers. However, no randomised controlled trials were identified, and better-quality research on workplace interventions to improve breastfeeding is needed.