Breastfeeding among women employed in Mexico's informal sector: strategies to overcome key barriers.

BACKGROUND: Rates of exclusive breastfeeding fall below recommended levels, particularly among women in paid employment. In Mexico, more than half of women are in informal employment, meaning they lack many of the protections that may support breastfeeding. METHODS: In-depth interviews with 15 key informants representing government agencies (n = 6 organizations), NGOs (n = 4), international organizations (n = 2), and academia (n = 2) in Mexico. Interviews were conducted between March and June 2023. To understand and describe barriers to breastfeeding among informally employed women in Mexico according to key informants and the current and potential policies to address these barriers, we conducted a qualitative thematic analysis. RESULTS: Current policies to promote, protect, and support breastfeeding predominantly apply to all employed women, but respondents expressed concern that they did not provide adequate protection for women in informal employment. Additional themes concerned the need for relevant programs to be institutionalized and coordinated, discussions of breastfeeding as a right, and the legal equivalence (whether true in practice or not) of formal and informal workers. CONCLUSIONS: Women employed in Mexico's informal sector face a dearth of maternity protections. According to key informants, few policies exist to promote, protect, and support breastfeeding among employed women, in general, but the economic vulnerability and challenging working conditions of women in informal employment exacerbates their situation. The lack of access to formal labor protections, such as paid maternity leave, creates a significant barrier to breastfeeding for women in the informal sector. Recommendations include short-term policies to fill gaps in social protection for informally employed women, as well as longer-term solutions such as the development of universal social protection programs and supporting formalization.

Association between maternity leave policies and postpartum depression: a systematic review.

PURPOSE: Working mothers are at greater risk for postpartum depression. Maternity leave characteristics, including length, wage replacement and employment protection, could have relevant implications for mothers' mental health. We propose to explore whether there is an association between maternity leave characteristics and postpartum depression. METHODS: We conducted a systematic review searching for randomized controlled trials, quasi-experimental, cohort or cross-sectional studies on five databases using search terms including maternity and parental leave and depression, as well as references in relevant articles. We identified 500 articles and included 23 of those. We used the EPHPP Quality Assessment Tool for Quantitative Studies to assess the quality of the studies. RESULTS: Paid and longer maternity leaves tend to be associated with a reduction of postpartum depression symptoms in high-income countries. No studies explored the association between employment protection and postpartum depression. The quality of studies ranged from strong to weak, mostly influenced by study design. CONCLUSION: More restrictive maternity leave policies tend to be associated with higher rates of postpartum depression, although more research needs to be conducted in the Global South.

Socio-economic inequalities in the effect of public policies and the COVID-19 pandemic on exclusive breastfeeding in Chile.

OBJECTIVE: To assess the impact of the addition of 12 maternity leave (ML) weeks (2011), a pay for performance (P4P) exclusive breastfeeding (EBF) promotion strategy (2015), and the COVID-19 pandemic in EBF inequalities in Chile. STUDY DESIGN: Interrupted time-series analyses (ITSAs). METHODS: Aggregated national EBF data by municipality and month were collected from 2009 to 2020. We assess the impact of the three events in EBF inequalities using two procedures: 1. ITSA stratified by municipal SES quintiles (Q1-Q5); 2. Calculating the EBF slope index of inequality (SII). RESULTS: The EBF prevalence was higher in lower SES municipalities before and after the three time-events. No impact in EBF inequalities was observed after the extended ML. The P4P strategy increased EBF at six months in all SES quintiles (effect size between 4% and 5%), but in a higher level in poorer municipalities (SII: -0.36% and -1.05%). During COVID-19, wealthier municipalities showed a slightly higher EBF at six months prevalence (SII: 1.44%). CONCLUSION: The null impact of the extended ML in EBF inequalities could be explained by a low access to ML among affiliated to the public health system (20%). The P4P strategy includes multiple interventions that seemed effective in increasing EBF across all SES quintiles, but further in lower quintiles. The restrictions in healthcare access in poorer municipalities could explain EBF inequalities during COVID-19.

Avaliação das políticas sociais brasileiras para a eliminação da desigualdade de gêneros / Assessment of the contribution of Brazilian social policies to the elimination of gender inequality

O Estado de Bem-estar é o resultado de uma evolução histórica, econômica, política e social, e dependendo do regime em cada país, haverá políticas sociais mais abrangentes que outras. Tais políticas apresentam um conjunto de garantias necessárias para a redução das distorções provenientes do modelo industrial capitalista que emergiu na Europa, no final do século XIX. Dentre os exemplos mais exitosos destacamos o regime dinamarquês, que ganha destaque neste trabalho por refletir o sistema de licenças familiares mais completo e eficiente, capaz de garantir acesso universal às mães e seus filhos pequenos, minimizando a estratificação social e a mercadorização das garantias sociais. O Brasil está longe dessa realidade, porém passou a desenvolver, após 1930, uma série de políticas sociais as quais, a partir da Constituição Federal de 1988, passaram a ter caráter universal. A presente pesquisa teve como objeto a análise comparativa das políticas sociais dirigidas às famílias com crianças pequenas no Brasil e na Dinamarca, e como objetivo analisar a contribuição das políticas sociais brasileiras para a superação da desigualdade de gêneros, para a promoção da cidadania das mulheres e do desenvolvimento das crianças. A análise centrou-se na regulamentação das licenças de proteção da maternidade, paternidade e parentalidade; nos subsídios atribuídos às famílias com crianças pequenas e na política de creches dos dois países. A metodologia utilizada foi baseada, principalmente, numa revisão bibliográfica e da legislação, utilizando como fonte secundária a base de dados online da Biblioteca Virtual em Saúde (BVS), Google acadêmico, periódicos CAPES, base de dados MISSOC - Mutual Information System on Social Protection, OCDE, ILO e CEPAL. Os dados estatísticos utilizados foram obtidos das bases da OCDE e da Pordata (baseada no Eurostat), Banco Mundial (The World Bank Data), além da Secretaria do Tesouro Nacional. Como resultados encontrei uma disparidade entre os 2 países analisados quanto: a licença parental - ausente no Brasil, e a política de creches na Dinamarca ­ universal a partir de 26 semanas de vida onde os profissionais possuem expertise para atuarem com crianças pequenas nas creches e jardins de infância. (AU)

The Welfare State is the result of a historical, economic, political and social evolution, and depending on the regime in each country, there will be more comprehensive social policies than others. These policies provide a set of guarantees needed to reduce the distortions caused by the capitalist industrial model that emerged in Europe at the end of the 19th century. Among the most successful examples is the Danish system, which is highlighted in this article for reflecting the most complete and efficient family leave system, capable of guaranteeing universal access to mothers and their young children, minimizing social stratification and the commodification of social guarantees. Brazil is far from this reality, but after 1930 it began to develop a series of social policies which, since the 1988 Federal Constitution, have been universal in nature. The purpose of this research is to compare social policies aimed at families with young children in Brazil and Denmark, with the aim of analyzing the contribution of Brazilian social policies to overcoming gender inequality, promoting women's citizenship and children's development. The analysis focused on the regulation of maternity, paternity, and parental leave; the subsidies granted to families with young children and the nursery policy of the two countries. The methodology used was based mainly on a bibliographic and legislative review, using as a secondary source the online database of the Virtual Health Library (VHL), Google Scholar, CAPES journals, MISSOC database - Mutual Information System on Social Protection, ILO and CEPAL. The statistical data used was obtained from the OECD and Pordata databases (based on Eurostat), World Bank (The World Bank Data) and National Treasury Secretary of Brazil. As a result, I found a disparity between the two countries analyzed in terms of: parental leave - absent in Brazil and the nursery policy in Denmark - universal from 26 weeks of age where professionals have the expertise to work with young children in day care centers and nurseries. (AU)

Association Between Maternal Work and Exclusive Breastfeeding in Countries of Latin America and Caribbean.

OBJECTIVE: The aim of this study was to estimate the association between individual and contextual characteristics related to maternal work and exclusive breastfeeding (EBF) in Latin America and the Caribbean. METHODS: A cross-sectional study, conducted with data from the Demographic and Health Survey of Bolivia (2008), Brazil (2006), Colombia (2010), the Dominican Republic (2007), Guatemala (2015), Haiti (2017), Honduras (2011) and Peru (2011). The sample included infants who were under 6 months of age and their mothers. The outcome was EBF (yes/no), individual predictors were maternal employment status (employed/not employed), type of occupation, and type of employment (formal/informal), and contextual predictors were gross domestic product, maternity leave, and percentage of women in the labor force. The association between maternal employment status and EBF was performed using multilevel Poisson analysis adjusted for maternal education level, presence of partner, place of residence, maternal age, type of childbirth, primiparity, wealth index and breastfeeding in the first hour of life. RESULTS: The prevalence of EBF was 58.0% in Bolivia, 41.1% in Brazil, 39.2% in Colombia, 7.6% in the Dominican Republic, 50.8% in Guatemala, 39.7% in Haiti, 31.1% in Honduras, and 68.1% in Peru. The percentage of employed women ranged from 19.1% in the Dominican Republic to 46.1% in Bolivia. Maternal employment was negatively associated with EBF (Prevalence Ratio [PR] = 0.77; 95% CI 0.73, 0.82), while the highest percentage of women in the labor force of the country was positively associated with EBF (PR = 1.03; 95% CI 1.01, 1.06), with an increase in the PR value after the inclusion of gross domestic product in the model. CONCLUSIONS: The prevalence of EBF was lower in infants whose mothers were employed. However, the prevalence of EBF was higher in countries with a larger percentage of women in the labor force.

Estimating the costs for implementing a maternity leave cash transfer program for women employed in the informal sector in Brazil and Ghana.

BACKGROUND: Maternity leave policies are designed to protect gender equality and the health of mothers in the workforce and their children. However, maternity leave schemes are often linked to jobs in the formal sector economy. In low- and middle-income countries a large share of women work in the informal sector, and are not eligible to such benefit. This is worrisome from a social justice and a policy perspective and suggests the need for intervening. Costing the implementation of potential interventions is needed for facilitating informed decisions by policy makers. METHODS: We developed and applied a costing methodology to assess the cost of a maternity leave cash transfer to be operated in the informal sector of the economy in Brazil and Ghana, two countries with very different employment structures and socioeconomic contexts. We conducted sensitivity analysis by modeling different numbers of weeks covered. RESULTS: In Brazil, the cost of the maternity cash transfer would be between 0.004% and 0.02% of the GDP, while in Ghana it would range between 0.076% and 0.28% of the GDP. The relative cost of rolling out a maternity intervention in Brazil is between 2.2 to 3.2 times the cost in Ghana depending on the benchmark used to assess the welfare measure. The differences in costs between countries was related to differences in labor market structure as well as demographic characteristics. CONCLUSIONS: Findings show how a standard methodology that relies on routinely available information is feasible and could assist policymakers in estimating the costs of supporting a maternity cash transfer for women employed in the informal sector, such intervention is expected to contribute to social justice, gender equity, and health trajectories.

A influência do retorno ao trabalho no aleitamento materno de trabalhadoras da enfermagem / La influencia de la reincorporación al trabajo sobre la lactancia materna en trabajadoras de enfermería / The influence of returning to work on maternal breastfeeding in nursing workers

Resumo Objetivo analisar a influência do retorno ao trabalho de mães trabalhadoras da enfermagem no aleitamento materno. Método pesquisa qualitativa, desenvolvida por meio de formulário semiestruturado, via Google Forms, junto a 49 trabalhadoras de enfermagem do estado do Rio de Janeiro. Os dados foram submetidos à análise lexicográfica, com auxílio do software Interface de R pour Analyses Multidimensionnelles de Textes Et de Questionnaires (IRAMUTEQ), pelo método de Nuvem de Palavras e Classificação Hierárquica Descendente. Resultados o aproveitamento do corpus textual foi de 88,24%, gerando quatro classes de segmentos de texto. As principais influências do retorno ao trabalho na amamentação relatadas pelas participantes foram: a falta de apoio dos chefes e colegas de trabalho, a necessidade de local e tempo adequados para ordenha do leite materno, a diminuição na produção de leite por fatores inerentes ao trabalho e sobrecarga e ambientes insalubres de trabalho na enfermagem. Conclusão e implicações para a prática a identificação desses fatores possibilita a compreensão das demandas das nutrizes participantes e aponta para a necessidade de estratégias inovadoras, que garantam o direito das trabalhadoras, assim como adequações de infraestrutura em seus ambientes laborais.

Resumen Objetivo analizar la influencia de la reincorporación al trabajo sobre la lactancia materna de madres lactantes trabajadoras de enfermería. Método investigación cualitativa, desarrollada a través de un formulario semiestructurado, con utilización de Google Forms, con 49 trabajadoras de enfermería en el estado de Río de Janeiro. Los datos fueron sometidos a análisis lexicográfico, con el auxilio del software Interface de R pour Analyses Multidimensionnelles de Textes Et de Questionnaires (IRAMUTEQ), por los métodos de Nube de Palabras y Clasificación Jerárquica Descendente. Resultados el aprovechamiento del corpus textual fue del 88,24%, y se generaron cuatro clases de segmentos textuales. Las principales influencias de la reincorporación al trabajo sobre la lactancia materna señaladas por las participantes fueron: falta de apoyo de jefes y compañeros, necesidad de disponer de lugar y tiempo adecuados para el ordeñe de la leche materna, disminución de la producción de leche por factores inherentes al trabajo y sobrecarga e insalubridad de los ambientes de trabajo en enfermería. Conclusión e implicaciones para la práctica la identificación de estos factores permite comprender las demandas de las madres lactantes participantes y señala la necesidad de adoptar estrategias innovadoras, que garanticen los derechos de las trabajadoras, además de adaptaciones de infraestructura en sus ambientes de trabajo.

Abstract Objective to analyze the influences of returning to work on maternal breastfeeding in mothers who are Nursing workers. Method a qualitative research developed through a semi-structured form, using Google Forms, with 49 female Nursing workers in the state of Rio de Janeiro. The data were submitted to lexicographic analysis, with the aid of the Interface de R pour Analyses Multidimensionnelles de Textes Et de Questionnaires (IRAMUTEQ) software, by the Word Cloud and Descending Hierarchical Classification methods. Results leverage of the text corpus was 88.24%, generating four classes of text segments. The main influences of returning to work on breastfeeding reported by the participants were as follows: lack of support from the management and coworkers, need for an adequate place and time for milking breast milk and decrease in milk production due to factors inherent to the work, in addition to overload and unhealthy working environments in Nursing. Conclusion and implications for the practice the identification of these factors enables understanding the demands of the participating nursing mothers and points to the need for innovative strategies, which guarantee the workers' rights, as well as infrastructure adaptations in their work environments.

The financing need for expanding paid maternity leave to support breastfeeding in the informal sector in the Philippines.

In low- and middle-income countries, almost three-fourths of women in the labour force lack maternity protection. In the Philippines, current laws do not guarantee paid maternity leave to workers in the informal economy. A non-contributory maternity cash transfer to informal sector workers could be used to promote social equity and economic productivity and could provide health benefits by helping mothers meet their breastfeeding goals. The objective of the study is to provide a realistic cost estimate and to assess the financial feasibility of implementing a publicly financed, non-contributory maternity cash transfer programme to the informal sector in the Philippines. Using a costing framework developed in Mexico, the study estimated the annual cost of a maternity cash transfer programme. The methodology estimated the unit cost of the programme, the incremental coverage of maternity leave and expected number of enrollees. Different unit and incremental costs assumptions were used to provide a range of scenarios. Administrative costs for running the programme were included in the analysis. The annual financing need of implementing maternity cash transfer programme in the Philippines ranges from a minimum scenario of USD42 million (14-week maternity cash transfer) to a more ideal scenario of USD309 million (26-week maternity cash transfer). The latter is financially feasible as it is equivalent to less than 0.1% of the country's gross domestic product substantially lower than the share cost of not breastfeeding (0.7%). The annual cost of the programme is only 10% of the total cost of the largest conditional cash transfer programme.

Costing a Maternity Leave Cash Transfer to Support Breastfeeding Among Informally Employed Mexican Women.

BACKGROUND: Investing in maternity protection for working women is an important social equity mechanism. Addressing the maternity leave needs of women employed in the informal sector economy should be a priority as more than half of women in Latin America, South Asia, and sub-Saharan Africa are employed in this sector. OBJECTIVE: To develop a costing methodology framework to assess the financial feasibility, at the national level, of implementing a maternity cash transfer for informally employed women. METHODS: A World Bank costing methodology was adapted for estimating the financial need to establish a maternity cash transfer benefit. The methodology estimates the cash transfer's unitary cost, the incremental coverage of the policy in terms of time, the weighted population to be covered, and the administrative costs. The 6-step methodology uses employment and sociodemographic data that are available in many countries through employment and demographic surveys and the population census. The methodology was tested with data for Mexico assuming different cash transfer unitary costs and the benefit's time coverage. RESULTS: The methodological framework estimated that the annual financial needs of setting up a maternity cash transfer for informally working women in Mexico ranges between US$87 million and US$280 million. CONCLUSIONS: A pragmatic methodology for assessing the costs of maternity cash transfer for informally employed women was developed. In the case of Mexico, the maternity cash transfer for women in the informal sector is financially feasible.

Maternity Leave and Its Impact on Breastfeeding: A Review of the Literature.

BACKGROUND: Breastfeeding is known to be the best source of nutrition for infants. The World Health Organization recommends to exclusively breastfeed up to the sixth month of life and to breastfeed with complementary foods until the age of 2. It is reported that maternity leave (ML) is one of the most important interventions for an extended breastfeeding duration. The aim of this review is to synthesize the available data worldwide on the association of ML and breastfeeding duration. We also intend to provide an overview of whether this association is differential by socioeconomic status. MATERIALS AND METHODS: Relevant primary studies relating ML and breastfeeding were included by searching several databases, including PubMed, SCielo, Health Systems Evidence, Health Evidence, Cochrane Reviews, and Epistemonikos. Articles were included up to May 2018. RESULTS: A total of 239 relevant articles were identified, of them 21 were included in the review based on exposure, outcome, and study design. These studies reported that an extended ML might be related to breastfeeding duration. In addition, studies reporting data on work type, race, and education showed that black women, women in less privileged position, and women with less education have less breastfeeding duration. CONCLUSIONS: This review showed a positive relationship between ML length and breastfeeding duration. These results have a homogeneous trend; however, this was different when studies reported results on ML and breastfeeding stratified by socioeconomic status. Public health policies should ensure that all women, especially the most vulnerable, have equal access to the benefits that ML provides.

Implicações do retorno ao trabalho após licença-maternidade na rotina e no trabalho da mulher / Implications of returning to work after maternity leave in routine and in women's work

O aumento da inserção da mulher no mercado de trabalho formal e as mudanças do papel feminino nos séculos XX e XXI, remetem a uma adaptação da mulher a esta realidade social. Muitas vezes, é necessário conciliar funções onde a mulher é desafiada a atender diversas demandas e cumprir expectativas provenientes de cada uma delas, como as funções profissional e materna. Este estudo buscou caracterizar as implicações na relação de mulheres com seu trabalho e rotina pessoal após a licença maternidade. Os dados foram coletados por meio de entrevista semiestruturada aplicadas a mulheres que haviam retornado ao trabalho após a licença maternidade de seu primeiro filho. Dentre os resultados, verificou-se que a maternidade é uma experiência significativa que influencia na rotina e no trabalho da mulher. Verificou-se ainda que as mulheres optam por conciliar os papéis materno e profissional, por perceberem benefícios sociais, cognitivos e emocionais viabilizados pelo trabalho.(AU)

Abstract The rise of the insertion of the woman in the formal job market an the changes in the female role in the age XX e XXI, remit to a woman adapting to this social reality. It is often necessary to conciliate functions where the woman is challenged to meet various demands and fulfill the expectations from each of them, such as professional and maternal functions. This study sought to characterize the implications on women's relationship with his work and his personal routine on returning to work after maternity leave. The dates have been collected through semi-structured interviews applied to wives which they had returned to work after maternity leave of her first son. Among the results, it was observed that motherhood is a meaningful experience and that influence in the routine and women's work. However also it was found that, for realize social, cognitives and emotional benefits made possibles by the work, women opt for combine both roles.(AU)

Impacto de la extensión del postnatal en la adherencia a la lactancia materna: estudio de cohorte / The impact of the extension of the post-natal in the adherence to breastfeeding: cohort study

INTRODUCCIÓN: En Chile, el año 2011 entró en vigencia la ley 20.545, correspondiente a la extensión del postnatal de 12 a 21 semanas. La Encuesta Nacional de Lactancia Materna (ENALMA), aplicada posterior al postnatal extendido, reportó un aumento del 12% en la adherencia a la lactancia materna exclusiva (LME) al sexto mes. Sin embargo, un 63% de las mujeres encuestadas eran laboralmente inactivas, por lo que las principales causas de cese de LM (lactancia materna) no estaban relacionadas con el tiempo de descanso materno. OBJETIVOS: Calcular el impacto de los cambios en la adherencia a la LME en pacientes atendidos en control sano, en el período previo y posterior a la entrada en vigencia del post natal extendido. MATERIALES Y MÉTODOS: Se realizó la extracción de datos de las fichas electrónicas del Centro Médico San Joaquín entre los años 2009 a 2013, los cuales fueron reclutados según criterios de inclusión y exclusión especificados (n = 938 pacientes). Posteriormente, fueron divididos en 2 grupos, según la presencia o ausencia de postnatal extendido, con seguimiento a los 3, 6 y 12 meses. Mediante tablas de frecuencia se realizó la caracterización de los grupos al comienzo del periodo de observación. Para evaluar homogeneidad de grupos, las variables del estudio se compararon entre los grupos mediante los test de chi cuadrado y Wilcolxon Mann-Whitney. Se comparó la prevalencia de mantención de LME mediante pr-test entre los grupos a los 3, 6 y 12 meses. Mediante análisis de sobrevida y regresión de Cox, se calculó el impacto del efecto del postnatal extendido entre ambos grupos en los primeros 12 meses. RESULTADOS: Al comienzo de los periodos de observación, no se observaron diferencias entre los grupos en las variables estudiadas. Al comparar ambos grupos, sin y con postnatal extendido, no se encontraron diferencias significativas en la adherencia a la LME a los 3 meses: 327(66%) vs 302(68%), p = 0,492, respectivamente. En contraste, en el seguimiento a 6 y 12 meses se evidenció un aumento en la adherencia a la LME: 164 (33%) a 187 (42%), p = 0,004 y a los 12 meses; de 51 (10%) a 72 (16%), p = 0,007. Al analizar el impacto de la extensión del postnatal en la adherencia a la lactancia materna, determinado por la razón de riesgo, el postnatal extendido podría influir positivamente en la adherencia a la LME en el tiempo, con un HR < 1 (HR: 0,852, p = 0,04 IC 95%: 0,728-0,996). CONCLUSIÓN: el aumento del tiempo de descanso materno, podría influir como factor protector de la adherencia a la LME.

INTRODUCTION: In Chile, Law 20,545 came into force in 2011, extending the maternity leave from 12 to 21 weeks. The National Breastfeeding Survey (ENALMA, in Spanish), applied after the exten ded maternity leave, reported a 12% increase in adherence to exclusive breastfeeding (EBF) at the sixth month. However, 63% of the women surveyed were unemployed, therefore, the main causes of cessation of breastfeeding (BF) were not related to maternal rest time. OBJECTIVES: To calculate the impact of changes in the EBF adherence in patients who attend to well-child visits in the period before and after the entry into force of the extended maternity leave. MATERIALS AND METHODS: Data were collected from electronic medical records of the San Joaquin Health Center between 2009 and 2013, which were recruited according to specified inclusion and exclusion criteria (n = 938 patients). Subsequently, they were divided into two groups according to the presence or absence of the ex tended maternity leave and with follow-up at three, six and 12 months. Using frequency tables, the characterization of the groups was carried out at the beginning of the observation period. To evaluate group homogeneity, study variables were compared between groups using Chi-square and Wico- lxon Mann-Whitney tests. The prevalence of EBF maintenance was compared by pr-test between the groups with follow-up at three, six and 12 months. Using survival analysis and Cox regression, the impact of the extended maternity leave effect between both groups in the first 12 months was cal culated. RESULTS: At the beginning of the observation periods, no differences were observed between the groups in the studied variables. When comparing groups, without and with extended maternity leave, there were no significant differences in EBF adherence at three months: 327 (66%) versus 302 (68%), p = 0.492, respectively. However, in the groups in follow-up at six and 12 months, there was an increase in EBF adherence from 164 (33%) to 187 (42%), p = 0.004 and from 51 (10%) to 72 (16), p = 0.007, respectively. Analyzing the impact of the maternity leave extension on the adherence to breastfeeding, determined by risk ratio, this extension may positively influence on the adherence to EBF over time, with a HR < 1 (HR: 0.852, p=0.04 CI 95%: 0.728-0.996). CONCLUSION: Increased ma ternal resting time may influence as a protective factor for adherence to EBF.

Influence of maternity leave on exclusive breastfeeding / Influência da licença-maternidade sobre a amamentação exclusiva

Abstract Objectives: To describe the profile of women with children aged under 4 months living in the Brazilian state capitals and in the Federal District according to their working status and to analyze the influence of maternity leave on exclusive breastfeeding (EBF) among working women. Methods: This was a cross-sectional study with data extracted from the II National Maternal Breastfeeding Prevalence Survey carried out in 2008. Initially, a descriptive analysis of the profile of 12,794 women was performed, according to their working status and maternity leave and the frequency of maternity leave in the Brazilian regions and capitals. The study used a multiple model to identify the influence of maternity leave on EBF interruption, including 3766 women who declared they were working and were on maternity leave at the time of the interview. The outcome assessed in the study was the interruption of the EBF, classified by the WHO. Results: Regarding the working status of the mothers, 63.4% did not work outside of their homes and among those who worked, 69.8% were on maternity leave. The largest prevalence among workers was of women older than 35 years of age, with more than 12 years of schooling, primiparous and from the Southeast and South regions. The lack of maternity leave increased by 23% the chance of EBF interruption. Conclusion: Maternity leave contributed to increase the prevalence of EBF in the Brazilian states capitals, supporting the importance of increasing the maternity leave period from four to six months.

Resumo Objetivos: Descrever perfil das mulheres com filhos menores de quatro meses residentes nas capitais brasileiras e no Distrito Federal segundo situação de trabalho e analisar a influência da licença-maternidade sobre o aleitamento materno exclusivo entre as mulheres trabalhadoras. Métodos: Estudo transversal com dados extraídos da II Pesquisa Nacional de Prevalência do Aleitamento Materno feita em 2008. Inicialmente foi feita análise descritiva do perfil das 12.794 mulheres participantes do estudo segundo situação de trabalho e de licença-maternidade, bem como a frequência de licença-maternidade nas regiões brasileiras e capitais. Em seguida, para identificar a influência da licença-maternidade na interrupção do AME, fez-se modelo múltiplo, no qual foram incluídas 3.766 mulheres que declararam trabalhar e estar em licença-maternidade no momento da entrevista. O desfecho adotado no estudo foi a interrupção do AME, classificado de acordo com a definição da OMS. Resultados: Em relação à situação de trabalho, 63,4% das mães entrevistadas no Brasil não trabalhavam fora do lar e dentre as que trabalhavam fora 69,8% usufruíam da licença-maternidade. Verificou-se maior concentração de mulheres que trabalhavam fora entre aquelas com mais de 35 anos, mais de 12 anos de escolaridade, primíparas, das regiões Sudeste e Sul. Não estar em licença-maternidade aumentou em 23% a chance de interrupção do AME. Conclusão: Constatou-se que a licença-maternidade contribuiu para aumentar a prevalência do AME nas capitais brasileiras, reforça a importância da ampliação da licença-maternidade para seis meses.

Influence of maternity leave on exclusive breastfeeding.

OBJECTIVES: To describe the profile of women with children aged under 4 months living in the Brazilian state capitals and in the Federal District according to their working status and to analyze the influence of maternity leave on exclusive breastfeeding (EBF) among working women. METHODS: This was a cross-sectional study with data extracted from the II National Maternal Breastfeeding Prevalence Survey carried out in 2008. Initially, a descriptive analysis of the profile of 12,794 women was performed, according to their working status and maternity leave and the frequency of maternity leave in the Brazilian regions and capitals. The study used a multiple model to identify the influence of maternity leave on EBF interruption, including 3766 women who declared they were working and were on maternity leave at the time of the interview. The outcome assessed in the study was the interruption of the EBF, classified by the WHO. RESULTS: Regarding the working status of the mothers, 63.4% did not work outside of their homes and among those who worked, 69.8% were on maternity leave. The largest prevalence among workers was of women older than 35 years of age, with more than 12 years of schooling, primiparous and from the Southeast and South regions. The lack of maternity leave increased by 23% the chance of EBF interruption. CONCLUSION: Maternity leave contributed to increase the prevalence of EBF in the Brazilian states capitals, supporting the importance of increasing the maternity leave period from four to six months.

Serviço Social e viabilização de direitos: a licença/salário‑maternidade nos casos de adoção / Social Work and the viability of rights: the statutory maternity pay and leave in cases of adoption

A licença e o salário‑maternidade são benefícios previstos no âmbito da seguridade social, integrantes da política pública de Previdência Social que se aplicam às gestantes e às mães trabalhadoras em razão da maternidade, independente da filiação biológica ou adotiva. Ocorre que o período de licença‑maternidade estabelecido em 120 dias, sem prejuízo do emprego e do salário, tem sido concedido apenas nos casos de filiação biológica, sendo fracionado a sua concessão em relação às mães adotivas conforme a idade da criança adotada. Diante dessa evidente desigualdade, constitui o presente relato um importante registro acerca da atuação e contribuição do Serviço Social, especificamente em sua prática sociojurídica, com a defesa e viabilização de dois importantes direitos sociais indissociáveis: o direito à licença/salário‑maternidade das mães adotivas (proteção à maternidade) e o direito à convivência familiar e comunitária das crianças e adolescentes (proteção à infância).

The statutory maternity pay and leave are benefits provided by the social security, and they are part of the public policy for social security. They apply to pregnant women and working mothers because of motherhood, regard-less the fact that the motherhood is biological or adoptive. It so happens that the 120‑day‑period of maternity leave, without any loss to the job or wage, has been granted only in cases of biological parentage, and it has been granted split into parts to adoptive mothers according to the child's age. This article reports this evident inequality, and it is an important record of the performance and contribution of Social Work (specifically in its socio‑legal practice) to the protection and viability of two important social rights that are inseparable: the right to statutory maternity pay and leave for adoptive mothers (maternity protection) and the right to family and community life for children and adolescents (childhood protection).

Influência da prorrogação da licença maternidade para seis meses na duração do aleitamento materno exclusivo / Influence of the extension of maternity leave to six months on the duration of exclusive breastfeeding / Influencia de la ampliación de la licencia por maternidad para seis meses en la duración de la lactancia materna exclusiva

Este estudo objetivou analisar a influência da prorrogação da licença maternidade para seis meses na duração do aleitamento materno exclusivo(AME) das mães usuárias de um Centro de Educação Infantil (CEI). Trata-se de uma pesquisa descritiva, exploratória de abordagem quantiqualitativa,realizada com 20 mães que, após o retorno da licença maternidade de 180 dias, retornaram aos seus respectivos serviços e ingressaram com seusbebês no CEI da Universidade Estadual de Maringá, em 2010. A coleta de dados foi realizada por meio de um instrumento semiestruturadocontendo questões fechadas e abertas. As questões fechadas foram tabuladas e analisadas em planilhas no programa Excel e os depoimentosavaliados por meio da análise de conteúdo. Os resultados mostraram que a população estudada apresentava fatores favoráveis à amamentação.A prorrogação da licença maternidade possibilitou que as mães amamentassem exclusivamente por um tempo mais longo, sendo o retorno aotrabalho o principal motivo para a interrupção do AME. Destarte, o estudo informa que esforços devem ser feitos pela equipe de saúde do CEI nosentido de orientar essas mães trabalhadoras, em todas as etapas do ciclo gravídico-puerperal, sobre a importância do AME até os seis meses, alémde atuar no manejo do aleitamento materno para que, quando elas retornarem ao trabalho, ainda estejam amamentando seus filhos.

This article aimed to analyze the influence of the maternity license extension from four to six months on the length of exclusive breastfeeding(EBF) of mothers whose children attended a Childhood Educational Center (CEC). This is a descriptive exploratory research with a qualiquantitativeapproach, conducted with 20 mothers that returned to work after a 180-day maternity leave, whose children attended the CECof the State University of Maringá in 2010. Data collection was performed through a semi-structured questionnaire containing closed- andopen-ended questions. The closed-ended questions were tabulated and analyzed into Excel spreadsheets and the statements were evaluatedthrough content analysis. The results showed that the population studied presented favorable factors towards breastfeeding. The maternityleave extension allowed mothers to exclusively breastfeed their babies for a longer period. The return to work was, then, the main reason forthe discontinuation of exclusive breastfeeding. Thereby, the study suggests that efforts should be made by the CEC health team in order toorientate these working mothers, during all the stages of the pregnancy and childbirth cycles, on the importance of exclusive breastfeeding onthe baby’s first six months. Moreover, they should enact breastfeeding management, so that when mothers return to work, they will be stillbreastfeeding their children.

El objetivo de este artículo es analizar la influencia de la prorrogación de la licencia por maternidad de las madres usuarias de un Centro de Educación Infantil (CEI) para seis meses, durante el período de lactancia exclusiva o amamantación exclusiva (AME). Se trata de una investigación descriptiva, exploratoria de enfoque cualitativo cuantitativo, realizada con 20 madres que, trás el término de la licencia por maternidad de 180 días, han vuelto a sus respectivas actividades laborales e ingresaron con sus bebés en el CEI de la Universidad Estatal de Maringá, en 2010. La recogida de datos se realizó por medio de un instrumento semi-estructurado compuesto por preguntas cerradas y abiertas. Las preguntas cerradas fueron tabuladas y analizadas en planillas con el programa Excel y las declaraciones fueron evaluadas por medio del análisis de contenido. Los resultados demostraron que el grupo estudiado presentaba factores favorables a la amamantación. La prorrogación de la licencia por maternidad posibilitó que las madres amamantasen exclusivamente por un tiempo mayor; el regreso al trabajo fue el principal motivo para la interrupción de la AME. El estudio indica que el equipo de salud del CEI debe hacer esfuerzos para orientar a estas madres trabajadoras, en todas las etapas del ciclo gravídico puerperal, sobre la importancia de la AME hasta los seis meses, además de ayudar en la administración de la lactancia, para que cuando ellas vuelvan al trabajo aún estén amamantando a sus hijos.

Após a licença maternidade: a percepção de professoras sobre a divisão das demandas familiares / After the maternity leave: perceptions of school teachers about the division of family work

Neste estudo, foram investigadas vivências de professoras após o retorno da licença maternidade, examinando a divisão de tarefas com seus cônjuges, satisfação com seu envolvimento familiar e o do cônjuge e com sua rede social de apoio. Foram entrevistadas 40 professoras de escolas públicas no interior paulista, mães de filhos de até dois anos. A maioria delas relatou dedicar o dobro do tempo que seus cônjuges às atividades domésticas e cuidados com os filhos, assumindo tarefas de alta frequência e com horários fixos. No geral, estas se sentiam satisfeitas com seu próprio envolvimento familiar, embora 65% delas relatou preferir passar mais tempo com seus filhos. Estas avaliaram positivamente o envolvimento familiar do esposo, mas sistematicamente menor que seu próprio. Muitas usaram outras fontes de apoio, avaliadas positivamente. Contudo, as respondentes enfrentavam grande sobrecarga, apontando para a necessidade de rever a divisão do trabalho familiar.

In this study, we investigated the experiences of school teachers returning from a maternity leave, examining the division of tasks with her partner as well as her satisfaction with her own and her partner's family involvement and with her wider social-support network. We interviewed 40 public-school teachers, mothers of children under two years of age, in the state of São Paulo. The majority of the participants related spending double the time spent by their partners on domestic chores and childcare, assuming more high-frequency tasks, performed at fixed times. In general, the respondents were satisfied with their own family involvement, although 65% wanted to spend more time with their children. They evaluated their partner's family involvement as being good, but systematically lower than their own. Many used other sources of support, which were evaluated positively. Nonetheless, the respondents were overloaded, pointing to the need to reorganize the division of family work.

Evolución de las licencias por enfermedad grave del niño(a) menor de un año 2004-2008: certezas e interrogantes / Sick leaves motivated by severe diseases of children of less than one year of age

Background: The increase in expenses of the health care system caused by sick leaves, especially those granted to mothers with children of less than one year of age with severe diseases, is a topic of concern. Aim: To describe the rates of sick leaves granted to mothers with children of less than one year of age with severe diseases from 2004 to 2008. Material and Methods: Analysis of databases containing information about sick leaves coming from Chilean public and private health care subsystems. Leaves granted to mothers with sick children of less than one year were specifically analyzed in terms of days off work and the amount of monetary benefits. Results: A sustained increase, ranging from 20 to 120% in the number of sick leaves motivated by diseases of children of less than one year, was observed. Thirty four percent of maternity leaves concentrate immediately after finishing the legal period (24 weeks after birth) and almost 60% of them occured within the first 6 months after birth. The most frequent diagnoses that motivated the higher number of leaves were gas-troesophageal reflux and bronchitis. Conclusions: There is probably a bad use of the benefit in a percentage of leaves. The benefit is also regressive since it favors mostly mothers of a better socioeconomic condition. The law that will extend the postnatal maternity leave will solve in part these problems.