The case for lactation-friendly work environments
Human milk is recognized as the optimal infant feeding method for at least the first 12 months of life to promote the health of both the lactating parent and the child.
Compared to formula-fed infants, those fed human milk have fewer ear infections, gastrointestinal and respiratory illnesses, and even have a reduced risk of certain chronic diseases like diabetes. Benefits for the parent may include reduced risk of cancer and faster postnatal weight loss.1
The impact of lactation extends far beyond the parent and child. For more than a decade, the US Department of Health and Human Services has campaigned “the business case for breastfeeding,” demonstrating that lactating parents miss fewer days of work due to child illness and also reduce healthcare costs.2
To maintain their milk production, the parent will need to express or pump at work. This is because lactation is based on a supply-and-demand relationship. Removing milk from the mammary gland, either by the infant or with manual expression or pumping, is the stimulus for continued milk production. If milk is removed less frequently, the body adjusts by making less milk, and infant formula may be required to make up the difference.
The Affordable Care Act protects a parent’s right to express milk in the workplace with the following requirements for businesses with 15 or more employees:
- Provide reasonable break time for an employee to express breast milk for two years after the child’s birth. Breaks do not have to be paid.
- Provide a private, convenient location (NOT a bathroom) for the employee to express milk.
These accommodations do not require a healthcare provider’s certification, nor can they be considered an “undue hardship” on the employer.3
Lactation disparities and workplace challenges
In an ideal world, high lactation rates create a win-win for the health of families and for workplace productivity.
In reality, only about one in four infants nationally is exclusively fed human milk for the first six months of life, just slightly lower than the WA state average of 28.9%. These statistics are much worse for low-income and non-Hispanic Black and American Indian/Alaska Native (AI/AN) families.4
Parents face a myriad of barriers in reaching their lactation goals, including individual factors like concerns about low milk supply, and societal factors like lack of support from healthcare providers.
Structural racism is a root cause of lactation disparities. For example, hospitals where Black parents give birth are less likely to offer lactation support compared to hospitals that serve primarily White birthing people.5
Returning to work after the birth of an infant presents unique obstacles for the lactating parent and can also exacerbate disparities. For example, some parents may not want to share their lactation status with coworkers or may simply not want to call attention to themselves when they need to pump.
This is particularly challenging for employees who do not have their own private office, like hourly workers. This disproportionately impacts people of color, who are underrepresented in the highest-paying occupational category, “management, professional, and related occupations.”6
Another workplace challenge is time constraints. Most lactating parents will need to express milk 2-3 times in an 8 hour work shift. Although this can typically be accomplished in 15–20-minute breaks, parents may worry about criticism from coworkers or falling behind on their own work.
Finally, the return-to-work period can compromise the amount of milk a parent is able to make. General job-related stress combined with the worry of being separated from their infant can decrease milk supply. Additionally, a pump does not remove milk as well as the infant does, which can lead to a drop in milk production over time.
Cultivating a workplace that supports lactation
The UW conforms to the Washington State Legislature workplace pregnancy accommodations (RCW 43.10.010). WorkLife, a division of UW Human Resources, maintains information for UW faculty, staff, and student parents, including a list and map of lactation rooms on all UW campuses and Harborview Medical Center.
WorkLife also holds informational panels for new and expecting parents on a variety of topics. An upcoming panel in late September will specifically cover lactation strategies for the return to work transition.
Beyond the support offered by WorkLife, individual departments are well-suited to implement lactation support programs that fit the unique needs of their employees. Such programs are recommended by the US Surgeon General and are composed of four elements: privacy for milk expression, flexible breaks and schedules, education, and support. These programs go above and beyond what is required to be provided by law to minimize common challenges.2
Example Elements of Lactation Support Programs Actions for Employers and Coworkers
Privacy for milk expression
- Add amenities to the department’s lactation room: running water for washing hands and pump parts, paper towels, a separate fridge to store milk, a comfortable chair, electrical outlets.
Flexible breaks and schedules
- Avoid scheduling meetings during a time that someone needs to pump.
- As a manager, if coverage is needed for a lactating employee to express milk, be proactive about adjusting work tasks and schedules so that non-lactating employees do not feel overburdened.
- Trust the lactating parent to know when they need to pump and for how long. Planned pumping breaks make it easier to anticipate when coverage is needed.
- Provide a list of community organizations that offer lactation support. The Washington Department of Health maintains an extensive list of general lactation and peer-to-peer organizations.
- Educate all staff on the importance of supporting lactation.
- Be mindful of gender-neutral language to respect the gender identity of all parents. Use “lactation,” “human milk,” “pumping,” “lactating parent.”7
- Use language that promotes human milk as the norm. Avoid asking questions like, “Are you still lactating?”
- If a lactating coworker shares frustrations, affirm their feelings and offer simple encouragement. Example: “You are doing such a great job. Your baby is so lucky to have you.” Ask if there is anything you can do to support the individual at work.
- Trust the lactating parent to know when they need to pump and for how long. Pre-planned pumping breaks make it easier to anticipate when coverage is needed.
Both parent knowledge and preparation and a supportive workplace lactation culture is crucial for the parent to be successful. Pro-lactation work environments benefit all by improving the health and productivity of the lactating coworker and by generally contributing to a positive, inclusive workplace morale.
Contact firstname.lastname@example.org if you have questions about returning to work as a lactating parent, are unable to find a lactation room that suits your needs, or if you have questions about how to support lactating employees in your department.
*To acknowledge and respect the gender identity of all parents, gender-neutral terminology is used to describe lactation throughout this article, except when referencing a named article or event.
Marah Zinnen is a registered dietitian, certified lactation specialist, and second year Master of Public Health student and Maternal Child Health Trainee with Western MCH Nutrition Partners.
Prior to starting graduate school at the UW, she worked as a dietitian for the Women, Infants and Children (WIC) program. Through her work there, she became passionate about supporting parents in their lactation journeys, and hopes to work in the program development and policy space to help address disparities in lactation rates. She wholeheartedly welcomes any questions or comments about the content in this article, and can be reached at email@example.com.
- CDC. Why It Matters. Centers for Disease Control and Prevention. Published August 3, 2022. Accessed August 11, 2022.
- Business Case for Breastfeeding | Office on Women’s Health. Accessed August 11, 2022.
- Reasonable Break Time for Nursing Mothers. Federal Register. Published December 21, 2010. Accessed August 11, 2022.
- Chiang KV. Racial and Ethnic Disparities in Breastfeeding Initiation ─ United States, 2019. MMWR Morb Mortal Wkly Rep. 2021;70. doi:10.15585/mmwr.mm7021a1
- Racial disparities persist for breastfeeding moms. Here’s why. PBS NewsHour. Published August 29, 2019. Accessed August 11, 2022.
- Labor force characteristics by race and ethnicity, 2020 : BLS Reports: U.S. Bureau of Labor Statistics. Accessed August 11, 2022.
- Bartick M, Stehel EK, Calhoun SL, et al. Academy of Breastfeeding Medicine Position Statement and Guideline: Infant Feeding and Lactation-Related Language and Gender. Breastfeed Med. Published online August 9, 2021. doi:10.1089/bfm.2021.29188.abm