The Business Case for Breastfeeding

Introduction

Although there are many factors that affect a woman's infant feeding decisions, one of the considerations for mothers is returning to work. In 2008, 56.4% of mothers with children under 1 year were participating in the labor force. ¹ For many of these women, job settings and demands pose significant barriers to reaching their breastfeeding goals. Lack of a private space and time to breastfeed or express milk during the work period, schedule demands, and lack of support are common reasons given by women for discontinuing breastfeeding. In fact, many women discontinue breastfeeding during their first month back at work. ²

National Attention to the Issues

While basic worksite accommodations such as a private, sanitary place for milk expression, time to express milk, access to professional support, and support from managers and coworkers can help women follow through on their breastfeeding goals, nearly 75% of companies in the United States do not provide these basic accommodations. ³ National attention on the need for worksite support for breastfeeding has reached an all-time high.

Section 4207 of the U.S Patient Protection and Affordable Care Act of 2010 (also known as “Health Care Reform”) requires employers to provide reasonable break time and a place for breastfeeding employees to express milk during the work period. ⁴ This legislation builds on state legislation available in 24 states plus Puerto Rico and the District of Columbia related to working and breastfeeding. In addition, the White House Task Force on Obesity included recommendations related to breastfeeding support in the workplace in their report to the President. ⁵

The Business Case for Breastfeeding

In 2008, the Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services, launched a national initiative to improve breastfeeding exclusivity and duration rates by encouraging businesses to establish worksite lactation programs. ⁶ The Business Case for Breastfeeding provides companies with step-by-step guidelines for implementing lactation support in the workplace. A comprehensive resource kit targeting multiple audience groups was created, and includes:

The Business Case for Breastfeeding (for business managers), with bottom line benefits to the company in healthcare savings, lower absenteeism and turnover rates, improved productivity, and loyalty

Both the full comprehensive kits and materials that are available individually are available from the HRSA Distribution Center at www.ask.hrsa.gov. They can also be downloaded from the website of the Office on Women's Health at www.womenshealth.gov/breastfeeding/programs/business-case/index.cfm. To date, thousands of kits have already been distributed to companies across the nation.

To encourage widespread usage of the kits, MCHB, with additional funding from the U.S. Department of Health and Human Services' Office on Women's Health, launched a comprehensive 3-year training initiative, “Implementing The Business Case for Breastfeeding in Your Community.” MCHB contracted with HCD International (Lanham, MD) and Every Mother, Inc. (Greenville, MS) to develop and provide comprehensive training and technical assistance for lactation consultants, healthcare providers, and community stakeholders in 32 states. These training events equipped more than 1,000, who in turn approached hundreds of businesses across the country. Universities, hospitals, retail stores, insurance companies, government agencies, and many other businesses are now actively involved in establishing or enhancing lactation support services as a result of their efforts.

Steps to Lactation Support

Most companies with comprehensive lactation programs that bring about a positive return on investment find that basic needs include a private area and break time to express milk approximately every 3 hours during the work period, education and access to professional support, and managerial support.^2,7,8 These components are outlined according to the following easy acronym STEP:

S—Support from employers, supervisors, and colleagues, as well as facilitation of mother-to-mother support among employees

Implementing Lactation Support in Smaller Worksite Settings

Small businesses are less likely to have these types of worksite support programs in place. A 2008 survey conducted by the Society for Human Resource Management found that although 35% of large employers with 500+ employees have a lactation room, only 13% of employers with one to 99 employees do so; only 2% of these small employers offer other lactation support services such as resources and access to professional support. ³ In addition, Section 4207 of the Patient Protection and Affordable Care Act of 2010 does not apply to businesses with fewer than 50 employees if doing so would pose an undue hardship. ⁴ This compounds existing barriers because 44.9% of women are employed in small businesses with fewer than 99 employees, and small businesses are more likely to hire younger, entry-level workers. ⁹

Common barriers to lactation services reported by smaller businesses include less perceived need for a program with fewer employees, lack of space, lack of funding, and fewer workers to cover for an employee who must be away from her workstation. State breastfeeding coalitions conducting outreach with employers are discovering that creativity and flexibility can make the difference in helping companies of all sizes support their breastfeeding employees. For example:

Some companies are implementing babies at work programs that allow their employees to bring their infants to work during the first few months (see www.babiesatwork.org). Bringing the baby to work does not require a lactation room, and the employee has the flexibility to feed her baby when needed. Slings and other cover-ups can be used for an employee who needs privacy.

When workers need flexible break time to breastfeed or express milk, employers can consider allowing them to take more frequent 5–10-minute milk expression breaks to relieve uncomfortable fullness and to sustain milk production. Employers and other workers should be reminded that breaks are predictable; absences are not. Employees who are supported to take needed breaks to express milk are more likely to have healthy babies and miss less work, which benefits all of the workers, not just the breastfeeding employee. In a worksite where an employee is unable to leave her workstation, a sling or other cover-up can be used if privacy is needed.

Companies large and small across the country have found that breastfeeding support can work. Creativity, flexibility, and support make the difference!

Resources

With the heightened national attention on worksite support issues, numerous resources are available to assist businesses and health providers with implementing lactation programs. These include:

Business Case for Breastfeeding resources at www.ask.hrsa.gov or www.womenshealth.gov/breastfeeding/programs/business-case/index.cfm