*3.3. Industry*

Table 5 presents the maternal demographic, employment, pregnancy, and breastfeeding characteristics stratified by industry (accommodation, healthcare, retail, and other). By industry, the percentage of people aged 18 to 34 was largest and smallest for retail and other industries (84.6% and 73.2%, respectively) and the percentage of people aged 35 and over was largest and smallest for healthcare and accommodation (20.2% and 6.9%, respectively, *p* = 0.023). There was no association between industry and race/ethnicity (*p* = 0.191). Employment status varied significantly by industry with the largest and smallest percent of full-time workers in accommodation and retail (48.3% and 33.8%, respectively), and the largest and smallest percent of part-time workers in retail and healthcare (60.0% and 34.0%, respectively, *p* = 0.017).


**Table 5.** Maternal Demographic, Employment, Pregnancy, and Breastfeeding Characteristics by Industry.

<sup>1</sup> *p*-Value was based on Fisher's exact tests or Fisher's exact tests with Freeman and Halton's adaptations for RxC tables. <sup>2</sup> Statistical significance (\*) was based on an alpha of 0.05 with Bonferroni correction based on the number of comparisons within each category or domain (with no correction for demographic variables). A Monte Carlo estimation with 10,000,000 samples was used to calculate Fisher–Freeman–Halton statistics for tables with industry. Estimates were considered marginally significant (ˆ) if they met the alpha criteria of 0.05 but were no longer significant after Bonferroni correction.

Across industries, there were marginally significant differences in how women hoped to feed or if they received information about breastfeeding during pregnancy. The greatest and smallest percentage of women who hoped to only breastfeed were in other industries and accommodation (63.0% and 42.5%, respectively), and the greatest and smallest percentage of women who hoped to only feed with formula were in accommodation and other industries (24.1% and 15.4%, respectively, *p* = 0.029, not significant after Bonferroni correction). The greatest and smallest percentage of women who received information about breastfeeding were in healthcare and accommodation (100.0% and 90.8%, respectively, *p* = 0.017, not significant after Bonferroni correction). Reasons for stopping breastfeeding did not vary significantly by industry (*p* = 0.256).

Table 6 presents the maternal workplace characteristics stratified by industry (accommodation, healthcare, retail, and other). By industry, there were significant and marginally significant differences in policies and culture domain factors. Women working in healthcare and retail had the greatest and smallest percentages of other forms of maternity leave (44.4% and 15.1%, *p* = 0.000). Further, women

working in healthcare and accommodation had the greatest and smallest percentages of other forms of maternity leave (20.0% and 3.9%, *p* = 0.003). In addition, there were marginally significant differences in paid maternity leave by industry. The greatest percentages of paid maternity were found among women working in healthcare and other industries and the smallest percentages were found among women working in accommodation and retail (22.1% and 23.3% vs. 7.3% and 15.9%, respectively, *p* = 0.021, not significant after Bonferroni correction).


**Table 6.** Maternal Workplace Characteristics by Industry.

<sup>1</sup> For the Total Worker Health well-being domain questions, survey participants were only instructed to reply for their current job, and if they were currently on maternity leave or recently left their job, they were asked to respond for their most recent job. <sup>2</sup> *p*-Value was based on Fisher's exact tests or Fisher's exact tests with Freeman and Halton's adaptations for RxC tables. <sup>3</sup> Statistical significance (\*) was based on an alpha of 0.05 with Bonferroni correction based on the number of comparisons within each category or domain (with no correction for demographic variables). A Monte Carlo estimation with 10,000,000 samples was used to calculate Fisher–Freeman–Halton statistics for tables with industry. Estimates were considered marginally significant (ˆ) if they met the alpha criteria of 0.05 but were no longer significant after Bonferroni correction.

Within the physical environment and safety climate domain, there were significant and marginally significant differences by industry. Women in healthcare and other industries had the greatest percentages of private pumping spaces in the workplace, compared to accommodation and retail

(55.0% and 46.3% vs. 26.0% and 24.2%, respectively, *p* = 0.000). Further, women in healthcare and "other" industries had the greatest percentages of supportive coworkers in the workplace, compared to accommodation and retail (63.9% and 61.1% vs. 42.5% and 42.6%, respectively, *p* = 0.034, not significant after Bonferroni correction), and women in healthcare and "other" industries had the greatest percentages of supportive supervisors in the workplace, compared to accommodation and retail (58.5% and 62.0% vs. 41.6% and 47.5%, respectively, *p* = 0.044, not significant after Bonferroni correction). Within the health behavior domain, greater percentages of women in healthcare and other industries pumped at work, compared to women in accommodation and retail (42.2% and 41.3% vs. 23.7% and 23.7%, respectively, *p* = 0.010). There were no significant differences within the work evaluation and experience domain factors by industry (all *p* > 0.095)

Similar to Tables 2 and 4, patterns emerged when examining responses of "not sure" in Table 6. Across significant effects, women working in retail had the greatest percentages of "not sure" and women working in other industries had the smallest percentages of "not sure."

#### **4. Discussion**

#### *4.1. Findings*

Based on previous research and the TWH model, this study explored, among WIC participants and by industry, factors that encourage and/or discourage the initiation and continuation of breastfeeding; pumping at work; and the workplace behaviors, policies, culture, environment, and safety climate associated with breastfeeding and pumping. Our study confirmed the results of a previous study of WIC participants and found that breastfeeding initiation was associated with age, race/ethnicity, and hoping or planning to breastfeed [13]. Further, also similar to this previous study, we found that breastfeeding initiation was not associated with employment status.

Our study did find, however, significant associations between industry and breastfeeding initiation, pumping at work, and the policies and physical environment related to breastfeeding and pumping. Confirming previous findings, we found that women in specific service-oriented industries (i.e., accommodation and retail) reported the lowest rates of breastfeeding initiation and workplace supports for breastfeeding and pumping [12]. Compared to healthcare and all other industries, women who worked in accommodation or retail had the smallest percentages of ever having breastfed, planning to only breastfeed, receiving information on breastfeeding while pregnant, paid maternity leave, a breastfeeding policy, private pumping spaces, and having pumped at work.

Notably, workplace policy factors supporting breastfeeding (i.e., having paid maternity leave, other maternity leave, and a breastfeeding policy) varied by industry but were not associated with breastfeeding initiation or duration. Further, how a woman hoped to feed and having a private pumping space at work were significantly associated with industry, breastfeeding initiation, and breastfeeding duration.

Our study confirms previous findings by Snyder et al. (2018) that having a breastfeeding policy, a space to pump, and coworker and supervisor support towards pumping at work vary by industry with the highest rates found among women in a professional industry (i.e., healthcare) [12]. Further, we also found women in service-oriented industries reported the lowest rates of having breastfed for four or more months. In contrast to Snyder et al. (2018), the majority of women in our study did not have or were "not sure" about each of these factors. Further, also unlike Synder et al. (2018), the majority of women in our study had not met their goal when they stopped breastfeeding.
