Breastfeeding is one of the most natural, protective and cost effective practices a mother engages in with her new infant [1–3]. Australian breastfeeding initiation rates at both the national and state level are high (around 90 percent) [4–6], but by three months, exclusive breastfeeding has dropped to 50 to 60 percent, and is at 15 percent at six months, well below the recommendation of exclusive breastfeeding for the first six months of life [4–9]. Breastfeeding continues to be major public health priority at both state and national levels [9, 10].
With women now representing 46 percent of the Australian labour force, it is evident that women make a significant contribution to the national economy . Twenty one percent of previously working Australian women resume employment in the first six months following childbirth, and 42 percent by 12 months . A woman's return to work has repeatedly been found to be a major contributor to the premature cessation of breastfeeding [12–19].
For the employer, the benefits of providing a working environment conducive to breastfeeding outweigh the costs. If breastfeeding is supported in the workplace, women are more likely to return to work, and return earlier, which contributes to women maintaining their job skills, as well as reducing staff turnover [20–22]. Women are also more likely to have reduced frequency and length of work absenteeism due to fewer and less severe baby-related illnesses [20–22]. Additionally, women are more likely to have higher morale and improved levels of concentration, resulting in increased productivity [20–22]. Accommodating breastfeeding mothers may also contribute towards the development of a positive corporate image [21, 23].
Workplaces can be an ideal setting for implementing policies and practices to promote and support the continuation and longer duration of breastfeeding [15, 21]. Studies indicate that mothers who have convenient access to their infant during the work day, or who expressed breast milk at work, have longer breastfeeding duration than other mothers [24, 25].
Support from staff and management, access to facilities to feed their infant or express and store breast milk, flexible hours and lactation breaks have all been identified as crucial elements required by women to successfully continue breastfeeding on their return to work [4, 15, 17, 20, 26–31]. A study by Dodgson, Chee and Yap  examining workplace breastfeeding policies and practices in Hong Kong hospitals found those hospitals with a committee addressing workplace breastfeeding issues achieved a more supportive environment than those hospitals without. Furthermore, development of a strategic plan and a positive attitude towards breastfeeding at work significantly enhanced the likelihood of policy success [29, 33].
The aim of this study was to examine the attitudes, breastfeeding practices and experiences of female employees in an Australian health service workplace who had returned to work from maternity leave, and to investigate their perceived level of organisational support to combine breastfeeding and work. This baseline survey forms a component of an evaluation, using a before and after study design, of a workplace intervention to encourage and support health service employees to combine breastfeeding and work.
The Sydney South West Area Health Service (SSWAHS), Australia looks after all public hospitals and health care facilities (eg early childhood clinics, community health centres) in the central and south-west regions of Sydney, New South Wales (NSW). It covers an area of 6380 square kilometres and contains 35 health facilities, including 11 hospitals. The workforce is predominately female (74%) and in 2007 numbered 23 419 employees . Staff are employed in a diverse range of clinical and non-clinical occupations, including doctors, nurses, allied health, population health, administration, management, information technology, and domestic services. Clinical staff may have less flexibility in their daily workload due to patient demands, which could impact on their ability to take regular lactation breaks.
At the time of the survey, full time and permanent part time health service employees who had completed 40 weeks continuous service were entitled to 14 weeks paid maternity leave and a further period of unpaid maternity leave of up to 12 months from the date of birth of their child. With management agreement, employees could also return from maternity leave on a part time basis until their child reached school age. Staff employed under the Nursing and Midwifery Award were entitled to a 30 minute paid lactation break per eight hour shift. Staff employed under other awards who wished to breastfeed or express breast milk during work time had to do so during their allocated meal breaks or unpaid time. Of the 35 SSWAHS facilities, only two had a dedicated staff breastfeeding room.