According to thematic analysis, the initial codes belonged in five categories (Table 1): knowledge about breastfeeding; breastfeeding corner; breastmilk pumping; support from others; and recommendations. We grouped the categories into two major areas. The first was breastfeeding support in the workplace, and the second was recommendations (see Table 1).
Breastfeeding support in the workplace
The findings can be categorized into four groups as follows: (1) breastfeeding corner; (2) breastmilk pumping; (3) health education or providing information about breastfeeding; and (4) support from others when mother returns to work.
Breastfeeding corner in workplaces
All participating workplaces had a breastfeeding corner in a first aid room. Mostly, the breastfeeding corners were divided from other parts of the first aid room by a curtain or a folding screen. The breastfeeding corner of some workplaces was a separate room within the first aid room. Furthermore, there were chairs or sofas, a table, a refrigerator, and a sink in the breastfeeding corner. Some participants mentioned that:
“…it’s a private room… it has a fridge, chairs, and an air conditioner… It’s privacy during pumping my breastmilk, I don’t want anything to disturb me [when breastmilk pumping]…” (Participant 1).
“…Here [a first aid room] may be the safest zone… This [first aid] room is clean, there is a nurse all [the] time. If we [mothers have] any problems, we can consult [a nurse]… when [mothers] pump [their] breastmilk, it has a curtain [to separate the breastfeeding corner from the first aid room]…” (Participant 6).
According to focus group discussions, most mothers did not pump their breastmilk at the breastfeeding corner. Mothers who did not work on the assembly line but had an office pumped breastmilk at their office because it was more convenient and comfortable than the breastfeeding corner. Meanwhile, mothers who were production line workers did not use the breastfeeding corner because some of them had to change their clothes before departing and entering the production line, and the breastfeeding corner might be too far from their work area. The participants said:
“…mostly it [my breastmilk pumping cycle] is during working hours… then I wear a [breastfeeding] scarf and pump [my breastmilk] in my office… At noon I have to eat [my lunch] and also pump [breastmilk]… It is convenient to be in the office [for breastmilk pumping…” (Participant 15).
“…we don’t have much time [for breastmilk pumping] because we have one hour for [a lunch] break…It takes time to change clothes…and it depends on which [mothers work in the] production line, near or far [from the breastfeeding corner]…” (Participant 4).
Breastmilk pumping
We categorized mothers who returned to work after giving birth into two main groups. The first group was non-breastfeeding mothers, and the second group was continued-breastfeeding mothers.
The first group discontinued breastfeeding because they did not live with their children; for example, their child lived in a different province with their grandparents. Another reason was that they had stopped providing breastmilk before returning to work. They may have had low milk production but could have had other reasons for stopping.
In terms of the second group, some of them pumped breastmilk at the workplace, while others breastfed their child or pumped breastmilk at home because it was not convenient to pump breastmilk at the workplace. One participant mentioned that:
“It isn’t convenient to pump [breastmilk in the workplace]… Because I had to…bring [a breast] pump [to the workplace], I don’t pump [in the workplace]…” (Participant 7).
None of the participating workplaces provided official lactation breaks to maternal employees who continued breastfeeding. Therefore, mothers who did not work on the assembly line but had their offices had more opportunities to pump breastmilk than mothers who worked in the production line because they could allocate their own time, and their office was more suitable for breastmilk pumping than line production. Participants stated:
“…If it [my office area] has not many people, then [I find it] more convenient to pump in my own [office] room than to go downstairs [to pump at the first aid room]…” (Participant 13).
“…if I finish work at 3 pm, around 2.30 pm I will ask a manager to [go to] pump breastmilk…If the manager understands, I can come here [to the breastfeeding corner] to pump [breastmilk]…[if I work on] night shift…I do not walk here [to the breastfeeding corner] because it is far [from my production line ]. It takes time [to walk to the breastfeeding corner]…So, I pump [breastmilk] at the locker room…but I throw [my breastmilk] away because I cannot wash a [feeding] bottle [at the locker room]…” (Participant 16).
A main reason why mothers did not pump breastmilk was that they had to work continually, even though it was time to pump breastmilk. However, sometimes a manager or other colleagues understood a woman’s need to be absent due to breastmilk pumping. Some participants mentioned that:
“…if there was an urgent work, I couldn’t go to pump [breastmilk]…” (Participant 2).
“…I cannot leave [the production line] to pump breastmilk…so I lost [the pumping] cycle…” (Participant 19).
“…no problem: my colleagues knew and understood that I have a kid.” (Participant 16).
Health education or providing information about breastfeeding
During pregnancy, participants said that they did not receive knowledge or information relating to breastfeeding or maternal and child health from their workplace. Nevertheless, they were provided with this information from health professionals: a pink book (maternal and child handouts) and online resources. A participant expressed that:
“I have to look [about taking care myself, taking care of children] on YouTube mostly…[When I went to antenatal care] there was a book [a pink book]…” (Participant 17).
According to the focus group, most mothers went to antenatal care at private hospitals because they would not take leave for antenatal care. A participant said that:
“If I went to a public hospital, I had to go there in official hours [8.30 am − 4.30 pm], but a private clinic open hour is open at 5 pm, which is time I finish work…so, I can go [to a private clinic] between 5 pm and 8 pm”. (Participant 4)
When employees returned to work after giving birth, they did not receive any health education or knowledge relating to breastfeeding from their workplace. However, if they had any breastfeeding problems, they could ask a nurse who was in the first aid room, or colleagues who had experience in breastfeeding. A participant mentioned that:
“There wasn’t health education [about breastfeeding]…If we [mothers] had a problem, [we] would ask a nurse [who was in the first aid room] or ask colleagues…[It] likes exchange information between mothers…” (Participant 13).
After giving birth, mothers could obtain knowledge or information about breastfeeding from health professionals at a postpartum care clinic or a well-baby clinic; from relatives, and the pink book. Interestingly, mothers also received information about breastfeeding and maternal and child health from baby food companies because they were members of a maternal club owned by these companies, and a representative called them to ask about the health and feeding of their child. However, baby food companies did not market their products in the workplace. Some participants said that:
“…On delivery day, there was a nurse to teach me [about breastfeeding] and if there was no breastmilk, they [a nurse] would express [my breastmilk by hand].” (Participant 4).
“…[during pregnancy] we are a member [of a baby food company’s mum’s club]. Then if we have a problem we can ask [an expert from the companies]…” (Participant 17).
“…I think they [a baby food company] were ok…A nutritionist [of a baby food company] called to me…They [a nutritionist of a baby food company often] asked how many times [my] child was fed [with breast milk]. So, I had to observe [the feeding of my child]. Next time, if they [a nutritionist of a baby food company] call me, we will be able to answer [a question about child feeding]…” (Participant 11).
Support from others after returning to work
Three groups of people supported mothers about breastfeeding when they returned to work after giving birth. First, family members such as grandparents, relatives, and partners or spouses supported mothers by taking care of an infant when they returned to work. Second, colleagues supported mothers to pump breastmilk at the workplace, and gave advice or exchanged experiences of breastfeeding. Last, health professionals provided advice relating to breastfeeding, and lactation consultants in particular helped to solve mothers’ problems. Participants stated that:
“…[my child] stayed with grandparents…[My child’s] father stayed with [the child] during the day and worked on the night shift…I went back to take care [of my child at night]…In the morning, grandmother used frozen breastmilk and fed [my child], and during the day, grandfather and father helped [grandmother] take care of [my child]…” (Participant 15).
“…they [my colleagues] knew I had to pump breastmilk. I would be 10–20 minutes late [to work]. They [my colleagues] had never complained…” (Participant 19).
“…[I] consulted [my child’s] doctor when my child went to [see the doctor] for a vaccination. If it was not an urgent problem, I would ask [a doctor] at that time [when my child saw a doctor for vaccination]…” (Participant 13).
Recommendations
During focus group discussions, participants provided recommendations about what they would like to support them to continue breastfeeding after returning to work.
Recommendations for a breastfeeding corner
Participants said there could be a refrigerator for breastmilk solely, including breastmilk storage bags, a spare breastmilk pump, and cleaning equipment.
“…I want a fridge for keeping breastmilk only…as I understand that it is public [fridge]. They [colleagues] can keep whatever they want in there…If there is a fridge for breastfeeding only…it may be better. It seems to be safer from germs…” (Participant 13).
“[It seems that] someone doesn’t have breastmilk pump…some brands [of breastmilk pump] need to be plugged in all the time…so, I want a [spare] pump [in a breastfeeding corner]. When we are pumping, the [ pump] battery may run out or break down….It [a spare breastmilk pump] is for an emergency situation…” (Participant 16).
Recommendations for lactation breaks
Participants wanted separate lactation breaks, in addition to regular breaks (15 minutes for morning and afternoon breaks and an hour for lunch breaks), meaning lactation breaks should be additional. However, lactation breaks could also be flexible based on the individual’s responsibility and workload. Employers should explicitly inform everyone in the workplace of the right to lactation breaks or permission to pump breast milk so that lactating employees feel comfortable.
“It is because it hasn’t made any announcement [about a lactation break from (human resources) HR]…but it [a lactation break] must be a rule of the factory…[My] boss wouldn’t have a problem if there was an announcement [about a lactation break from HR]…” (Participant 4).
“…[it was like] inform them [my boss about breastmilk pumping]…[I] will be relieved of a worry because at least they [my boss] has known [about breastmilk pumping]…I will pump comfortably…” (Participant 13).
Recommendations for breastfeeding health education
Regarding focus group discussions, participants said most female employees visited antenatal care at a private health facility. Therefore, they were unlikely to be educated or trained about breastfeeding by antenatal care. Employers might provide employees with health education or information about breastfeeding; also about maternal and child health from a nurse who was responsible for a first aid room.
“Actually, they [pregnant employees] must be given knowledge about breastfeeding and breastmilk pumping…but we [our factory] don’t give this knowledge, so, [pregnant] employees wouldn’t know…In fact, we [our factory] have a nurse [in a first aid room]. The nurse should know [about breastfeeding and breastmilk pumping]…because they [the nurses] are trusted by employees. I mean they have more knowledge [about breastfeeding and breastmilk pumping] than others…” (Participant 6).
Furthermore, when employees return to work after giving birth, employers or human resources staff could inform them of the breastfeeding corner, and provide information about how to pump breastmilk because some employees might be new mothers. Some participants stated that they would like to know more about infant formula milk to understand whether to choose to use infant formula if needed.
“…[It was like] making [ lactating employees] understand because someone [a lactating employee] might not know that we [our factory] have a breastfeeding corner. [Lactating employees] are able to go [to the breastfeeding corner]…” (Participant 11).
“…because someone [female employee] is a new mother…they might not know how to do [breastfeeding or breastmilk pumping]…If [our] company conducts health education, it would be good…” (Participant 2).
“In case my child stop being breastfed…[I] wanted to know which milk formula is ok…There is [milk ] formula 1 (infant formula]; formula 2 (follow-on formula], and formula 3 (growing-up milk]…for example…I don’t know whether it [formula 1] can be fed continually, or not….“ (Participant 14).
Recommendations for social support
Participants mentioned that MOL could extend parental leave to six months for female employees, while male employees should have a right to leave for one month to assist their spouse or partner to take care of their child.
“[MOL should] increase time to accumulate breastmilk…[increase maternity leave to] six months…” (Participant 12).
“Fathers should have parental leave to take care of their child…for around one month [because taking care of a baby in] the first month [after birth] is very heavy…” (Participant 15).
Moreover, some participants said that there should be a childcare center in workplaces because some mothers might not have relatives or others to take care of their child when they are working. Therefore, if there was a nursery in the workplace, it might reduce employees’ financial burden, and be an opportunity for mothers to be with their child.
“…promoting workplaces to have a nursery [childcare center] because [in workplaces] it is an opportunity to be with our child. There is more opportunity [to breastfeed their child]…for example…if [we] can bring our child here [a nursery in the workplace] and there is a caregiver. At noon, we don’t pump [breastmilk], we can instead breastfeed our child…” (Participant 6).
Some participants mentioned that they needed financial support during parental leave. Currently, they receive paid maternity leave from the Social Security Office (SSO), but this can be insufficient. SSO should increase the financial support by calculating needs based on mothers’ salaries. In addition, fathers should receive money for taking care of their child.
“…[I wanted] MOL to pay more money to us [during maternity leave]…[nowadays] they [MOL] pay THB 15,000 [monthly]. I mean regardless of a high or low salary or whatever, they pay THB 15,000 [only].” (Participant 7).
“…Suppose if they [fathers] have SSO insurance…they [father] pay money [to a social security fund every month] the same as the mother…They [father] should receive [money during their spouses’ or partner’s maternity leave]…They [father] could spend the money on family [expenditure, e.g. taking care of their child]…” (Participant 6]
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