EXCLUSIVE BREASTFEEDING: A STUDY ON THE CURRENT PRACTICES AND FACTORS

AFFECTING DISCONTINUITY OF BREASTFEEDING AMONG

WORKING MOTHERS OF SAN JOSE, MONTALBAN, RIZAL

A Baccalaureate Thesis

Presented to the Faculty of

COLLEGE OF NURSING

In partial Fulfillment

of the Requirements for the Courses

NURSING RESEARCH I

Bonifacio, Jhill Lhoraine P.

Ayuson, Jianna Kaye Cee P.

Angeles, Alyssa Coleen M.

Barretto, Saira Joice P.

Cuello, Renee Allison G.

Muhamed Idroos, Bushra M.

College of Nursing, SBLC

NCM 111: Nursing Research

July 2023
 APPROVAL SHEET

In partial fulfillment of the requirements for the Baccalaureate Degree in Nursing, this thesis

entitled, “Exclusive Breastfeeding: A Study on the Current Practices And Factors

Affecting Discontinuity Of Breastfeeding Among Working Mothers Of San Jose,

Montalban, Rizal”, was prepared and submitted by Bonifacio, Jhill Lhoraine P., Ayuson,

Jianna Kaye Cee P., Angeles, Alyssa Coleen M., Barretto, Saira Joice P., Cuello, Renee

Allison G., and Muhamed Idroos, Bushra M. of BSN3-1, is hereby recommended for final

defense.

MICHAEL JOHN V. FLORES, PhDNEd, RN, LPT, PD-SML

Course Facilitator

Approved as partial fulfillment of the requirements for the

BACCALAUREATE DEGREE IN NURSING by the

Committee on Oral Examination.

MICHAEL JOHN V. FLORES, PhDNEd, RN, LPT, PD-SML

Research Mentor

Accepted as partial fulfillment of the requirements for the

BACCALAUREATE DEGREE IN NURSING.

JOHN S. FLORES, RN, MAN

Dean, College of Higher Education

 Acknowledgement

First of all, the researchers would like to extend their deepest gratitude to the Heavenly Father

for giving them the wisdom, understanding, and guidance to conduct this research study.

The completion of this research paper would have not been possible if not for those people who

gave knowledge and assistance to the researchers all throughout the process of finishing the

paper. the researchers would like to express their appreciation particularly to the following:

The researchers would like to acknowledge Mr. Micahel John V. Flores, PhDNEd, RN, LPT,

PD-SML, the mentor and course facilitator who has given his support and has shared his

knowledge. He has guided the researchers in conducting this research study.

Acknowledgement and gratitude to the College of Nursing of SBLC, Dean John S. Flores

and College of Nursing faculty, for giving the researchers their utmost support and

considerations while conducting this research study.

Deep thankfulness to our Statistician and Validators, for helping us to make this research

reliable and valid. Their knowledge and expertise have greatly helped us complete this research

within deadline.

B.J.L.P., A.J.K.C.P., A.A.C.M., B.S.J.P., C.R.A.G., M.I.B.M.

 CERTIFICATE OF ORIGINALITY

The researchers hereby certify that this research study entitled, “EXCLUSIVE

BREASTFEEDING: A STUDY ON THE CURRENT PRACTICES AND FACTORS AFFECTING

DISCONTINUITY OF BREASTFEEDING AMONG WORKING MOTHERS OF SAN JOSE,

MONTALBAN, RIZAL” was authored by the undersigned. No content in this study was

previously published or written by another person(s) except where due acknowledgements were

made. Any help that we had received for the completion of this study had been identified and

acknowledged. We certify that all sources of information and literature used were properly cited

and indicated in this research study. 

Researchers, 

Bonifacio, Jhill Lhoraine P.

Researcher

Ayuson, Jianna Kaye Cee P.

Researcher

Angeles, Alyssa Coleen M.

Researcher

Barretto, Saira Joice P.

Researcher

Cuello, Renee Allison G.

Researcher

Muhamed Idroos, Bushra M.

Researcher
 ABSTRACT

Background: Exclusive breastfeeding means giving only breastmilk to an infant for the

first six month of life and no other food items shall be given to an infant. Exclusive breastfeeding

comes with a lot of health benefits to both mother and the baby.

Objective: This study aims to understand the underlying factors that contributes to the

discontinuity of exclusive breastfeeding to formulate infographic materials that suggests

solutions to resolve existing issues and to fill in the gaps when it comes to the factors there is a

difficulty in continuing exclusive breastfeeding following the suggested duration by the World

Health Organization.

Design: This study is design as a quantitative descriptive study, endeavor to achieve on

the current practices and factors affecting discontinuity of breastfeeding among working mothers

of San Jose, Montalban, Rizal. The population of this study should be residing in San Jose,

Montalban, Rizal and will focus on working mothers nonetheless if the subjects are private or

government employed, can be outside San Jose, Montalban, Rizal, whereas giving honest and

accurate facts will be established with regards to concerning how factors affect exclusive

breastfeeding. The researcher used a self-developed structured questionnaire with closed-

ended questions to gather data for the quantitative phase. Through research of the literature,

the questionnaire was put together, which consists of questions related to the factors that may

affect exclusive breastfeeding. It contains questions regarding the respondent’s personal

information, employment status, socioeconomic status, medical history, and more aspects of

exclusive breastfeeding.

Findings:

Conclusions:
 TABLE OF CONTENTS

PRELIMENARIES

Title Page…………………………………………………………………………….……………

Approval Sheet………………………………………………………………………..…………..

Acknowledgement…………………………………………………………………..…………….

Certificate of Originality………………………………………………………………..………….

Abstract…………………………………………………………………………………..…………

Table of contents…………………………………………………………………………………..

THE PROBLEM AND ITS BACKGROUND

Introduction…………………………………………………………………………………………

Statement of the Problem………………………………………………………………………...

Hypotheses………………………………………………………………………………………...

Significance of the Study…………………………………………………………………………

Scope and Limitation……………………………………………………………………………...

Definition of Terms………………………………………………………………………………...

CHAPTER II

Review of Related Literature……………………………………………………………………………..

Synthesis of the Study……………………………………………………………………………

Theoretical Framework……………………………………………………………………………

Conceptual Framework…………………………………………………………………………...
CHAPTER III

METHODOLOGY…………………………………………………………………………………………..

Research Design…………………………………………………………………………………..

Study Site…………………………………………………………………………………………..

Sample and Sampling Design……………………………………………………………………

Research Instrument……………………………………………………………………………...

Validation of the Instrument………………………………………………………………………

Ensuring the trustworthiness……………………………………………………………………..

Procedure of Data Collection……………………………………………………………………

Data Gathering Procedure………………………………………………………………………..

Statistical Tool……………………………………………………………………………………..

Mode of Analysis…………………………………………………………………………………..

Ethical Considerations…………………………………………………………………………….

Consent Process…………………………………………………………………………………..

Beneficence………………………………………………………………………………………..

Respect of Human Dignity………………………………………………………………………..

Anonymity…………………………………………………………………………………………..
 THE PROBLEM AND ITS BACKGROUND

Introduction

According to World Health Organization (2022), exclusive breastfeeding recommends

mothers to exclusively breastfeed their infants in the first six months of their life. Exclusive

breastfeeding is defined as infant feeding by breast milk only, except water and with no other

substance entering an infant's mouth for feeding purposes, excluding any medically necessary

vitamins or mineral supplements and drugs. Exclusive breastfeeding is highly recommended to

mothers for its undeniable benefits and advantages to infants. Mother's milk helps your baby

grow and develop, it has immunity for sickness and disease, breastfeed babies have higher

intelligence IQ test, provides closeness and comfort for the infants, saves money, time, and

effort and economical which also saves the environment.

Breastfeeding will aways be a relevant topic to tackle, in this research study in particular,

most of the researchers are registered midwives. The researchers observed that not all mothers

are willing to exclusively breastfeed their babies from birth up to 6 months even after the health

teachings, explaining the importance and benefits of breastmilk. According to the study done by

Batool Ali Al-Katufi et al (2020), the breastmilk has many components that enhance

gastrointestinal (GI) development, mobility, and maturity for infants, and it also protects them

from necrotizing enterocolitis. Infants that are fed by breast milk are at a lower risk of

gastroenteritis, diarrheal illnesses, urinary tract infections (UTIs), sepsis, and respiratory

infections compared with infants who are fed by a formula.

According to Ruth Petersen et.al (Breastfeeding Report Card United States, 2022),

Among infants born in 2019, most (83.2%) started out receiving some breast milk, and 78.6%

were receiving any breast milk at 1 month. At 6 months, 55.8% of infants received any breast

milk and 24.9% received breast milk exclusively. Families can face many challenges when it
comes to breastfeeding. Yet data show that most infants start out breastfeeding, and many are

still receiving some breast milk at 6 months. Even some breast milk is beneficial to infants.

However, many families do not breastfeed for as long as they intend to and breastfeeding

disparities by race and ethnicity persist. The steady decline in any and exclusive breastfeeding

from month-to-month indicates that breastfeeding families may need stronger systems of

support to reach their breastfeeding goals.

As stated by the Philippine Statistics Authority, exclusive breastfeeding practices in the

Philippines have increased modestly over time. The last National Demographic and Health

Survey to capture exclusive breastfeeding was in 2008, at which point 34% of children were

exclusively breastfed. In 2022, the percentage has increased to 41%. Despite the significant

health advantages of breastfeeding, including both in the short term and the longer term to

infants and their mothers (Binns et al, 2016), mothers still had a hard time engaging to exclusive

breastfeeding. In the Philippines, formulated milk’s rate is way up that breastfeeding’s rate.

Work-related conflicts (40%) had predominantly intervened in the continuation of exclusive

breastfeeding among 62.5% of the mothers. (Carlo Mayo, et al. 2023).

A study done by Ilana Azulay Chertok et.al. (2022), their study aimed to examine

intrapersonal, interpersonal, organizational, and community/society factors associated with

maternal report of exclusive breastfeeding at the time of discharge. Study was done in 17 WHO

European Region countries, among mothers, 72. 4% exclusively breastfed and 26.6% did not

exclusively breastfed at discharge. There was a significantly lower rate following the publication

of the WHO breastfeeding guidelines on 2020. Factors significantly associated with exclusive

breastfeeding outcomes in the logistic regression analysis included maternal age, parity,

education, health insurance, mode of birth, inadequate breastfeeding support, lack of early

breastfeeding initiation, lack of full rooming-in, birth attendant, perceived healthcare

professionalism and attention, facility room cleanliness, timing of birth, and location of birth.
 In relation to that, In the Philippines, as stated by Jigger Jerusalem (2019), breastfeeding

remains a challenge for working moms. The considerable number of lactating women who are

employed has remained one of the challenges in promoting breastfeeding outside the confines

of home. Furthermore, Antonette Gail Garcia (2023) stated that the transitioning back to the

workplace is a challenge for the breastfeeding mother, her baby, and the family or caretaker at

home. Working mothers may be able to go back to work without having to worry about their

child’s feeding if the family members or the baby’s caregiver learn how to handle breastmilk

properly and feed the child. Mothers who chose to invest in breastfeeding often lose income

opportunities or even worse, work, thus there is also a massive need for the support of

businesses, employers, labor groups and advocates, and the government in promoting

breastfeeding and providing workplaces that are breastfeeding friendly. By the establishment of

lactation stations and breastfeeding-friendly workplaces, optimal infant feeding practices are

promoted.

Few studies have already been done to identify factors that affects exclusive

breastfeeding to working mothers. According to Cecile Leah T. Bayaga et al., (2020), The

questionnaire used in their study was able to capture more information regarding socio-

demographics, food intake, and family composition. However, the focus was only on

employment status, educational attainment, and civil status. The other variables may be

explored; therefore, we must also take into consideration the civil status and/or the support from

husbands or partner of the breastfeeding young adult mothers to further provide more insight

into what affects the breastfeeding practices of mothers. This study shows that there are many

possible variables to be explored, therefor many factors may take into consideration especially

the external factors, such as the support from the husband or partner of the breastfeeding

mothers or even their family can affect the breastfeeding practices of mothers.
 In addition to that, limited studies investigated the effect of civil status in the willingness

of the mother to practice breastfeeding, employment status, and educational attainment, inability

to exclusively breastfeed is a problem to most mothers and this study aims to find out which

other factors are the reason for the cessation of exclusive breastfeeding among working

mothers in San Jose, Montalban, Rizal, whether it is internal factor or external factor that are

considered by the researchers.

The researchers contemplate different selected circumstances that hinders working

mothers of Montalban, Rizal, including understanding on exclusive breastfeeding,

sociodemographic factors, breastfeeding initiation, and different variables that fails to engage in

exclusive breastfeeding. This study aims to understand the underlying factors that contributes to

the discontinuity of exclusive breastfeeding to formulate infographic materials that suggests

solutions to resolve existing issues and to fill in the gaps when it comes to the factors there is a

difficulty in continuing exclusive breastfeeding following the suggested duration by the World

Health Organization.

This study aims at identifying or exploring the level of competency, level of compliance

and the factors affecting discontinuity of breastfeeding among working mothers of San Jose,

Montalban, Rizal. The researchers would like to further investigate on the reasons why

exclusive breastfeeding is being discontinued before the intended age for exclusive

breastfeeding specifically to working mothers of San Jose, Montalban, Rizal. The results and

finding of this study will contribute to nursing practice, policy, education, and research. The

outcome of this study will add to the existing literature and may be used to further improve

nursing practice in relation to exclusive breastfeeding.

Statement of the Problem

 Existing studies had been made to other demographic but showed knowledge gap

pertaining to the current practices and factors affecting exclusive breastfeeding to young adult

working mothers. This particularly study aims to further determine the current practices and

factors affecting discontinuity of breastfeeding among working mothers of San Jose, Montalban,

Rizal.

Specifically, it seeks to answer the following questions:

1. What is the profile in terms of:

1.1 Age

1.2 Civil Status

1.3 Work Set-up

1.4 Type of Institution

1.5 Socio-economic status

2. What are the factors affecting exclusive breastfeeding among working mothers? As to.

2.1 Internal Factors

2.2 External factors

3. What is the level of competency on exclusive breastfeeding among working mothers? As to.

1.1 Knowledge

1.2 Skill

1.3 Attitude

4. What is the level of compliance on exclusive breastfeeding among working mothers?

5. Is there a significant difference between the level of competency and level compliance on

exclusive breastfeeding among working mothers when grouped according to their profile?

6. Is there a significant relationship between the respondent’s profile and the level of

competency and compliance on exclusive breastfeeding among working mothers?

7. Is there a significant relationship between the respondent’s profile and the factors affecting

exclusive breastfeeding among working mothers?

8. Based on the result of the study what infographic material could be developed to better

assist working mothers to continue exclusive breastfeeding?

Hypotheses

“Breastfeeding provides unmatched health benefits for babies and mothers. It is the

clinical gold standard for infant feeding and nutrition, with breast milk uniquely tailored to meet

the health needs of a growing baby. We must do more to create supportive and safe

environments for mothers who choose to breastfeed.” Dr. Ruth Petersen, director of CDC’s

Division of Nutrition, Physical Activity, and Obesity

Ha1: There is no significant difference between the level of competency and level

compliance on exclusive breastfeeding among working mothers when grouped

according to their profile?

Ha2: There is no significant relationship between the respondent’s profile and the level

of competency and compliance on exclusive breastfeeding among working mothers?

Ha3: There is no significant relationship between the respondent’s profile and the factors

affecting exclusive breastfeeding among working mothers?

Significance of the Study

This study aims at identifying or exploring on the level of competency, level of

compliance, and factors affecting discontinuity of breastfeeding among working mothers of San

Jose, Montalban, Rizal. The researchers would like to further investigate on the reasons why

exclusive breastfeeding is being discontinued before the intended age for exclusive
breastfeeding specifically to working mothers of San Jose, Montalban, Rizal. Vital results of this

study will be highly significant and beneficial to the following:

Nursing Practice. This study intends to help nurses understand mother’s reasons why

they can no longer commit to exclusive breastfeeding and help them find solutions so mothers

can continue exclusively breastfeed their infants. It has been scientifically proven that breastmilk

is way more beneficial than formula milk. The result of this study will help them be more patient

specific when giving advice on exclusive breastfeeding, in a way it will make nursing practice

more effective.

Nursing Administration. This will be beneficial for institutions to gain understanding to

different situations of breastfeeding mothers when it comes to breastfeeding. This will help

institutions that are catering maternal cases to improve their way in convincing mothers to

exclusive breastfeed their infants for the first 6 months. Moreover, this will guide them in

identifying program to support working mothers in pursuing exclusive breastfeeding.

Nursing Educators. This study can be used to further understand breastfeeding which

will serve as an additional learning to nursing educators. This will also help nursing educators

and nursing students improve their health teaching when handling actual patients.

Nursing Research. Future researchers can use this study as a reference to their own

research particularly when it comes to exclusive breastfeeding of the same or different

demography. They can use this study to a wider number of respondents to gather more data.

Scope and Limitation

This study will focus on the current practices and factors affecting discontinuity of

breastfeeding among working mothers of San Jose, Montalban, Rizal. The respondents are
working mothers who are breastfeeding or had been breastfeeding with infants aged 6 months

or below, respondents must be residing in San Jose, Montalban, Rizal. This study will only focus

to the factors or problems that may affect working mothers to exclusively breastfeed their

newborn baby or infant and is limited only to working mothers who breastfeed and with infants

aged 6 months or below residing in San Jose, Montalban, Rizal.

This study will explore the current practice and factors affecting the exclusive

breastfeeding of working mothers on why exclusive breastfeeding are discontinued before the

first 6months of their infants. Respondents will be interviewed in a form of a questionnaire; each

respondent will be given the same questionnaire and their answers will be used for this study.

The data that will be gathered from the said respondents and will be treated with at least

confidentiality and strictly used for this particular study.  

Definition of Terms

Key words are defined both conceptually and operationally. Conceptual definitions are derived

from the dictionary or from other authors. While the operational definition is the way that the

researcher defines and uses keywords involving his research.

Exclusive Breastfeeding

This is defined as feeding infants only breastmilk, not any other food or liquid, it may be

directly from the breast or expressed during the first 6 months of life (WHO, 2023).

Unexclusive Breastfeeding

Contrast to exclusive breastfeeding, it is giving formula milk to infants during the first 6

months of life.

Early Initiation of Breastfeeding

 This is defined as provision of mothers’ breastmilk to infants within the first (1) hour of

life and ensures that newborn receives colostrum (Cleaveland Clinic Medical Professional,

2022). This is also included in the last step of Essential Intrapartum Newborn Care (EINC) that

is strictly implemented in the lying-in clinics and hospitals in the Philippines.

Breastmilk

Also referred to as ‘mother’s milk’. This is produced by the mammary gland in the breast

of woman during or after pregnancy ( Arthur I. Eidelman, MD et al, 2012). This provides all the

nutrients that is needed by the infants during their first six (6) months of life.

Formula Milks

Milk that is usually made from cow’s milk, also called as a ‘breastmilk substitute’. This is

manufactured to mimic human milk and is used when mother is medically advised not to

breastfeed due to illnesses that can be transmitted through breastmilk (Olivia Ballard and

Ardythe L. Morrow, 2014).

Immunity

A protection against any infection. Breastmilk contains IgA antibodies that protects baby

from infections and illnesses (Genevieve G. Fouda, 2018).

Infant

A child in the first year of life.

Competence

Possession of sufficient knowledge or skill (Merriam Webster,2023).

Compliance
 The act or process of complying to a desire, demand, proposal, or regimen or to

coercion (Merriam Webster,2023).

Chapter II

Review of Related Literature

This chapter presents the literature of related studies that served as basis and guide for

the researchers. This chapter also presents the synthesis of the study, theoretical and

conceptual framework to further support the present study.

According to CDC (Centers for Disease Control & Prevention) division of nutrition,

physical activity, and obesity (July, 2021), breastfeeding has health benefits for both mothers

and babies. This health benefits can protect both mothers and babies against certain illnesses

and diseases. Breast milk provides a baby with nutrition and support growth and development.

According to them there are five (5) great benefits of breastfeeding: Breast milk is the best

source of nutrition for most babies, Breastfeeding can help protect babies against some short-

and long- term illnesses and diseases, Breast milk share antibodies from mother with her baby,

Mothers can breastfeed anytime and anywhere, and Breastfeeding can reduce them mother’s

risk of breast and ovarian cancer, type 2 diabetes, and high blood pressure. The American

Academy of Pediatrics recommends exclusive breastfeeding for about 6 months, and then

continuing breastfeeding while introducing complementary foods until child is 12 months old or

older.
 Additionally, according to the study written by Koura, Hussein (“Risk Factor for

Cessation of Breastfeeding”, January- March 2019), exclusive breastfeeding decreases

mortality and morbidity from pneumonia and diarrhea, which are the main child

killers. Breastfeeding decreases the threat of noncommunicable diseases, including childhood

asthma, obesity, diabetes, and heart disease later in life. In addition to unique health

advantages for infants and mothers, breastfeeding additionally benefits the society by means of

reducing health care cost, parental employee absenteeism, and associated lack of family

income. The findings of this study have proven that delivery by caesarean section, mother’s

employment, usage of oral contraceptives, higher level of education, and absence of support

for breastfeeding are risk factors for cessation of breastfeeding.

As well as indicated in the study of Amira Ali Aldalili and Azza Mahalli (2022), “Sore

breast or nipples” was another risk factor related to the cessation of EBF. Mothers complained

of painful nipples, general or unspecified BF pain, sore breasts, engorgement, breast pain, and

biting. Moreover, “perceived minimal milk quantity” was a risk factor associated with cessation of

exclusive breastfeeding. On the other hand, perceived insufficient milk comes from lack of

mothers’ knowledge about lactation physiology. One study addressed maternal concerns in

relation to perceived insufficient milk, especially regarding the role of maternal interpretation of

crying as a sign of hunger and its role as the initiator of the perceived insufficient milk cycle. The

study recommended making the connection between incomplete or infrequent removal of milk

from the breast and breast milk production clearer to women may play an important role in

reducing the prevalence of perceived insufficient milk and its impact on exclusive breastfeeding

rates. Additionally, the study recommended manual breast milk extraction if the mother and

baby were apart.

According to Yusuf M. Salim and William Stones, the odds of exclusively breastfeeding

for a mother aged 25 to 34 years is 0.91 times high compared to the reference group of mothers
aged 15 to 24 years. This category is not significant on the outcome variable. Similarly, the odds

of exclusively breastfeeding for a mother aged 35 years and above is 1.63 times as high as the

odds of mothers aged 15 to 24 years being exclusively breastfeeding. This category is also not

significant on the outcome variable.

Furthermore, Mary Anne Dunkin (2022) stated that, one of the most common risk factors

for a high-risk pregnancy is the age of the mother-to-be. Women who will be under age 17 or over

age 35 when their baby is due are at greater risk of complications than those between their

late teens and early 30s. The risk of miscarriage and genetic defects further increases after age 40.

Childbearing below 18 years old and above 35 years old are most likely to develop complication

during pregnancy and labor may result to higher morbidity and mortality to both mother and child.

The marital status (Civil Status) of the mother was identified as the associated factor

with practice exclusive breastfeeding. The result showed that married mothers were more likely

to practice exclusive breastfeeding compared to unmarried mothers. This result was consistent

with the other studies conducted in Tanzania, and Canada. The probable reason could be

married mothers get support to practice exclusive breastfeeding from their partners and other

family members. Mothers and husbands with no education were less likely to exclusively

breastfeed their infants compared to educated mothers and husbands (Mitiku Wale Muluneh,

2023). 

Furthermore, Marital status, residence, and actual times of mothers to return back to

work were statically significant for mothers’ good knowledge towards exclusive breastfeeding.

Mothers’ level of education, support from husbands, maternity leave, and actual time of mothers

to return back to their workplace were statistically significant for appropriate practice of
exclusive breastfeeding. Generally, the level of exclusive breastfeeding practice among

employed mothers in the study area was low as compared with the World Health Organization

recommendation. Actual time to return to work from leave was statistically associated for both

knowledge and practice of exclusive breastfeeding. For employed mothers, it is advisable to use

their annual leave after the end of the maternity leave. Husbands should actively support their

wives in the practice of exclusive breastfeeding. For the policy makers, it is advisable to revise

the existing maternity leave to extend for some additional months. Government should work on

mothers’ education to increase the exclusive breastfeeding practice (Amare Lisanu Mazengia

and Hibru Demissie, 2020).

As stated by Mitiku Wale Mulune (2023), mothers who are housewives were more likely

to practice exclusive breastfeeding than employed mothers. The possible explanation may be

the early return of employed mothers to the office, lack of support from the office and short

maternity leave (only four months paid leave in the Ethiopian case) could also discourage

employed mothers. Employed mothers may be relatively overloaded with their office and home

activities and may have limited contact time with infants.

On the one hand, according to research that made by S. Ickes, et. al, (“Exclusive

Breastfeeding Among Working Mothers in Kenya: Perspectives from women, families, and

employer), there are many factors why many working mothers in their country cannot abide the

6 months exclusive breastfeeding. Their study shows the different factors that affects many

working mothers in Kenya, these are: Employment- related challenges to EBF (Exclusive

Breastfeeding, Experiences with breast milk expression, BF (Breastfeeding) in the context of

HIV, Workplace supports for working mothers, and Recommended interventions to support

EBF. The conclusion of their study is that despite consistent knowledge of the child feeding

recommendations and benefits of EBF, the need for mothers to return to work after maternity

leave corresponds with numerous challenges. These include distance to childcare, inability to
nurse during the workday and lack of support for and experience with milk expression, making

EBF unattainable for most mothers in these industries.

In the same way, as stated by the research of E. Adugnaw, G. Gizaw, M. Girma, et. al

(Scientific Reports 13, Article number: 6259, 2023), the findings of their study revealed that

employed mothers were more likely to cease exclusive breastfeeding before 6 months. Family

support and perceived breast milk adequacy were associated factors with cessation of exclusive

breastfeeding before 6 months among unemployed mothers. Employed mothers may likely

return to work early after giving birth, if necessary, support to continue exclusive breastfeeding

is not provided by employers. Postnatal counselling on exclusive breastfeeding was also

significantly associated with the cessation of exclusive breastfeeding in this study. The hazard

of mothers who were not informed about exclusive breastfeeding in their post-natal care visits

was 3.9 times more likely to cease exclusive breastfeeding before 6 months as compared to

mothers who were informed about exclusive breastfeeding during postnatal care visit. 

Also, As explained by the writers of the study “Enablers and Barriers of Exclusive

Breastfeeding Among Employed Women in Low and Lower Middle- Income Countries”, K.

Gebrekidan, et. al, under the Sustainable Development Goals (SDG), the global under five

mortality rate is targeted to be 25 per 1000 live births by 2030. In 2018, the rate was 39 per

1000 live births globally, while the figure was much higher (68 deaths per 1000 live births) in

low-income countries. Exclusive breastfeeding (EBF) provides an important and effective

strategy to achieve the SDG goal, for developing countries.

Apart from this, research has found that returning to work is the most common reason

for not adhering to EBF. This is particularly the case in low and lower middle-income countries

where women more commonly need to return to work before six months after giving birth,

compared to women in higher-income countries. Due to high poverty rates, lack of clean water,

poor sanitation infrastructure and lack of access to healthcare in underdeveloped countries,

interruptions in EBF can negatively influence infants’ health and growth (Sexual & Reproductive

Healthcare, Vol. 25, October 2020).

As well as said by Batool Ali Al-Katufi, et al, 2020, The most pervasive barrier to

exclusive breastfeeding was an early return to work, followed by deficient work support for

breastfeeding. Insufficient breast milk was a third barrier to exclusive breastfeeding found in this

study, and the fourth barrier to exclusive breastfeeding was a lack of time to commit to the

process of breastfeeding. Lack of nursing breaks, lactation places, and expressed milk storing

facilities inside work are the major work-related barriers to continuity of exclusive breastfeeding.

A majority of working mothers are aware about benefits of exclusive breastfeeding, although

nearly half of them stop breastfeeding after they rejoin the workforce. The majority complained

about strict work times that prevented them from freely using their nursing breaks.

Additionally, according to Gordon Abekah-Nkrumah et al (2020), Consistent with the

ecological theory, the results suggest that individual, interpersonal, community, organizational

and policy level attributes explain working mothers’ decision to exclusively breastfeed for 6

months. Specifically, knowledge and experience and workplace factors constitute key drivers of

exclusive breastfeeding by mothers. This finding is contrary to the constant emphasis on

individual level factors such as information dissemination and education of nursing mothers,

both within the literature and at the policy level. It is therefore important that policy interventions

begin to focus on addressing workplace factors. Through the appropriate incentive system, the

state can encourage employers to address issues related to closing time for nursing mothers,

provision of institutional support with respect to maternity leave policy in organizations, and

work-family imbalance. Addressing these challenges will not only help in promoting exclusive

breastfeeding with its intended benefits but will also be instrumental in helping breastfeeding

mothers to be productive at the workplace.

 Furthermore, based on the study of Rachel E. McCardel and Heather M. Padilla (2020),

working mothers’ experiences with expressing breast milk at work depended on their job

characteristics. Some barriers were specific to job duties such as traveling for work while others

represented challenges most working mothers may face such as no access to a private space

for breastfeeding, while common facilitators were access to breaks for breastfeeding, private

spaces to breastfeed, and social support from coworkers or supervisors. Previous studies have

shown that the number of workplace resources working mothers received was positively

associated with exclusively breastfeeding for the first 6 month.

As well as reported by Rita Surianee Ahmad et al. (2022), Working mothers need

support from their spouses, families, friends, employers, and healthcare staff. This finding

indicates the need for interventions in the form of simple and user-friendly breastfeeding

education programs specifically for working mothers. Working mothers have difficulties to

enhance knowledge regarding breastfeeding due to time limitations and work commitments, this

mother needs persistent motivation related to breastfeeding. Information on the causes of

breastfeeding challenges and how to overcome them is crucial to preventing mothers from

thinking that breastfeeding is difficult, especially when they return to work. The main challenge

to continuing breastfeeding was having insufficient breast milk, especially when the mothers

returned to work. This influenced their decision to continue breastfeeding. Studies have found

that insufficient milk, engorged breasts, and pain during breastfeeding are the main challenges

to breastfeeding during confinement.

Additionally ,based on the study of Gordon Abekah-Nkrumah et al. (2020), Consistent

with the ecological theory, the results suggest that individual, interpersonal, community,

organizational and policy level attributes explain working mothers’ decision to exclusively

breastfeed for 6 months. Specifically, knowledge and experience and workplace factors

constitute key drivers of exclusive breastfeeding by mothers. It is contrary to the constant

emphasis on individual level factors such as information dissemination and education of nursing

mothers, both within the literature and at the policy level. It is therefore important that policy

interventions begin to focus on addressing workplace factors. Through the appropriate incentive

system, the state can encourage employers to address issues related to closing time for nursing

mothers, provision of institutional support with respect to maternity leave policy in organizations,

and work-family imbalance. Addressing these challenges will not only help in promoting

exclusive breastfeeding with its intended benefits but will also be instrumental in helping

breastfeeding mothers to be productive at the workplace.

Similarly, Scott B. Ickes et al (2021) stated that Mothers employed in low-wage work

receive some supports from their employers for infant care responsibilities. Despite consistent

knowledge of the child feeding recommendations and benefits of EBF, the need for mothers to

return to work after maternity leave corresponds with numerous challenges. These include

distance to childcare, inability to nurse during the workday and lack of support for and

experience with milk expression, making EBF unattainable for most mothers in these industries.

Additionally, as demonstrated by Firmaye Bogale Wolde et al (2021) Providing mothers

with a friendly environment makes them work with stability, motivation, and satisfaction based

on the current study. This, however, requires a suitable supporting condition with a focus on the

different kinds of work environments of the mothers and the different risks related to each

respective environment. The presented supporting conditions had their advantages and

drawbacks suggesting that there is not a single absolute solution. Additionally, six months

maternity leave was also stated as a good option that can improve breastfeeding habits among

working mothers and one that brings more stability to mothers’ working status. 

On the one hand, in the qualitative part of the study of Jiawen Chen et al (2019), heavy

workload, high level of stress at workplace, and other barriers may negatively influence

continuous breastfeeding. This may be especially true for mothers in business and white-collar
positions. Although some mothers might have breastfeeding breaks, distance from home or lack

of lactation rooms at workplace hindered their current breastfeeding practices. Some studies

have identified that having a designated lactation room (other than a bathroom, storage space,

or equipment room) is a factor associated with breastfeeding success. Women need clean and

private facilities where they can express breast milk at work. Our findings suggest that lack of

lactation rooms is one of the most serious barriers for working mothers to continue

breastfeeding. Additionally, heavy traffic problems in urban metropolis are another barrier to

breastfeeding, making it difficult for mothers to return home during breastfeeding breaks.

Considering all the stated barriers, many mothers shared the concerns about the difficulties of

expressing, storing, and transporting breast milk at work.

Moreover, based on Tolossa Kebede et al (2020) Barriers of expressing milk in the

workplace include lack of flexibility for milk expression in the work schedule, lack of

accommodations to pump or store breastmilk, lack of support from employers and colleagues,

and real or perceived low milk supply. However earlier studies showed that providing employed

mothers with pumping information and the necessary facilities could reduce the cessation of

exclusive breastfeeding. Failing to express milk in workplace and home is a barrier against

successful EBF after return to work and can lead to premature weaning. In bivariable logistic

regression, achieving secondary education and diploma level, being employee of private

organization, short duration of maternity leave, lack of a reasonable lactation break, being full

time employee, lack of flexible working time, having shift work, workplace being far from her

child, not pumping breast milk, and lack of a breastfeeding place at the workplace all resulted in

a significantly higher chance of discontinuing exclusive breastfeeding.

According to Amare Zewdie et al (2022), exclusive breastfeeding practice is found lower

compared to the expected standard of achievement. There is a significant difference in the

prevalence of exclusive breastfeeding practice between employed and unemployed mothers.

Unemployed mothers are more likely to exclusively breastfed their children than employed

mothers. This showed that maternal employment is associated with low exclusive breastfeeding

practice. Some predictor variables are different for employed and unemployed mothers.

In addition, C. Horwood et al (2020), stated that women informal workers face multiple

challenges to breastfeeding their children leading to poor feeding practices that may adversely

affect child health and development in this vulnerable population. Household income is

frequently dependent on women’s work and informal workers struggle to balance childcare

needs with the need to work and provide for themselves and their family. Unless the challenges

facing women working in the informal economy are addressed at the individual, household,

community and municipal level, it is unlikely that global health and development goals, and

global breastfeeding targets will be met. This will require removing the structural and societal

barriers to childcare and increasing the value that communities place on maternal and child

health. Investments in social protection and public services are required, including childcare, to

support gender equality within families and society at large. The next step of our multi-country

collaboration is to address the interconnected pathways for intervention and support informal

working mothers to sustain their livelihoods, protect their own health and nurture their children.

Also, Scott Ickes et al (2021) stated that mothers employed in low-wage work receive

some supports from their employers for infant care responsibilities. Despite consistent

knowledge of the child feeding recommendations and benefits of exclusive breastfeeding, the

need for mothers to return to work after maternity leave corresponds with numerous challenges.

These include distance to childcare, inability to nurse during the workday and lack of support for

and experience with milk expression, making exclusive breastfeeding unattainable for most

mothers in these industries. Participants' recommended interventions to support exclusive

breastfeeding for working mothers were consistent across participant groups; however, quality

evaluation of some of these interventions is needed. Improved intervention implementation,

coupled with rigorous evaluation, is necessary to strengthen employed mothers' opportunities

for optimal breastfeeding practices, including exclusive breastfeeding, upon return to work.

For further instance, according to Cecile L T Bayaga et al (2020), that there is a

strong relationship between employment status, educational attainment, and civil status

mothers to their breastfeeding practice. Mothers with full-time work are less likely to

continue exclusive breastfeeding due to the need to return to the workplace. Mothers who were

able to reach college were also less likely to exclusively breastfeed their infants. This may be

attributed to the correlation of having a job with having higher educational attainment compared

to others. Mothers who are married are less likely to practice exclusive breastfeeding, and this

may be influenced by parental support and other environmental factors that were not considered

in the study. Regarding the working mothers, it is encouraged that companies allow the

presence of breastfeeding rooms with adequate storage facilities so that the mother can provide

breastmilk to the infant. Health and nutrition experts should also provide information

dissemination on alternatives for breastfeeding such as keeping milk at the mother’s home so

that they have the resources for when the mother has to go to work. Further studies are

recommended to be able to cover more environmental factors and a bigger sample size to be

able to create a clearer picture of the current status and hindrances on exclusive breastfeeding.

For further instance, based on Valerie Gilbert Ulep et al (2020), a publicly financed non-

contributory maternity protection program or informally employed women. Although the political

and institutional feasibility of such program needs further assessment, its cost seems affordable

especially in light of the economic gains from positive health and non-health outcomes

associated with improved breastfeeding rates and female labor force participation. The

Philippines had a long history of implementing and managing income protection schemes. Also,

there are already existing social protection schemes that can be used to properly tailor a

maternity cash transfer program in the Philippine context.

 Moreover, according to Em de Guzman-Cruz (2020) Working from home in the new

normal affords parents some advantages: spending more time with their kids, seeing their

baby’s milestones, and for breastfeeding moms – more chances to breastfeed. And while this

breastfeeding mom-WFH mom flexibility has a higher chance of success, it can also leave us

moms tired and burned out on both fronts. breastfeeding moms might have got their routines

down pat: have their pump, milk bags, and ice packs, and set a pumping sked throughout. But

what about breastfeeding work from home moms? Granted, it can be easier to just latch while in

front of the computer at home, but when you’re juggling a crying baby, video calls, and an active

toddler all at the same time, things can get out of hand

As specified by Gordon Abekah-Nkrumah et al, (2020) Given that all respondents had

the experience of breastfeeding at least one child, they understood the importance of exclusive

breastfeeding. This notwithstanding, they all faced some challenges in complying with the

recommended 6 months of exclusive breastfeeding. All respondents indicated that for the first 4

months (3 months maternity leave and 1month annual leave) they were physically present to

exclusively breastfeed their babies. However, when they returned to work, they had to rely on

relatives to feed their babies with expressed breast milk in feeding bottles. Also, mothers

indicated that while at home (i.e., on leave), they were able to manage their household chores

alongside exclusive breastfeeding of their babies.

In addition, according to Firmaye Bogale Wolde (2021), The three months’ leave is

expressed as not being sufficient and that it forces mothers to seek other ways of solution like

using their annual leave, sick leave, or asking for unofficial arrangements from their bosses.

This situation has created a gap that allows and makes employers give unofficial and non-

uniform supports to breastfeeding mothers which are explained in a great intensity by mothers

with only three months of maternity leave. Besides, the three months of maternity leave is

implemented in a non-consistent way in organizations where it is flexible to postpone in some

places but not in others. This inconsistency of the maternity leave would lead to partiality or

differential treatment as reflected by the mothers. Mothers in this study have used their annual

leave as a solution and stayed home longer than their officially provided leave. Such type of

unexpected longer leave might bring more pressure and affect the work process more than a

planned one.

As well as mentioned in the study of Tria Astika Ednah Permatasari and Ni Wayan

Sudiartini (2020), the low proportion of exclusive breastfeeding among working mothers may be

influenced by several factors such as support at workplace, family support, and health worker

support. Working mothers have shorter have a shorter time to breastfeed their babies than

mothers who don’t work. It also has an impact on the timing of breastmilk pumping that probably

corelated with breastmilk volume. Likewise, nursing mothers who become full-time workers

especially in urban areas leaves her baby at home at least 10hrs every day which is the total

number of trips to work and return home plus the hours used at workplace. Their study showed

that husband’s and health workers’ support positively related with exclusive breastfeeding

practice.

Moreover, based on the study conducted by Getu Engida Wake and Yohannes Moges

Mittiku (2021), Full-time maternal employment was negatively associated with the practice of

exclusive breastfeeding in comparison to unemployed mothers. The prevalence of exclusive

breastfeeding in Ethiopia is low in comparison to the global recommendation. Based on our

review findings, we recommended that the Ethiopian government should increase legislated

paid maternity leave after delivery beyond currently paid maternity leave and implement policies

that empower women. The governmental and non-governmental organizations should create a

conducive environment for employed mothers to practice exclusive breastfeeding at the

workplace. Mothers who returned to work before 6 months postnatally and who have less

frequent contact with their baby and employed mothers who begin liquid and solid based
supplementation of food before the recommended age of starting weaning food which will result

in the decreased practice of exclusive breastfeeding.

Additionally, Ermiyas Mulu Kebede and Benyam Seifu stated that most of the

government institutions do not have nursery facilities, and workplace breastfeeding

arrangements and support for employed mothers by employers and other initiatives are

nonexistent. Maternity leave is one of the opportunities that will promote breastfeeding for

working mothers. The absence of breastfeeding laws, arrangements, and supports for employed

mothers limits their ability and right to practice optimal breastfeeding. Policymakers,

governments, and all concerned bodies should give due attention to enacting and enforcing

sound laws and establishing arrangements and supports that will enable employed mothers to

practice optimal breastfeeding upon return to work. Future researchers could focus on

assessing the consequences of the problem and contextualizing and piloting different

breastfeeding-friendly workplace interventions.

Also, according to Rubina Shrestha et al (2021), Employment status was significantly

associated with exclusive breastfeeding practice. The reason could be short maternity leave

period, no childcare facilities at workplace to carry infant, consecutively influences them to

continue exclusive breastfeeding practice and introduce formula feeding. Study revealed that

mothers with low monthly income had significant association with breastfeeding practices. The

prevalence of exclusive breastfeeding practice was low among employed mothers in

comparison to unemployed mothers. Thus, exclusive breastfeeding practice should be

encouraged to support working mothers by extending maternal leave, creating work-site

daycare centers for infants and conducting health programs on exclusive breastfeeding

practices including how to use expressed milk when they are away from their child.

According to the Implementing Ruled and Regulations of Republic Act no. 11210 known

as “An Act Increasing the Maternity Leave Period to 105 days for Female Workers with an
Option to Extend for an Additional 30 days without pay, and Granting an Additional 15 days for

Solo Mothers, and for Other Purposes. Maternity leave benefits are leave credits extended to

cover all female employees who may want to use them during their pregnancy and even after

their delivery, so that they remain paid during such absence from work. Whether single or

married, female employees can use the said leave credits in every instance of pregnancy,

miscarriage or emergency termination of pregnancy, regardless of frequency.

Gordon Abekah-Nkrumah et al. (2020) stated that, many working mothers’ decision to

continue exclusive breastfeeding is in part influenced by the knowledge that breastfeeding the

baby helps to give the baby some added advantage compared to non-breastfed babies.

Furthermore, existing evidence suggests that a longer duration of exclusive breastfeeding is

significantly associated with positive maternal attitudes toward breastfeeding and good mother-

infant bonding. The level of mother’s education is also associated with the level of dedication in

the practice of exclusive breastfeeding. It is common knowledge that the educational level of

mothers helps them to make informed decisions on the benefits of exclusive breastfeeding.

In addition, the study that been conducted to Thailand about “Exploring the association

between Socioeconomic and Psychological Factors and Breastfeeding in the First Year of Life

during the COVID-19 Pandemic in Thailand” (S. Nuampa, C. Patil, et. al, Dec., 2022), the

purpose of their study is to examine the relation between socioeconomic and psychological

factors with breastfeeding duration in the first year of life during the COVID-19 pandemic. It

states that as a result of COVID-19’s effects of economic and psychological difficulties,

breastfeeding outcomes have declined. Their study shows that during the pandemic,

psychological factors were more strongly associated with breastfeeding during the first year of

life than socioeconomic factors. They stated that health workers or health providers should

promote breastfeeding intention, motivate COVID-19 vaccination intention, and support mental

health among lactating mothers, particularly in the event of a pandemic.

 Moreover, Mehedi Hasan et al (2021), found several factors, such as good knowledge

and positive attitude, hospital and vaginal delivery, education level, and housewife mothers,

were significantly associated with good exclusive breastfeeding practices. These findings help

to design interventions that need to improve exclusive breastfeeding. Counselling programs

both at the community and individual level to promote exclusive breastfeeding practices are

needed. Government and non- government organizations should take steps designing an

intervention on discouraging home delivery in absence of healthcare providers or skilled birth

attendant, and encouraging vaginal delivery to increase exclusive breastfeeding practices

among Bangladeshi mothers. Initiatives should be taken for the proper execution of the

recommended interventions, which should significantly increase exclusive breastfeeding

practice, reduce infant morbidity and mortality rates, and help to achieve SDG-3(good health

and well-being) in Bangladesh.

Such as according to the of findings David Haas et al (2022) that age and weight are not

associated with breastfeeding duration. Women who smoked proximate to delivery were less

likely to breastfeed. Their finding was also noted among individuals in a Spanish birth cohort, in

whom smoking was associated with a more than two-fold higher rate of formula feeding and

shorter breastfeeding duration. Previous studies found that other social markers (such as lower

education attainment and not attending prenatal classes), as well as physiologic factors such as

delayed onset of lactation, inadequate milk production, nipple pain, latching problems and lack

of social support are associated with early discontinuation of breastfeeding. Attending prenatal

classes and a previous successful breastfeeding experience have been associated with longer

duration of breastfeeding.

Furthermore, according to a multivariate analysis done by Diana Cascone et al (2019),

practicing exclusive breastfeeding during the hospital stay and receiving a recommendation to

breastfeed during the hospital discharge were the factors most strongly associated with the
practice of exclusive breastfeeding. These results highlight the key role of healthcare providers

in increasing appropriate behaviors regarding breastfeeding and, therefore, the importance of

women receiving proper information. Other previous studies have also confirmed the key role

and influence of correct information on breastfeeding provided by healthcare professionals. In

addition, women with a college degree or higher level of education were more likely to have

heard about exclusive breastfeeding and to know that it should be practiced for up to six

months. This result is consistent with other previous studies conducted among women in the

same geographical area, which confirmed the positive impact of a high level of educational on

the subject’s knowledge related to the health topics.

Thus, Dr. Stella Marie Jose and Dr. Aurora Gloria Libidia (2022) advised that mothers

who are already working need to know how to collect and store their breast milk. At room

temperature, breast milk lasts four to eight hours; inside the refrigerator at two to four degrees

centigrade, it lasts one to eight days; if it can be placed in the freezer or in the compartment of a

refrigerator, for two weeks; if using a two-door refrigerator, inside the freezer, three months; if

using a deep freezer, six to 12 months; and if it's already thawed in a refrigerator, it lasts for 24

hours. Slow thawing is accomplished by transferring the milk from the freezer to the refrigerator

one day before use; quick thawing is accomplished by placing the milk in a large container of

warm water or tap water.

In addition, Dr. Libadia pointed out that mothers should empty their breasts every two to

three hours to sustain lactation and cup feeding with expressed breastmilk to prevent nipple

confusion. She discussed that RA 100028 protects breastfeeding employees with the provision

of a lactation period for breastfeeding employees in addition to mealtimes for a total of 40

minutes for an 8-hour work period.

Such as cited in the study of D. Capili, J. Datu- Sanguyo, C. Mogol- Sales, et. al,

(October, 2022) the Philippine Milk Code was enacted in 1986 to protect breastfeeding and
reduce inappropriate marketing of breastmilk substitutes (BMS). The Philippine Milk Code is

categorized as “substantially aligned” with the International Code of Marketing of Breast-milk

Substitutes (“the Code”), but its provisions are assessed as relatively weak in prohibiting

promotion to the general public. The extent to which violations of the Philippine Milk Code

persist in traditional media platforms and in the digital space has not been systematically

explored.

Furthermore, the Philippines was among the first countries to adopt a national legislation

on the Code through Executive Order No. 51 s. 1986 (EO51), or the National Code of Marketing

of Breastmilk Substitutes, Breastmilk Supplements and Related Products, more commonly

known as the Philippine Milk Code. Revised Implementing Rules and Regulations (RIRR) were

adopted in 2007 after a protracted legal battle against the formula milk industry.

On the one hand, the aggressive marketing of breastmilk substitutes (BMS) reduces

breastfeeding, and harms child and maternal health globally. Yet forty years after the World

Health Assembly adopted the International Code of Marketing of Breast-milk Substitutes (The

Code), many countries are still to fully implement its provisions into national law. Furthermore,

despite The Code, commercial milk formula (CMF) markets have markedly expanded, (P.

Baker, P. Zambrano, R. Marthisen, et. al, Globalization and Health 17, Article number: 125,

2021).

In addition, the study shows that despite of the Philippine breastfeeding policy

framework and protection law (the ‘Milk Code’), the industry still aggressively promotes the

commercial milk formulas for older infant and young children. The WHO/UNICEF Global

Strategy for Infant and Young Child Feeding calls on governments to protect, promote and

support breastfeeding, including through the adoption of The International Code of Marketing of

Breast-Milk Substitutes (The Code) into national law. The country’s exclusive breastfeeding rate

(< 6 months) sits at just 34%. Scaling-up breastfeeding to near universal levels would prevent
the deaths of an estimated 9000 Filipino children and 1900 mothers annually, and a further

three million cases of child diarrhea and pneumonia, and 16,800 cases of child obesity.

According to Alade T. et al. (2021) low income reduced exclusive breastfeeding due to

women's lack of access to food for themselves and emotional and physical stress. Also, the

finding supported the view of who opened that low prevalence of exclusive breastfeeding among

educated Nigerian mothers might be linked to the current economic hardship in Nigeria that

compel mothers to resume full time work shortening duration of breastfeeding. Certain socio-

economic factors such as the lack of suitable facilities outside the home, inconveniences,

conflicts at work, family pressure and ignorance were found to adversely affect the willingness

of women to practice exclusive breastfeeding.

Also, Artemio Morado Gonzales Jr stated literate, living below the poverty line, and

young adults met the required number of prenatal visits, utilized accredited birthing facilities,

and handled by skilled birth attendants. Furthermore, the respondents mostly practiced

exclusive breastfeeding. The postpartum mothers responded in the study were confident in

breastfeeding as a measure of breastfeeding efficacy. The number of prenatal check-ups is

positively correlated with breastfeeding self-efficacy which means as the number of prenatal

check-ups increases, the breastfeeding self-efficacy also increases. Strenuous public health

efforts are needed to improve breastfeeding behaviors, particularly among socioeconomically

disadvantaged groups. Caregivers need to fully understand the expectations that patients have

in their care and provide care that is consistent with those expectations.

According to Novitria Dwinanda, et al. writers of “Factors Affecting Exclusive

Breastfeeding in Term Infants” (Paediatr Indones, Vol. 58, No. 1, January 2018), confidence in

breast milk production and support form husband or family affecting the success of exclusive

breastfeeding until 6 months. In population, if mother was not confidence with her breast milk

production and there was not support from her husband or family, exclusive breastfeeding will
not be accomplished. They also specified that early breastfeeding initiation affected the success

of exclusive breastfeeding in the first two (2) moths of life. Their research also shows that

support from their husband or families had 6-49 times higher likelihood to successfully

breastfeed exclusively for every month in the 6 months compared to mothers with no support. It

also shows that the other factors affecting exclusive breastfeeding, when the mother experience

cracked nipples or inverted or flat nipples and breast engorgement.

Additionally, based on the research study of Shrivastava, S. RamBhariLal, and P.

Saurabh (“Supporting Women to Initiate and Continue Breastfeeding: The World Health

Organization and the United Nations), in the era of the Sustainable Development Goals (SDGs),

it is essential to understand that apart from being crucial for the health of mothers and children,

breastfeeding is extremely important for the attainment of various other SDGs such as

improving nutrition, prevention of child mortality, and reduction in the risk of acquiring

noncommunicable diseases, in assisting in cognitive development and education, and in ending

poverty, facilitating financial growth, and minimizing inequalities. It is important to realize that

breastfeeding is not a one-woman job and that they require support from different stakeholders

to ensure that they can provide their children with the best possible start to their life. To create

awareness about the merits linked with breastfeeding, each year in the first week of the August

month, breastfeeding week is being observed across the world with a single goal to augment

the awareness and enhance the prevalence of exclusive breastfeeding.

As well as mentioned in the study of J. Chen, X. Lai, L. Zhou, et. al (“Association

between exclusive breastfeeding and postpartum post-traumatic stress disorder”), Ninety-two of

759 (12.1%) mothers developed postpartum PTSD within 42 days after childbirth. Compared

with partially breastfeeding mothers, exclusively breastfeeding mothers had lower risks of

postpartum PTSD. After adjustment for family support, parity, mode of delivery, perceived birth

trauma, early contact / suckling, and rooming-in, associations between exclusive breastfeeding
and postpartum PTSD remained significant. Exclusive breastfeeding up to 42 days after

childbirth was associated with reduced risk of postpartum PTSD. While the potential for reverse

causation cannot be ruled out, strategies to improve rates of exclusive breastfeeding through

teaching, counselling, and support may benefit mothers and their infants by reducing the risk of

postpartum PTSD. (International Breastfeeding Journal 17, Article no. 78, 2022)

Also, based on the study of Suparp Thaithae et al, occupation (work or study), digital

technology literacy, family support, pregnancy intention, breastfeeding self-efficacy, and

perceived breastfeeding benefits can predict breastfeeding among Thai adolescent mothers.

Nurse–midwives and other health professionals should assess pregnancy intentions. The

partners and husbands of adolescent mothers, and the infants’ grandmothers, should also be

included in the activities or intervention. There should be coordination in promoting

breastfeeding between hospital and community nurses, educational institutions, and enterprises

and in facilitating the breastfeeding of adolescent mothers by providing favorable places and

allocating time to promote breastfeeding with mothers of other ages. Moreover, understanding

unique adolescents and their needs should be emphasized in breastfeeding promotion

programs via maternal education in health facilities and digital technology information in order to

enhance breastfeeding self-efficacy and the perceived benefits of breastfeeding and increase

exclusive breastfeeding. Strategies and activities to overcome breastfeeding barriers within

schools, workplaces, and communities should be supported and encouraged among adolescent

mothers and their families.

Furthermore, the findings suggest the need of manipulating the modifiable factors (like

perceived benefits and self-efficacy in breastfeeding) by designing a breastfeeding promoting

program developed for the mothers to strengthen their awareness toward the advantages of

exclusive breastfeeding and the beliefs in their ability to continue exclusive breastfeeding for a

six-month period. It seems that decision-making on breastfeeding is more of a cooperative

effort. Thus, the involvement of significant family members in the intervention of exclusive

breastfeeding promotion is essential. Both clinical and community nurses should also equip

these family members with up-to-date knowledge and positive attitudes toward exclusive

breastfeeding so that they will become good supporters of the mothers. A six-month duration is

quite long and a mother whose breastfeeding self-efficacy is not established may feel

discouraged and doubt her ability to maintain 6-month exclusive breastfeeding as intended. In

contrast, a mother who develops high breastfeeding self-efficacy, despite any challenges, would

exert every effort to overcome the constraints and obstacles and attain the desired outcomes by

providing exclusive breastfeeding. (Nhan Thi Nguyen et al, 2021)

As well as explained by Kashu Gebrekidan et al (2022), there was lack of government

policies to support breastfeeding mothers except those relating to maternal and annual leave.

The managers who participated in this study asserted the need for a national policy or

guidelines to support breastfeeding mothers. Findings of this study will help policy makers to

identify the gaps and to improve the support given to breastfeeding women who return to paid

employment. Increasing the maternal leave to six months may be the best solution to increase

EBF and promote wellbeing for both the baby and the mother. However, if this is not possible in

the current political and fiscal climate, then providing resources for the establishment of

breastfeeding rooms in workplaces would encourage mothers to continue to exclusively

breastfeed until six months. Of note, this study mainly focused on lower-level managers;

therefore, future study involving higher-ranking managers and policy makers is recommended.

That is as stated by Vivian Omuemu (2019), a gap between the knowledge and practice

of adequate breastfeeding among this population of working women and identified some

perceived barriers to optimal breastfeeding. High level advocacy to the government by relevant

stakeholders to pass, implement and enforce enabling laws which will guarantee adequate

breastfeeding breaks, availability and accessibility of crèches as well as other provisions of the
maternity protection convention. Partner support has been found to be associated with

breastfeeding practice. A supportive social network which may include a spouse, family

members or friends can enable working women to continue breastfeeding even after they have

returned to work. An unfavorable working environment that is not supportive can make it difficult

for mothers to practice optimal breastfeeding. Our study found that though majority of the

organizations observed had a breastfeeding policy, only about half of them gave adequate

provision for an on-site crèche and maternity leave for more than 12 weeks. A woman’s ability to

breastfeed is markedly reduced when she returns to work, if breastfeeding breaks are not

available and if quality infant care facility is inaccessible or unaffordable. Therefore, legislation

guaranteeing breastfeeding breaks which has been reported to improve working mothers’ ability

to continue breastfeeding is essential. Long working hours makes mothers to breastfeed for

shorter periods.

In addition, according to the study of Jade Louise Vibieda et al (2023), Knowledge of

mothers on breastfeeding was found to be suboptimal. Social support was found to be high for

all mothers, with highest reported support from the health care providers. However, among the

three sources of support, only with the husbands was there enough evidence to suggest a

relationship between current breastfeeding practices and social support. Despite the high social

support provided by the husbands, there were more mothers who did not practice exclusive

breastfeeding, which may be attributed to negative support. Social support was also found to

influence maternal intention to breastfeed exclusively for six months and continue breastfeeding

up to two years. Since support has been shown to have a relationship with breastfeeding

practice and intention, active involvement of husbands and other family members in the

breastfeeding interventions during the antenatal and postnatal period should be encouraged.

Further, the study of Jyn Allec Samaniego et al (2022) stated that, overcoming individual

barriers requires support to address perceptions of low milk supply and increase self-efficacy to
breastfeed through evidence-based counseling that includes assessment of breastfeeding

status, self-assessment of breastmilk supply, how to increase breastmilk supply, interpretation

of infant behavior, and proper latching and positioning. Breastfeeding support groups and peer

counseling to provide practical support on breastfeeding difficulties would likely improve self-

efficacy and exclusive breastfeeding. Counseling should be provided and made available both

before and after birth, rather than in one period only, and should include family members to

create a supportive environment and proper assistance for the lactating mother. The lack of

paternal attendance in breastfeeding classes and the lack of support from family members can

lead to the discontinuation of exclusive breastfeeding. The vacuum created by the lack of

support is filled by aggressive marketing practices, including misinformation that questions the

adequacy of breastmilk and idealizes substitutes instead.

Additionally, based on the study of Philip Baker et al (2021) the decline in breastfeeding

and the rise in commercial milk formula consumption in the Philippines has associated with the

intensive marketing practices of the baby food industry, and that such practices are in

themselves a powerful way in which the industry shapes first-food systems. Arguably of equal

importance, we also show how this industry uses a number of political strategies to protect and

sustain its commercial milk formula market, through actions against the country’s breastfeeding

policy framework, and especially the Milk Code.  our findings highlight the need for continued

vigilance in order to protect this policy framework, and the importance of sustaining and indeed

strengthening the country’s breastfeeding coalition under the leadership of the department of

health, including coordinated efforts with regional offices, partner government agencies (who

are also members of the National Nutrition Council), local government units and civil society

groups.

Christina Ricci et al. (2023), Stated that Although Canadian exclusive breastfeeding

rates are rising, the majority of females still do not meet the recommendation to exclusively
breastfeed for at least six months. Given that the largest decline in exclusive breastfeeding

occurs before infants are a month old, and in light of the fact that numerous societal and

maternal characteristics are associated with breastfeeding duration, there continues to be a

need for early and multipronged interventions to support females to exclusively breastfeed

longer. The leading reason for the early cessation of exclusive breastfeeding was insufficient

supply of milk, followed by difficulty of breastfeeding, and lastly was medical condition of mother

or baby.  Other reasons – ready for solids, fatigue due to breastfeeding, planned to stop at this

time, child weaned him/herself, returning to school or work – were given less frequently.

SYNTHESIS OF THE STUDY

Exclusive breastfeeding requires full commitment which made it difficult for working

mothers, employed mothers not only needed the support of family but also support from

employers, government, and healthcare workers. Nurses are vital in implementing the exclusive

breastfeeding among mothers particularly to working mothers, health teachings should be done

starting from prenatal care up to postnatal care. Nurses constantly interact with the clients in

every healthcare facility; therefore, nurses are the ones responsible in delivering proper and

correct information. Proper breastfeeding and exclusive breastfeeding are very common health

teaching subjects, so common that sometimes it not retaliated well enough to become effective.

Factors that cause early cessation of exclusive breastfeeding varies depending on mother’

situation which “one size fits all” type of health teaching is not applicable.

Numerous info-graphical materials had been done regarding the importance of exclusive

breastfeeding which may come up as a positive factor, but in reality, it is mostly overlooked by

mothers. This is why further study should be done to help working mothers make exclusive

breastfeeding work regardless of their work schedule. Therefore, it is important that nurses
should find ways to help working mothers be more flexible in managing exclusive breastfeeding

and their work.

THEORETICAL FRAMEWORK

This research utilized two theoretical models that will be used as a guide and to support

the current study in the relationship of exclusive breastfeeding and working mothers.

Theory of Self-efficacy

Psychologist Albert Bandura has defined self-efficacy as people’s belief in their ability to

control their functioning and events that affect their lives. One’s sense of self-efficacy can

provide the foundation for motivation, well-being, and personal accomplishment. People’s

beliefs in their efficacy are developed by four primary sources of influence, including (i) mastery

experiences, (ii) vicarious experiences, (iii) social persuasion, and (iv) emotional states. High

self-efficacy has numerous benefits to daily life, such as resilience to adversity and stress,

healthy lifestyle habits, improved employee performance, and educational achievement.

Mastery Experience. The first and foremost source of self-efficacy is through mastery

experiences. However, nothing is more powerful than having a direct experience of mastery to

increase self-efficacy. Having a success, for example in mastering a task or controlling an

environment, will build self- belief in that area whereas a failure will undermine that efficacy

belief. To have a resilient sense of self-efficacy requires experience in overcoming obstacles

through effort and perseverance.

Vicarious Experience. The second source of self-efficacy comes from our observation of

people around us, especially people we consider as role models. Seeing people similar to

ourselves succeed by their sustained effort raises our beliefs that we too possess the

capabilities to master the activities needed for success in that area.

 Social Persuasion. Influential people in our lives such as parents, teachers, managers or

coaches can strengthen our beliefs that we have what it takes to succeed. Being persuaded that

we possess the capabilities to master certain activities means that we are more likely to put in

the effort and sustain it when problems arise.

Emotional States. The state you’re in will influence how you judge your self-efficacy. The

state you’re in will influence how you judge your self-efficacy. 

Breastfeeding counseling is effective on self-efficacy 4 months postpartum. Most of the

studies in this field are consistent with the present study. Counseling with mothers, particularly

those with previously failed breastfeeding, in healthcare centers and by midwives and

breastfeeding counselors, during exclusive breastfeeding period, can improve children’s health

and well-being in the community (Fahimeh Sehhatie Shafaei et al, 2020).

Figure 1:

Albert Bandura’ Theory of Self-Efficacy

CONCEPTUAL FRAMEWORK

The Conscious Competence Learning Model

The concept of Conscious Competence Learning was originally coined by Abraham

Maslow with the Four Stage of Learning theory. The CCL model describes how individuals learn
and the stages that are passed in the learning process so that a person masters a certain

competence. According to the CCL Model, learning takes place through four stages, namely: (1)

Stage 1: Unconscious Competence (unaware of their inability). (2) Stage 2: Conscious

Competence (realizing his inability). (3) Stage 3: Conscious Competence (realizing his abilities).

(4) Stage 4: Unconscious Competence (not realizing one's abilities).

Stage 1 is unconscious incompetence. This stage is the stage where a person is not

aware of his weakness or inadequacy in something. Individuals who do not realize that they are

actually inadequate usually perform or face situations with a sense of confidence, oversimplify

problems, and do not realize that there is something that needs to be known and learned.

Stage 2 is Conscious Incompetence stage. Is the stage where the individual has

realized that he does not have certain knowledge or skills (competence), which is needed. At

this stage he became aware that in fact there were many things they did not know and had to

learn, more than they thought. At first, they were still confused, because they did not really

understand what they did not know.

Stage 3 is the stage of Conscious Competence. This stage is the stage where the

individual realizes and knows that he already knows (new things) or is able to do something

new. This stage is the stage of assimilation, where there is a combination of (old) learning

experiences that have been owned by the individual with new experiences and understandings.

competence (unconscious competence).

Stage 4 is Unconscious Competence. This stage is the highest stage in the learning

stage model. At this stage the individual seems not to feel the competence any longer. When

performing the skill, one does not need to think about it. Everything is done as just flowing,

"automatically", not too or unnecessarily with full awareness of doing it.

 Figure 2:

Abraham Maslow’s Conscious Competence Model

The researcher had constructed the figure to represent the relationship among the

variable used in the current study. The study consists of input, process and the output. The

independent variable presents the respondent’s profile and the dependent variable which are

the factors affecting the exclusive breastfeeding of working mothers. Moreover, the process

includes statistical analysis and qualitative mode of analysis to interpret and analyze the results

and the findings. The output would be presented to working mothers to help them continue

exclusive breastfeeding that will work with their employment status.

Figure 3:

Conceptual Framework

Input Process Output

1. What is the profile in terms of: Statistical Analysis End Product

1.1 Age

1.2 Civil Status

1.3 Work Set-up

1.4 Type of Institution

1.5 Socio-economic status

 CHAPTER III

METHODOLOGY

This chapter focused on research methodology related to the study. The methodologies

will include research design, study site, sample and sampling design, research instrument,

validation instrument, validation technique, procedure for data collection, statistical tools, and

ethical considerations.

Research Design

This study is design as a quantitative descriptive study, endeavor to achieve level of

compliance, level of competency and factors affecting exclusive breastfeeding among working

mothers in Brgy. San Jose, Montalban, Rizal. Quantitative methods emphasize objective

measurements and the statistical, mathematical, or numerical analysis of data collected through

polls, questionnaires, and surveys, or by manipulating pre-existing statistical data using

computational techniques. Quantitative research focuses on gathering numerical data and

generalizing it across groups of people or to explain a particular phenomenon. (Barbie, E.R, et

al. 2010).

According to Formplus Blog (2023), descriptive research can be used to investigate the

background of a research problem and get the required information needed to carry out further

research. It is used in multiple ways by different organizations, and especially when getting the

required information about their target audience.

Descriptive research uses a quantitative research method by collecting quantifiable

information to be used for statistical analysis of the population sample. This descriptive type of

research employs surveys to collect information on various topics. This data aims to determine

the degree to which certain conditions may be attained. You can extrapolate or generalize the

information you obtain from sample surveys to the larger group being researched. (Heath, 2023)

Study Site

The research will be conducted in selected in Brgy. San Jose, Montalban, Rizal. This

study will focus on working mothers who are breastfeeding that must be residing in Brgy. San

Jose, Montalban, Rizal.

According to Cabardo (2022), by strengthening its efforts in promoting the practice of

breastfeeding, Department of health is aiming to improve the rate of exclusive breastfeeding

being practiced by mothers in the region, wherein their target is to have at least 50%. The

encouragement of exclusive breastfeeding even beyond six months and up to two years will

collectively create a healthy community.

Sample and Sampling Design

The sample of the study will be selected using purposive sampling. Purposive sampling

is a non-probability sampling method. This sampling technique is also known as judgmental

sampling or selective sampling because the researchers rely on their judgment when identifying

and selecting the individuals, cases, or events that can provide the best information to achieve

the study’s objectives (Nikolopoulou, 2022). The ultimate goal of purposive sampling is to

increase the validity and reliability of research findings by selecting participants based on

specific criteria relevant to the research questions or objectives (Hassan, 2022). Hence, the

flexibility of purposive sampling allows researchers to save time and money while they are

collecting data (Regoli, 2019).

The respondents will purposely be chosen because the researchers believe that the

entire sampling process depends on their knowledge and judgment to choose the best-fit

participants that can answer their research questions. Furthermore, the respondents of the

study will be the selected working mothers who breastfeed and reside in San Jose, Montalban

Rizal. Mothers with the following criteria will be included in the study: age; educational

attainment; civil status; employment status; type of institution; position at work; socio-economic

status; and duration of maternity leave. On the other hand, mothers experiencing any health

problems and being prohibited from breastfeeding by a doctor will be excluded.

The population of this study should be residing in San Jose, Montalban, Rizal and will

focus on working mothers, can be outside San Jose, Montalban, Rizal, whereas giving honest

and accurate facts will be established with regards to concerning how factors affect exclusive

breastfeeding.

Research Instrument

Using a survey, the researchers will be able to gather and examine data from a large

number of individuals. A specific method or device for gathering these data is a questionnaire. A

questionnaire is a research instrument consisting of a series of questions for the purpose of

gathering information from respondents. Questionnaires can be thought of as a kind of written

interview. They can be carried out face to face, by telephone, computer or post (Mcleod, 2023)

The researcher used a self-developed structured questionnaire with closed-ended

questions and to gather data for the quantitative phase. Through research of the literature, the

questionnaire was put together, which consists of questions related to the factors that may

affect exclusive breastfeeding. It contains questions regarding the respondent’s personal

information, employment status, socioeconomic status, medical history, and more aspects of

exclusive breastfeeding.

These will help the researchers answer, The Current Practices and Factors Affecting

Exclusive Breastfeeding Among Working Mothers in San Jose, Montalban Rizal.

1. What is the profile in terms of:

1.1 Age

1.2 Civil Status

1.3 Work Set-up

1.4 Type of Institution

1.5 Socio-economic status

2. What are the factors affecting exclusive breastfeeding among working mothers? As to.

2.3 Internal Factors

2.4 External factors

3. What is the level of competency on exclusive breastfeeding among working mothers? As to.

1.4 Knowledge

1.5 Skill

1.6 Attitude

4. What is the level of compliance on exclusive breastfeeding among working mothers?

5. Is there a significant difference between the level of competency and level compliance on

exclusive breastfeeding among working mothers when grouped according to their profile?

6. Is there a significant relationship between the respondent’s profile and the level of

competency and compliance on exclusive breastfeeding among working mothers?

7. Is there a significant relationship between the respondent’s profile and the factors affecting

exclusive breastfeeding among working mothers?

8. Based on the result of the study what infographic material could be developed to better

assist working mothers to continue exclusive breastfeeding?

Validation of the Instrument

After reviewing a number of relevant articles, the researchers modified their self-

developed questionnaire for the study. The following are some of these: Exploring the

association between Socioeconomic and Psychological Factors and Breastfeeding in the First

Year of Life during the COVID-19 Pandemic in Thailand (S. Nuampa, C. Patil, et. al, Dec.,

2022), Factors Affecting Exclusive Breastfeeding in Term Infants (Paediatr Indones, Vol. 58, No.

1, January 2018), Exclusive Breastfeeding Among Working Mothers in Kenya: Perspectives

from women, families, and employer (S. Ickes, H. Sanders, D. Denno, et. al), Supporting

Women to Initiate and Continue Breastfeeding: The World Health Organization and the United

Nations (Shrivastava, S. RamBhariLal,), Enablers and Barriers of Exclusive Breastfeeding

Among Employed Women in Low and Lower Middle- Income Countries (K. Gebrekidan, et. al)

Ensuring The Trustworthiness

Trustworthiness or rigor of a study refers to the degree of confidence in data,

interpretation and methods used to ensure the quality of a study (Stahl & King, 2020). This was

achieved through four main criteria: credibility, dependability, transferability and confirmability.
 According to Nyirenda L, Kumar MB, Theobald S, Sarker M, et al (2020),

Dependability (reliability) is the degree to which a study can be replicated, and whether, when

there is more than one observer, members of the research team agree about what they see and

hear. Confirmability (objectivity) is neutrality of researcher in interpreting findings; findings being

free from bias, including social-desirability bias, which can be inherent since researcher’s design

and execute tools. Maintaining reflexivity is key to managing such bias. Reflexivity is the

consideration and acknowledgment of how one’s beliefs and experiences can influence the

research process, including participant responses and how data are collected, interpreted,

analysed and presented. However, regardless of reflexivity involved, biases cannot be

completely ruled out.

  To allow transferability, they provide sufficient detail of the context of the fieldwork for a

reader to be able to decide whether the prevailing environment is similar to another situation

with which he or she is familiar and whether the findings can justifiably be applied to the other

setting (Enworo O. C., 2023).

According to Liamputtong (2019, p. 20), “Confirmability attempts to show that the

findings and the interpretations of the findings do not derive from the imagination of the

researchers but are clearly linked to the data.” The purpose is to extend the confidence that the

results of a study would be confirmed or corroborated by other researchers (Forero et al., 2018).

Procedure Of Data Collection

To start with the data collection, the researchers went to in San Jose, Montalban, Rizal

and showed a letter of request to conduct study to the Owners, Midwives and Nurses. The letter

includes the goal, purpose, and considerations for the improvement of the study.

Once approved, the researchers first action would be establishing a self-constructed

closed ended questionnaire relevant to the study and proceed to data gathering via online
platform and distributing printed questionnaire to gather significant data from the respondents

with the approved informed consent from the respondents.

After gathering/tallying all the information from the questionnaire both via online platform

and printed, the researchers will proceed in documentation and interpretation of the data to

support the study.

Data Gathering Procedure

The data gathering procedure involves four phases:

Permission to use Adoption of parts Approval of SBLC

the tool of questionnaire IERB, Dean of
Nursing, and
Phase 1 Research adviser

Approval of the Printing out and Handing out

barangay of San generating personally and
Phase 2 Jose, Montalban, Questionnaires posting through
Rizal social media
platforms

Verifying then Incentive scheme Tallying and

distribution of recording of results
(Small token of
Phase 3 informed consent
appreciation to
each respondent.)

Data analysis Interpretation

Statisticalof
the results
treatment
Phase 4
Statistical Tool

The data gathered will be analyze and interpret by the researchers through the following

statistical procedure:

1) Frequency, percentage, and ranking

Since this is quantitative research, it will help the researchers to easily tally all the

data that has been gathered. Through the percentage and ranking, it will certainly

help the researchers to analyze the data.

2) Mean

This tool will be used to identify the different factors that affects working mothers

to exclusively breastfeed their babies. The formula is:

P = F/ N x constant value

Where:

P = total percentage

F = frequency

N = total number of respondents

Mode of Analysis

Using the data gathered, data analysis may be use of to distinguish the factors that

affects working mothers to exclusively breastfeed their babies, the procedures to be perceive

are as the follows:

Numerical data. This would be done through the tally that would base on the

respondents answer to the survey questionnaire that will be the done through frequency,

percentage, and ranking.

Ethical Considerations

The study was submitted for ethics review and approval. Participants know the title,

purpose, benefits, risks, and funding behind the study before they agree or decline to join.

Participant’s information will be kept confidential. Researchers ensures that the results will be

represented accurately.

Consent Process

Informed consent was obtained. In order to ensure that the participants understand the

study being done, they were provided with appropriate information about the study in a

language that the respondents can understand.

Beneficence

Respondents will be treated with utmost respect, the data collected will be used for the

study alone.

Respect For Human Dignity

In order to maintain the respondents trust, participants will be treated with respect, there

will be a valid consent process and the promotion of dignity for the participants. Autonomy

includes the ability to deliberate about a decision and to act based on that deliberation.

Respecting autonomy means giving due deference to a person’s judgment and ensuring that

the person is free to choose without interference (Tri- Council Policy Statement, 2022). The data

collected will be confidential and will be used for this study only.

Anonymity

Anonymity will be guaranteed, if there will be a need to identify the respondents, data

pseudonymization will be used to replace identifying information about participants with

pseudonymous, or fake, identifiers.

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 QUESTIONAIRRE

“A STUDY ON THE LEVEL OF COMPETENCY AND COMPLIANCE TO EXCLUSIVE

BREASTFEEDING AMONG WORKING MOTHERS OF SAN JOSE, MONTALBAN,

RIZAL”

General Directions: Please spare few minutes of your valuable time to answer this

questionnaire carefully and honestly. Rest assured that any information you will supply will be

treated with outmost confidentiality and anonymity.

SECTION A: RESPONDENT’S PROFILE.

Directions: Encircle the letter before your chosen answer.

1. How old are you?

 a. 18-23 years old

b. 24-29 years old

c. 30-35 years old

d. 36 years old – above

2. What is your civil status?

a. Single

b. Married

c. Annulled

d. Separated

e. Widow

3. What type of work set-up do you have?

a. On-Site

b. Work From Home

c. Hybrid

4. What is your socioeconomic status?

a. Upper-Class (109,200 -182,000 pesos/month)

b. Upper-Middle Class (63,700- 109,200 pesos/month)

c. Middle- Middle Class (36,400- 63,700 pesos/ month)

d. Lower-Middle Class (18,200- 36,400 pesos/month)

e. Working-Class/ Low income (9,100-18,200 pesos/ month)

f. Poor class (Less than 9,100 pesos/month)

(Section B: what are the factors affecting exclusive breastfeeding b.1 internal b.2 external)

SECTION C: LEVEL OF KNOWLEDGE IN EXCLUSIVE BREASTFEEDING

Directions: The following questions are created to identify your knowledge to exclusive

breastfeeding. Please put a check (✓) mark on your corresponding answer. Follow the

numerical guide for your reference.

Guide:

4 – Unconscious Competent - I have an excellent knowledge about the techniques and

3 – Conscious Competent
2 – Conscious Incompetent
1 - Unconscious Incompetent
SECTION C.1:
concepts of the statement mentioned.
- I have a good knowledge about the techniques and
concepts of the statement mentioned.
- I have a fair knowledge of the techniques and concepts of
the statement mentioned.
- I have a poor knowledge about the techniques and
concepts of the statement mentioned.

No. Statements: 4 3 2 1
I. Skin to Skin Contact
I am aware that skin to skin contact keeps the baby calm and
C1
warm
I know that skin to skin contact promotes bonding of mother and
C2
the baby
I understand that skin to skin contact helps breastfeeding get
C3
started
II. Early Initiation of Breastfeeding
In early initiation of breastfeeding, I know that it will build mother’s
C4
confidence.
I know that early initiation of breastfeeding promotes breastmilk
C5
production and maintenance
I am aware that early initiation of breastfeeding prevents
C6 unnecessary use of milk formula that may lead to drying up the
mother’s breastmilk due to low demand from baby.
 III. Baby-Led Feeding and Feeding Cues
C7 I know that breastfeeding will prevent breast engorgement
I am aware that breastfeeding will lessen the crying of the baby
C8
which may avoid temptation to supplementary feeding
In baby-led feeding, I know that the baby will get immune rich
C9 colostrum, fastens milk supply, and fastens weight gain for the
baby
C10 I am aware of the baby’s feeding cues
IV. Benefits of Breastfeeding
I know that breastmilk provides best nutrition for the improvement
C11
of cognitive and physical development of the baby
I am aware that breastfeeding is the safes and healthiest infant
C12
feeding method
I understand that breastfeeding is less expensive and it is cost
C13
effective
V. Good Positioning and Good Attachment
C14 I know the different breastfeeding positioning
I am aware of the signs of good attachment of the baby to the
C15
breast
I am aware that proper positioning and attachment help the baby
C16 to get lots of milk and prevents sore nipples and sore breast of
the mother
VI. Manual Milk Expression and storage
C17 I know how to perform manual milk expression
C18 I am aware on how to properly store expressed breastmilk
VII. Duration of breastfeeding
I know that exclusive breastfeeding is feeding the baby
C19 exclusively with breastmilk alone for up to 6 months (every 2
hours or on demand)

SECTION C.2: LEVEL OF SKILL IN EXCLUSIVE BREASTFEEDING

Directions: The following questions are created to identify your skill to exclusive breastfeeding.

Please put a check (✓) mark on your corresponding answer. Follow the numerical guide for your

reference.

Guide:

4 – Unconscious Competent - I always practice the statement mentioned and I exhibit it

at all times.
3 – Conscious Competent - I often practice the statement mentioned.
2 – Conscious Incompetent - sometimes practice the statement mentioned.
1 - Unconscious Incompetent - rarely practice the statement mentioned and rarely exhibit
it.
No
Statements: 4 3 2 1
.
I. Skin to Skin Contact
Place the baby on mother’s chest skin to skin with the baby only
wearing diaper and baby bonnet
Skin to skin contact for the first 2 hours after birth of the baby
II. Early Initiation of Breastfeeding
Started breastfeeding as soon as the baby display the desire to
breastfeed
III. Baby-Led Feeding and Feeding cues
Able to identify the baby’s feeding cues
Able to identify when the baby is already satisfied with feeding

IV. Benefits of Breastfeeding

Initiated exclusive breastfeeding noting the importance and
benefits of exclusive breastfeeding and
V. Good Positioning and Good Attachment
Performed breastfeeding using different proper positioning in
breastfeeding
Able to identify signs of good attachment of baby to the breast
VI. Manual Milk Expression and storage
Able to properly do manual breastmilk expression
 Able to properly store expressed breastmilk
VII. Exclusive breastfeeding
Breastfeeding exclusively for the first 6 months of the baby and
without any other supplementary formulas

SECTION C.3. LEVEL OF ATTITUDE IN EXCLUSIVE BREASTFEEDING

Directions: The following questions are created to identify your attitude to exclusive

breastfeeding. Please put a check (✓) mark on your corresponding answer. Follow the

numerical guide for your reference.

Guide:

4 – Unconscious Competent - I strongly agree with the statement mentioned and I

exhibit it at all times.

3 – Conscious Competent - I agree with the statement mentioned.

2 – Conscious Incompetent - I disagree with the statement mentioned

1 - Unconscious Incompetent - I strongly disagree with the statement mentioned and I

not exhibit it at all times

No. Statements: 4 3 2 1

I. Skin to Skin Contact

I immediately put the baby on my chest to initiate early skin to
skin contact, with the baby only wearing diaper and baby bonnet
I initiate the early skin to skin contact for the first 2 hours after the
birth of the baby
II. Early Initiation of Breastfeeding
I start breastfeeding my baby after he/ she shows the desire to
breastfeed
III. Rooming- In
I ensure to attend the baby’s needs immediately by staying with
the baby in close proximity
I plan to continue breastfeeding my baby up to 6 months or more
to have successful and effective breastfeeding
IV. Baby- Led Feeding and Feeding Cues
 I know the different cues when to feed the baby
I know if the baby is already satisfied with the feeding and aware
when to stop
I am aware that breastfeeding helps me to prevent breast
engorgement
V. Benefits of Breastfeeding
I know the benefits of breastfeeding for my baby
I am aware about the importance of breastfeeding for the both
mother and baby
I know that it is less expensive and cost effective
I know that breastfeeding is the safest method for infant feeding
VI. Good Positioning and Good Attachment
I put my baby in different proper position that makes him/ her
comfortable when breastfeeding
I ensure that my baby latch to me properly to get enough milk
I assure that my baby’s position and attachment won’t left me in
having sore nipple or sore breast
VII. Manual Milk Expression and Storage
I am able to express my breastmilk properly
I store my breastmilk in the place where it will last longer and
won’t spoil immediately
I put my manually express breastmilk in the container that won’t
get contaminated
VIII. Exclusive Breastfeeding
I will feed my baby with only breastmilk until 6 months or more
I won’t give any other supplements nor introduce formula milk to
my baby not until he/ she is beyond 6 months old

SECTION D. EXTENT OF COMPLIANCE IN EXCLUSIVE BREASTFEEDING

Directions: The following questions are created to identify your Compliance to exclusive

breastfeeding. Please put a check (✓) mark on your corresponding answer. Follow the

numerical guide for your reference.

Guide:

4 – Unconscious Competent - I always adhere to the statement mentioned and I exhibit

it at all times.
3 – Conscious Competent - I often adhere to the statement mentioned.

2 – Conscious Incompetent - I sometimes adhere with the statement mentioned

No. Statements: 4 3 2 1
I. Skin to Skin Contact
I practiced skin to skin contact immediately after birth and
continue frequent skin to skin contact at home
II. Early Initiation of Breastfeeding
I initiated breastfeeding immediately after birth of the baby
III. Rooming-In
IV. Baby-led feeding and Feeding Cues
I made sure to look and identify the feeding cues of the baby
I breastfeed the baby as soon as the baby display the feeding
cues
I look at the signs that the baby is already satisfied with feeding
V. Good Positioning and Good Attachment
I observe proper positioning while breastfeeding
I observe proper attachment of the baby to the breast during
breastfeeding
I breastfeed alternately to left and right breast
VI. Manual Milk Expression and Storage
I do manual expression of milk properly
I made sure to properly store expressed breastmilk in a proper
container and the right temperature
VII. Duration of breastfeeding
I feed the baby with only breastmilk without introducing or using
formula milk as a form of supplementary feeding
1 - Unconscious Incompetent - I rarely adhere with the statement mentioned and rarely
exhibit it.
APPENDICES