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An Exploration of Lactation Support Programs within Accredited Academic Public Health Universities Open Access

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Background: Lack of lactation accommodations for employed mothers and students within academia is a barrier to breastfeeding continuation. Workplace lactation support programs (LSPs) serve as initiatives that provide supportive accommodations to employed mothers by providing 1) a space to pump milk; 2) time for lactation breaks; 3) education on lactation, as well as other supportive components that align with these three support areas. There is a lack of evidence on the adoption of LSPs in general, but specifically among universities, which also include students who need lactation support. Accredited academic public health universities should be at the forefront of workplaces that provide their employees with LSPs that ensure equitable access to lactation resources and support, and subsequently, promote healthier communities. Objective: This study sought to explore the adoption of LSPs among the population of APH universities, by examining contextual and system antecedents to adoption, how many schools adopt these programs, what these programs look like within the university setting, who adopts these programs, why these programs are adopted, and how these programs are implemented. Methods: this explorative qualitative study was conceptualized using the diffusion of innovation (DOI) model. Inferential descriptive methods were used to measure LSP adoption, describe LSPs and group LSPs into three consecutive levels of support: adequate, expanded, and comprehensive based on the frequency and type of LSP components present. Comparative case study analysis was employed using 10 selected cases to determine the factors that distinguished adopter universities (5 cases) from non-adopter universities (5 cases) and identify LSP implementation barriers and facilitators among adopter cases. Results: The majority of APH universities (62%) have adopted a LSP; a rate that is significantly higher than national levels (28%). The majority of LSPs provided a comprehensive level of support (51%), followed by expanded (27%), and adequate-basic (22%). Adoption of campus wide LSPs is driven by: an identified campus wide need among university employees and dedicated program champions; team work and networking; incorporating LSPs within existing policies and programs that facilitate collaborations with the campus office of human resources, office of facilities management, and the campus hospital; as well as having a comprehensive marketing strategy and extensive supportive networks. Barriers to LSP implementation centered around the absence and limitations of federal, state, and campus lactation policies. Allocating sufficient and suitable lactation spaces that fall in line with federal mandates and maintaining both room ownership and security was also a barrier.Conclusions: LSPs within APH universities provide for excellent lactation support services that go beyond basic recommendations and expand services to students. Efforts to increase program uptake among universities should center around establishing LSPs as an essential employee workplace wellness program or benefit that expands lactation services to students; establishing concrete partnerships between entities that have been shown to support program implementation; and developing official campus lactation polices that institute lactation support provisions for both employees and students. These findings also inform future research that aims to increase overall LSP adoption and improve national breastfeeding outcomes.

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