Dedicating space for breastfeeding in childcare: A qualitative study from a multi-state sample of childcare facilities

Background: In the U.S., over 57% of mothers work and many rely on childcare. Organizational conditions for breastfeeding are vital to ensuring mothers breastfeed for the recommended duration (6-24 months). However, less is known about how to modify childcare facilities to assure breastfeeding occurs. This study examined how childcare centers modified their facilities to dedicate space for breastfeeding.

Methods: Interviews (N=31) with center directors across six states were conducted. Each center had recently participated in a national program that aimed to improve policies and practices for physical activity and nutrition, including the promotion of breastfeeding. We used a grounded theory approach, conducting semi-structured, qualitative interviews to examine: a.) Motivation to create dedicated breastfeeding space, b.) The process of bringing about this change, and c.) The implementation and enforcement of this change. Interviews were conducted until theoretical saturation was reached. Data was analyzed using NVivo.

Results: Out of the 31 interviews completed, key themes for motivating change included: seeing media stories on breastfeeding, anticipating nursing mothers to enter the program, and breastfeeding trainings. Change also involved informal conversation, formal staff brainstorming, planning, and dedicating time and effort to change. A lack of remodeling skills, time, and money were cited as barriers to creating dedicated space for breastfeeding. Internal staff training, updating parent materials, and dedicated efforts to ensure maintenance of the space was also discussed.

Conclusion: A minimal amount of time, technical support, and funding can potentially enable most centers to improve their breastfeeding environments.