Lcagw presentation110906
- 1. Support for Breastfeeding Women in the Workplace Presented by Jane J. Balkam, PhD, APRN,CPNP,IBCLC LCAGW Meeting, November 9,2006
- 2. Introduction Barriers to prolonged breastfeeding posed by the workplace. States with legislation protecting breastfeeding women in the workplace. Barriers faced by employers in providing support. Approaches businesses can take. Strategies mothers can use to sustain BF
- 3. The Department of Health and Human Services has singled out the workplace as one of the most important barriers to extended breastfeeding for women in the United States. USHHS (2000) HHS Blueprint for Action on Breastfeeding.
- 4. Scope of the Problem 70% of employed women in the US who have children under the age of three years work full time. 1/3 return to work within 3 months of the baby’s birth 2/3 return by 6 months of age DHHS (2000) HHS Blueprint for Action on Breastfeeding
- 5. Evidence for Workplace as Barrier 1984 study Timing of return to work had a greater impact on duration than number of hours worked Likelihood of early weaning ↑ if mother returned to work before infant was 4 months of age Auerbach (1984)
- 6. Work Intensity and Breastfeeding Full-time employment decreases initiation, intensity, and duration Part-time work neither increases nor decreases initiation and duration Part-time work lowers breastfeeding intensity to a less extent than full-time work Fein, S. B., & Roe, B. (1998).
- 7. Length of Leave and Duration FDA Infant Feeding Practices Study Duration of work leave contributed significantly to duration of BF Each week of work leave ↑ the duration of BF by almost ½ week Roe,et al (1999)
- 8. Workplace Strategies FDA Infant Feeding Practices Study Researchers stated that if women develop a strategy to balance breastfeeding and working, the negative effect of work outside the home may dissipate. Roe, et al (1999)
- 9. Effect of Strategies on Intensity of Breastfeeding (Mean # Feeds/Day) From talk by Sara Fein, PhD, January 2006
- 10. Workplace Barriers Lack of time to BF or express milk Lack of a place to BF or express milk Lack of equipment for milk expression Lack of support from supervisors Lack of support from co-workers Real or perceived low milk supply
- 11. What is Maternity Protection (MP)? An adjustment of a woman’s workload during pregnancy, childbirth, recovery, and lactation. What is being protected? her health, her child’s health, her livelihood, her right to work free from discrimination because she is a mother From talk given by Chris Mulford, RN,IBCLC, January, 2006
- 12. What is Maternity Protection (MP)? Wide variation among nations: 3 years of maternity leave in some Eastern European countries, with very low pay 1 year shared between the parents in Sweden, with nearly full pay Leave starts 6 wks before the due date in many countries. http://www.waba.org.my/womenwork/mpc19Nov04.pdf From talk given by Chris Mulford, RN,IBCLC, January, 2006
- 13. What MP laws do we have in the U.S.A.? National: Family & Medical Leave Act (1993) Unpaid leave 12 weeks Large employers only To be eligible, an employee must work 1,250 hours in the previous year. From talk given by Chris Mulford, RN,IBCLC, January, 2006
- 14. What MP laws do we have in the U.S.A.? Five states and Puerto Rico provide paid leave during pregnancy under TDI (Temporary Disability Insurance) New York New Jersey Hawaii Rhode Island California http://www.econop.org/FLI-ActivityAcrossUS.htm From talk given by Chris Mulford, RN,IBCLC, January, 2006
- 15. Laws to protect breastfeeding in the workplace Congresswoman Carolyn Maloney’s bills in the House http://www.house.gov/maloney/issues/breastfeeding/ State legislation in 12 states http://www.lalecheleague.org/Law/summary.html Proposed legislation in 4 more states http://www.lalecheleague.org/Law/proposedsummary.html From talk given by Chris Mulford, RN,IBCLC, January, 2006
- 16. California Breastfeeding at Work law 1998 Encourages employers to provide facilities for BF or milk expression Lactation Accommodation Law 2002 Expands prior workplace law to require adequate break time and space for BF or milk expression Fine $100
- 17. Texas 1995 Law Set forth basic components of workplace support for breastfeeding Employers complying can be designated as a Mother-Friendly Workplace
- 18. Employers’ Issues 1997 Questionnaires- civic group- small, rural southern community 2001 Focus groups-HR professionals- Austin, TX 2002 Questionnaires-employers- small Midwestern city 2004 Survey -HR directors-selected Colorado businesses
- 19. 1997 Bridges, Frank & Curtain Survey only concerned with attitudes 94% married, male and white 48% had personal experience with BF 67% had not worked with women who nursed or expressed in the workplace 70% did not know of businesses employing BF mothers
- 20. Results 88% offered 8 weeks maternity leave 37% offered paid maternity leave 41% had allowed break time to nurse 43% expressed support for a nursing mothers break room Overall, weak, + support for BF in the workplace 41% believed FF as healthy as BF
- 21. 2001 Brown, Poag & Kasprzycki Focus groups Knew about benefits of BF Did not place high priority on BF support Accommodated employees on as needed basis None with company policy concerning BF
- 22. Barriers Identified Cost of providing space to express Productivity-time it takes away from job Other employees objecting to extra time Liability for stored milk Health regulations concerning milk storage
- 23. Motivators Recruitment tool Employee demand Need to follow industry leaders Tax incentives or matching funds Data showing costs savings on health insurance, etc. Mother-friendly designation might aid recruitment
- 24. 2002 Libbus & Bullock Attitudes only using Bridges survey 69% of respondents women 50% of female respondents had BF 50% of all respondents experience with BF 50% willing to establish NMBR < 25% saw value of promoting BF in workplace 75% would support woman who wanted to BF or express in the workplace
- 25. 2004 Dunn, Zavela, Cline & Cost Also used Bridges survey instrument 608 businesses surveyed, all sizes, 26% completed 28% said they provided BF support services However 85% with 3 months ML 73% with flextime, job share or PT options 62% provided breaks for milk expression 71% provided refrigerator for milk storage
- 26. Other Findings Majority not aware of benefits of BF to employers Large employers more likely than small to support BF in workplace Not enthusiastic about incentives Employers who scored higher on attitudes more likely to have benefits and services
- 27. Resources for Employers U.S. Breastfeeding Committee Issue Papers Benefits of Breastfeeding (2002). Workplace Breastfeeding Support (2002) Breastfeeding and Child Care (2002) Economic Benefits of Breastfeeding (2002) www.usbreastfeeding.org
- 28. Programs Continuum from minimally supportive policies to full support with professional lactation consultant services Roles of mother, supervisor and human resources professional described Bar-Yam (2004) USBC Workplace BF Support Issue Paper (2002)
- 29. Cohen Studies Results from Workplace Lactation Programs 1994 Impact on incidence and duration of BF-75% BF 6 mos., average duration 8 mo. 1995 rates of absenteeism of mothers and infant illness-Babies who were BF had fewer illnesses and mothers took fewer days off to care for sick infant
- 30. California WIC Study 6 local WIC agencies in LA County Employees provided with worksite support 99% of employees initiated BF 88% BF 6 mos. 48% of study participants never introduced infant formula Whaley,Meehan,Lange, Slusser & Jenks (2002)
- 31. My Study Large public sector employer Survey of employees participating over a 3 year period
- 32. Main Research Question What is the effect of a workplace lactation program on the duration of breastfeeding for women who work outside the home for a large public sector employer?
- 33. Sub-Questions Was there a difference those who had a short postpartum maternity leave and those who had a longer maternity leave concerning duration of breastfeeding? Was there a difference between program participants who worked part-time and those who worked full-time concerning duration of breastfeeding? Which program service had the most impact on duration of breastfeeding?
- 34. Definitions Breastfeeding Breast milk feeding Exclusive breastfeeding/breast milk feeding (BF/BMF) Workplace lactation program Supportive-educative nursing system
- 35. Methodology Utilization-focused program evaluation as described by Patton Cross-sectional survey approach using both quantitative and qualitative methodologies Participant survey (305 of 598 prev. part.) Program evaluation forms (358 forms)
- 36. Data Analysis Mailed questionnaire-questions based on questions from FDA Infant Feeding Practices Study 303 current employees surveyed 134 responded (44%), 6 discarded 128 usable surveys - usable rate of 42% SSPS for data analysis
- 37. Data Analysis Program evaluation form-358 responses 10 Likert Scale questions 1 open-ended comment section SPSS for analysis of the Likert Scale questions Content analysis for open-ended question
- 38. Data Analysis Chi-square analysis was used for comparison of groups in the cross tabulations ANOVA was used for comparison of means Hierarchical regression analysis was used in examining the relationship between duration of breastfeeding and 3 demographic variables and 4 study variables Content analysis on the one qualitative question on the program evaluation form
- 39. Results
- 40. Demographics From mailed questionnaire 97% married 69% white 82% English-speaking 88% with BS or higher degree 65% with combined income > $100,000 Group that studies have shown to most successful with prolonged breastfeeding
- 41. Demographics 74% vaginal deliveries 26% Cesarean section 57% First time mothers Feeding method at hospital discharge Breastfeeding 92% Feeding pumped milk 20% Formula feeding 21%
- 42. Breastfeeding and Work 48% < 12 weeks maternity leave 52% > 12 weeks maternity leave Worked part-time (< 35 hr/w) 24% Worked full-time (> 35 hr/w) 76% Feeding method just prior to RTW Breastfeeding 89% Breast milk feeding 56% Formula feeding 43%
- 43. Breastfeeding and Work Expressed milk at work 94% Used a large electric pump 74% Used a battery operated pump 21% Used a manual pump 7% Used program lactation room 70% Preferred to use own office 13% No room available 7%
- 44. Services of Workplace Lactation Program Prenatal education Maternity leave telephone support Return to work consultation Ongoing support in the workplace Access to employer supplied rooms and large electric breast pumps
- 45. Was there a difference between those who worked part-time and those who worked full-time concerning breastfeeding duration? Program Service with most impact?
- 47. Was there a difference between program participants who had a short maternity leave and those with a longer maternity leave in duration of breastfeeding?
- 50. Conclusions Even a very supportive workplace lactation program was not able to assist FT working mothers to attain the same duration of BF/BMF as PT working mothers. No significant differences were found in duration of BF/BMF by length of maternity leave The RTW Consultation appeared to have the most impact on duration of BF/BMF
- 52. Options Exclusive breastfeeding Partial weaning Formula feeding
- 53. Exclusive Breastfeeding Feed infant at breast when with infant Pump for any feeding mother is away from infant No formula supplementation Goal is to preserve full milk supply
- 54. Partial Weaning Feed infant at breast when with infant Supplement with formula when at work Mother’s milk supply will decrease Has potential to lead to early weaning
- 55. Formula Feeding Mother weans to formula prior to return to work Recommend gradually process
- 56. Choosing and Using a Breast Pump Types of pumps Right pump for the job Which one is right for me? Where do I purchase a pump and or attachments?
- 57. Storing and Handling Milk Insulated bag with ice packs at work Refrigerate if plan to use within 3 to 4 days Freeze 2-3 months in household refrigerator-freezer
- 58. Containers Plastic bottles with caps Freezer bags designed for collection and storage Store approximately 1 feeding per container
- 59. Strategies to Increase Supply Principle of “supply and demand” May take 2-3 days possibly up to a week to increase production Breastfeed more frequently (1 st choice) Increase frequency or duration of pumping if at work or baby not nursing Use of galactagogues or other techniques not recommended as first line