Women of childbearing age constitute a high proportion of the workforce and make significant contributions to national economies. In industrialised countries where the collection of organised statistics allows the easy estimation of their numbers, women of childbearing age represent anywhere from 45% to 60% of the total labour force (ABS 2003; Statcan 2001; UK Office 2002; US Census 2002).

Women of childbearing age may become pregnant during employment and many of them may decide to return to work after the birth of their babies. Unless supported by their employers, this return to employment can be a barrier to breastfeeding because they can be separated from their babies and it may impact on the duration and exclusivity of breastfeeding (Osis 2004; Visness 1997). If they are not supported, women may decide to entirely wean their children when returning to work (Arthur 2003). It is encouraging to know that most women report the desire to continue breastfeeding after returning to work if they have access to facilities, work flexible hours and take rest breaks during working hours (Kosmala‐Anderson2006). In addition, a large number of working mothers can continue breastfeeding for six months (Cohen 1994; Ortiz 2004) if the workplace is ideal and supportive. Workplace intervention may also have a positive impact on breastfeeding initiation. A study from the US showed that among working mothers enrolled in an employer‐sponsored lactation program, breastfeeding was initiated by 97.5% of the women (Ortiz 2004). Hence, workplace interventions could have a positive impact on both initiation and duration of breastfeeding.

The range of health benefits of breastfeeding for infants and mothers are well documented. The benefits of breastfeeding also extend to employers as it reduces work absenteeism and increases employee morale and retention (Cohen 1994; Cohen 1995). Similarly, if employers support breastfeeding in the workplace, women who continue to breastfeed after returning to work miss less time from work because of baby‐related illnesses, and have shorter absenteeism when they do miss work (Cohen 1995). The public health benefits of continued breastfeeding are improved maternal (CGHFBC 2002; Labbok 2001) and infant health (Bick 1999; Dewey 1995; Gillman 2001; Kramer 2001; Kramer 2002; Mortensen 2002; Wilson 1998).

Exclusive breastfeeding for at least the first six months of life is recommended by the World Health Organization (WHO) (WHO 2002). This recommendation is evidence‐based and adherence to it improves infants outcomes (Kramer 2001), such as decreased risk of gastrointestinal tract infections and atopic eczema in the first year of life (Kramer 2001). Unfortunately, a minority of the world's infants (35%) are exclusively breastfed beyond the first three to four months of age (WHO 2003), and even this is short of the duration recommended by the WHO. Information about breastfeeding by employed versus unemployed women is not available. However, the prevalence of exclusive breastfeeding rates for all women vary worldwide. In industrialised countries like Australia and the US, 54% and 41.1% of women exclusively breastfeed for three months, and 32% and 14.2% for six months, respectively (ABS 2004; CDC 2004). In developing countries such as Kenya, Bangladesh, Vietnam and Turkey, the exclusive breastfeeding rate for three months by working mothers ranges from 13% to 59% (Dearden 2002; Haider 1995; Lakati 2002; Yilmaz 2002). Overall, these rates are low.

To reach the WHO's recommendation of six months of exclusive breastfeeding, women need a supportive environment (at home and work) that protects and promotes breastfeeding. For women in the workforce, merging breastfeeding and paid work is difficult. Undoubtedly, workplaces are excellent settings for interventions to encourage and assist the initiation and continuation of exclusive breastfeeding (Cohen 1994; NSW 2004; Ortiz 2004). However, women face various barriers in the workplace and the type of support and information needed to encourage them to continue breastfeeding (Zinn 2000) has yet to be fully identified and addressed by all parties. In this regard, policies at the level of both the government and employers may be warranted.

Various types of workplace strategies are available to support the promotion of breastfeeding. They include maternity leave provisions; flexible employment practices; lactation breaks; and physical facilities such as private rooms and access to refrigeration (NSW 2004; Rea 2004). To date, few workplace interventions have been implemented and their findings reported in the literature (Cohen 1994; Cohen 2002; Ortiz 2004). In general, to achieve high rates of both breastfeeding and women's employment, socio‐cultural support and labour market, health and early childhood policies are vital (Galtry 2003).

The WHO and UNICEF have initiated the Global Strategy for Infant and Young Child Feeding. The strategy highlights the priority actions, duties and responsibilities of various organisations and calls for governments to pass imaginative legislation to protect the rights of working women to breastfeed, and to establish the means to enforce these policies, which are consistent with international labour standards (WHO/UNICEF 2003).

To date, various systematic reviews addressing issues associated with breastfeeding have been conducted and reported in the Cochrane Database of Systematic Reviews (Anderson 2003; Dyson 2005; Kramer 2002; Shah 2006). In addition, one other review is currently underway (Ram 2002). However, none of these reviews are explicit to mechanisms for facilitating breastfeeding among women in employment. Our review aims to assess the interventions in the workplace to support, encourage and promote breastfeeding among working mothers.