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Objectives New to Healthy People 2020
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MICH HP2020–26:
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Increase the percentage of employers who have worksite lactation programs.
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Status: New to Healthy People 2020.
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View Objective Comments
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Data Source, Status:
The U.S. Breastfeeding Committee (USBC) welcomes this objective, which addresses the workplace as a key social and physical environment for many mothers. In 2003 more than half the mothers of infants were working for pay. Without worksite lactation support, many U.S. mothers begin giving formula or completely wean their babies when they return to work. Some women never even start breastfeeding, knowing that, lacking paid leave, they will have to be back at work in just a few weeks.
Attention to the worksite environment will facilitate a redirection of focus from individual behavior to the environmental determinants of breastfeeding. This new objective will help USBC and others to advocate for the improved “infrastructure” that is needed to close the gap between evidence and practice in our nation’s breastfeeding rates.
“Worksite lactation programs” should be broadly interpreted to include not only providing lactating women the time and space they need for expressing milk, but also the possibility of flexible work scheduling, prenatal and/or postpartum breastfeeding education and support, bring-baby-to-work programs, onsite childcare, and paid maternity leave or family leave. In addition, lactating employees should be protected from harassment and discrimination.
We are concerned that measuring progress toward this objective through the SHRM survey might miss the employers who are too small to employ a Human Resources professional. Questions about workplace support for breastfeeding should also be included in the nation-wide surveys that collect data on infant feeding.
Social and physical environments—including family, community, health care system, workplaces, businesses, schools, transportation, and the media—continue to exert an enormous influence on breastfeeding success, often acting as barriers to improved duration and exclusivity rates. The inclusion of this objective is an excellent example of how, by giving attention to the social determinants of health, HP2020 can reach beyond the health sector to spur actions and programs that support healthy behavior.
The US Breastfeeding Committee (USBC) is an independent nonprofit coalition of 34 national professional and educational organizations, plus seven government agency partners. USBC works closely with a network of breastfeeding coalitions in every U.S. state and territory.
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Objective Clarification, Objective Text:
The International Formula Council (IFC) appreciates the opportunity to provide comments on the proposed Healthy People 2020 Objectives. The IFC is an association of manufacturers and marketers of formulated nutrition products, e.g., infant formulas and adult nutritionals, whose members are based predominantly in North America.* We fully support and commend the aim of Healthy People 2020 to improve the health of all infants. We also fully support exclusive breastfeeding, especially within the first six months of life, as recommended by numerous health authorities.
The IFC supports the proposed objective of increasing the percentage of employers who have worksite lactation programs. The need to return to work after having a child is a significant barrier to increased breastfeeding for women in the U.S. , , ,
• One third of mothers return to work within three months of giving birth. For many working mothers – especially those in hourly paid positions or minimum wage jobs – the lack of a workplace program that encourages and supports breastfeeding may force them to reduce or abandon their breastfeeding efforts.
• When asked which government actions would be most effective in helping increase breastfeeding initiation and duration in the U.S., the most common response was that mothers supported the notion of the government guaranteeing paid maternity leave or longer maternity leave (33%), and providing support for breastfeeding in the workplace (12%).
• In a July 2008 survey of the Working Mother Magazine 100 Best Companies, more than one third of employers said there are real barriers to implementing lactation programs for hourly and lower wage employees, including scheduling conflicts, lack of dedicated lactation rooms, and limited promotion of lactation benefits to hourly employees.
This objective could be strengthened by adding a particular focus on increasing the percentage of employers who offer worksite lactation programs for hourly and lower-wage workers.
I. Thulier D , Mercer D. Variables associated with breastfeeding duration. Journal of Obstetrics,
Gynecologic and Neonatal Nursing. 2009;49:259-268.
II. Ahluwalia et al. Why do women stop breastfeeding? Findings from the pregnancy risk assessment and
monitoring system. Pediatrics 2005;116;1408-1412.
III. Taveras EM, Capra AM, Braveman PA, Jensvold NG, Escobar GJ, Lieu TA. Clinician Support and
Psychosocial Risk Factors Associated With Breastfeeding Discontinuation. Pediatrics. 2003;112(1):108-
115.
IV. Ryan AS, ZhouW, Arensberg MB. The effect of employment status on breastfeeding in the United
States. Womens Health Issues. Sep-Oct 2006;16(5):243-251.
* IFC members are Abbott Nutrition, Mead Johnson Nutrition, Nestlé Infant Nutrition, and Pfizer Nutrition.
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Objective Text:
Propose Revision of Objective Text
Increase the proportion of worksites that have policies that support breastfeeding mothers, including lactation rooms and pump loaner programs, and time off with pay to breast pump.
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Objective Clarification:
One thing to consider in shaping this objective is a real, practical standard for workplace access to lactation programs. Some workplaces technically have lactation rooms now, but because of the size of the workplace (such as on larger campuses), location of the room, and inadequate break time, the rooms are inaccessible. This allows the workplace to claim that they have such a service without it actually being clearly usable by the majority of lactating mothers. Addressing accessibility and discouraging this type of lactation whitewashing will be an important component of implementation.
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Objective Clarification, Objective Text, Data Source:
Status: New to Healthy People 2020.
LifeCare Comments:
The measure is very broadly stated and would benefit from a clearer definition of ‘corporate lactation’ as well as a measurement parameter that focuses on improving the current status year over year. Currently, approximately 25% of employers provide workplace lactation support. A target goal should be established for accomplishment by 2020.
The business case for increasing the percentage of employers who have worksite lactation programs can be supported by the following:
• Mothers with infants are one of the largest and fastest growing segments of the U.S. workforce—particularly in retail, service, and other hourly and lower-wage industries where breastfeeding support is less common.
• More than half (56%) of all mothers of infants in the U.S. work. More than 40% of first-time moms return to work less than three months after delivery.
• Returning to work is the biggest barrier to breastfeeding, yet employer medical costs are higher for never-breastfed infants than fully breastfed infants. It has been documented by the American Academy of Pediatrics that breastfed infants need fewer sick visits, prescriptions and hospitalizations. UCLA Center for Healthier Children, Families and Communities found that in two companies corporate lactation programs resulted in annual savings of $240,000 and $60,000 in health care claims.
• Employee productivity is lower among non-breastfeeding mothers of infants. Their children are sick more often and they account for a higher percentage of absenteeism and presenteeism than breastfeeding mothers. The American Journal of Lactation reported that breastfed infants had 33% fewer illnesses than formula-fed infants. The overall impact was a 28% decrease in absenteeism and a 36% reduction in sick child claims for the breastfed population.
• According to Medela, the premier manufacturer of breast pumps, for every dollar spent on a workplace lactation program an employer can save between $1.75 and $4.00 in maternal absenteeism, medical claims and pharmacy costs. Based on Life Care’s studies of employer populations who utilize the Mothers@Work Lactation program, for every dollar invested, there is a return of the original dollar plus approximately $7.34.
• According to the recently released Shriver Report, the ‘new workforce’ is half women of whom two-thirds of primary breadwinners and co-breadwinners are mothers. Businesses have failed to recognize this reality and Healthy People 2020 is positioned to increase the recognition that women in the workforce can be nursing mothers and effective employees simultaneously.
• In a recent survey, new moms reported the major barriers to breastfeeding are “the need to return to work or school” (61%), “not being able to produce enough milk” (61%), and “the cost of a breast pump” (53%).
The definition of a worksite lactation program is fairly broad and can encompass anything from defining break times to allow for pumping, to accommodations for pumping and storing breast milk and appropriate education of the entire workforce around the benefits of a corporate lactation program.
Workplace lactation programs benefit everyone. A comprehensive workplace lactation program can increase breastfeeding initiation and duration rates by as much as 30 percentage points. Healthier babies lead to decreased employee absenteeism, reduced healthcare costs and increased employee loyalty and productivity.
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Objective Text:
ASTPHND recommends modification:
Add these indicators-
Increase the percent (need to establish baseline first) of women who go back to work and continue to exclusively breastfeed at 3mo and 6 mo. (this could added to the objective above or become a new objective)
? Increase to 50% the number of babies who are exclusively breastfed until 3 months of age.
? Increase to 25% the number of babies who are exclusively breastfed until 6 months of age.
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Objective Clarification:
The Family Health council of Central PA supports this objective. Breastfeeding protects the health of infants and ultimately affects many health outcomes. Educating employers about the productivity and bottom-line benefits to their business that result when mothers breastfeed their babies would do much to encourage worksite lactation programs.
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Objective Clarification:
Rewrite Objective: Increase the percentage of employers who have worksite lactation support programs.
Rationale: The addition of the word “support” provides needed clarity. Workplace programs support women’s efforts to continue reastfeeding/lactation.
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Objective Text, Data Source:
This is an important objective and addresses a common barrier to breastfeeding. I wonder if a group could survey worksites, such as CDC did with hospitals. Are there any standard surveys of workplaces? It would be great if employers understood what is in it for them to support breastfeeding. If there is a standard survey perhaps a question related to benefits of breastfeeding support for employers could be included. Some local breastfeeding coalitions offer businesses a decal to show they are "breastfeeding friendly" perhaps there could be national criteria for minimum BF Friendly Business declaration and local and state coalitions or health departments could report the # they have awarded, the number they have added.
Child care is critical, too. I've heard child care providers comment that they are surprised that other child care providers won't accept breastfed babies.
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Objective Text:
This is a fabulous addition to our national health goals.
Business stands to win big time here too, as their health care expenditures will decrease along with employee absences.
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The March of Dimes Foundation strongly supports the addition of this objective to Healthy People 2020.
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Objective Text, Data Source:
This is such a vital objective that impacts breastfeeding initiation, duration, and exclusivity rates. A possible data source: The Maternal Child Health Bureau's Business Case for Breastfeeding Tool Kit.
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Objective Clarification:
One of the most frequent reasons for avoidance or abandonment of breastfeeding is return to employment. Exclusive breastfeeding rates suffer when mothers encounter employer resistance to providing accomodations for pumping milk or lack on-site child care. This is a vital objective if we are to meet any of the exclusive breastfeeding sub-objectives and for mothers to adhere to the medically recommended exclusive breastfeeding for 6 months.
Employers will enjoy reduced health claims, less employee absenteeism to care for sick children, greater employee retention, savings from not having to recruit and train new employees, and greater employee productivity. Multiple studies have confirmed these outcomes.
The US Lactation Consultant Association as well as state breastfeeding coalitions have experts available to put in place and administer worksite breastfeeding programs. The return on investment for a company with workplace lactation accomodations is often 3 to 1.
This objective is a vital piece of breastfeeding support, laying the groundwork for improved health outcomes and reduced healthcare dollars being spent on diseases and conditions preventable by breastfeeding.
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Objective Clarification, Objective Text:
This is an important goal, because it is a huge problem for many women today; our breastfeeding duration rates in the U.S. will not increase without addressing it. I agree with other commenters who recommend defining in the goal what is meant by a "worksite lactation program".
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Data Source:
Thanks for adding this objective because many women with very young children are working. The workplace is outside of the heath care system, but what happens there has a big effect on health. Small businesses without human resources managers need to be surveyed also. By adding this objective, I believe it will drive more research about ways working women can be supported to sustain breastfeeding.
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Objective Clarification, Objective Text:
Add
o Increase the percent (need to establish baseline first) of women who go back to work and continue to exclusively breastfeed at 3 months and 6 months (this could be added to the objective above or become a new objective).
? Increase to 50% the number of babies who are exclusively breastfed until 3 months of age.
? Increase to 25% the number of babies who are exclusively breastfed until 6 months of age.
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Objective Text:
The lack of resources to allow a new mom to continue breastfeeding when she returns to work has far more impact than any free samples, coupons, advertising, giveaways etc. that she may get from formula companies. It seems unfair that they get painted as the cause of early weaning rates when in fact they are offering the only viable solution to this dilemma for many working parents. The only thing that might motivate employers to respond is legislation to enforce the objective.
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Objective Text:
The lack of resources to allow a new mom to continue breastfeeding when she returns to work has far more impact than any free samples, coupons, advertising, giveaways etc. that she may get from formula companies. It seems unfair that they get painted as the cause of early weaning rates when in fact they are offering the only viable solution to this dilemma for many working parents. The only thing that might motivate employers to respond is legislation to enforce the objective.
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Objective Text, Data Source, Status:
I support this objective 100%. Breastfeeding is normal and healthy. Every woman that chooses to breastfeed her child should be able to WHEREVER and WHENEVER. Breastmilk has antibodies that protect infants from illnesses, reducing healthcare costs.
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Objective Clarification, Data Source:
Please cross reference this objective in the ECBP section, Worksite Wellness Programs, within the definition of "comprehensive program" offered by employers.
Data source, could be National Business Group on Health
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Objective Clarification, Objective Text, Data Source, Status:
Agree. Mothers and Women should have this right in all states.
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Objective Text:
This objective is clearly linked to the exclusive breastfeeding objectives from Healthy People 2000. If we have any hope to meet those objectives, legislationg that protects breastfeeding at work is necessary. Research shows that women who start working wean 8 weeks earlier than other mothers. We need legislation that protect working moms in ALL STATES.
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Objective Clarification:
I think this is a great objective. Working as a nurse, it is very difficult to be able to take adequate breaks in order to pump. I feel that this objective should be further defined in regards to a what a worksite lactation program consists of and what increase you would like to see. Breastfeeding is so important and should be supported when women return to work.
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Objective Clarification:
On behalf of all the working moms I know, this is such a CRITICAL issue! More than anything else, our need to return to work soon after our babies were born puts so much additional stress and guilt on us, from deciding whether to use a daycare center or hire a nanny, or wean and switch to formula or try to juggle getting our work done while trying to pump enough to meet our babies' demands. Any increased percentage of the number of employers that truly support AND accommodate continued breastfeeding would at least alleviate some of the guilt we feel when we go back to work and hand our children over to someone else to take care of them. This challenge had the more impact than any other on all my breastfeeding/working mom friend's decisions to wean earlier than they expected to. Real life employers need to be more aware of the various needs of their real life employees.
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Objective Clarification:
Not sure how to suggest this objective can be achieved in all workplaces, but no doubt I would have tried to breastfeed my second child if I had had more than 4 weeks maternity leave before having to go back to my job in retail (my first child got the benefit of 4 months of breastfeeding before I had to go back to work- different employer). Before she was born, I knew there would be no time, never mind place for me to try to pump and store my milk when I got back to work, so I didn't even bother to start nursing since I knew we would be making a switch within just a couple of weeks. My daughter did just fine with formula, but it would have been nice to have the option to nurse her for longer like I did her older sister, and the biggest difference for me was the environment I had to go back to work in.
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Objective Clarification:
This is so important to me. I'm no longer a working mother, but when I was I had to fight tooth and nail for a lactation room. They told me that I should have to pump in the bathroom and that "This isn't Macy's, we don't have a barka lounge for you." I would have been happy with a closet. Moms aren't that picky but they deserve 15 minutes to pump and a clean, safe location to do so. Once the economy turns around, I'd love to see some laws along the lines of FMLA. Something like if you have 50+ employees, you must provide a safe, clean environment for expressing breastmilk.
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Couldn't agree more that this is the greatest barrier to lengthening the time a working mom can successfully breastfeed her babies!!!!!
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Objective Clarification, Objective Text, Data Source:
I support this objective as maternal employment is a major barrier to breastfeeding duration rates in the US.
Consider defining 1 or 2 required elements of a worksite lactation program, e.g. employer clarifying that break times can be used for milk expression without penalty; all employees are informed of the lactation program upon hiring.
Would also like to see the level of increase defined. What is it currently and how much of an increase?
Becky Mannel, BS, IBCLC
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Objective Text:
There needs to be an inclusion statement that there will be no reprimands for having non-"bathroom" break time or added break times available to pump at work.
What does a "program" consits of? A place to brng a brat pump? a room available with no sink or pump? A lactation consultant and reading material or support group available?
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Objective Clarification:
It is critical to include on site childcare and bringing babies to the job (bringing non-mobile infants to work is a policy at our Kansas state Department of Health and Environment). Pumping and bottle feeding is NOT the same as breastfeeding!
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Objective Clarification:
what % are we aiming for? this is great!!
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Excellent objective to help support women when returning to work.
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