Texas Mother-Friendly Worksite Policy Initiative Promoting Prevention and Wellness through Worksite Lactation Support Julie Stagg, MSN, RN, IBCLC, RLC Maternal and Child Health Nurse Consultant Office of Program Decision Support Division for Family and Community Health Services firstname.lastname@example.org 512-458-7111 X6917
Learning Objectives • Describe three reasons that worksite lactation support is an important employee wellness strategy. • Identify state and federal laws and public health recommendations related to worksite lactation support. • Describe four minimum requirements to be recognized as a Texas Mother Friendly Worksite. • Identify 3 components of the Mother-Friendly Worksite Policy Initiative.
Texas Mother-Friendly Worksite Program Texas Mother-Friendly Worksite Program • IT’S ABOUT WELLNESS
The Burden of Obesity Estimated $3.3 Billion Cost to Employers r/t Adult Obesity in Texas, 20051
Barriers to Worksite Wellness5 • Managers don’t see themselves as in the business of making people healthy • Do not have information about wellness strategies and methods that are effective
Worksite Wellness Barriers5 • Lack of awareness that wellness is an investment strategy • Do not how to go about implementing programs • Cost is a barrier • Turnover reduces Return on Investment (ROI)
Workforce of the Future • 30% of children aged 2-5 enrolled in WIC overweight or obese (2008)2 • 42% of Texas 4th graders overweight or obese (2004-2005 School Year)3 • 66% of Texas adults overweight or obese (2008)4
The Burden of Obesity “Projecting costs of obesity to 2025 and accounting for the increase in the prevalence of obesity and the increase in the working population, obesity and obesity-related illnesses could cost Texas businesses $15.8 billion annually by 2025.”1
Breastfeeding is an Obesity Prevention Strategy6-7 • Breastfeeding is an important primary prevention strategy for obesity and other chronic diseases. • Breastfeeding reduces risk of obesity in a dose-response manner. • The longer and more intensely (more exclusively) a mother breastfeeds, the greater the risk reduction.
Breastfeeding is an Obesity Prevention Strategy • Breastfeeding reduces risk of obesity by up to 30%7. • Breastfeeding promotion is a cornerstone of the Centers for Disease Control and Prevention’s obesity prevention efforts.
Worksite Lactation Support is a Public Health Priority Recommended by every major medical & professional health organization • American Academy of Pediatrics (AAP) • American College of Obstetricians & Gynecologists (ACOG) • American Academy of Family Physicians (AAFP) • Association of Women’s Health, Obstetric, & Neonatal Nurses (AWHONN) • American Dietetics Association (ADA) • American Public Health Association (APHA)
Texas Mother-Friendly Worksite Program Breastmilk: Its More Than Just Food
Breastfeeding:Keeps Babies Well • Reduced Risk with Exclusive Breastfeeding7: Obesity Ear infections Respiratory infections Gastrointestinal infections Atopic Dermatitis Type 1 & Type 2 diabetes Leukemia Sudden Infant Death Syndrome Necrotizing Enterocolitis
Breastfeeding:Keeps Babies Well • For every 1,000 babies not breastfed8: • an excess of 2,033 physician visits • an excess of 212 days in the hospital • an excess of 609 prescriptions • Breastfeeding is important for neurodevelopment, and associated with different brain development, higher IQ, and improved school outcomes.9-12
Breastfeeding:Keeps Babies Well • Sub-optimal breastfeeding is riskier for infants enrolled in daycare centers13,14 • Infants in child care centers are at 69% increased risk of hospitalization for respiratory infection • Being in a child care setting doubles odds of needing antibiotics by age 1.5-5 years • Exclusive breastfeeding at least 4 months had protective effect for 2.5 years • Among infants of employed mothers who were never sick during the first year, 86% were breastfed
Breastfeeding:Healthy for Mothers • Breastfeeding reduces risk of7: • Premenopausal breast cancer • Ovarian cancer • Type 2 diabetes • PPD • Cardiovascular Disease15 • Metabolic Syndrome16 • Recovery from pregnancy is slowed and menses returns more quickly if breastfeeding doesn’t occur
Breastfeeding:Healthy for Families • Breastfeeding is associated with lower risk of: • Substantiated Child Abuse and Neglect17 • Infant Abandonment18 • Infant Death19
Risk of post-neonatal death in the US “Overall, children who were ever breastfed had 0.79times the riskof never breastfed children for dying in the postneonatal period.Longer breastfeeding was associated with lower risk. Odds ratiosby cause of death varied from 0.59 for injuries to 0.84 for sudden infantdeath syndrome.” 19
Burden of Sub-Optimal Breastfeeding “If 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be in infants ($10.5 billion and 741 deaths at 80% compliance).”20
Texas Mother-Friendly Worksite Program Balancing Biology and Industry
Why must working women express breastmilk? • Supply is based on demand. • What comes out comes back in. • An emptied breast makes more milk. • An unemptied breast signals the body to slow production.
The natural rhythm of breastfeeding • Breastfeeding usually occurs 8-12 times in a 24 hour period, or every 2 to 3 hours on average. • Feeding time and duration is led by the baby’s hunger and satiety signals as well as by mother’s level of fullness and comfort. • Frequency may fluctuate based on a variety of factors. • Need to express milk is temporary (12-15 mos).
Texas Mother-Friendly Worksite Program Women Working • AND MOTHERING TOO
Working and Breastfeeding • What do babies and businesses have in common? • They both depend on working, breastfeeding mothers. • Amelia Psmythe, OR
Women in the Workforce23 Historical Context • 59% of all women 16 and older are in the workforce • 66 million women were employed in the U.S in 2009. • 74 percent of employed women worked on full-time jobs, while 26 percent worked on a part-time basis. • Women are primary bread winner in almost 40% of families • Women are the fastest growing segment of US labor force & 46.8% of total workforce
Women in the Workforce24 • 42% of all women giving birth to their first child 2000-2002 were working by 3-months postpartum. • For women who worked during pregnancy, 58% of women had returned to work by 3 months, and 42% were working full-time.
Texas Mother-Friendly Worksite Program Work Remains a Breastfeeding Barrier • Negatively impacting health outcomes
Working and Breastfeeding28-30 • Full-time employment decreases breastfeeding duration by an average of more than 8 weeks. • Mothers are most likely to wean their infants within the first month after returning to work. • Only 10% of full-time working women exclusively breastfeed for 6 months. • Full-time employment an economic necessity for many.
Working, Breastfeeding Mothers’ Concerns • Modesty • Time and Social Constraints • Lack of Support • Making Enough Milk for Their Baby
Worksite Lactation Support • Addresses concerns to balance rhythm of industry to biology • Allows for maintenance of milk supply • Physical comfort of mother • Balanced needs and priorities=productivity • Ideal nutrition and immune protection for infant
Worksite Lactation Support is a Public Health Priority • 1919 ILO Convention 3 and Multiple subsequent UN Declarations and Conventions • 1984 Surgeon General’s Workshop on Breastfeeding and Human Lactation • 1990 Innocenti Declaration and the Surgeon General’s Blueprint for Action on Breastfeeding • 1995 Texas Health and Safety Code 165: Breast-feeding
Texas Health and Safety Code 165 • Breastfeeding is “the best method of infant nutrition” and “an important and basic act of nurture that must be encouraged in the interests of maternal and child health and family values.” • “The legislature recognizes a mother's responsibility to both her job and her child when she returns to work and acknowledges that a woman's choice to breast-feed benefits the family, the employer, and society.”
Texas Health and Safety Code 165 • Affirms a woman’s right to breastfeed in any location in which she “is authorized to be” • “Mother-Friendly” Business Designation • Service provided by state agencies • DSHS to make recommendations and create a model pilot MFW
Worksite Lactation Support is a Public Health Priority • 1996 CDC’s Healthier Worksite Initiative: Includes Lactation Support Program • 2001 The Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity • 2004 WIC Reauthorization
Worksite Lactation Support is a Public Health Priority • 2005-2010 Strategic Plan for the Prevention of Obesity in Texas: Increase the number of worksites that have initiated policies and practices to support breastfeeding and lactation • 2005 CDC Guide to Breastfeeding Interventions • 2008 MCHB/HRSA Business Case for Breastfeeding
2008 Statewide Agency Wellness Program-Building Healthy Texans • 2009 CDC’s Recommended community strategies and measurements to prevent obesity in the United States: Increase support for breastfeeding (workplace) • Healthy People 2020 Draft Objective: “Increase the percentage of employers who have worksite lactation programs.” Worksite Lactation Support is a Public Health Priority
Worksite Lactation Support is a Public Health Priority • January, 2010: The Surgeon General’s Vision for a Healthy and Fit Nation: • “To create healthy work sites, employers can: … • Support employees who want to breastfeed by providing written policies and designated private, clean spaces for breastfeeding or expressing milk.”
February, 2010 $2.8 million competitive grant awarded to Texas DSHS to implement MFWPI as a large scale, statewide policy and environmental change for prevention of chronic disease • March, 2010: Reasonable Break Time for Nursing Mothers signed into law • May, 2010: White House Taskforce on Childhood Obesity’s Report: Solving the Problem of Childhood Obesity Within a Generation Worksite Lactation Support is a Public Health Priority
Reasonable Break Time for Nursing Mothers • March, 2010: US became the 127th country with worksite breastfeeding protections (Australia is #128) • Amends the Fair Labor Standards Act, and applies to employees covered under this act (“non-exempt” employees) • Reasonable break time each time a mother has a need to express breastmilk until child is one. Does not need to be paid time.
Reasonable Break Time for Nursing Mothers • Employer must provide a place that is not a bathroom that is “shielded from view and free from intrusion” to express breastmilk. • An employer with fewer than 50 employees may be exempt if compliance would impose “an undue hardship”. Burden of proof for hardship is on the employer.
Reasonable Break Time for Nursing Mothers • What types of employers are covered? • What types of workers are covered? • When does the law take effect? • What about space?
Texas Mother-Friendly Worksite Program Business Case for Breastfeeding