Employed mothers’ breastfeeding: Exploring breastfeeding experience of employed mothers in different work environments in Ethiopia

Firmaye Bogale Wolde; Jemal Haidar Ali; Yalemwork Getnet Mengistu

doi:10.1371/journal.pone.0259831

Peer Review History

Original SubmissionDecember 28, 2020
8 Apr 2021 Decision Letter - Elena Ambrosino, Editor PONE-D-20-40733 Employed mothers’ breastfeeding: Exploring breastfeeding experience of employed mothers in different work environments PLOS ONE Dear Dr. Wolde, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by May 23 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Elena Ambrosino Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. When reporting the results of qualitative research, we suggest consulting the COREQ guidelines: http://intqhc.oxfordjournals.org/content/19/6/349. In this case, please consider including more information on the interviewer’s training and characteristics; and please provide the interview guide used. 3. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. 4. We note you have included a table to which you do not refer in the text of your manuscript. Please ensure that you refer to Table 1 in your text; if accepted, production will need this reference to link the reader to the Table. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: I Don't Know Reviewer #3: N/A ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Overall, the manuscript presented an important aspect of child health and wellbeing as well as human rights issue. Through the qualitative descriptive analysis, it has presented factors related to motivation and berries of breastfeeding in working environment nicely. However, there has some issues should be taken care of this manuscript so that readers can understand the information clearly. No major issues. However the following minor issues should be addressed. a) Line: 75-78 / I think your research questions and specific objective of this manuscript are similar. If not, please mention about the specific objectives. b) Line: 97-98/ it would be good to make a separate paragraph about interview guide and questions. c) Line: 101-103 / about the demographic information collection, you could write in the paragraph of participants. d) Line: 117-122/ This paragraph can be taken as first paragraph for consistency of the information. e) Line: 128/ did you transcript it in local dialect or translated into other language? Which language ? Please make it clear. f) Line: 142/ what is Amharic ? if it is local language please make clear the meaning in the bracket. g) Did you use any qualitative data analysis software for data coding? If you do please mention name and version of the software. h) Line: 154-155/ 64% mother’s had 1 child; did 64% mother also belong to mean age 30 years? If different please write different line. What about the status of other percentage participants’ status? You should mention both. i) Line: 166-169/ Can you give the full abbreviations of the word mn, mcc and msm? j) Line: 194/ Did women perceived that there previous children were not in good health because of lack of breast feeding. How did they know about it? You have collected data from employees of both government and private organizations. What about the government policy about maternity leave in Addis Ababa? You could mention it in the discussion section. Reviewer #2: It is an important topic especially as more women enter the workforce. Please see suggested changes/questions Line 18/19- please mention a source of the literature Line 40- please start the sentence with breast feeding is a life saving intervention. It is one of the most cost-effective interventions to reduce infant mortality and that point should be made upfront Line 43 Please mention WHO recommendations around exclusive breastfeeding and maybe look for a more recent source. Authors are quoting from 2000 Line 47 please look for data that demonstrates the link of breastfeeding with Infant mortality in addition to child mortality Line 54-59. Suggest moving this paragraph at the beginning – around line 43 Line 63 and 64- is there a source for these recommendations? What about breastfeeding rooms at workplace where women can pump and store breastmilk? Why is that not referenced? Line 80- please explain why this design and approach was selected and why is it most suitable to answer the questions being studied In the study design, please indicate the rationale for the sample size. Is interviewing 17 mothers sufficient? What is the guidance? In the background, please mention if Ethiopia has any nation-wide policies that guide maternity leave or child care. In the conclusion- I don’t see any reference to the option of 6 month maternity leave. It seems that women quoted that as a good option. The only one highlighted is the child care center. Please include a section on study limitations. The sample size seems extremely small to be able to draw your conclusions Reviewer #3: In the manuscript, Employed mothers’ breastfeeding: Exploring breastfeeding experience of employed mothers in different work environments, the authors conduct a series of in-depth interviews with employed women in Ethiopia who have varying levels of postpartum breastfeeding support – three months of maternity leave, six months of maternity leave, and onsite child care. Emergent themes included the barriers and facilitators to breastfeeding while returning to work, the impact of the workplace environment on the breastfeeding journey, and ways in which women cope with challenges associated with breastfeeding while employed. The study results speak to the lived experiences of women in Ethiopia who work in various employment settings while continuing to breastfeed. The manuscript would benefit from additional edits, please see below for specific suggestions. Major suggestions include: (1) The impact of employment, or return to employment, on breastfeeding is quite will researched throughout various contexts. In the Introduction, the authors state that few studies “focus on exploring the opinions and experiences of employed mothers on breastfeeding…” It seems that there are, however, quite a few qualitative and quantitative studies exploring women’s experiences with employment and breastfeeding. After an initial search through the literature, it seems that research being published on the topic specific to Ethiopia is quantitative. I might suggest framing this study within the context of what is currently known about Ethiopia specifically, rather than including a mix of global and country-specific data in the Introduction. For example, the authors could consider framing this study as a way to better understand the quantitative findings and trends that exist in Ethiopia through a qualitative exploration of women’s lived experiences. To achieve this, I would suggest tailoring the introduction to be more specific to the study context; after summarizing the importance of breastfeeding globally, the authors could describe what is known broadly – and within Ethiopia specifically – about the barriers and facilitators to breastfeeding among employed women. The authors could then describe existing gaps in the literature specifically within the context of what is known on the topic in Ethiopia, rather than globally. I would also suggest this change is reflected in the title of the manuscript, making it clear that the findings are specific to the study context rather than more globally generalizable. (2) The authors describe the inclusion and selection criteria for study participants. However, it would be useful to include additional detail on the sampling procedure, such as how institutions were selection and what communication with participants entailed for recruitment and follow-up. (3) The authors include an overview of the various phases of data analysis; at the end of the Data Analysis section (Lines 145-148), the authors explain that all three authors were included in each phase of analysis. I would suggest moving this statement up in the section and providing additional detail to make it clear who was involved in each phase of analysis and what their roles were. (4) The authors present very rich, insightful data as a result of the interviews; the quotes included are very powerful. When reading the Results section, I have a difficult time identifying the differences between the first two themes – motivators and barriers, and work environment and breastfeeding. There also seems to be some overlap in content between these two main themes; for example, within both themes there’s a discussion around women’s experiences differing between their children. In the third theme, coping mechanisms, the data from the quotes indicate that the authors collected many suggestions from women on how to improve their experiences, as well as suggestions around larger, systemic improvements. It seems like the two main categories of themes might be related to (1) barriers and facilitators to breastfeeding and employment, and (2) suggestions for addressing barriers. It might be helpful to consider how to re-structure the Results section in a way that tells a clearer story of women’s experiences for the reader. (5) Similar to my suggestions related to the Introduction, it would be useful to consider re-framing the Discussion section to first explain what these study findings add to the generalizable knowledge within Ethiopia, and then include a broader assessment of how these findings relate to other contexts. For example, a qualitative study was recently published (Gebrekidan, et al. 2020) describing managers’ perspectives on factors that impact exclusive breastfeeding in the work place in Ethiopia; consider situating these results within what is known specifically within Ethiopia. Minor suggestions include: (1) Under Data Collection, the authors explain that the data collection tool used for interviews was adapted from a national breastfeeding study in Pakistan. Please include a citation for this study, as well as related citations for its application in other countries. (2) The “Operational Definition” section seems like it may be out of place. Can this be included elsewhere in the narrative, without having a separate section to define what is meant by a supportive condition at work? (3) Include a reference to Table 1 within the text of the manuscript. (4) Please be sure that the manuscript formatting aligns with the journal requirements. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Reviewer #3: Yes:** Stephanie Bogdewic [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: Review report _D-20-40733.docx https://doi.org/10.1371/journal.pone.0259831.r001
Revision 1
30 Jul 2021 Author Response Reviewer 1: Overall, the manuscript presented an important aspect of child health and wellbeing as well as human rights issue. Through the qualitative descriptive analysis, it has presented factors related to motivation and berries of breastfeeding in working environment nicely. However, there has some issues should be taken care of this manuscript so that readers can understand the information clearly. No major issues. However the following minor issues should be addressed. 1. Line: 75-78 / I think your research questions and specific objective of this manuscript are similar. If not, please mention about the specific objectives Authors’ response: Thank you for your comment. Even though the research question and the objectives seem similar there are more details in the specific objectives. Thus, we have included the specific objectives in the first section of the materials and methods and stated the specific objectives in (line 92-96) 2. Line: 97-98/ it would be good to make a separate paragraph about interview guide and questions Authors’ response: as per the suggestion we have made the paragraphs separate in the data collection section (second and third paragraph) 3. Line: 101-103 / about the demographic information collection, you could write in the paragraph of participants Authors’ response: while we appreciate the reviewer’s suggestion, we feel that the collected data is better placed in the data collection section with the explanation of the question types. But we have rearranged the place (line 135-137) 4. Line: 117-122/ This paragraph can be taken as first paragraph for consistency of the information Authors’ response: we agree with the comment and we have moved it to the first paragraph (line 124-129) 5. Line: 128/ did you transcript it in local dialect or translated into other language? Which language? Please make it clear Authors’ response: Thank you for pointing this out. We have clarified that Amharic is a local dialect (line 166) 6. Line: 142/ what is Amharic? If it is local language please make clear the meaning in the bracket Authors’ response: in relation with the above comments we have clarified that Amharic is a local dialect (line 166) 7. Did you use any qualitative data analysis software for data coding? If you do please mention name and version of the software Authors’ response: we did the analysis manually so we did not use software. 8. Line: 154-155/ 64% mother’s had 1 child; did 64% mother also belong to mean age 30 years? If different please write different line. What about the status of other percentage participants’ status? You should mention both Authors’ response: According to the suggestion by the reviewer we have seen that the statement could be confusing and we have edited it to include additional information and be clearer. Result section (line 178-184) 9. Line: 166-169/ Can you give the full abbreviations of the word mn, mcc and msm? Authors’ response: we have added the suggested full abbreviations for Mn, Mcc and Msm (line 188-195) 10. Line: 194/ Did women perceived that there previous children were not in good health because of lack of breast feeding. How did they know about it? Authors’ response: Thank you for the question. As indicated in the quoted statement of a mother on line 225-227 other mothers also stated that they saw the difference in the frequency of illness and status of health of their breastfed and non-breastfed child which made them almost certain that the breastfeeding brought change on the health and immunity of their children 11. You have collected data from employees of both government and private organizations. What about the government policy about maternity leave in Addis Ababa? You could mention it in the discussion section Authors’ response: Thank you for the comment. We agree that it is an important aspect to show. Thus, we have included it in the background section (line 75-77) Reviewer 2: It is an important topic especially as more women enter the workforce. Please see suggested changes/questions 1. Line 18/19- please mention a source of the literature Authors’ response: Thank you for the comment. While we respect the suggestion, we feel it is better to cite the source in the background section (line 62) where we brought this statement from. 2. Line 40- please start the sentence with breast feeding is a life-saving intervention. It is one of the most cost-effective interventions to reduce infant mortality and that point should be made upfront Authors’ response: Thank you for the insightful comment and we have edited the start of the introduction as recommended (line 39-42) 3. Line 43 Please mention WHO recommendations around exclusive breastfeeding and maybe look for a more recent source. Authors are quoting from 2000 Authors’ response: thank you for the comment. We have mentioned the WHO recommendation for exclusive breastfeeding on line 43-46 and we have also corrected the WHO report to a more recent source by the year 2021 (line 47-49) 4. Line 47 please look for data that demonstrates the link of breastfeeding with Infant mortality in addition to child mortality Authors’ response: we appreciated the comment and we have included studies that show the relation of breastfeeding with neonatal, infant and under-five child mortality for a wholesome view (line50-52) 5. Line 54-59. Suggest moving this paragraph at the beginning – around line 43 Authors’ response: We accept the suggestion and moved the statement to first paragraph in the introduction and edited the statements 6. Line 63 and 64- is there a source for these recommendations? What about breastfeeding rooms at workplace where women can pump and store breastmilk? Why is that not referenced? Authors’ response: Thank you for an insightful comment. We have included additional settings for mother friendly worksites in background section in (line 57-62) and (line 71-73) 7. Line 80- please explain why this design and approach was selected and why is it most suitable to answer the questions being studied Authors’ response: Thank you for pointing the missing information. We have explained the reason for the selection of the design (line 102-106) 8. In the study design, please indicate the rationale for the sample size. Is interviewing 17 mothers sufficient? What is the guidance? Authors’ response: We appreciate the suggestion. The rationale for the number of participants was information saturation. Accordingly, we have included the explanation for the number of study participants being based on information saturation in (line 127-129). 9. In the background, please mention if Ethiopia has any nation-wide policies that guide maternity leave or child care Authors’ response: Thank you for the important comment. Accordingly, we have included it in the background section (line 75-77) 10. In the conclusion- I don’t see any reference to the option of 6 month maternity leave. It seems that women quoted that as a good option. The only one highlighted is the child care center Authors’ response: Thank you for pointing this out. We have now highlighted the six months maternity leave in conclusion (line 466-470) 11. Please include a section on study limitations. The sample size seems extremely small to be able to draw your conclusions Authors’ response: Thank you for the comment. We have tried as much as possible to attain information saturation during data collection and we have based our conclusion on the extensive information from the interviewed participants. However, it is true that we were not able to include mothers from diverse organizations which had supporting arrangements for mothers which has in turn limited the diversity of women and ideas included and thus we have agreed to include study limitation presented in (line 474-477) Reviewer 3: In the manuscript, Employed mothers’ breastfeeding: Exploring breastfeeding experience of employed mothers in different work environments, the authors conduct a series of in-depth interviews with employed women in Ethiopia who have varying levels of postpartum breastfeeding support – three months of maternity leave, six months of maternity leave, and onsite child care. Emergent themes included the barriers and facilitators to breastfeeding while returning to work, the impact of the workplace environment on the breastfeeding journey, and ways in which women cope with challenges associated with breastfeeding while employed. The study results speak to the lived experiences of women in Ethiopia who work in various employment settings while continuing to breastfeed. The manuscript would benefit from additional edits, please see below for specific suggestions. Major suggestions include 1. The impact of employment, or return to employment, on breastfeeding is quite will researched throughout various contexts. In the Introduction, the authors state that few studies “focus on exploring the opinions and experiences of employed mothers on breastfeeding…” It seems that there are, however, quite a few qualitative and quantitative studies exploring women’s experiences with employment and breastfeeding. After an initial search through the literature, it seems that research being published on the topic specific to Ethiopia is quantitative. I might suggest framing this study within the context of what is currently known about Ethiopia specifically, rather than including a mix of global and country-specific data in the Introduction. For example, the authors could consider framing this study as a way to better understand the quantitative findings and trends that exist in Ethiopia through a qualitative exploration of women’s lived experiences. To achieve this, I would suggest tailoring the introduction to be more specific to the study context; after summarizing the importance of breastfeeding globally, the authors could describe what is known broadly – and within Ethiopia specifically – about the barriers and facilitators to breastfeeding among employed women. The authors could then describe existing gaps in the literature specifically within the context of what is known on the topic in Ethiopia, rather than globally. I would also suggest this change is reflected in the title of the manuscript, making it clear that the findings are specific to the study context rather than more globally generalizable. Authors’ response: We sincerely appreciate the depth of review and comment. As suggested in the comment we have tried to focus the introduction to the Ethiopian context, what is missing and the current proclamation on maternity leave. Additionally, we have edited the title to indicate its focus by including the term “Ethiopia” in the title. 2. The authors describe the inclusion and selection criteria for study participants. However, it would be useful to include additional detail on the sampling procedure, such as how institutions were selection and what communication with participants entailed for recruitment and follow-up Authors’ response: Thank you for the comment. We have accepted the suggestion and elaborated more on the selection of institutions and participants for the study in Participants section (line 113-122) 3. The authors include an overview of the various phases of data analysis; at the end of the Data Analysis section (Lines 145-148), the authors explain that all three authors were included in each phase of analysis. I would suggest moving this statement up in the section and providing additional detail to make it clear who was involved in each phase of analysis and what their roles were Authors’ response: we appreciate the comment and even though all authors were involved in the study we have elaborated their specific participation in (line 158-164) 4. The authors present very rich, insightful data as a result of the interviews; the quotes included are very powerful. When reading the Results section, I have a difficult time identifying the differences between the first two themes – motivators and barriers, and work environment and breastfeeding. There also seems to be some overlap in content between these two main themes; for example, within both themes there’s a discussion around women’s experiences differing between their children. In the third theme, coping mechanisms, the data from the quotes indicate that the authors collected many suggestions from women on how to improve their experiences, as well as suggestions around larger, systemic improvements. It seems like the two main categories of themes might be related to (1) barriers and facilitators to breastfeeding and employment, and (2) suggestions for addressing barriers. It might be helpful to consider how to re-structure the Results section in a way that tells a clearer story of women’s experiences for the reader. Authors’ response: Thank you again for the insightful comment. After reading and rereading the themes and subthemes we also agree that that they can be brought together. Thus, we have incorporated the findings in to two themes where the themes are in (line 216 and line 372) 5. Similar to my suggestions related to the Introduction, it would be useful to consider re-framing the Discussion section to first explain what these study findings add to the generalizable knowledge within Ethiopia, and then include a broader assessment of how these findings relate to other contexts. For example, a qualitative study was recently published (Gebrekidan, et al. 2020) describing managers’ perspectives on factors that impact exclusive breastfeeding in the work place in Ethiopia; consider situating these results within what is known specifically within Ethiopia. Authors’ response: In line with the introduction we have also made some changes in the discussion where we have tried to focus on Ethiopian context and relate it with the global setting (changes in the discussion are highlighted) Minor suggestions include: 1. Under Data Collection, the authors explain that the data collection tool used for interviews was adapted from a national breastfeeding study in Pakistan. Please include a citation for this study, as well as related citations for its application in other countries. Authors’ response: Thank you for pointing that out. We have now included the reference (line 132) 2. The “Operational Definition” section seems like it may be out of place. Can this be included elsewhere in the narrative, without having a separate section to define what is meant by a supportive condition at work? Authors’ response: we agree with the suggestion and we have included the definition in participants section (line 114-115) 3. Include a reference to Table 1 within the text of the manuscript. Authors’ response: Thank you, we have cited the table in the manuscript as suggested (line 188) 4. Please be sure that the manuscript formatting aligns with the journal requirements. Authors’ response: Thank you for stressing this out. We have tried to carefully align the manuscript with journal requirements. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0259831.r002
15 Sep 2021 Decision Letter - Elena Ambrosino, Editor PONE-D-20-40733R1Employed mothers’ breastfeeding: Exploring breastfeeding experience of employed mothers in different work environments in EthiopiaPLOS ONE Dear Dr. Wolde, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Oct 30 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Elena Ambrosino Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: All comments have been addressed Reviewer #3: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: Yes Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Reviewer #3: N/A ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: Yes Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: Yes Reviewer #3: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: The authors have done a great job of responding to the comments. Please copyedit the document. Reviewer #3: Thank you for the opportunity to review the updated manuscript titled, "Employed mothers’ breastfeeding: Exploring breastfeeding experience of employed mothers in different work environments in Ethiopia." The authors successfully addressed the majority of reviewer comments. However, the text added to the Introduction to describe the quantitative research done in Ethiopia on the topic is missing citations. Please add citations to support the claims made on lines 79-82. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #2: No Reviewer #3: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0259831.r003
Revision 2
19 Oct 2021 Author Response Reviewer #2: 1- The authors have done a great job of responding to the comments. Please copyedit the document. Authors response:- Thank you for your time and comments. We have now copyedited the document. Reviewer #3: 1- Thank you for the opportunity to review the updated manuscript titled, "Employed mothers’ breastfeeding: Exploring breastfeeding experience of employed mothers in different work environments in Ethiopia." The authors successfully addressed the majority of reviewer comments. However, the text added to the Introduction to describe the quantitative research done in Ethiopia on the topic is missing citations. Please add citations to support the claims made on lines 79-82. Authors response:- Thank you for your comments and your time. We have now inserted relevant references to the statement on lines 79-82 Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0259831.r004
28 Oct 2021 Decision Letter - Elena Ambrosino, Editor Employed mothers’ breastfeeding: Exploring breastfeeding experience of employed mothers in different work environments in Ethiopia PONE-D-20-40733R2 Dear Dr. Wolde, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Elena Ambrosino Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0259831.r005
Formally Accepted
3 Nov 2021 Acceptance Letter - Elena Ambrosino, Editor PONE-D-20-40733R2 Employed mothers’ breastfeeding: Exploring breastfeeding experience of employed mothers in different work environments in Ethiopia Dear Dr. Wolde: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Elena Ambrosino Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0259831.r006

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .