EC Paediatrics

Background: Breastfeeding offers optimal nutritional, immunological, and developmental benefits for infants. Despite high initiation rates, exclusive breastfeeding remains difficult to sustain among employed mothers, particularly in middle-income countries. Evidence from Morocco remains limited, although women’s workforce participation continues to rise. This study aimed to assess breastfeeding practices among active mothers, identify workplace and sociocultural barriers to continuation after returning to work, and explore the strategies used to maintain lactation.

Methods: A descriptive cross-sectional study was conducted between January and June 2024 among 150 employed mothers attending the maternity and pediatric departments of the Mohammed VI University Hospital Center in Tangier, Morocco. Eligible participants were mothers aged 20 - 45 years who had resumed work within one year postpartum and breastfed for at least one month. Data were collected through structured interviews and analyzed using descriptive statistics and chi-square tests. Qualitative responses were examined thematically.

Results: Breastfeeding initiation was high (94%), although only 36% achieved exclusive breastfeeding for six months. Early return to work (72%) was significantly associated with early cessation (p < 0.01). Major barriers included workload (68%), absence of lactation rooms (61%), and short maternity leave (56%). Support from employers and families was positively associated with breastfeeding continuation (p = 0.02). Mothers adopted several coping mechanisms, notably milk expression (42%), schedule adjustments (38%), and mixed feeding (31%), though these strategies seldom compensated for structural limitations.

Conclusion: Breastfeeding continuation among Moroccan working mothers is strongly constrained by workplace conditions, limited institutional support, and sociocultural pressures. Although many mothers attempt to maintain lactation through individual strategies, systemic interventions-such as extended maternity leave, breastfeeding-friendly workplace policies, and culturally sensitive counseling-are necessary to improve breastfeeding outcomes nationally.

Keywords: Breastfeeding; Working Mothers; Lactation Support; Maternity Leave; Workplace Barriers; Infant Nutrition; Morocco; Public Health Policy

1. Victora CG., et al. “Breastfeeding in the 21^st century: epidemiology, mechanisms, and lifelong effects”. Lancet 10017 (2016): 475-490.
2. Rollins NC., et al. “Why invest, and what it will take to improve breastfeeding practices?” Lancet10017 (2016): 491-504.
3. World Health Organization. “Infant and young child feeding: Model chapter for textbooks for medical students and allied health professionals”. Geneva: WHO (2009).
4. World Health Organization, UNICEF. “Global breastfeeding scorecard 2024: Enabling breastfeeding - investing in policies and programs”. Geneva: WHO/UNICEF (2024).
5. Ministry of Health, Morocco WHO EMRO. “Morocco: Nutrition profile and infant and young child feeding practices”. Cairo: WHO EMRO (2019).
6. El Mossaoui M and Barkat A. “Breastfeeding practices in Morocco (1992-2025): Multicentric analysis of national surveys, meta-analysis, and exploration of key indicators”. International Journal of Child Health and Nutrition 2 (2025): 140-154.
7. Faraj K., et al. “Early breastfeeding initiation: exploring rates and determinants among postpartum women in Eastern Morocco”. Scientific African 21 (2023): e01883.
8. Mohammed S., et al. “Systematic review and meta-analysis of the prevalence and determinants of exclusive breastfeeding in the first six months of life in Ghana”. BMC Public Health1 (2023): 920.
9. Gebrekidan K., et al. “Exclusive breastfeeding continuation and associated factors among employed women in North Ethiopia: a cross-sectional study”. PLoS One7 (2021): e0252445.
10. Tolossa T., et al. “Exclusive breastfeeding cessation and associated factors among employed mothers in Dukem town, Central Ethiopia”. International Breastfeeding Journal 1 (2020): 6.
11. Hamada H., et al. “Female hospital workers in Morocco: factors influencing breastfeeding duration with self-reported experiences”. Health Care for Women International 8 (2020): 928-948.
12. Abou-ElWafa HS and El-Gilany AH. “Maternal work and exclusive breastfeeding in Mansoura, Egypt”. Family Practice 5 (2019): 568-572.
13. Abekah-Nkrumah G., et al. “Examining working mothers’ experience of exclusive breastfeeding in Ghana”. International Breastfeeding Journal 1 (2020): 56.
14. Radwan H. “Patterns and determinants of breastfeeding and complementary feeding practices of Emirati mothers in the UAE”. BMC Public Health 13 (2013): 171.
15. Rehayem A., et al. “Infant feeding beliefs and practices of Arabic mothers in Australia: a qualitative study”. Women and Birth4 (2020): e391-e399.
16. Oweis A., et al. “Breastfeeding practices among Jordanian women”. International Journal of Nursing Practice 1 (2009): 32-40.
17. Thulier D and Mercer J. “Variables associated with breastfeeding duration”. Journal of Obstetric, Gynecologic and Neonatal Nursing 3 (2009): 259-268.
18. Bai Y., et al. “Lactation accommodation in the workplace and duration of exclusive breastfeeding”. Journal of Midwifery and Women's Health 6 (2013): 690-696.
19. Vilar-Compte M., et al. “Breastfeeding at the workplace: a systematic review of interventions to improve workplace environments to facilitate breastfeeding among working women”. International Journal for Equity in Health 1 (2021): 110.
20. Barasinski C., et al. “Workplace lactation support and breastfeeding duration: a cross-sectional study in a French university hospital and perinatal network”. Nutrients17 (2022): 3463.
21. Fein SB., et al. “Success of strategies for combining employment and breastfeeding”. Pediatrics2 (2008): S56-S62.
22. World Health Organization, UNICEF. “Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services: the revised Baby-friendly Hospital Initiative 2018”. Geneva: WHO. Organisation mondiale de la santé (2018).
23. International Labour Organization. “Maternity Protection Convention, 2000 (No. 183)”. Geneva: ILO. Normlex (2000).
24. Adarmouch L., et al. “[Weaning before the age of 6 months in Marrakech: associated factors and prevalence]”. Revue d'Épidémiologie et de Santé Publique 5 (2013): 429-435.
25. Dutheil F., et al. “Breastfeeding after returning to work: a systematic review and meta-analysis”. International Journal of Environmental Research and Public Health 16 (2021): 8631.