title: Breast milk expression among formally employed women in urban and rural Malaysia: A qualitative study.
abstract: BACKGROUND
  Many women are unable to practice exclusive breastfeeding because they are separated from their infants while working. Expressing their breast milk helps them to continue breastfeeding. This study explores the perception and experiences related to the feasibility, acceptability and safety of breast milk expression among formally employed women in Kelantan, Malaysia.
  
  
  METHODS
  A qualitative method using in-depth interviews was conducted from December 2008 to December 2009 among Malay women from urban and rural areas. A snowball sampling method was used to recruit the informants, and the interviews, which were facilitated by an interview guide, were audio-recorded and transcribed verbatim. Thematic analysis was conducted, with construction of codes and themes from each interview.
  
  
  RESULTS
  Analysis of the interviews with 20 informants identified three themes related to breast milk expression. The themes were as follows: (i) lack of feasibility of expressing breast milk, (ii) negative feelings about expressing breast milk, and (iii) doubts about the safety and hygiene of expressed breast milk. The informants who did not practice exclusive breastfeeding believed that expressing their breast milk was not feasible, commonly because they felt there were not enough facilities for them. They also had negative feelings such as embarrassment. The safety and hygiene of the expressed breast milk was also their main concern.
  
  
  CONCLUSIONS
  More practical and focused education, as well as provision of facilities, is needed for women to effectively and safely express and store their breast milk. The issue of inadequate milk production should be emphasized, especially by encouraging them to express their breast milk as a way to improve milk production.
authors.affiliation: Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, 16150, Malaysia.
authors.forename: Tengku Alina Tengku
authors.initials: TAT
authors.lastname: Ismail
authors.affiliation: School of Public Health and Human Biosciences, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria, Australia.|Women's Health Development Unit, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kuala Lumpur, Malaysia.
authors.forename: Zaharah
authors.initials: Z
authors.lastname: Sulaiman
authors.affiliation: Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, 16150, Malaysia.
authors.forename: Rohana
authors.initials: R
authors.lastname: Jalil
authors.affiliation: School of Health Sciences,, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, 16150, Malaysia.
authors.forename: Wan Manan Wan
authors.initials: WMW
authors.lastname: Muda
authors.affiliation: Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, 16150, Malaysia.
authors.forename: Nik Normanieza Nik
authors.initials: NNN
authors.lastname: Man