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Promoting Worker Well-Being through Maternal and Child Health: Breastfeeding Accommodations in the Workplace

Posted on by Carissa M Rocheleau, PhD; Albeliz Santiago-Colon, PhD; and CDR Heidi Hudson, MPH
Photo by ©MonthiraYodtiwong/Getty Images

As one of the fastest-growing segments of the U.S. labor force, the contributions of working mothers are vital to a strong economy. Yet working mothers can also struggle to balance their career and work demands with reproductive plans and caregiving. As a holistic approach to worker well-being, Total Worker Health® encourages policies and practices that simultaneously protect workers while also improving their health and well-being—such as providing the work-related support to sustain an employee’s decision to breastfeed.

Breastfeeding has many health benefits for both moms and babies. For mothers, breastfeeding reduces their risk of ovarian cancer, breast cancer, type 2 diabetes, and cardiovascular disease.1 For babies, the American Association of Pediatrics recommends that all babies be exclusively breastfed for the first six months, and that breastfeeding continue after other foods are introduced for at least the first year.2 This can help prevent infections in babies (like respiratory infections, diarrhea, and ear infections), and can even improve a baby’s survival.

In 2011, the U.S. Surgeon General issued a call to action to support breastfeeding that included four recommendations for employers, one of which is to establish and maintain comprehensive, high-quality lactation support programs for their employees.3 Breastfeeding at work can be hard for mothers. Employers are typically required by federal law to provide: 1) unpaid break time for pumping for one year after the child’s birth, and 2) a place, other than a bathroom, for a mother to pump that is shielded from view and protected from intrusion.4,5 Some states provide additional workplace protections for breastfeeding.6 However, in a recent survey, only 40% of mothers reported having access to both break time and a private space to pump.7 There is also a lot of variation in how employers meet these legal requirements. News and social media report that some moms are dismayed to find that a locked janitorial closet could be the designated pumping location, or that they must follow a cumbersome process to request their unpaid break.8-10 Among women who work full-time, only 10% of those who started breastfeeding their babies will still be breastfeeding six months later.11 The expectation that it will be difficult to pump at work can prevent moms from trying to breastfeed at all, especially if they have very short maternity leave—and in the U.S., nearly a third of working moms return to work in less than a week after childbirth.12

Breastfeeding duration is dramatically increased when employers support the choice to do so. Comprehensive corporate lactation programs have reported that 75% or more of participating moms achieve 6 months or more of breastfeeding.13 Corporate lactation programs aren’t just for female employees: these programs make resources available to the partners of male employees such as access to lactation consultants and hospital-grade breast pumps, and can help male employees learn how to support their partner’s decision to breastfeed. Partner support plays an important role in promoting breastfeeding,14,15 and fathers benefit from having healthier babies too.16

Providing comprehensive lactation programs may benefit employers in the following ways:

    • Reducing absenteeism: Absences to care for sick children decrease with breastfeeding: at one large employer, one-day absences to care for sick children occurred more than twice as often for mothers of formula feeding infants than for mothers of breastfed infants.17
    • Improving productivity: Since breastfeeding reduces infections in children, parents of breastfed infants might be less likely to be up in the night taking care of a sick child, or be worried about a sick child at home, so they might be more productive at work.
    • Improving employee satisfaction: The Los Angeles Department of Water and Power found that after implementing a lactation support program open to all employees and their partners, 83% of employees felt more positively about the company.16 This was true of both male and female employees (80% of staff were male).
    • Improving employee retention: Several companies with lactation programs found that it greatly increased retention rates compared to the national average19-; this translates into a substantial cost-savings by reducing recruitment, hiring, and training costs. In a 2007 survey of 44 companies rated highly by working mothers, 98% of the companies believe these programs are important or very important to their workforce, and 59% noted greater retention following childbirth due to corporate lactation programs.18
    • Improving employee recruitment and public relations: Many companies with strong lactation programs receive public recognition and media attention, which can boost recruitment efforts and general goodwill in the community.
    • Lower medical insurance claims: Health care costs are lower for breastfed infants due to fewer doctor visits, hospitalizations, and prescriptions. Reducing medical costs reduces insurance rates, which helps the company bottom line when employers subsidize health insurance. A study by Mutual of Omaha found that health costs were three times lower for newborns whose mothers participated in the company’s maternity and lactation program, saving thousands of dollars in healthcare costs for each employee participating in the program.19

 

So what makes a successful corporate lactation program?

  • Perform a risk assessment for breastfeeding workers: Are there exposures in the workplace that could affect a lactating worker and her child, and if so, are there ways to better control these hazards?
  • Management support: There are policies in place to support new moms, training for managers on lactation policy, and support for breastfeeding at all levels of management.19,20 Managers recognize that the accommodations needed for nursing employees are minor, temporary, and infrequent, but the accommodations offer lasting benefits for everyone involved.
  • Time and space for pumping: New moms will need to take a few short breaks and have access to a convenient, clean, and private space where they can pump.20 Some corporate lactation programs also provide access to hospital-grade breast pumps for employees to use.
  • Education and social support: Breastfeeding can be difficult, and figuring out the logistics of pumping at work can be challenging. Social support systems encourage new parents and help solve problems. Support can take the form of in-person or online access to a lactation consultant, virtual or in-person support groups, or even a one-on-one support system between new and experienced parents in the workplace.20

 

For companies that want to start a corporate lactation program, or improve the program they already have, there are many resources to help:

The Total Worker Health® approach is a comprehensive approach to worker well-being that recognizes that the safety and health of our current and future workers is imperative to sustain our economy and way of life. This approach supports new research that improves the design of work, management practices, and the physical and psychosocial work environment to support the health of working parents. Healthy and family-supportive work environments can reduce pressures for working parents and their families, and relate positively to job satisfaction, commitment, and intentions to stay with an organization. The Total Worker Health approach also aims to inspire innovative surveillance and research linking working conditions to population health outcomes. For companies that want to implement a Total Worker Health approach in their workplace, there are many NIOSH resources to help:

 

Carissa M Rocheleau, PhD, is a reproductive occupational epidemiologist in the Division of Surveillance, Hazard Evaluation, and Field Studies.

Albeliz Santiago-Colon, PhD, is an ORISE fellow in reproductive epidemiology in the Division of Surveillance, Hazard Evaluation, and Field Studies.

CDR Heidi Hudson, MPH, is a team leader and health scientist in the Office for Total Worker Health.

 

This blog is also available in Spanish.

Total Worker Health®  is a registered trademark of the U.S. Department of Health and Human Services.

 

References

  1. Ip S, Chung M, Raman G, et. al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep.). 2007 (153): 1-186.
  2. World Health Organization (WHO). Breastfeeding. http://www.who.int/maternal_child_adolescent/topics/newborn/nutrition/breastfeeding/en/
  3. Office of the Surgeon General; Centers for Disease Control and Prevention; Office on Women’s Health. The Surgeon General’s Call to Action to Support Breastfeeding. Rockville, MD: Office of the Surgeon General (US); 2011. https://www.ncbi.nlm.nih.gov/books/NBK52691/
  4. Legal Information Institute. 29 U.S. Code 2017(r) – Reasonable Break Time for Nursing Mothers. https://www.law.cornell.edu/uscode/text/29/207
  5. U.S. Department of Labor, Wage and Hour Division. Fact Sheet #73: Break Time for Nursing Mothers under the FLSA. https://www.dol.gov/whd/regs/compliance/whdfs73.htm
  6. U.S. Department of Labor. Employment protections for workers who are pregnant or nursing. https://www.dol.gov/wb/map/
  7. Kozhimannil KB, Jou J, Gjerdingen DK, and McGovern PM. Access to workplace accommodations to support breastfeeding after passage of the Affordable Care Act. Womens Heath Issues. 2016; 26(1):6-13.
  8. Goodman, M. Nursing moms: when employers make it hard to pump, ABC News May 10, 2011 http://abcnews.go.com/Business/nursing-moms-employer-makes-hard-pump-job/story?id=13547943
  9. Goldwert, L. The horrors of pumping breast milk at work (and why employers should care). Fast Company January 26, 2015 https://www.fastcompany.com/3041277/the-horrors-of-pumping-breast-milk-at-work-and-why-employers-should-care
  10. Wittmeyer, M. Pumped up: breastfeeding mothers fight for rights at work. U.S. News January 10, 2014 https://usnews.newsvine.com/_news/2014/01/10/22257760-pumped-up-breastfeeding-mothers-fight-for-rights-at-work?lite.
  11. Johnston ML and Esposito N. Barriers and facilitators for breastfeeding among working women in the United States. J Obstet Gynecol Neonatal Nurs. 2007; 36(1):9-20.
  12. Bakera M and Milligan K. Maternal employment, breastfeeding, and health: evidence from maternity leave mandates. Journal of Health Economics. 2008; 27(4): 871–887.
  13. Cohen R and Mrtek M. The impact of two corporate lactation programs on the incidence and duration of breast-feeding by employed mothers. American Journal of Health Promotion. 1994; 8(6):436-441.
  14. Mitchell-Box KM and Braun KL. Impact of male-partner-focused interventions on breastfeeding initiation, exclusivity, and continuation. Journal of Human Lactation. 2013; 29(4):473-9.
  15. Maycock B, Binns CW, Dhaliwal S, Tohota J, Hauck Y, Burns S, and Howat P. Education and support for fathers improves breastfeeding rates: a randomizes controlled trial. Journal of Human Lactation. 2013; 29(4):484-90.
  16. Cohen R, Lange L, and Slusser W. A description of a male-focused breastfeeding promotion corporate lactation program. Journal of Human Lactation. 2002; 18(1): 61-65.
  17. Cohen R, Mrtek MB, Mrtek RG. Comparison of maternal absenteeism and infant illness rates among breast-feeding and formula-feeding women in two corporations. American Journal of Health Promotion. 1995; 10(2):148-53.
  18. Medela and the National Women’s Health Resource Center (NWHRC). 2007. Working Mother 100 Best Survey. http://www.medelabreastfeedingus.com/media-center/17/survey-corporate-lactation-programs-increase-retention
  19. As reported in: U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau. 2008. The Business Case for Breastfeeding: Steps for Creating a Breastfeeding Friendly Worksite. https://www.womenshealth.gov/files/assets/docs/breastfeeding/business-case/business-case-for-breastfeeding-for-business-managers.pdf
  20. Rollins, N.C., et al., Why invest, and what it will take to improve breastfeeding practices? The Lancet. 387(10017): p. 491-504. http://thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)01044-2.pdf
Posted on by Carissa M Rocheleau, PhD; Albeliz Santiago-Colon, PhD; and CDR Heidi Hudson, MPH

9 comments on “Promoting Worker Well-Being through Maternal and Child Health: Breastfeeding Accommodations in the Workplace”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    it would be great honestly if all employers offered this. my last boss was ok with me breast feeding my son untill ….one day she asked how many months my son was. i said 6 months. she said and your still breast feeding him? i said yes she said i only breast fed 3 months. thats fine for her. its enough guilt leaving your child to go back to work. having your co workers see your boobs every time they walked in to the back hall. yes! where i was placed after being told not to take any of the exam rooms because those are for the patients that pay to see our doctor. at one point i asked if i could have permission to pump in the rest room and that was a definite no ! because the clients need the restroom too. then i was transferred mysteriously to a new location after being there over 5 yrs ! they said the doctor was complaining about me. i was transferred a few cities away from where i worked. making it impossible for me to make it there on time, it was a new route. finally they fired me. at the time i was so stressed my milk supply had dropped . i gave up and made it through the struggle of trying to be a working mom that breast feeds and just stayed home with my son. that was the best for us . we sacrificed cut down on the wants vs the needs and pulled through ok. it was hard with one income not being able to save having to pay student dept renting the relatives back house. hoping one day we can save for the dream home. and its true breast feeding your baby is the best immunity you can give your child. my son is 2 yrs old and he is a healthy toddler. god willing continues to thrive!

    I think it is a really important topic in the life of every woman of working age who wants to have a family. Of course, it can also be controversial, but if it can help anyone – companies should say “yes” to this solution.
    Best Regards

    Great information and highly presented…..Great and excellent Job!
    I do seriously believed that this is the beginning of bonding between mother and child(children),also do accommodated that should be enforced for at least 6 months period at the workplace and could be stored with the help of the pumping machine in a private place to be taken home during break or lunch time for the baby to have……And this should be promoted and re-enforced with “GOOD FAITH”.
    Emmanuel Eregie,
    Gwinnett County Public School(Buice Center,Suwanee,GA).

    I work at Aeroflow Breastpumps, and I thought you might be interested in some recent research we conducted. As a breast pumps supplier, anecdotally we know most of our moms use a breast pump to maintain breastfeeding. We wanted to know firsthand how supported moms felt at work. The results weren’t as favorable as we hoped.

    • Over 62% felt like there was a stigma attached to moms who breastfeed at work
    • Nearly 50% were concerned breastfeeding at work could impact their career growth
    • 47% considered a job/career change in order to pump at work
    The article mentions breastfeeding can be hard for mothers, but education and social support can make a successful lactation program. I thought you might be interested to see a lot of women still feel there’s a lack of breastfeeding support at work.

    In New Hampshire, we (the NH Occupational Health Surveillance Program, in partnership with the NH Department of Health and Human Services) conducted a survey of women participating in the WIC program about breastfeeding initiation, duration, and accommodations in the workplace. Survey results indicate that, by industry, a greater percentage of women who had ever breastfed worked in healthcare and a smaller percentage worked in accommodation and retail than women who had never breastfed. The study also found significant associations between industry and breastfeeding initiation, pumping at work, and the policies and physical environment related to breastfeeding and pumping. Specifically, women in service-oriented industries (i.e., accommodation and retail) reported the lowest rates of breastfeeding initiation and workplace supports for breastfeeding and pumping. This study, “Identifying Barriers and Supports to Breastfeeding in the Workplace Experienced by Mothers in the New Hampshire Special Supplemental Nutrition Program for Women, Infants, and Children Utilizing the Total Worker Health Framework”, is published in the International Journal of Public Health Research at: https://www.mdpi.com/1660-4601/16/4/529/htm

    Thank you for sharing your research! More research like this will help to better address work-related determinants of breastfeeding (initiation and duration). Many public health interventions around breastfeeding involve educating postpartum mothers in the hospital. However, when returning to work, many of these moms face profound work-related barriers for continuing to successfully breastfeed their children. Interventions that address work-related barriers and facilitators to breastfeeding and encourage partnerships between public health and employers to promote breastfeeding are critical to supporting the health of working mothers and their children.

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