Breastfeeding-Friendly Policies And Programs In Selected Public Universities In Ghana

doi:10.21203/rs.3.rs-476351/v1

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Breastfeeding-Friendly Policies And Programs In Selected Public Universities In Ghana

https://doi.org/10.21203/rs.3.rs-476351/v1

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Background

The United Nations through its Sustainable Development Goals 3 and 5 has championed Women empowerment for exclusive breastfeeding through various action plans and expected the concept to be decentralized through locally mandatory implementation of various institutional policies and programs in member Countries. Using Kabeer’s empowerment concept, the authors in this paper assessed the availability and implementation of breastfeeding policies and programs in selected public universities in Ghana.

Methods

The study design was an integration of descriptive, exploratory, and case study using an unstructured interview guide developed by the authors for qualitative data collection. Thematic analysis of data on breastfeeding experiences was done yielding three main categories (breastfeeding policy and programs, support, and views on breastfeeding) emerged during data analysis. The in-depth interviews of respondents lasted 60 minutes. The University of Cape-Coast Ethics Review Board gave ethical approval for the study.

Results

Although Ghana has ascribed to various international conventions on childcare and developed policies enshrined in its labour law to support breastfeeding, none of the universities in this study has a formal breastfeeding/childcare policy/program and there are no future policy plans for on-campus facilities to enhance breastfeeding. Financial cost emerged as a major challenge hindering the universities from implementing a policy/program in this regard, hence nursing mothers continue to make personal but challenging arrangements for breastfeeding on university campuses.

Conclusions

The finding that formal breastfeeding-friendly policy/program was unavailable in the various universities in Ghana reflects negative implications for childcare, hence achieving the Sustainable Development Goals 3 and 5 in Ghana. The authors recommend formal breastfeeding-friendly policies/programs as a criterion for accreditation of universities in Ghana to enhance childcare.

Obstetrics & Gynecology

Pediatrics

Breastfeeding

Ghana

policies

programs

Sustainable-Development-Goals

Universities

Women’s empowerment has remained a focal part of the United Nations (UN) declarations on women’s issues since 1975 because of its importance in global development (Mandal, 2013). In various international development frameworks such as the UN Sustainable Development Goals 3 and 5; the UN conventions on child care/rights, women empowerment is considered an intrinsic goal for national development because of its pivotal roles in child health, care, growth and development (Chant & McIlwaine, 2009, p.206; Malhotra & Schuler, 2005; Desai, 2010). These initiatives have stimulated women’s increasing engagement in various social spheres of life across diverse settings as women are increasingly bridging huge gender gaps with men in various social domains (Millazo & Goldstein, 2017). Gender gaps in basic, secondary, and tertiary education have shrunk substantially in many countries over the past three decades (UNESCO, 2015). These improvements in the educational status of women are paving way for more women to participate in politics, governance, formal labor market, and public life (Sackey, 2005; Barnes & Burchard, 2013; Millazo & Goldstein, 2017; Abraham, Ohemeng & Ohemeng, 2017).

The positive outcomes of women's empowerment and development are evident in Ghana (Oduro & Ackah, 2017). Presently, Ghana boasts of increased female enrollment at all levels of education and formal employment. Female gross enrollment in the second cycle and tertiary institutions stood at 59.76 and 13.32 respectively in 2015 compared to 33.54 and 0.02 respectively in 1991 (Index Mundi, 2018). Even though the proportion of women in government is quite low, the percentage of women engaged in economic activities is high in Ghana’s formal sector (GLSS, 2014). The entry of more women of childbearing age into job markets and tertiary institutions have made it increasingly imperative that support for breastfeeding and childcare are provided at workplaces and academic institutions. This study adopted an existing concept of empowerment from Kabeer (1999) and explored critical roles played in promoting the development and rights of women in paid employment and educational opportunities linking it to the support offered to students and employee mothers in public universities in Ghana. Kabeer (1999) explained women empowerment as a process by which women take control and ownership of their lives through expansion of their choices.

Ghana has many legal and institutional frameworks supporting women's empowerment. For instance, article 17(1) and (2) of the 1992 constitution guarantee gender equality. Apart from the constitution, other frameworks available for promoting women's empowerment are: 1) Executive Instrument 8 of 2001which established the Ministry of Gender and Social Welfare. 2) The various Growth and Poverty Reduction Strategies. 3) Free Compulsory Universal Primary Education and the Free Senior High School Education. In terms of pressure from civil society, institutional actors, such as bilateral agencies and non-governmental organizations also influence policy and discuss issues related to women’s rights and continued empowerment (Anyidoho & Manuh, 2010).

Ghana being a member of UN and affiliate organizations like the International Labor Organization (ILO), has responsibilities to conventions and recommendations of UN affiliates. Yet, apart from the Labor Act (Act 651of 2003) which guarantee twelve weeks paid maternity leave and a further extension in the case of multiple births or intrapartum and postpartum complications, and the Breastfeeding Promotion Regulation Act of 2000 (LI 667), regulating the marketing of breastmilk substitute, it appears Ghana has not fully implemented the ILO’s conventions (No. 103 of 1952; No. 3, 1999; No, 156 of 1981; No. 183, 2000) and recommendations (No. 95, 1952; 165, 1981; 191, 2000) which seeks to broaden the scope and entitlement of maternity protection at work (ILO, 2012). It is important to build national consensus through research and advocacy to support women in balancing a formal job and academic responsibilities with optimum breastfeeding practices when required.

Over the past three decades, international development scholars have used the concept of empowerment as a guiding framework in championing women's development (Kabeer 1999; King & Mason 2001; Mandal 2013). According to Kabeer (2005), access to resources (economic, human and social) confer on individuals and groups ability (referred to as agency) to define and achieve their life’s goals or the capacity to dominate the abilities of other individuals and groups through the exercise of authority or coercion. Resources together with an agency are the instruments of individual and group potentials for making choices in life (referred to as achievement). However, access to resources depends on rules and norms governing distribution and exchange in social institutions (Kabeer, 1999).

Based on Kabeer’s concept of empowerment, the authors argue that without institutional arrangements and norms that are supportive of childcare in the formal labor market and higher institutions of learning, many women of childbearing age would be denied access to higher education and opportunities to participate in the formal labor market. Based on this perspective, the concept of empowerment, as emphasized by Ranjula (2007), can be seen as transcending beyond mere economic betterment and well-being of women to exclusive breastfeeding which forms one of the strategic gender issues discussed in this paper.

Exclusive breastfeeding in Ghana usually declines during the third month of infants’ life; a situation which is attributed to the practice of women returning to work after maternity leave at which time the infant will be three months old (Ghana Statistical Service, 2014). Studies have shown that the multiple roles of women conflict with their ability to perform optimum breastfeeding responsibilities, especially in cases where remunerated work is crucial to supplement the family budget (DeRose, 2003; Amoah, 2018). Further, the maternity protection provision of the Labor Act in Ghana does not extend to female students of higher institutions of learning who become pregnant and deliver in the course of study.

Even though some studies have reported the plight of employee and student mothers on university campuses (Esia-Donkoh, 2014), there is limited evidence of actions taken by university authorities to provide support for students and employee mothers (i.e. paid maternity leave for working mothers and provision for student mothers to differ a program after childbirth if required). Additionally, apart from flexibilities in allowing nursing mothers on the various university campuses for breastfeeding, there is no further support given to working and/or student mothers within the general framework of promoting the development and rights of women to equal opportunities in society. The few studies that have explored this domain (Derose, 2003; Gladzah, 2013; Waterhuse et al., 2017) have mostly focused on breastfeeding among mothers in the informal labor market and breastfeeding related issues at the expense of those in the formal labor market. Upon this backdrop, the question is: what support do employers and academic institutions provide for women to effectively combine their formal job or academic responsibilities with their day-to-day duties of providing optimum breastfeeding practice and childcare? The aim is to obtain answers to this question for filling these pockets of grey spaces identified in the current literature on women’s development and the current national effort in empowering women in Ghana by exploring public universities' support for breastfeeding and childcare among students and employee mothers.

Design

The authors used an integrated descriptive, case study, and exploratory research design with a qualitative approach for data collection and analysis. The COREQ checklist (https://www.equator-network.org/reporting-guidelines/coreq/) provided additional guidance for reporting the study. The choice of this integrated design aligns with the study objective to examine the policies and programs available in public universities to support breastfeeding and childcare practices for employee and student mothers.

Setting

Three renowned public universities [(University of Cape Coast (UCC), University of Education, Winneba (UEW), and Kwame Nkrumah University of Science and Technology (KNUST)] were involved in the study. KNUST is in Kumasi and covers seven square miles in the area. Sixty percent of the student population resides in private hostels due to limited hostel facilities (KNUST, 2009). KNUST has decentralized collegiate administration with six colleges since January 2005. The colleges are semi-autonomous and headed by a provost. There are Deans and Directors heading the various centres, faculties, and institutes in each college (KNUST, 2019). UCC is located in the central region of Ghana with a current student population of 67,938. The University began operations as a College in October 1962 and has grown over the years into five Colleges with six Faculties and eight Schools headed by Provosts and Deans respectively (UCC, 2017–2018). UEW was established in 1992 with a mandate to train educationists. The University is divided into satellite campuses across Ghana and has a current student population of 59,916. Administratively, UEW operates a centralized system headed by a Vice-Chancellor (UEW, 2016–2017). These three universities have other modules of admissions (matured student admission, sandwich, weekend, and evening school admissions) in addition to the regular admissions. Such modules of admissions attract large numbers of working mothers and adults who may have reproductive intentions.

Target population

The target population for this study comprised employees, the management of the universities, and student mothers in public universities in Ghana. The target institutions (KNUST, UCC, and UEW) and respondents for the study were purposively selected. The unique characteristics of these universities make them suitable for this study. In the case of UEW, which has four satellite campuses, three out of its four campuses including the main campus were selected at random as per the study inclusion criteria.

Inclusion and Exclusion criteria

Participants in the study were senior staff members from key divisions of the respective universities whose activities have a direct bearing on the research topic (i.e Human Resource Division, Quality Assurance Division, Academic Planning Division, Office of the Dean of students and the University Teachers Association (Local Branch).

Data Collection

Author developed an unstructured interview guide was used to collect data from respondents in the identified institutions. The interview guide was adapted from the ILO’s maternity resource package (ILO, 2012), which spells out conditions for embarking on paid maternity leave. Additionally, an interview guide developed for a previous study by Nkrumah and Gbagbo, (2018) was also used as a guide. Interviews commenced after formal approvals were obtained from the three universities and respondents. Data was collected using author developed interview guides and field notes. The interviews lasted between 40 to 60 minutes and discussions continued until saturation was reached when no new related issue and views no longer came. Data were collected between April and July 2018 using the research instruments and field notes. All interviews were conducted in English. The Institutional Review Board (IRB) for research Ethics at the University of Cape-Coast gave ethical approval for the study.

Data Analysis

Data Analysis was done manually. In the manual analysis, the data collected were transcribed immediately after each interview and analyzed using a thematic analysis approach. The transcribed data was tabulated with two columns (A and B). Column ‘A’ contained the transcribed data and column ‘B’ the field notes. This rough tabulation was done to compare the transcribed data and field notes so as to ensure that no relevant information was omitted. The synchronization of the transcribed audio and field notes constituted the final results from the field work.

Table 1 presents the distributions of respondents. Twenty-four respondents from 5 offices in the respective universities participated in the study. The distribution includes the Human Resource Division (6), Quality Assurance Division (6), Academic Planning Division (6), the office of the Dean of students (3), and three respondents from the University Teachers Association (Local Branches).

Table 1

Distributions of respondents
Institution	Office	Number of respondents
KNUST	Human Resource Division	2
	Quality Assurance Division	2
	Academic Planning Division	2
	Dean of students	1
	University Teachers Association (Local Branch)	1
UCC	Human Resource Division	2
	Quality Assurance Division	2
	Academic Planning Division	2
	Dean of students	1
	University Teachers Association (Local Branch)	1
UEW	Human Resource Division	2
	Quality Assurance Division	2
	Academic Planning Division	2
	Dean of students	1
	University Teachers Association (Local Branch)	1
Source: constructed by authors using field data, 2018–2019

Three main themes (breastfeeding policy and programs, institutional support, and views on Breastfeeding/Childcare Support) emerged during data analysis. The breastfeeding policy and program had 3 sub-themes; institutional support on the other hand has 1 sub-theme and views on breastfeeding/childcare support have 2 sub-themes (Table 2).

Table 2

Main and Sub-themes
Main themes	Sub-themes
1. Availability of breastfeeding policy and programs	i. Official policies and programs of the universities
	ii. Conditions of Work (CW)
	iii. Maternity Protection Privileges
2. Institutional support for breastfeeding/Childcare	i. Childcare related Support
3. Views on breastfeeding/childcare support	i. Management Perception of Support
3. Views on breastfeeding/childcare support	ii. Perceived institutional challenges
Source: constructed by authors using field data, 2018–2019

Availability of Breastfeeding Policy and Programs

This category focused on existing official policies and programs of the universities that outline their position on breastfeeding and childcare among employee and student mothers. Conditions of work, related documents and maternity protection privileges are sub-themes that emerged from the main category.

Official policies and programs of the universities

This sub-theme exhibited official policies and programs of the university on breastfeeding and childcare related supports. It is concerned with the various policy and programs provided by the universities to help student and employee mothers cope with breastfeeding and childcare. It was observed that, although the various universities had some flexible and informal arrangements to support breastfeeding mothers (i.e taking short breaks to breastfeed, closing earlier than official working hours, and in some cases bringing nannies around the work/school environment to prompt mothers when their babies require breastfeeding). There were however no official policies and programs binding these flexibilities. A respondent explained that ‘--we are humans, for that matter, we ensure some flexibility in these issues to ensure our nursing mothers don’t unnecessarily deprive their babies of breastfeeding when required…’ (Human Resource Manager, University 1).

Conditions of Work (CW)

Despite comprehensive policies on the conditions of work with respect to childbirth in the various universities involved in this study, there were no explicit formal policy documents for breastfeeding and childcare in the three participating universities. The closest available document to childcare policy was the condition of work (CW) of the three universities which guarantee maternity protection for employee mothers in line with the Labour Laws of Ghana. The content of this document is explained to employees during orientations and copies are made available in faculties and department offices, online, and in libraries of the universities.

In addition to the CW of the universities, two of the universities had provisions in their strategic plans to provide childcare related support to both students and employee mothers. Even though one of the universities has a directorate that champions gender issues, specific policies, and programs to support childcare and breastfeeding were not available. Heads of some key units in two of the universities indicated that the strategic plan of their university has strategic goals towards promoting infants and child care at the university. One university had plans to provide on-site crèche for both student and employee mothers. An officer from the planning unit in one of the universities outlined some provisions in their strategic plan as follows.

‘In this University’s strategic plan......decisions have been made to provide a crèche...we have allocated a place and we are going to build’. (Head of Planning, University 3)

‘This issue has never crossed our mind as an institution, but it’s worth considering for our future plans since it’s a relevant issue for our females’. (Local UTAG executive, University 3)

Maternity Protection Privileges

All officials interviewed in the three universities reported that ‘employee mothers are entitled to the statutory maternity leave but no such provision for student mothers. Some officers indicated that:

‘…….where a mother encounter complication, the case then moves beyond pregnancy.....the employee will have to follow the procedure for that......once this is done, we extend the maternity leave’. (HR representative of university 3).

‘……we have provisions for paid maternity leaves for our employee mothers but there is nothing like maternity leave for student mothers….. At best a student mother is allowed to defer the course either on health grounds or upon a reasonable request to nurse a newborn baby.’ (Office of Dean of students, University 2).

Additionally, employee mothers were found to have the privilege of taking casual leave or leave of absence where necessary. It was also noted that employee mothers are allowed to arrange for their annual leave at the expiration of their maternity leave. On resumption from maternity leave, mothers are made to work five days weekly or 20-hours per week (5/20) for nine consecutive months instead of the usual five-days, 40-hour work per week (5/40).

A review of student handbooks of the universities revealed the existence of procedures that partially support academic work and childcare. The universities provide counseling services for academic, social, and personal issues affecting students. They also have in place procedures for deferment of programs and examinations. However, deferment of programs has some limitations. As part of the policy, a student cannot defer his/her program in the first year of admission. Where applicable, deferment is limited to two semesters. Only one university had a maximum period of four semesters on grounds that the deferment period would not exceed the maximum period allowed for completion of the program.

In terms of housing or on-campus accommodation policies, none of the universities had specific accommodation arrangements for nursing mothers. This was explained that pregnancy among students is usually not predictable for the university to invest in such a policy/program.

‘…….we are concern with academic work and not childbearing issues….. A woman who opts to be pregnant in school is expected to make her own arrangements to nurse her baby…’ (Quality Assurance Directorate, University 1).

‘…….the University has plans to build mother and child hostel with facilities convenient to accommodate nursing student and employee mothers in future but not now.…..’(Academic Planning Division, University 3)

Institutional breastfeeding Support

All three universities did not have designated facilities for breastfeeding. In one of the universities, officials indicated that by convention, employee mothers are not expected to come to work with babies. The workplace is considered not conducive for nursing babies and breastfeeding break is not practiced. An official indicated that:

‘.... employees are not allowed to be at work with their babies. Though this is not a policy. I think the work environment could be hazardous to the child’. (HR representative of university 2)

‘.....no, we don’t have breastfeeding facilities or a lactation room. There is a kitchenette but since employees are not supposed to come to work with babies, I don’t think the kitchenette will serve that purpose’. (HR representative of university 3)

In another university, an official said that the university does not regulate workplace nursing, hence have no ceiling on the number of breaks available to a mother in a day. Despite this flexible work environment aimed to enhance child care, most employee mothers choose not to come to work with babies so as to avoid interfering breastfeeding with their work.

‘Breastfeeding staff can break anytime to breastfeed their babies provided there is no pressure or workload on them’. (HR representative of university 1).

Likewise, there is no policy in any of the Universities that prevents student mothers from nursing their babies on campus.

‘Although this is an academic environment, people have their rights to childbirth and childcare hence, the university does not prevent student and employee mothers from nursing their babies in any of these university campuses…. What we discourage however is for babies to be left to loiter around unattended to and disturbing official work and lectures as usually seen during our sandwich and weekend programs…..’(HR representative of university 2).

Only one of the universities has a purposefully built but privately managed on-site crèche situated in close proximity to lecture halls and administrative offices. The remaining two universities didn’t have on-site crèche for employees and student mothers.

Childcare related support

The practice of five-day 20-hour work per week (5/20) “half-day” was found to be substitutive to breastfeeding break. As part of flexible work schedule practices, employee mothers can arrange with their immediate boss on which time of the day to report to and close from work for their 4-hour work per day. A human resource officer explained further:

‘There is no breastfeeding break because of the half-day........but there is flexibility, for instance, if a staff is supposed to report at 8 am and close at 12 pm, she can arrange with her head so she can come at 9 am and close at 1 pm’. (HR representative of university 3)

Officials interviewed indicated that they resort to the various internal arrangement because the universities have no standard procedures on flexible work schedules. In one of the universities, an official mentioned that the Vice-Chancellor is supportive of women’s welfare and that housing arrangements for students are made to favor female students. There was however no future plans for on-campus accommodation for student mothers. Rather, the universities have breastfeeding promotion and education programs for employee mothers at the universities' hospitals as part of maternity services.

‘......at the university hospital, we have a complete area for pregnant women...... the staff is aware of it and they go there for antenatal, weighing and receive breastfeeding education’.

(HR representative of university 1)

‘I don’t think we have such programs, but we have breastfeeding awareness creation in the departments annually’. (HR representative of university 2)

Views on Breastfeeding/Childcare Support

This category provides information on university management perception about the workplace and on-campus support for breastfeeding and childcare. Management perception of support and perceived challenges are the sub-categories.

Management Perception of Support

In one of the universities, it was mentioned that management considers breastfeeding as an important element of infant care due to its immense benefit to mothers and infants. An official from another university said providing support for breastfeeding and childcare is about the welfare of employees and their children, as such the university will support it. Another official also mention some health benefits of breastfeeding and suggested that it is important to support employee mothers. However, no mention was made of support for student mothers to help them combined childcare and academic work effectively.

Perceived institutional challenges

Financial cost emerged as a major challenge hindering universities' support for breastfeeding and childcare. All officials interviewed concluded that maternity leave is expensive in terms of loss of man-hours. Cost of relieving duties, difficulties in finding a replacement for staff going on maternity leave, and/or work overload on existing staff. Increased work overload often results in fatigue and low productivity among staff. ‘-----Someone may have to take on extra responsibility and the person may suffer stress..........sometimes we have vacant positions due to maternity leaves’. (HR represented, university 3)

‘----The proposed six months maternity leave would have been the best ........so that mothers can have ample time to breastfeed their babies, but the vacancy it will create would be difficult to fill.....it also comes with extra cost’---. (HR reprehensive from university 2)

Human resource representatives interviewed suggested that future review of the maternity protection provision of the Labor Act should consider extending the period of the “half-day” currently enjoyed by mothers instead of the maternity leave duration. They also proposed the implementation of baby and child-friendly work environment initiatives such as the provision of breastfeeding rooms and on-site crèche in place of extension of the maternity leave period. Initiatives such as allowing employee mothers take maternity leave in addition to current and ensuing year’s annual leave were proposed.

The findings suggest gaps in breastfeeding and childcare provisions in public universities in Ghana, which have a policy and program implications as the present arrangement is discriminatory and nurtures gender inequality. In the works of Sholkamy (2010) on women empowerment within the Arab world, advocating for women’s right to work in the formal labor market, acquire property, and freedom to speak on issues relating to their safety and sexuality goes beyond providing access to micro-credit and sewing machines. This shows that efforts to promote women’s empowerment and rights to equal opportunities, especially in the Ghanaian context, also need to transcend mere livelihood empowerment and social assistance programs to genuine initiatives that weaken social and institutional barriers to equality.

Official breastfeeding and/or childcare policies for employees and student mothers were not available in all the universities. Documents analyzed showed that the labor Act does not fully address the provisions of convention 183 of the ILO (Maternity protection at work, p:3). This shortfall is reflected in the conditions of work (CW) of the three public universities. The CW of the universities provides 12-weeks maternity leave instead of 14-weeks. One commendable provision in the CW is the five-day 20-hour work per week (5/20) offered to mothers returning to work from maternity leave. The absence of official breastfeeding and childcare policy in the universities corroborate national survey findings of colleges and universities in the United States where it was reported that only 5 out of 139 institutions had a formal policy on lactation (Bostick, Albrecht, Baghdadi, Haley & Spatz, 2016).

The ILO convention (1981), stresses the need to provide family-friendly working hours and childcare services with suitable facilities for workers to cope with childcare needs (Maternity protection at work, p:5). Yet the universities have no breastfeeding rooms for employees and student mothers. Breastfeeding break was not consistent among universities studied since the various universities had different informal breastfeeding practices. Even though officials provided some reasons for not allowing it, such as the unconducive nature of the office environment for breastfeeding and childcare, partial implementation of breastfeeding break by the universities was mainly due to the non-availability of breastfeeding rooms and childcare facilities to provide mothers time and privacy to breastfeed. Although Johnson and Salpini (2017) emphasize the importance of space at workplaces for breastfeeding and childcare, a key observation from this study shows that there are many bureaucratic bottle necks for implementing this good practice in the universities studied. For instance, there are various stakeholder consultations, collaborations, and funding support to be done to move this idea, which might not be a top priority for most of the universities in the short term.

Flexible work arrangement is not standardized across units and is left to the discretions of the various heads of departments and units. This has the potential to deny employee mothers the flexibility required to combine work and optimum breastfeeding and childcare in circumstances where the predisposition of ahead of unit or department is not supportive of nursing and childcare. Only one out of the three universities studied was found as an exemplar in childcare arrangements. This university has a purposefully built crèche. However, the location of the facility is quite distant from some departments; a situation that can challenges mothers’ ability to provide optimum breastfeeding. It must be noted that the maternity protection provision of the labor act and by extension, CW of the universities do not extend to student mothers. The only privilege available to students and/or expectant mothers in the course of their study program is the option for one-year deferral, in cases of pregnancy or childbirth. Yet, the deferment policies of public universities are subjected to certain limitations and exclude first and final year students from enjoying such privileges. Therefore, students who are not sure of readmission prefer combing these two incompatible roles (Nkrumah & Gbagbo, 2017).

Although the study did not assess university management knowledge on the benefit they stand to gain from providing breastfeeding support at the workplace, it was evident that they are aware of these benefits. Yet, no remarks were made regarding breastfeeding and childcare support for student mothers. Officials rather pointed out likely challenges such as Cost and work overload to come their way should there be an extension of maternity leave beyond the current period. It was also noted that making provisions to support student mothers to provide the necessary care for their babies whilst pursuing academic programs on the various university campuses is not one of the immediate priorities of these universities. Although it was observed that such provision is desirable, it is not mandatory nor an urgent need considering the population of students faced with such challenges.

The observation that Universities in the study do not have adequate policies, programs, and facilities to support breastfeeding and childcare for employee and student mothers, to a large extent discriminate against women’s right to equal opportunities for work, education and their ability to freely exhibit their fundament human rights of childbirth by choice in an academic environment. The absence of a formal breastfeeding/childcare policy and program in the various universities could have negative implications for achieving the Sustainable Development Goals 3 and 5 in Ghana. This deficiency has the potential to also negatively affect women’s development and rights to equal opportunities in Ghana.

Limitations

The study design had a limitation because of its scope which excludes data from student mothers to ascertain their challenges relating to childcare on campus. The study was also silent on work performance appraisal reports and academic performance of employees and student mothers to critically establish the effects of on-campus childcare on performance for decision making.

Assessing the availability and implementation of breastfeeding policies and programs in the selected public Universities in Ghana shows a lack of formal breastfeeding policy/program in the various universities. These observations could have negative implications for achieving Sustainable Development Goals 3 and 5 in Ghana. The author, recommends that the national accreditation board for tertiary institutions should incorporate childcare modalities as part of the requirements for the accreditation of universities in Ghana to enforce the law. This when done, will enhance on-campus facilities for breastfeeding and childcare which will empower women of reproductive age to combine their reproductive intentions with academic pursuits at the tertiary level. Additionally, a national qualitative survey is also recommended to assess the current status of breastfeeding and childcare support from the perspectives of employers, employees, and students in the various tertiary institutions in Ghana to guide policy and program decisions/interventions.

CW : Condition of work

GLSS : Ghana Living Standard Survey

HR : Human Resource

ILO : International Labor Organization

KNUST : Kwame Nkrumah University of Science and Technology

UN : United Nations

UEW : University of Education, Winneba

UNESCO : United Nations Educational, Scientific and Cultural Organization

UCC : University of Cape Coast

UTAG : University Teachers’ Association of Ghana

Ethics approval and consent to participate

The Institutional Review Board of the University of Cape Coast, Ghana, approved the study protocol (UCC/IRB/R/1/285)

Consent for publication

All participants consented to the publication of the study anonymously

Availability of data and materials

Data for the study can be obtained from the corresponding author upon reasonable request

Competing interests

We declare no conflict of interest in this study.

Funding

There was no funding for this study

Authors' contributions

Author one (F. Y. G) reviewed the literature, participated in data collection, data analysis, interpretation of results and drafted the manuscript. Author two (J. N.) conceptualized the study, took part in the literature review, data collection, data analysis and interpretation of results. Both authors reviewed and approved the final manuscript before submission.

Acknowledgements

We are grateful to all institutions and individuals who supported and/or participated in the study.

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Breastfeeding-Friendly Policies And Programs In Selected Public Universities In Ghana

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Abstract

Background

Methods

Design

Setting

Target population

Inclusion and Exclusion criteria

Data Collection

Data Analysis

Results

Discussion

Limitations

Conclusion

Abbreviations

Declarations

References

Status:

Version 1