Implementing The Business Case for Breastfeeding
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Implementing
The Business Case for Breastfeeding
In Your Community
Train the Trainer Curriculum
A curriculum designed for state and local breastfeeding coalitions, Healthy Start projects and communities, lactation educators and advocates, and other community health care professionals involved in improving workplace lactation support for breastfeeding women
Supported by Contract #HHSH240200735008C between the U.S. Department of Health and Human Services, Health Resources and Services Administration,
Maternal and Child Health Bureau and HCD International, Inc.
Table of Contents
Acknowledgements iii
Curriculum Contents iv
Project Overview v
Abstract v
Background v
The Business Case for Breastfeeding viii
Training Details x
Potential Target Audience Groups x
Learning Objectives x
Training Content xi
Checklist of Materials and Equipment xii
Ideas for Making Training FUN ii
Presentation Speaker Notes
Section 1: Project Overview 1
Section 2: Breastfeeding is Good for Business 13
Section 3: Easy Steps to Implementing a Worksite Lactation Program 28
Section 4: Supporting Working Women 48
Section 5: Effective Outreach with Businesses 67
Section 6: Using the MCHB Lactation Resource Kit 90
Section 7: Building your Plan 97
Section 8: The Business Case for Breastfeeding
(Business Networking Session) 106
Section 9: References 117
Section 10: Resources ??
Acknowledgements
This training curriculum, “Implementing The Business Case for Breastfeeding in Your Community,” and the companion workplace lactation resource kit, The Business Case for Breastfeeding, was published in 2008 by the U.S. Department of Health and Human Services, Health Resources and Services Administration’s (HRSA), Maternal and Child Health Bureau.
“…HRSA, the lead U.S. Department of Health and Human Services Agency for improving access to health care for underserved and vulnerable individuals…”
External Reviewers:
MCHB wishes to thank the following content experts who volunteered to assist the project by reviewing the curriculum for accuracy and consistency.
Rona Cohen, RN, MN, IBCLC
President, MCH Services, Inc.
Cate Colburn-Smith, BS
Co-Author, The Milk Memos
Chris Mulford, RN, BSN, IBCLC
Co-Coordinator, Women and Work Task Force (World Alliance for Breastfeeding Advocacy)
Chair, Workplace Breastfeeding Support Committee, United States Breastfeeding Committee
National Business Group on Health
This curriculum was produced under contract for the U.S. Department of Health and Human Services, Health Resources and Services Administration by HCD International, Inc., Every Mother, Inc., and Rich Winter Design and Multimedia.
Curriculum Contents
The training curriculum includes the following:
■ The Business Case for Breastfeeding workplace lactation resource kit produced by the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration’s Maternal and Child Health Bureau.
■ CURRICULUM MANUAL with comprehensive speaker notes, instructions for all activities, instructional guidance, resources that can be helpful background information in providing the training, and checklists of materials needed.
■ POWERPOINT PRESENTATION that can be used in providing a community-based training program.
■ CD-ROM with electronic files of the PowerPoint presentation, speaker notes, and training handouts for the training program.
The curriculum contents, including the PowerPoint presentation, are the property of the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration’s Maternal and Child Health Bureau, and as such, trainers have the right to duplicate materials as needed for providing a community-based training program. It should be noted that HHS has purchased rights to the photographic images strictly for use in the Business Case for Breastfeeding workplace lactation resource kit and “Implementing The Business Case for Breastfeeding in YOUR Community” training program. These images cannot be duplicated or used for other purposes or posted on the Internet without written permission from MCHB.
No part of this curriculum may be sold.
Project Overview
Abstract
The U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration’s Maternal and Child Health Bureau (MCHB) has developed The Business Case for Breastfeeding, a comprehensive resource kit that targets a broad spectrum of individuals and groups involved in supporting employed breastfeeding women. HHS further developed the training curriculum, “Implementing The Business Case for Breastfeeding in YOUR Community,” as a train-the-trainer program for State and local breastfeeding coalitions, lactation consultants, breastfeeding educators and advocates, and community health care professionals involved in improving workplace lactation support for employed breastfeeding women. The curriculum is part of a national training and technical assistance initiative designed to equip State breastfeeding coalitions and Healthy Start programs in conducting effective outreach to local businesses using the MCHB workplace lactation resource kit, The Business Case for Breastfeeding. Healthy Start is an HHS funded program providing community-based initiatives to reduce infant mortality rates and to improve the health of women, infants, children, and their families. Healthy Start programs focus on decreasing infant mortality. HHS funds approximately 100 Healthy Start sites across the United States and its territories. A directory of Healthy Start sites in each state is available at .
Background Information
The U.S. Department of Health and Human Services “Healthy People 2010” goals include objectives to increase the number of women initiating breastfeeding to 75 percent, and increasing duration rates of breastfeeding at both 6 months (50 percent) and 12 months (25 percent) (U.S. Dept. of HHS Healthy People 2010). The Healthy People 2010’s Midcourse Review released in December 2006 also reflects the addition of two new goals for breastfeeding exclusivity at 3 months (60 percent) and 6 months (25 percent). Mounting evidence in the field of infant and child health demonstrates that breastfeeding exclusivity and duration contribute to significant health advantages for infants, as well as for mothers. In fact, the American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately the first 6 months, and supports continued breastfeeding for the first year and beyond as mutually desired by the mother and child (AAP 2005).
Despite the wide body of evidence supporting the importance of breastfeeding, the breastfeeding duration goals at 6 months and 12 months have not been met in most U.S. states. Rates of exclusive breastfeeding are also low nationally, with only 30.5 percent breastfeeding exclusively at 3 months and 14.2 percent breastfeeding exclusively at 6 months (CDC 2007). Research shows that one of the most significant barriers to continuing breastfeeding is the mother’s return to work or school (Ryan 2002). Currently nearly 60 percent of new mothers with children under the age of 3 are in the work force (U.S. Department of Labor 2007b), and several studies show that this decision to resume employment impacts both how long mothers breastfeed (Arlotti 1998) and how long they will exclusively breastfeed (McLeod 2002). Full-time employment decreases breastfeeding duration by an average of 8.6 weeks (Taveras 2003) and the first month back at work appears to be the time when most working women wean (Cardenas 2005).
A growing trend among businesses is offering lactation support programs that include a private area for women to breastfeed or express milk during the work day, flexible breaks for feeding or expressing milk, prenatal/postpartum breastfeeding education and access to professional support from a lactation consultant or other breastfeeding expert, and support from management and other workers. Research shows that employers who provide comprehensive lactation programs have enjoyed numerous business advantages, including lower absenteeism and turnover rates (Galtry 1997; Cohen 1995; Lyness 1999), lower health care costs (Mutual of Omaha 2001; Dickson 2000), and improved productivity and loyalty among employees (Cohen 2002). These programs have also been proven to increase breastfeeding duration rates (Cohen 1995; Cohen 1994). However, few employers are aware of these benefits (Brown 2001). According to the 2007 Benefits Survey conducted by the Society for Human Resource Management, 26 percent of all employers offer lactation related benefits (SHRM 2007).
The U.S. Department of Health and Human Services, Health Resources and Services Administration’s Maternal and Child Health Bureau developed a national workplace lactation resource kit, The Business Case for Breastfeeding to address these issues. The resource kit is designed to improve support for breastfeeding mothers who return to work, to encourage and equip employers and human resource managers with tools needed to establish and sustain lactation programs, and to equip local breastfeeding educators and advocates with resources for effectively engaging employers in their community. The materials, which target a broad spectrum of individuals and groups involved in supporting working mothers, are divided into five sections packaged together in a polished, professional format and designed for versatile storage in a file drawer or on a bookshelf. Reproducible templates are provided on a CD-ROM diskette for personalization by a business or outreach worker. The chart on the following page provides detail about each of the five sections to the resource kit, including target audience and key content for each.
This training curriculum, “Implementing The Business Case for Breastfeeding in Your Community,” was developed to assist State and local breastfeeding coalitions, Healthy Start programs, lactation consultants, and other health care professionals with implementing the resource kit in their community. The curriculum includes speaker notes, handouts, PowerPoint presentations, and guidance on implementing The Business Case for Breastfeeding.
The Business Case for Breastfeeding Resource Kit
|Materials |Target Audience |Content |
|The Business Case for Breastfeeding |Employers |How a lactation support program can yield an excellent |
| | |return on investment (ROI) and other advantages to |
| | |companies |
| | |Lactation program components |
|Easy Steps to Supporting Breastfeeding|Human resource managers, wellness |Conducting a needs assessment |
|Employees |coordinators, occupational health |Obtaining support from company stakeholders |
| |nurses, and other company staff |Utilizing community resources |
| |responsible for implementing a |Addressing common concerns of employed breastfeeding women |
| |lactation support program |Options for milk expression space, breast pump equipment, |
| | |flexible breaks and work options, prenatal and postpartum |
| | |lactation education and counseling, and workplace support |
| | |Promoting the program |
|Tool Kit |Same as above |Reproducible tools for implementing a workplace lactation |
| | |support program, including template lactation support |
| | |policy, assessment and feedback tools, timeline for |
| | |implementation, and promotional communication tools |
| | |Resource Guide with links to professional and community |
| | |resources to assist a business in project implementation |
| | |Employer Spotlights of successful lactation support |
| | |programs in a variety of businesses across the U.S. |
|Employees’ Guide to Breastfeeding and |Employees of childbearing age and their|Strategies for establishing and maintaining lactation after|
|Working |partners |returning to work |
| | |Options for milk expression at work |
| | |Strategies for communicating with supervisors and |
| | |colleagues about breastfeeding needs |
| | |Resources for support |
|Outreach Marketing Guide |Community breastfeeding educators and |The impact of employment on breastfeeding initiation, |
| |advocates, and health care providers |duration and exclusivity rates |
| | |Successful strategies for supporting working mothers |
| | |Effective outreach opportunities with community businesses |
| | |Employment legislation language |
| | |Snapshots of successful outreach programs |
| | |Outreach Resources, including PowerPoint presentation for |
| | |local outreach with businesses or business groups, sample |
| | |lesson plans for workplace lactation education, and |
| | |template outreach tools |
Implementing The Business Case for Breastfeeding in Your Community
Training Details
Training Length: 1.5 to 2 days (for comprehensive training)
Potential Community Target Audience Groups for Training
■ State and local breastfeeding coalitions
■ Healthy Start grantee program staff
■ International Board Certified Lactation Consultants (IBCLCs)
■ Hospital and private clinic health care professionals
■ La Leche League Leaders
■ Staff of the United States Department of Agriculture (USDA) Special Supplemental Nutrition Program for Women, Infants and Children (WIC)
Potential Guests at the Business Networking Session
■ Employers, human resource managers, wellness coordinators, occupational health nurses
■ Child care providers
■ Insurance providers
Project Goal: To increase workplace lactation support for employed breastfeeding women by equipping lactation consultants and other professionals within community Healthy Start programs and State breastfeeding coalitions to conduct effective outreach and education activities with employers and other stakeholders.
Learning Objectives
Upon completion of this training program, participants will be able to:
1. Describe three ways supporting breastfeeding families can improve a company’s bottom line.
2. Identify at least three common challenges to sustaining breastfeeding after women return to work, and a strategy for addressing each.
3. List the four components of a successful workplace lactation support program targeting male and female employees.
4. Describe at least two motivators of employers and two barriers to implementing a workplace lactation program.
5. Develop a strategic plan for implementing The Business Case for Breastfeeding in a community.
6. Identify at least two teaching strategies that can be used in presenting the “Implementing The Business Case for Breastfeeding in YOUR Community” as a community-based training program.
Training Content
The train-the-trainer curriculum for implementing The Business Case for Breastfeeding addresses:
■ Utilizing the MCHB workplace lactation resource kit, The Business Case for Breastfeeding, in a community-based workplace lactation support outreach program.
■ Benefits of a lactation support program in reducing health care and employee turnover costs for a business.
■ Components of a successful lactation support program.
■ Barriers to sustained breastfeeding after returning to work, including short maternity leave, lack of paid leave, lack of child care alternatives, limited workplace accommodations, physical challenges (including maintaining milk production), and psychosocial challenges.
■ Strategies for assisting mothers in overcoming barriers, including solutions for maintaining milk supply, options for milk expression during the work day, and gaining support from supervisors, colleagues, and other working mothers.
■ Easy steps for implementing a lactation support program, including gaining buy-in from stakeholders, and the components of a comprehensive program, including space for a lactation room, flexible breaks for expressing milk, breast pump equipment, milk storage options, prenatal and postpartum education, and lactation support.
■ Conducting effective outreach with businesses, including identifying companies to approach, identifying appropriate stakeholders, learning how to talk with employers, understanding factors that can motivate employers to implement lactation support programs, and solutions to business constraints and barriers.
■ Strategy planning to identify targeted workplaces, barriers to address, and community outreach planning.
■ Providing a community-based training utilizing this curriculum.
Checklist of Materials and Equipment
AV Equipment
✓ LCD projector for PowerPoint display
✓ Computer
✓ Projection screen
✓ Flip chart and markers
Teaching Tools and Training Props
The following training props are to be prepared and used by the trainer in presenting the curriculum in local communities.
Section 2 – Breastfeeding is Good for Business
✓ 5-6 small business briefcases (options: CD holders or storage boxes designed to resemble a briefcase, or cutting poster board or standard file folders in the shape of a briefcase)
✓ Index card inside each briefcase with a proposed service/product to discuss
✓ Larger briefcase for speaker to use as a visual
✓ 5 small 5x7 signs made of poster board with one of the following words on each: “Benefits,” “Costs,” Options/Rationale,” “Risks,” and “Risk of NOT Implementing”
Section 3 – Easy Steps to Implementing a Lactation Support Program
✓ 6 brown envelopes
✓ Photo of women working in common non-office settings such as:
School
Military
Hotel
Child care center
Factory
Convenience store
Farm/agriculture
Ski lodge
Small retail store at a mall
Construction site
Section 4 – Supporting Working Women:
Turning Obstacles into Opportunities
✓ Flip chart sheets and markers for 6-8 tables
✓ Items to represent varied jobs (hats, shoes, or other small items). Examples:
Police badge or toy police car
Thermometer (to represent a nurse)
Mini chalkboard with “#1 Teacher” written on it
Inter-office memo
Hair curler
Toy ambulance or fire truck
Restaurant menu
Grocery store receipt
Toy construction set (to represent construction worker)
Other items representing other common jobs in your community
✓ Set of 5 lunch boxes with the following items in each:
Photo of a woman working in a cubicle work station
Nursing pads
Baby bottle
Pocket calendar
Stopwatch
Dollar bill (play money is acceptable)
Milk storage bag
Handouts
✓ PowerPoint Handouts – Sections 1-10
✓ Handout A – “Elevator Speech” (Section 2)
✓ Handout B – “Solutions for Working Mothers” (Section 4)
✓ Handout C – “Press Release” (Section 5)
✓ Handout D – “Company Profile” (Section 5)
✓ Handout E – “Role Play Scenarios” (Section 5)
✓ Handout F – “Community Resource Template” (Section 6)
✓ Handout G – USBC’s “Accommodations for Breastfeeding in the Workplace” (Section 7)
✓ Strategy Planning Worksheets (Section 7)
Worksheet #1 – General Program Planning
Worksheet #2 – Businesses to Target
Worksheet #3 – Workplace Challenges
Worksheet #4 – Outreach Plan
Basic Resource
■ The Business Case for Breastfeeding workplace lactation resource kit produced by the U.S. Department of Health and Human Services, Health Resources and Services Administration’s Maternal and Child Health Bureau. Available from the HRSA Information Center at: ask. or 1-888-ASK-HRSA. It is also available online at the Office on Women’s Health at: .
Other Helpful Resources
■ Center for Disease Control and Prevention’s “Lactation Support Program Tool Kit” available at: nccdphp/dnpa/hwi/toolkits/lactation/index.htm
■ The National Business Group on Health’s “Maternal and Child Health: An Employer’s Toolkit” available at: healthtopics/maternalchild/investing/
■ United States Breastfeeding Committee issue papers on working and breastfeeding. Available at:
■ Position Statements
■ International Lactation Consultant Association –
■ United States Breastfeeding Committee –
■ American Academy of Pediatrics –
■ American Academy of Family Physicians –
■ Books
■ Berggren K. 2006. Working Without Weaning
■ Colburn-Smith C and Serrette A. 2007. The Milk Memos: How Real Moms Learned to Mix Business with Babies – and How You Can, Too
■ Mohrbacher N and Kendall-Tackett K. 2005. Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers
■ Moquin C. 2008. How to Start a Babies-at-Work Program.
■ Pryor G. 2007. Nursing Mother, Working Mother
|Ideas for Making Trainings FUN |
| |
|Provide a selection of various candy treats at each table for attendees to enjoy throughout the training. Post flip chart sheets around the room with|
|the name of each candy treat printed at the top. Throughout the training, ask trainees to think of slogans or “headlines” about worksite lactation |
|support that could be written using the name of that candy treat, focusing on slogans that would speak to employers. Candy treat examples: tootsie |
|rolls, mints, “Smarties,” lifesavers, gold nugget chocolates, raisins, etc. Examples of fun slogans: “Save a mint with an employee lactation support|
|program;” “A lactation support program can be a lifesaver for your company’s bottom line;” “Lactation Support: SMART business plan!” Have trainees |
|vote on the slogan they like best and give certificates or small prizes to the winners. |
| |
|Door prizes throughout the training always help make a training fun. Think of inexpensive prizes such as inexpensive plant pots from a local dollar |
|store with a package of seeds and a small plastic storage bag of potting soil to remind participants that they are “planting seeds” with businesses |
|that will bring fruit for mothers and babies for years to come. Announce that prizes will be given immediately at the end of each break and lunch |
|period only for those present in the room to encourage people to return on time. |
| |
|Always affirm attendees when they offer ideas and comments to contribute to the discussion. This helps create an atmosphere of trust that encourages |
|open and meaningful discussion. |
| |
|Provide “The Business Case Survival Kits” to all attendees at the end of the training. Fill a plastic resealable sandwich bag with some or all of the|
|following little items to remind attendees of the important points of the training after they leave. Examples: |
|“Curious George” bookmark…be curious and ask questions before making contacts with employers |
|Pipe cleaner…be flexible when working with businesses |
|Tootsie Roll…everyone has a “role” to play in supporting working mothers with breastfeeding |
|Piece of a map…we’re on a journey together |
|Puzzle piece…it takes each person to make a difference |
|Rock…there may be obstacles along the way, but we can turn those obstacles into opportunities |
|Eraser…it’s okay to make mistakes as long we learn from them |
|Birthday candle…celebrate your accomplishments along the way |
|Stick of gum…be persistent and “stick” with it |
|Penny…even a small change makes a big difference |
|Rubber duckie…just dive in and get started! |
|Plant seeds or miniature pot…we are planting important seeds that will take root in the lives of families for years to come |
|Thread…you are the thread that connects breastfeeding mothers to employer support |
Implementing
The Business Case for Breastfeeding
In Your Community
Speaker Notes
Section 1: Project Overview
Welcome and introduction of speakers and participants.
Slide #1 Section 1: Project Overview
Slide #2 Implementing The Business Case for Breastfeeding
in Your Community
■ Welcome to today’s training, “Implementing The Business Case for Breastfeeding in Your Community,” a project sponsored by the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration’s Maternal and Child Health Bureau, with additional funding from the HHS Office on Women’s Health.
■ This project includes a comprehensive resource kit, The Business Case for Breastfeeding, which helps employers develop lactation support programs, as well as a comprehensive training program, “Implementing The Business Case for Breastfeeding in Your Community.” Both of these are designed to be used by your group to help increase the number of businesses in your community that provide a supportive environment for breastfeeding employees.
Slide #3 Project Goals
■ This training program is part of a major national initiative of DHHS to increase breastfeeding duration and exclusivity rates among employed breastfeeding women.
■ The project goal is to increase workplace lactation support for employed breastfeeding women by equipping lactation consultants and other professionals within community Healthy Start programs and State breastfeeding coalitions to conduct effective outreach and education activities with employers.
■ Healthy Start is a Federal program aimed at reducing mortality rates and improving the health of women, infants, children, and their families. Healthy Start programs focus on access to health care and meeting basic health needs. Approximately 100 Healthy Start programs are funded by HHS across the United States and its territories. For a complete directory of Healthy Start programs by state, visit the Web site at and click on “Directory.”
Slide #4 Train the Trainer Program
■ During the research phase of the project it was discovered that while many breastfeeding educators and health care professionals are very confident in their ability to support working mothers, they are not always as confident in their ability to relate to employers. Health care professionals tend to operate from a communication model focused on health outcomes which may not get the attention of employers and human resource managers.
■ To assist with conducting effective outreach to these and other groups, this Train the Trainer program has been developed for State breastfeeding coalitions and Healthy Start communities to use in training other local groups in their community.
■ The curriculum, which focuses on how to improve workplace lactation support in communities, includes:
■ Training manual with PowerPoint presentation, speaker notes, and handouts
■ CD-ROM with all presentation materials
■ The training includes:
■ Ways to communicate effectively with businesses
■ Evidence-based information about ways to improve support for employed breastfeeding women
■ Techniques for state/community-based strategy planning.
Slide #5 Sneak Preview: Section 1
■ Topics covered: Health implications of breastfeeding, rationale for supporting breastfeeding mothers who return to work, and an overview of the U.S. Department of Health and Human Services, Health Resources and Services Administration’s Maternal and Child Health Bureau project, The Business Case for Breastfeeding.
■ Show trainees:
The Business Case for Breastfeeding workplace lactation resource kit
Slide #6 Getting to Know You
■ Activity: Opening Ice Breaker
■ Instructions:
■ Invite participants to pair up with a partner.
■ Interview each other about your very first paid job.
■ Ask each other:
■ What was the BEST thing about that job?
■ How easy would it have been to combine breastfeeding and working in that job setting?
■ Ask 2-3 individuals to share their experience with the full group.
■ Discuss the fact that these jobs can often be quite challenging settings for breastfeeding women. Today’s training will address strategies for supporting mothers as well as encouraging businesses to provide a breastfeeding-friendly environment.
Slide #7 Profits and People
■ According to the 2006 U.S. Bureau of Labor Statistics (U.S. Dept. of Labor 2007b):
■ Women comprise 46.3 percent or nearly half of the U.S. labor force.
■ Women with children are the fastest growing segment of the U.S. workforce. (To say a woman is in the “work force” means she is either employed or actively seeking employment.)
■ Almost 60 percent of American women are in the work force; of these, 62 percent are of childbearing age.
Slide #8 Women in the Work Force
■ The numbers of women with children, and especially young children under the age of 3, who are in the work force are high, and the numbers are even higher among African American women.
■ The chart on this slide shows the breakdown between population groups. This shows that:
■ Among ALL women with children under the age of 18, 70.6% are in the workforce and 67.2% are actively employed.
■ Among ALL women with children under the age of 6, 63% are in the work force, and 59% are actively employed.
■ Among ALL women with children under the age or 3, nearly 60% are in the work force and 56% are actively employed.
■ The breakdown among all population groups in the work force is as follows (U.S. Department of Labor 2007):
|Category |ALL Women |Caucasian Women |African American |Asian Women |Hispanic/ |
| | | |Women | |Latino Women |
|Children Under Age 18 |70.6% |70.1% |76.1% |66.6% |60.5% |
|Children Under Age 6 |63% |62% |71% |60.2% |52% |
|Children Under Age 3 |59.9% |59.3% |66.2% |56.8% |48.1% |
Slide #9 U.S. Breastfeeding Rates
■ The U.S. Department of Health and Human Services (HHS), Healthy People 2010 goals (HHS 2000) for breastfeeding include:
■ 75 percent of all mothers initiating breastfeeding
■ 50 percent of all mothers continuing to breastfeed at 6 months
■ 25 percent of all mothers continuing to breastfeed at 12 months
■ Healthy People 2010’s Midcourse Review issued in December 2006 added additional goals for breastfeeding exclusivity:
■ 40 percent exclusively breastfeeding at 3 months
■ 17 percent exclusively breastfeeding at 6 months
■ Exclusive breastfeeding means that the baby consumes only human milk either directly at the breast or via previously expressed milk. Small amounts of vitamins and medications are permitted. Other foods, formula, and other drinks, including water, are not recommended.
■ The American Academy of Pediatrics recommends that women breastfeed their infants exclusively until around 6 months of age, and continue to breastfeed after complementary foods are added until at least one year, and thereafter for as long as the mother and the baby desire (AAP 2005).
■ According to the 2007 findings of the National Health and Nutrition Examination Surveys (NHANES) conducted by the HHS Centers for Disease Control and Prevention, the national breastfeeding rates have now exceeded the Healthy People 2010 goals. Breastfeeding rates are now at their highest rate in over 30 years.
Slide #10 Why We Care
■ Encouraging women to breastfeed their infants is a national health imperative supported by numerous Federal, medical, and professional organizations.
■ Although the numbers of women initiating breastfeeding in the United States are high (nearly 74 percent) (CDC 2006), breastfeeding duration and exclusivity rates (babies consuming only human milk) drop dramatically over the course of 3, 6, and 12 months.
■ Family-friendly policies and programs that provide support for both female employees and female partners of male employees will assist women in meeting their goals for continued breastfeeding.
■ Currently in the United States around 26 percent of employers offer this type of support (SHRM 2007).
Slide #11 Health Implications for Babies
■ NOT breastfeeding increases an infant’s risk of numerous health concerns (AHRQ 2007), including:
■ Obesity
■ Ear infections
■ Respiratory infections
■ Gastrointestinal diseases
■ Skin conditions such as dermatitis
■ Type 1 and Type 2 diabetes
■ Leukemia
■ Sudden Infant Death Syndrome
Slide #12 Increased Risks for Babies of Employed Mothers
■ Infants are at a 69 percent increased risk of hospitalizations for acute respiratory infections if enrolled in a child care center (Kamper 2006)
■ Being in day-care settings doubles the odds of needing antibiotics by age 1.5-5 years (Dubois 2005).
■ One study found that exclusively breastfeeding for at least 4 months significantly reduced the need for antibiotics for those children enrolled in daycare, and the protective effect seems to last until the child is at least 2.5 years of age (Dubois 2005).
■ Another study found that 86 percent of breastfed babies of employed mothers were never sick during their first year of life (Cohen 1994).
■ This is a major contributing factor to the reduced absenteeism rates among women who breastfeed their babies.
Slide #13 Health Implications for Employed Mothers
■ The health implications also extend to women who complete the natural reproductive cycle by breastfeeding their babies.
■ According to the government study issued by the HHS Agency for Healthcare Research and Quality (AHRQ 2007), mothers who breastfeed are at lower risk of:
■ Premenopausal breast cancer and ovarian cancer
■ Type 2 diabetes
■ The financial impact of breast cancer and diabetes on female employees is significant, posing a substantial workplace burden as a result of significantly higher medical costs, and higher rates of absenteeism and “presenteeism” (or the loss of productivity that arises when workers come to work even though they are ill) (Sasser 2005).
■ Women who breastfeed recover from pregnancy faster and usually experience no menses for several months after the birth of their infants.
■ Healthy employees are more productive and better able to withstand the competing demands of being a mother and an employee.
Slide #14 Impact of Employment on Breastfeeding
■ The reality is that employment has a direct negative impact on breastfeeding duration. A recent study of U.S. mothers found that the majority of breastfeeding women weaned their infants within their first month back at work (Cardenas 2005).
■ Work status plays a role. Women who are employed full-time are less likely to initiate breastfeeding and to continue after they return to work (Ryan 1997).
■ Mothers who plan to work part-time are more likely to initiate breastfeeding (Scott 2001) and to breastfeed longer (Fein & Roe 1998; Ryan 1997), especially if they are employed less than 20 hours per week.
■ Women who are not employed at all tend to breastfeed at least 8 weeks longer than mothers who work full-time (Fein & Roe 1998).
■ The reality, however, is that many women choose full-time work due to economic necessity and fringe benefits they desperately need (Galtry 1997).
■ Challenges such as lack of paid leave or a short maternity leave, availability of affordable quality child care, issues maintaining milk production, as well as on-the-job challenges can contribute to a decline in breastfeeding duration among women. Family-friendly programs such as onsite child care and lactation support programs can help women achieve their infant feeding goals.
Slide #15 Direct Breastfeeding vs. Pumping at Work
■ New data from the national Infant Feeding Practices Survey conducted by the U.S. Department of Health and Human Services found that women who breastfeed their infants directly at work breastfeed for longer durations (>7 weeks) than mothers who only express their milk while at work (Fein 2008).
■ Women who do not breastfeed or pump while at work do not breastfeed as long (Fein 2008).
■ Breastfeeding at work includes various options, including keeping the baby at work, breastfeeding the infant at the onsite childcare center provided by the workplace, or having the childcare provider bring the baby to the mother for feedings.
■ Other studies have found that women working in supportive worksite environments with comprehensive lactation support programs tend to breastfeed as long as women who feed their babies exclusively at the breast (Whaley 2002; Cohen 1994; Ortiz 2004).
■ An important strategy in meeting US breastfeeding exclusivity and duration goals is to support mothers in directly feeding their infants while at work, and encourage workplaces to provide a breastfeeding-friendly environment.
Slide #16 Concerns of Special Population Groups
■ The need for workplace support is especially crucial for African American mothers (Hermann 2001).
■ African American women tend to breastfeed at lower rates (CDC 2006).
■ African American women are also more likely to return to work sooner than other population groups, and to be employed full-time (Cricco-Lizza 2002; Caulfield 1998; Klerman 1994: Galtry 1997; Ryan 1997).
■ African American and Hispanic workers tend to experience poverty at much higher rates than Caucasians, and are more likely to be employed in low-wage job settings that may not be conducive to breastfeeding or milk expression (Beers 2001).
■ Mothers in disadvantaged population groups appear to have the greatest difficulty combining employment with breastfeeding (Kimbro 2006).
■ Women in lower income levels are more often employed in low-wage positions where job settings make continued breastfeeding difficult (Cricco-Lizza 2002).
■ The Welfare Reform Act of 1996 was instituted to encourage self-sufficiency by emphasizing job preparation and instituting work participation requirements. However, administration of the legislation was left to individual states to interpret and manage. One study examining the impact of the Welfare Reform Act found that it led to more women returning to work sooner than they had planned, resulting in significant difficulties maintaining lactation (Haider 2003).
Slide #17 Support in the Workplace
■ Ample evidence shows that a supportive workplace environment, including family-friendly policies and accommodations for milk expression when mothers are away from their babies can help women sustain lactation and bring about a positive return on investment to the company (Cohen 95).
■ This support can include components such as maternity leave, flexible return to work options, onsite child care centers, private areas to express milk or breastfeed during the work day, and other benefits.
Slide #18 The Business Case for Breastfeeding
■ To address these significant concerns and opportunities, the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau (HHS/HRSA/MCHB) has launched a major nationwide project aimed specifically at improving breastfeeding support for employed women across the country.
■ It is called The Business Case for Breastfeeding, and includes several major components:
■ Research and strategy planning conducted in 2004, including a comprehensive literature review, interviews with employers, and convening of a national strategy panel to identify appropriate solutions for addressing the needs of employed breastfeeding women.
■ Development of a workplace lactation support kit, The Business Case for Breastfeeding
■ A national training and technical assistance initiative to equip State breastfeeding coalitions and Healthy Start communities with funds to engage in community-based initiatives to implement The Business Case for Breastfeeding.
Slide #19 The Business Case for Breastfeeding
■ The workplace lactation resource kit, The Business Case for Breastfeeding, is a comprehensive approach to increasing breastfeeding support for employed breastfeeding women.
■ The kit targets several key audience groups critical to making the kinds of changes that are needed to improve that support.
■ The kit includes a wide variety of materials and tools, packaged in five separate file folders which are placed inside an attractive box. The box can be placed in a file cabinet or on a bookshelf, and individual folders can also be filed, if desired.
■ It should be noted that the kit is not designed to be given in its entirety to an employer since resources and materials are aimed at a variety of audience groups and designed to be used in different ways. Think of the kit as your “advocacy kit” to aid you in conducting outreach with businesses in your community, and select pieces that are most relevant to the audience group you are addressing. Additional copies of individual outreach pieces can also be obtained from HRSA.
■ To obtain copies of the resource kit, contact the HHS HRSA Information Center at ask. or phone 1-888-275-4772 (ASK HRSA).
Slide #20 The Business Case for Breastfeeding: For Employers
(Folder #1)
■ The signature document is The Business Case for Breastfeeding, designed specifically as a short, easy to read document for an employer with limited time.
■ The content focuses on the things most important to a business owner or employer: the bottom line benefits of supporting breastfeeding employees.
Slide #21 Easy Steps to Supporting Breastfeeding Employees: For
Human Resource Managers (Folder #2)
■ Designed for those involved in the implementation of a lactation support program in a business or organization. This might include the human resource manager, a company’s wellness coordinator, an occupational health nurse, or other staff responsible for family-friendly benefits programs.
■ The content focuses on specific strategies for implementing the program, including assessing program needs, gaining buy-in from stakeholders, program options, policies to consider, and promoting the program.
Slide #22 Tool Kit: For Human Resource Managers (Folder #3)
■ To accompany the “Easy Steps” guidelines, a Tool Kit is provided with a wealth of resources that can be tweaked and tailored to fit the needs of a specific company. These reproducible templates include a sample workplace policy, assessment and feedback forms, and promotional items.
■ The Tool Kit also includes a Resource Guide with helpful links to Federal, national, and local resources, and snapshots of other corporate lactation programs and their impact data.
■ All materials are provided as both hard copies and on a CD-ROM, and packaged in a pocket folder.
Slide #23 Employees’ Guide to Breastfeeding and Working: For
Employees (Folder #4)
■ This guide is designed specifically for working mothers, and includes many valuable tips for combining breastfeeding with employment.
■ Of special interest is a sample “Dear Supervisor” letter, a helpful tool to assist a mother in communicating her needs to her supervisor. This tool can also be helpful as documentation of the mother’s needs and request for assistance.
Slide #24 Outreach Marketing Guide: For Outreach Workers (Folder
#5)
■ The Outreach Marketing Guide is a helpful tool for you, the lactation consultants and educators, health care professionals, and other community organizations interested in supporting working mothers.
■ Content includes strategies for communicating effectively with employers and a CD-ROM with numerous helpful resources, including a PowerPoint presentation you can use to present to local businesses, template letters that you can use to promote workplace lactation support, sample legislative language of states providing workplace breastfeeding legislation, and sample lesson plans if you are planning to offer workplace breastfeeding classes or support group meetings.
Slide #25 Project Expectations
■ After this training experience, State Breastfeeding Coalitions and Healthy Start programs participating in the project will be expected to develop a plan for utilizing The Business Case for Breastfeeding resource kit in outreach with businesses in your community, and to provide trainings with others. This will include:
■ Identifying appropriate businesses in your community to target for outreach, and partners who can help you with this effort.
■ Conducting outreach with targeted employers in their community to encourage them to establish supportive programs for breastfeeding employees.
■ You will also be expected to use this “Train the Trainer” curriculum to conduct additional trainings with others in your area.
Slide #26 Technical Assistance
■ To help you with both of these tasks (providing training and conducting outreach with businesses) this project provides technical assistance to support your group as you begin the process of implementing The Business Case for Breastfeeding in your community.
■ This technical assistance includes:
■ A follow-up site visit to your location within a year following this initial training to meet with you and other identified stakeholders. Specific goals and activities for the visit will be determined closer to the site visit after your group completes a work plan for approaching businesses.
■ Ongoing technical assistance via telephone, email and teleconferences for one year following your initial training.
■ A toll-free technical assistance telephone line: 1-866-435-4808
■ A Web site providing up-to-date information and resources, and a venue for idea and strategy sharing among programs” hrsa/worksitelactationsupport/index.html
Implementing
The Business Case for Breastfeeding
In Your Community
Speaker Notes
Section 2: Breastfeeding is Good for Business
Slide #1 Section 2: Breastfeeding is Good for Business
Slide #2 Sneak Preview: Section 2
Learning Objective:
Describe three ways supporting breastfeeding families can improve a company’s bottom line.
Topics covered: The business case for breastfeeding, including impact of a lactation support program in improving a company’s bottom line.
Handouts:
Handout A: “Elevator Speech”
Show Trainees:
The Business Case for Breastfeeding workplace lactation resource kit
Folder #1, The Business Case for Breastfeeding
Slide #3 Understanding Business Priorities
■ Today’s economic environment poses tremendous challenges for businesses large and small. STAYING in business is a top priority.
■ New start-up businesses face even greater challenges. Estimates are that over half of new small businesses will not make it past their first year of operation and 8 out of 10 will be dissolved within the first five 5 years (Gerber 1995).
■ In this economic environment, many businesses may be reluctant to consider new programs, making it imperative that the financial benefits of these programs be compelling.
■ Because of the economic challenges, businesses are concerned about:
■ Becoming more efficient: handling more work with less people
■ Shrinking workforce of qualified people
■ More stress and higher disability claims
■ Competitive global market
■ Keeping up with changes in technology
■ Productivity among workers
Slide #4 The GOOD News!
■ Lactation support programs can provide solutions to help address these needs.
■ The changing environment requires managers to apply cutting edge methods in human resource management to reduce absenteeism and tardiness, maximize each employee’s contribution to the workplace, and minimize losses in products associated with employee turnover.
■ Employers are also looking at ways to reduce the rate of “presenteeism.” Presenteeism means that a worker is physically present but functionally absent due to illness (Shamansky 2002), with lower productivity contributing to significant employer costs (Burton 2006). Risk factors such as stress and fatigue are among contributors to poor employee output (Shamansky 2002).
■ This can results in a “ripple effect.” For example, a sick baby can cause the mother to become sick, who may then come to work before she is fully recovered, in turn infecting co-workers. The resulting lost productivity and financial losses could have been prevented by keeping infants healthy to begin with.
■ Employers are implementing novel programs to attract new employees, improve employee health, and retain their high performing staff.
Slide #5 Family-Friendly Programs are On the Rise!
■ Many companies are implementing a variety of family-friendly programs to address the issues of staff retention and productivity.
■ Examples (Alliance for Work-Life Programs 2007):
■ UPS implemented flexible work schedules and reported a reduction in turnover rates from 50 percent to just 6 percent.
■ Illinois Bell implemented telecommuting options for employees which resulted in a 40% increase in productivity.
■ Hewlett Packard implemented a compressed workweek option for employees. The results were staggering. The program resulted in a 200 percent increase in the number of business transactions conducted each day, a 50 percent reduction in overtime, and a doubling of productivity among workers.
■ IBM implemented workplace flexibility options and found that workers worked 8 hours more a week and still felt they had work-life balance.
Slide #6 Family –Friendly Programs WORK
■ Family-friendly programs have been well researched in business journals and found to be effective at accomplishing the goals of the business.
■ Aetna, for example, implemented a program of 6 months of unpaid leave and a part-time return-to-work option following family/maternity leave. The result: turnover rates dropped by 50% and the company saved $1 million per year by not having to replace those individuals (Cardenas 2005).
■ Another study of general family-friendly programs found that companies with family-friendly benefits have lower turnover rates, greater job satisfaction among employees, and employees tend to work later into their pregnancies and return to work sooner. Interestingly, there is also a spillover effect, with employees reporting that they feel they have less stress at home, too (Schwartz 1996).
Slide #7 The Bottom Line
■ Family-friendly programs have been shown to put money back into the human relations budget. For every $1 spent on wellness, companies typically save $16 in improved productivity, lower absenteeism and turnover rates, and lower healthcare premiums.
Slide #8 The Business Case for Breastfeeding
■ In today’s economic environment, employers will be more likely to respond to new programs that provide solutions that increase the bottom line. A lactation program can be demonstrated as a solution to address the priorities of the company.
■ As health care professionals, breastfeeding educators, and community workers, it can be difficult to understand the business language and practices that drive most corporate decision-making. When we promote breastfeeding, we promote it as the “right” thing to do because of the positive health outcomes.
■ To sell an employer on a lactation program, however, will involve linking it to business priorities.
■ “The Business Case” is the title of the workplace lactation resource kit, and the title of the employer resource in folder #1. Yet what exactly does it mean to say “business case”?
■ The term “business case” refers to the logic and financial justification behind a proposed project. It is a common business term that helps employers decide if a program or service is worth their investment. The business case is a justification that includes such things as the expected business benefits, expected costs, potential risks, as well as the risk of doing nothing, along with options for implementing the program.
■ A “business case” shows how the proposed project is a solution to a business need.
■ To see how a formal “business case” is set up, conduct an Internet search using the key words, “sample business case.”
■ The good news is that a lactation support program does support business goals and it does so in several different ways.
Slide #9 Activity: The Business Case
■ Activity: The Business Case
■ Instructions:
■ Divide the group into 5 or 6 small groups of 6-8 participants each.
■ Provide each group with a small metal or plastic briefcase, or use poster board cut in the shape of a briefcase.
■ Place an index card inside each “briefcase” with a particular project or service for the group to consider written on the index card.
■ The following services or projects can be written on the index cards. Make sure each group has a different topic.
Providing chocolate to all employees before important staff meetings.
Offering take-out dinners at reasonable prices for employees.
Extending the lunch break from 30 to 60 minutes.
Offering stress management classes for employees.
Providing an extra 10-minute fitness break for all employees.
Providing or enhancing an onsite exercise facility.
■ Groups should remove the index card inside the case that describes a proposed service or project and develop a “case” for this service or project by answering the following questions:
■ What is the financial benefit?
■ What is the expected cost?
■ What are the potential risks?
■ What is the risk of not investing in this?
■ What options could be considered?
■ Ask groups to briefly report their “Business Case” to the full group. Discuss common risks and costs. What are the costs and risks that might be associated with a lactation program?
■ Time Allotment: 8-10 minutes
Slide #10 Show Me the Money!
■ To present lactation support, as well, focus on the business case.
■ This means that instead of discussing concepts and philosophies, translate it into language businesses understand: the potential impact on the bottom line of a company, or the anticipated Return on Investment (ROI).
Slide #11 Return on Investment (ROI)
■ “Return on Investment,” often abbreviated as ROI, is a common accounting method used by businesses to calculate the financial benefit a company expects to gain from investing in a new program.
■ To calculate an ROI the following formula is used:
(total benefit - total costs) = ____ X 100 = ROI
total costs
Total benefit = money saved or income realized which contributes to the bottom line.
Discussion: What kinds of financial benefits could a business potentially realize from a lactation support program?
■ Consider: health care savings, savings from lower staff turnover rates, savings from a reduction in staff absenteeism, increased business as a result of a positive public image as a family-friendly company, and avoidance of monetary penalties if state legislation requires employers to provide lactation support.
Total costs = monetary investment
■ Discussion: What kinds of costs (both obvious and “hidden”) might be involved in establishing a lactation support program?
■ Consider tangible or obvious costs such as physical renovations to convert existing space to a lactation room, purchasing furnishings and breast pump equipment, printing forms and publications, and contractual costs for hiring an IBCLC or other knowledgeable lactation expert to provide education and clinical support.
■ Consider intangible or hidden costs such as staff time to implement, manage, and monitor the program, employee time spent expressing milk, promotion costs, and program tracking and evaluation.
■ What is a GOOD ROI? Employers know that an ROI ratio of at least 1 to 1 (breaking even with the program) is often necessary to justify expenditures for a lactation program. A break-even ratio is often expected during the first year of a program when start-up expenses are incurred.
■ The longer the life of a program, the higher the ROI. Once initial costs are spent on the program, the return on investment tends to rise. An ROI of 2-1 or higher demonstrates to employers that the program is truly saving them money and therefore worth the investment.
Slide #12 Practice!
■ Practice #1. A company expects to gain $40,000 from their investment in a lactation support program in health care savings and reduced turnover rates. It will cost $10,000 to establish and maintain the program for a full year.
■ What is the ROI? [Use the formula above to calculate the ROI. The ROI is 300 percent or 3 to 1, which means the net benefit of a program will be 3 times the expected costs, or for every $1 dollar invested in the lactation support program the company can expect to make $3.]
■ Practice #2. A company is considering a lactation program. It is anticipated that a total of 30 employees will be eligible for the program during the first year.
■ Anticipated BENEFITS:
■ $1,000 in health care savings per employee
■ $30,000 savings in turnover costs for keeping an anticipated 6 employees that they might otherwise lose
■ $1,000 in absenteeism savings per employee
■ Anticipated COSTS:
■ $5,000 for creation of a room
■ $300 for breast pumps for each employee
■ $40,000 for staff time to implement the program
■ $10,000 for contract with an IBCLC
■ $2,000 for administrative costs and paperwork
■ Answer:
Total Benefits = $240,000
Total Costs = $66,000
ROI = 2.63 or nearly 3 to 1.
Slide #13 Comprehensive Lactation Support Program
■ A lactation support program can have many definitions. For the purposes of this training, the definition of a lactation program is:
a comprehensive program of support for breastfeeding employees in a workplace that includes the following four components:
■ Support from supervisors, colleagues, and other mothers.
■ Flexible return to work options and time to express milk during the work period;
■ Education and access to professional lactation support; and
■ A private space for women to express milk or breastfeed while they are at work;
■ To date, the only studies available on the impact of lactation programs have been conducted with comprehensive programs that include these components. Research has not yet been done to study the impact of single interventions such as only the presence of a lactation room. However, encouraging a business to provide support might mean starting small, meeting a business where they are comfortably able to begin, and assisting them in moving toward that full complement of services.
Slide #14 The Bottom Line: Breastfeeding is GOOD for Business
■ Several companies with lactation support programs have conducted program impact assessments to examine the cost effectiveness of workplace lactation support programs. Some of these include CIGNA, Mutual of Omaha, and the Los Angeles Department of Water and Power. [Read more about their programs and their outcome data in the “Employer Snapshots” found in the “Tool Kit” section of The Business Case for Breastfeeding resource kit.]
■ What they have found: Breastfeeding IS good for business! Rather than depleting funds from human resource benefits, lactation support actually puts money back into those benefits funds.
Slide #15 Lactation Support: Reduces Health Care Costs
■ Research shows that what an infant is fed has a major impact on health. With employers carrying the major burden of health case costs in the United States today, this becomes a significant selling point for supporting breastfeeding.
■ For every 1,000 babies NOT breastfed, there are an extra:
■ 2,033 physician visits
■ 212 hospitalization days
■ 609 prescriptions (Ball 1999)
What does that mean in language businesses understand?
Slide #16 Show Me the Money: Mutual of Omaha Case Study
■ Newborn health care costs were THREE TIMES LESS for mothers who participated in the company’s comprehensive lactation support program ($1,269 compared to $3,415 for infants of mothers who did NOT participate in the program).
■ Mutual of Omaha found a whopping yearly savings of $115,881 in health care costs alone.
■ The Bottom Line – Annual Savings Per Participant: $2,146
(Mutual of Omaha 2001)
Slide #17 Show Me the Money: Aetna Case Study
■ The insurance company Aetna estimated that it saved $1,435 in medical claims per breastfed infant during his or her first year of life as a result of the company’s comprehensive lactation support program.
■ Aetna’s annual savings in health care claims was $108,737, for a Return on Investment (ROI) of 3 to 1 (Ball 2001).
■ The Bottom Line – Annual Savings Per Participant: $1,435
Slide #18 Lactation Support: Reduces Absenteeism
■ Research shows that healthier babies mean that mothers and fathers are less likely to miss work to take care of a sick child. When a breastfed baby does become ill, the baby is likely to recover more quickly, reducing the duration of the parent’s absence from work.
■ One-day absences occur twice as often for employees who do not breastfeed (Cohen 1995).
■ Absenteeism rates are also lower among male employees when female partners breastfeed (Galtry 1997).
■ How does this information translate into what employers are most interested in?
Slide #19 Show Me the Money: CIGNA Case Study
■ CIGNA’s comprehensive lactation program resulted in a 77 percent reduction in lost work time due to infant illness.
■ For CIGNA, this translated into an annual savings of $60,000 in lower absenteeism rates alone (Dickson 2000).
Slide #20 Lactation Support: Lowers Turnover Rates
■ Another critical issue for employers is keeping their valuable employees after their maternity leave. This is usually referred to as retention.
■ Retention is a leading challenge for businesses today. Low unemployment rates and weak company loyalty (due in part to widespread downsizing) have resulted in employees “jumping ship” for better opportunities and better work environments. Employers are desperate for turnover remedies that have proven track records.
■ Nationally, only 59 percent of women who partake in maternity leave return to their same job after giving birth. This means companies typically lose 41 percent of their female employees after they leave to have a baby.
■ Companies that have lactation programs have a much higher rate of return to work after childbirth, and mothers who feel supported once they return to work are more likely to remain at that workplace.
■ For example, at Mutual of Omaha, 83 percent of their employees return to work (Mutual of Omaha 2001).
■ A recent study of 9 different companies providing lactation programs found that the average return to work rate was 94.2 percent (Ortiz 2006).
Slide #21 Show Me the Money: The Cost of Replacing Employees
■ Replacing valuable employees is costly. Some of those costs are obvious, and some are not as obvious.
■ Businesses tend to group replacement costs into 3 major cost categories:
Separation Costs
■ Paying off accrued vacation time
■ Arranging for temporary replacement staff
■ Loss of the body of knowledge and experience possessed by the person who left
Replacement Costs:
■ Costs for temporary staff
■ Management time to manage paperwork of departing employees and recruiting and hiring replacements
■ Advertising costs for the position
■ Time spent screening and reviewing new job candidates
■ Travel and relocation expenses
■ Lost time in productivity during the initial period of employment
■ Losses due to mistakes during the initial learning curve
Training Costs:
■ Training costs for the new employee (Griffith 2001)
■ Business employers know that keeping valuable employees is an important way to keep business costs down.
Slide #22 Show Me the Money: Replacement Costs
■ How much does all that cost? It is difficult to assign exact numbers because many factors affect turnover costs, including type of business and position being replaced. Also, companies follow different rules and formulas to determine replacement costs.
■ However, a study evaluating the effects of the U.S. Family Medical Leave Act concluded that it is VERY costly to replace valuable employees, and amounts to approximately 150 percent of that person’s annual salary (Reh 2007).
■ A New Zealand study found that companies save an average of NZ$75,000 (US $50,000) per retained employee (EEO Trust 2001) if the employee returns to her job. This is comparable to around $50,000 at the current U.S. exchange rate.
■ Estimates for costs in the United States range from 70 percent of that person’s salary for a receptionist job to up to 200 percent for replacing managers.
■ The U.S. Department of Labor Web site has a “Cost of Turnover Worksheet” at cfbci/turnover.htm (accessed 1-15-08) to help a company calculate their turnover costs.
■ Retaining up to 94 percent of female employees after childbirth, as the previously mentioned study of companies with lactation programs demonstrated, can therefore translate to significant savings for the company.
Slide #23 Lactation Support: Satisfies Employees
■ Research shows that employees of companies providing lactation support programs return from their maternity leave sooner. This may be because women feel they will be supported in their efforts to continue breastfeeding.
■ They also have been found to be more loyal to their company, and feel they are more productive (Galtry 1997; Frank 1998).
■ Other studies confirm that employees of companies that provide family-friendly benefits such as paid parental leave, flexible scheduling, child care assistance, and supportive supervisors experienced greater job satisfaction and company loyalty, worked more on their own time, worked later into their pregnancies, returned to work more quickly, and were more open to organization changes. The benefits also impacted employees’ personal and family lives, with employees reporting less stress at home (Schwartz 1996).
Slide #24 Show Me the Money: L.A. Department of Water and Power
Case Study
■ The Los Angeles Department of Water and Power is a predominantly male staffed company that implemented a comprehensive lactation support program which included employee access to an International Board Certified Lactation Consultant (IBCLC) for both male and female employees and their partners. The program made a profound impact in employee satisfaction.
■ As a direct result of the program, 83 percent of employees stated they were more positive about the company, and 67 percent said they intended to make it their long-term employer (Cohen 2002).
■ Keeping 67 percent of their employees long-term translates into significant cost savings over time.
Slide #25 WIN! WIN! WIN!
■ Supporting breastfeeding mothers in a company is a WIN-WIN-WIN for all three groups: babies, mothers, and their employers.
Slide #26 Lactation Support Benefits by Company Size
■ The reality is that the financial benefits of lactation support programs are not well known or understood by most businesses.
■ The Society for Human Resource Management (SHRM), a U.S. association for human resource managers, conducts an employee benefits survey every 2 years among companies across the country.
■ Their 2007 survey findings showed that the number of companies providing lactation support benefits is increasing among some types of businesses, although the overall numbers remain low (SHRM 2007).
■ 26 percent of ALL companies provide some type of lactation support benefits.
■ 42 percent of large companies (500 or more employees) provide lactation benefits.
■ 26 percent of mid-sized companies (100-499 employees) provide lactation benefits.
■ 9 percent of small companies (1-99 employees) provide lactation benefits.
■ Although the overall number of companies (especially small businesses) offering lactation support is relatively small, these beginning efforts demonstrate that lactation support is being established in increasing numbers. These companies can serve as role models for other workplaces.
■ Of special note is that the number of large companies providing lactation benefits increased from 28 percent to 42 percent from 2005 to 2007. Clearly a positive trend is emerging that can begin to trickle down to smaller businesses.
■ It should also be noted that among Working Woman magazine’s list of “100 Best Companies” for working women, 98 percent provide a lactation support program or designated area for milk expression, over half provide onsite child care, and all of the companies offer flextime and telecommuting options, among other family friendly benefits (Working Mother 2007).
Slide #27 Common Family-Friendly Benefits
■ The 2007 SHRM Benefits Survey provides data on the most common family-friendly benefits offered, which include increases since 2005. They include:
Benefit 2007 2005
Flextime 58% 56%
Paid FMLA 33% 30%
Family leave above the Federal FMLA 29% 26%
Bringing infant to work in emergencies 27% 27%
Lactation program or designated space 26% 19%
Slide #28 Lactation Program Benefits by Industry
■ The types of companies providing lactation support are typically those within the health care industry. This may be because breastfeeding and the associated benefits are aligned with the overall goals and mission of health care industries.
■ Financial institutions, which include insurance companies, are also increasingly adopting lactation programs.
■ The prevalence of lactation support programs by industry in 2007 compared to 2005 include:
Type of Industry 2007 2005
Health 32% 40%
Services (profit) 25% 27%
Services (non-profit) 16% 25%
Finance 38% 19%
Manufacturing (durable goods)* 16% 15%
Manufacturing (non-durable goods)** 5% 35%
Wholesale/Retail Trade 17% 10%
Government 11% 4%
*Durable goods refers to manufactured items such as machinery, computer equipment, furniture, metal and wood products, electrical equipment and appliances, transportation equipment, and other items.
**Non-durable goods refers to items such as food, beverages, textiles, paper products, printing, chemical and petroleum manufacturing, etc.
Slide #29 Elevator Speech
■ In preparing to discuss breastfeeding with business owners, it is helpful to have a brief, simple statement prepared that addresses the benefits of a lactation program. This concise, carefully planned promotional speech is commonly referred to as an “elevator speech” or “elevator pitch” that you could give at a moment’s notice and in about the same amount of time it takes you to go up the elevator, or around 30 seconds.
■ An effective elevator pitch answers some of the following:
■ What service are you proposing?
■ What problem will it help solve?
■ What target group will it impact?
■ How will the service improve the bottom line?
■ What is the competitive advantage for providing this service?
■ What are you asking the listener to provide?
■ How will you help?
■ Activity: Write an Elevator Pitch
■ Handout A – “Elevator Pitch”
■ Instructions:
■ Provide participants with Handout A, “Elevator Pitch,” that lists the above questions.
■ Ask participants to spend 2 minutes jotting down their answers to the questions on their handout as they relate to promoting a lactation support program. If time permits, invite them to work in small groups to discuss.
■ Ask participants/groups to use their answers as the basis for writing a 90-second speech about the importance of lactation support.
■ Invite 2-3 people/groups to share their elevator speech.
■ Consider typing up the elevator speeches and making copies to distribute on the second day of the training, or include the speeches in a follow-up email to participants.
■ Sample Elevator Speech:
I see you’re a company that is already committed to innovative family-friendly programs. We’d like to talk with you about a way to increase value to that benefit platform by putting dollars back into those HR benefits through lactation services for breastfeeding employees. The pay-off is significant: a 3 to 1 ROI due to lower absenteeism and turnover rates after maternity leave, lower health care costs, and happier, more productive employees. A lactation program is easy, and there are lots of people who can help. Can we schedule a short meeting to share more with you?
■ Discuss: What additional information do you think an employer will want after presenting an elevator pitch?
Implementing
The Business Case for Breastfeeding
In Your Community
Speaker Notes
Section 3: Easy Steps to
Implementing a Lactation Support Program
Slide #1 Section 3: Easy Steps to Implementing a Lactation
Support Program
Slide #2 Sneak Preview: Section 3
Learning Objective:
List the 4 components of a successful workplace lactation support program targeting male and female employees.
Topics Covered: the four basic components of a lactation support program, and options for implementing lactation support in a business.
Show Trainees:
■ The Business Case for Breastfeeding workplace lactation resource kit
■ Folder #2, Easy Steps to Supporting Breastfeeding Employees
■ Folder #3, Tool Kit (CD-ROM)
■ Folder #5, Outreach Marketing Resources (CD-ROM)
Slide #3 Components of a Lactation Support Program
■ A workplace lactation support program can help breastfeeding employees manage breastfeeding and employment. Research shows the strongest business case for return on investment (ROI) is a comprehensive program that includes all four of the primary components mentioned previously.
■ In presenting these components to a business, it might be helpful to present them using the acronym, “S.T.E.P.” to utilize language businesses are familiar with and to help them see the “menu” of options presented in a methodical way.
■ S = SUPPORT
…from supervisors, colleagues, and other mothers
■ T = TIME
…a period of leave after giving birth, as well as a flexible work schedule after returning to work to express milk periodically.
■ E = EDUCATION
…for both female employees and female partners of male employees. This education ideally is provided during the woman’s pregnancy, during the early postpartum period, and after she returns to work, and includes access to professional lactation support from an International Board Certified Lactation Consultant (IBCLC) or other lactation expert.
■ P = PLACE
…a private area for a woman to express her milk or breastfeed her baby while she is at work
■ In presenting the four “S.T.E.P.s” to a comprehensive lactation support program, remember that it is best to meet a business where they are, and to help them fashion a program that can grow and build as the need for lactation support grows. For some businesses, the easiest thing to begin with might be identifying space for women to express milk.
■ Folder #2, “Easy Steps to Supporting Breastfeeding Employees,” presents all four “S.T.E.P.s” in a menu of “Basic/Even Better/State of the Art” so employers can gain a sense of choices they can consider.
Slide #4 Where to House the Program
■ Lactation support programs are more easily accepted by employers when they are promoted as a health benefit and woven in as part of an employee health benefit platform.
■ The National Business Group on Health has developed an outstanding model health plan of maternal and child health benefits, developed through a grant from the DHHS/HRSA/MCHB. The model health plan includes lactation support as part of that platform of benefits, and is available online at: healthtopics/maternalchild/investing/
■ Employee health benefit programs are often housed within the company’s employee benefits division, with oversight by the human resource division or company wellness programs. Other places to house a program include:
■ Work/life departments
■ Benefits
■ Health/wellness/fitness divisions
■ Employee relations
■ Employee Assistance Programs (EAP)
Slide #5 Getting Started
■ Getting a program implemented is usually undertaken by staff in the company’s human resource department, wellness program, or perhaps an occupational health nurse or other medical professional that the company employs.
■ A company might want to begin by convening a task force of key stakeholders and knowledgeable experts such as lactation consultants or other health professionals, as well as pregnant and current and previous breastfeeding mothers in the company.
■ The task force could conduct a simple needs assessment, examining such issues as:
■ How many women and men will need this benefit each year?
■ What department should be responsible for overseeing the program?
■ What policies should be developed?
■ What documentation will the company require?
■ What options are there for helping mothers find a private area to express milk?
■ Folder #3, “Tool Kit,” in the Business Case for Breastfeeding workplace lactation resource kit provides sample assessment forms that can be used to determine priorities for a company’s program.
■ The task force can also identify community resources that might be available to assist them. The “Resource Guide” in the “Tool Kit” provides a list of resources available from national, state, and local organizations.
Slide #6 Building the Team
■ Gaining buy-in works best when stakeholders who have resources or expertise to share, along with stakeholders who will be impacted by the program, are brought in as part of the program team.
■ Involving stakeholders is one of the best ways to gain buy-in and support for a new program, and helps assure that potential obstacles and needs are addressed early on.
■ Stakeholders vary from company to company and throughout communities. Potential stakeholders can include:
■ Company staff: staff from the human resource division, wellness coordinator, medical staff, facilities management, financial advisor, public relations, supervisors, representative staff from various related departments such as work/life programs, health benefits, and employee relations, as well as current and previous breastfeeding employees. Including a male employee and a non-parent employee will help broaden the perspectives needed for a well-rounded inclusive program.
■ Community resources: local breastfeeding coalition, local Lactation Consultant chapters, health care professionals, lactation consultants, WIC, La Leche League Leaders, and insurance carriers. See the “Resource Guide” in Folder #3, “Tool Kit” section of the Business Case for Breastfeeding workplace lactation resource kit for information on reaching community groups.
Slide #7 Lactation Program Components
■ Each business has unique needs, company goals, and business environment. A lactation program must fit within those parameters of the individual business to be accepted by an employer.
■ Employers appreciate knowing they have OPTIONS so they can tailor a program that will work best for them.
Slide #8 S = SUPPORT
Options for Managerial Support
■ Breastfeeding employees often report that the thing they value most about their company’s lactation program is company support from supervisors, colleagues, and other breastfeeding employees (Best Start 2004).
■ This top-level support is most effective when it trickles down to all levels of management. Top-level managers need to communicate with company leaders, supervisors, and employees the rationale behind a lactation program and the expectation that everyone will support it. Incorporating lactation support information in existing sexual harassment training can help minimize inappropriate jokes and comments.
■ One way to assist employers is to offer to provide training for supervisors to help them better understand the positive impact of a lactation support program on all employees, as well as the particular needs of breastfeeding employees
■ A sample presentation is available on the CD-ROM in Folder #5, “Outreach Marketing Guide,” in The Business Case for Breastfeeding resource kit. Sample template letters from a mother’s physician and from a respected official in the State or community are also provided on the CD-ROM to assist in educating employers.
Slide #9 S = SUPPORT
Options for Managerial Support
■ Support begins at the highest levels in the form of workplace policies that support employees’ breastfeeding needs. A sample workplace policy that a company can consider is in Folder #3, “Tool Kit,” in The Business Case for Breastfeeding workplace lactation resource kit.
■ Not all employers are ready to institutionalize a formal policy. For many employers the policy itself may be the barrier that keeps them from establishing lactation support programs. Some find that it is easier to establish the program first and implement a policy later.
■ Options for integrating lactation policies include:
■ Integrating it with other employee benefits policies
■ Including it in personnel policies
■ Mentioning the need to eliminate inappropriate jokes and comments by addressing them in existing sexual harassment policies
■ Another avenue for integrating lactation support is within state or local gender bias laws that might exist. National laws protect women from pregnancy discrimination by mandating that companies cannot dismiss women on the basis of pregnancy. If a woman is not able to perform the physical duties of her job, she has the right to be reassigned. Some states also have gender bias laws as well as urban planning and zoning laws that address similar issues. Lactation support could be incorporated into existing laws and policies.
■ Lactation support policies should be communicated to all employees and included in new employee orientation.
Slide #10 S = SUPPORT
Options for Mother-to-Mother Support
■ Women often value the opportunity to share their life’s experiences with other mothers, and it is no different for working mothers.
■ Some companies help facilitate mother-to-mother support opportunities through monthly lunchtime support group meetings, or by providing bulletin boards or photo albums in lactation rooms for mothers to display photos of their babies and notes of encouragement to one another.
■ Several Web sites also offer online breastfeeding discussion forums. See Folder #3, “Tool Kit – Resource Guide” for contact information.
■ An electronic discussion board through the company’s Web site can also be a way of sharing ongoing support.
■ Employees at an IBM lactation room found a way to support one another by using a common spiral notebook as a running journal of shared struggles and words of encouragement (Colburn-Smith & Serrette 2007). Their thoughts make it easy to see why it is often the support of other mothers that helps women continue breastfeeding.
Slide #11 T = TIME
Maternity Leave Considerations
■ Women need time for their bodies to recover from childbirth and to establish ample milk production (see Section 7, “Supporting Working Women: Turning Obstacles into Opportunities”).
■ Breastfeeding is more than nutrition; it is a relationship between parents and their children. The early weeks after childbirth are an important time for women to build that relationship, and employers should be sensitive to allowing women both the time they need to establish that relationship, as well as options that enable them to be with their babies as long as possible such as allowing women to bring their breastfeeding infants to work with them.
■ Most women need a minimum of 6 weeks to allow for recovery from childbirth, although ideally, 16 weeks is best for helping women fully establish and maintain ample milk production (Galtry 1997).
■ A 16-country study found that adequate maternity leave policies might increase breastfeeding sufficiently to prevent 0.6 to 1.0 post neonatal deaths per 1,000 live births (Ruhm 2000).
■ A report by the Institute for Health and Social Policy examined maternity leave policies for 170 countries and found that only four countries do NOT offer paid maternity leave benefits: United States, Liberia, Papua New Guinea, and Swaziland. The report also showed that one year of paid leave has been associated to lower mortality rates (Heymann 2007).
■ The American Academy of Pediatrics released a recent study showing that postpartum maternity leave has a positive effect on breastfeeding among full-time workers, especially those who are not in managerial positions. The AAP urges pediatricians to advocate for paid maternity leave and flexibility in working conditions for breastfeeding women (Guendelman 2008).
■ Currently in the U.S. up to half of all U.S. workers do not even have paid sick days. Sixty-eight percent of women have NO sick time to care for sick children or for maternity leave, and 1 in 8 have been fired for taking sick time.
■ Other countries recognize this through generous leave policies. In Sweden, for example, infancy and early childhood are so highly regarded that the government allows a full 15 months of paid leave plus an extra 3 months of unpaid leave that can be used by mothers and/or fathers. This provision may contribute to the high Swedish breastfeeding initiation rate of 98 percent.
■ Other examples (Kamerman 2000):
■ Canada – 6 months maternity/parental leave paid at 55 percent
■ United Kingdom – 18 weeks of maternity leave paid at 90 percent for the first 6 weeks and a flat rate thereafter
■ Germany – 14 weeks of leave paid at 100 percent and an additional 2 years paid at a flat rate
■ Italy – 5 months of maternity leave paid at 80 percent and another 6 months paid at 30 percent
■ France – 16 weeks leave paid at 100 percent and additional unpaid leave
Slide #12 T = TIME
Options for Maternity Leave Time: Federal Level
■ The U.S. Family and Medical Leave Act (FMLA) provides up to 12 weeks of job-protected unpaid maternity leave for both men and women after the birth of a baby. It was designed to provide minimum guarantees. However, FMLA eligibility depends on several criteria (Galtry 1997):
■ Employment in a workplace of more than 50 employees;
■ Working more than 24 hours per week; and
■ Continuous employment at that company for at least one year.
■ Recent federal legislation introduced:
■ Senate bill #1681, “Family Leave Insurance Act of 2007,” has been introduced by Senator Chris Dodd (D-CT) to address the maternity leave issues. The bill, to be directed by the U.S. Department of Labor, would entitle eligible employers and employees both to pay into an insurance program that would guarantee them a percentage of their daily earnings for up to 8 weeks of leave under the FMLA of 1993.
■ House Bill #HR626 introduced by Rep. Carolyn Maloney (D-NY) was introduced in January 2009 to provide paid leave for federal employees.
■ House Bill #2236, “The Breastfeeding Promotion Act” introduced by Representative Carolyn Maloney (D-NY) includes provisions for employer support of breastfeeding employees.
Slide #13 T = TIME
Options for Maternity Leave Time: State Level
■ A State-level Temporary Disability Insurance Program (TDIP) provides paid medical insurance benefits in 6 U.S. States and territories who take leave for childbirth.
■ TDIP benefits are available in: California, Hawaii, New Jersey, New York, Rhode Island, and Puerto Rico.
■ Since 2004 the State of California has also provided a paid family leave program titled the “California Paid Family Leave Program.” This program covers up to 6 additional weeks of partial wage replacement for new parents or newly adopting parents, in addition to TDIP benefits (law.html). Washington has also passed legislation providing 5 weeks of paid leave, and New Jersey has also recently passed paid leave legislation.
Slide #14 T = TIME
Options for Maternity Leave Time: Company Level
■ Some companies work with employees individually to offer paid or unpaid leave options. The 2007 SHRM survey indicated that 21 percent of companies offer leave beyond the Federal and State level FMLA coverage and 33 percent offer paid family leave options (SHRM 2007).
■ The 2007 SHRM survey indicated that although larger companies with 500 or more employees are more likely to offer paid leave or leave beyond FMLA compared to smaller companies of less than 100 employees (37 percent vs. 14 percent), and more likely to offer onsite child care (12 percent vs. 1 percent), smaller companies tend to more likely to allow mothers to bring their children to work in an emergency (43 percent vs. 17 percent) (SHRM 2007).
■ The Joint Economic Commission reports that 75% of Fortune 500 companies offer paid leave of 6-8 weeks.
■ In addition, Employee Assistance Programs (EAP) are designed to help address employee personal concerns, which includes but is not limited to health, emotional, and family issues that may affect job performance.
Slide #15 T = TIME
Options for Flexible Break Time
■ Employers may not be aware that milk production in a breastfeeding mother is an ongoing, continuous process that occurs around the clock.
■ This ongoing process requires that a woman drain her breasts regularly to avoid uncomfortable fullness and leaking, which can lead to painful engorgement and breast infections.
■ This regular draining also ensures that her body will continue to make milk regularly since milk is made on a “supply and demand” basis.
■ Regular milk expression when a mother is away from her baby allows her to provide the best nutrition to her infant.
Once back at work, breastfeeding women usually need around two to three milk expression sessions during a typical 8-hour work period to drain the milk (Slusser 2004).
Slide #16 T = TIME
Options for Flexible Break Time
■ Each milk expression session takes around 15 minutes excluding the time needed to go to and from the lactation room.
■ As the baby begins eating solid foods (usually around 6 months) the mother may not need to express milk as often.
■ Employers like to know that milk expression is a temporary need and that by the time babies are 12-15 months old most women have discontinued their need for expressing milk at work.
■ Employers also like to know that employees can usually express milk easily by taking their usual lunch and break times. If extra time is needed, it can be made up in several different ways:
■ The employer can consider it paid time knowing that the time she spends expressing milk is ultimately benefiting the company through lower health care costs.
■ She can take unpaid leave time.
■ She can come in early or stay later to make up the time.
■ Some mothers choose to continue working while they are expressing milk with such tasks as making phone calls, checking email, or reading documents. Hands-free devices can help make this possible. It should be noted, however, that employers should NOT expect or require women to work while expressing milk. Many mothers need to mentally disengage from work to relax enough to get the milk flowing.
Slide #17 E = EDUCATION
Program Options
■ There are many options for educating employed pregnant and breastfeeding women, their partners, and other family or friends prenatally, during the postpartum period, and after returning to work. Education and access to professional support are a significant part of the overall lactation program that contributes to the company’s ROI.
■ Many companies with corporate lactation programs contract with an International Board Certified Lactation Consultant (IBCLC) or other lactation professional to assist them with providing this education. Some companies use a nurse or other medical professional on staff who has been trained in lactation.
■ In addition to helping companies establish a lactation support program, lactation experts often provide onsite classes at the business for pregnant and breastfeeding employees and their partners, and lead support group meetings.
■ Companies with comprehensive lactation programs also typically contract with IBCLCs to provide one-on-one consultations with mothers during the prenatal and postpartum period and tailor specific assistance for the mother’s special situation. IBCLCs can often be found at local hospitals, in private practice, or working for the WIC Program.
■ Resources such as books and videos can enhance the education component, as can referral to community lactation programs and health care professionals. Many organizations such as the Federal USDA Supplemental Nutrition Program for Women, Infants and Children (WIC), La Leche League, International, breastfeeding coalitions, doctor’s offices, and other groups provide classes and support group meetings for new mothers.
■ The local breastfeeding coalition can provide information about qualified instructors. The “Resource Guide” on the CD-ROM in Folder #3, “Tool Kit” of The Business Case for Breastfeeding workplace lactation resource kit also provides options for qualified individuals who can provide education.
Slide #18 E = EDUCATION
Options for Classes
■ Prenatal lunch-and-learn classes can be conducted with employees and their partners, making them useful for companies with predominantly male employees, as well.
■ Often classes work best when provided during the lunch or other meal break.
■ Prenatal classes often cover:
■ How to get a good start with breastfeeding
■ Ways to prevent and manage common concerns (discussed in Section 4, “Supporting Working Women”)
■ Building ample milk production that can be sustained after returning to work
■ How to express human milk using hand expression or a breast pump
■ How to handle and store human milk
■ Back-to-work education can help employees make a smooth transition back to work by addressing their questions and offering practical solutions to manage challenges that may arise. Ideal education to cover includes:
■ Preparing for returning to work – thinking through options
■ Preparing the baby for separation
■ Setting a schedule for milk expression
■ Qualified instructors can include IBCLCs, medical staff at the business, WIC breastfeeding program staff, La Leche League leaders, and other lactation experts in the community.
■ The CD-ROM in Folder #5, “Outreach Marketing Guide,” in The Business Case for Breastfeeding workplace lactation resource kit provides sample lesson plans that can be used in providing prenatal and back-to-work classes.
Slide #19 E = EDUCATION
Options for Professional Support
■ After the employee delivers her baby, postpartum consultations with qualified professionals can help address any concerns she may encounter. Some insurance companies now pay for consultations with an International Board Certified Lactation Consultant (IBCLC), who can work with the health care team to help mothers manage concerns that arise. Mothers can check with their company benefits coordinator to see if lactation consultants or breast pumps are included in their health benefits.
■ Some companies contract with an IBCLC or other health professional to provide lactation support to their employees. Other companies simply provide the names of IBCLCs, health professionals, and other lactation experts in the community.
■ IBCLCs can often be found through a local hospital or identified in private practice in the community.
■ The International Lactation Consultant Association (ILCA) provides two online directories at that can be helpful for both employers and employees. The directories list ILCA members who are IBCLCs and available to assist, and include:
■ Directory of IBCLCs Providing Workplace Lactation Support (lists IBCLCs available to assist employers with establishing a lactation support program or to support employees)
■ Find a Lactation Consultant Directory (lists IBCLCs available to provide lactation support to mothers in the community)
■ See the “Resource Guide” in Folder #3, “Tool Kit,” in The Business Case for Breastfeeding” workplace lactation resource kit.
Slide #20 P = PLACE
Options for a Designated Lactation Room
■ Because mothers work in a variety of work settings and have many different job roles, employers will need flexible options for providing privacy for milk expression during the work period.
■ In a traditional office setting, mothers might be able to express milk:
■ In their own private office.
■ In the private office of a supervisor or colleague.
■ In a conference room or other location where they can enjoy privacy.
■ Providing a designated lactation room is ideal, when possible. The amount of space is minimal and does not require a full-sized office, which employers often mistakenly believe. The size can be as small as 4’ x 5’ to accommodate a comfortable chair and a small table or shelf for equipment.
■ This space can often be created by converting a small space such as a coat closet or small storage room into a milk expression area for employees.
■ When space is not available, other options can be considered, including:
■ Partitions or screens in the corner of an open office or room such as a larger office area, an inventory room, server/IT room, or break room.
■ Enclosing a corner of a ladies’ lounge area.
■ A dressing room in a retail store setting.
■ Remind employers that the lactation room should be conveniently located for employees, and should also be accessible to persons who are disabled.
■ Encourage businesses to include facility staff in discussions about future renovations or new building construction to plan for lactation space.
Slide #21 P = Place
Number of Rooms Needed
■ Businesses often wonder how many rooms might be needed.
■ Many factors go into the decision about how many lactation rooms to offer, including the types of work spaces of employees, the physical size of the company (including number of buildings), work schedule/shifts, and numbers of women of childbearing age.
■ One estimate to consider starting with is 1 room for every 50 women of childbearing age. Companies can always increase the number of rooms should the need arise, or consider creating a multi-user room to accommodate more than one mother at a time.
Slide #22 P = PLACE
Options for Single User Lactation Rooms
■ Lactation rooms are often designed to accommodate a single user at a time to maximize privacy.
■ Rooms can be as simple as the room set up at the Iowa State Capitol Building in Des Moines (pictured in the PowerPoint presentation in this curriculum), or as elaborate as the room established at the Mutual of Omaha, pictured in Folder #2, “Easy Steps to Supporting Breastfeeding Employees” in The Business Case for Breastfeeding workplace lactation resource kit.
Slide #23 P = PLACE
Options for Multiple User Lactation Rooms
■ Many companies have also found that providing multi-user rooms with private stations for each user can be a cost effective way to accommodate more women, especially when demand is high.
■ Mutual of Omaha’s multi-user room includes lattice dividers to afford some privacy.
■ The Pentagon’s multi-user room, also pictured in the “Easy Steps to Supporting Breastfeeding Employees” booklet, is very simple, but accommodates several women at one time.
■ Other companies have installed curtains or partitions to create individual pumping stations.
■ Women often report that the multi-user stations are effective because it allows them the opportunity to gain support from other mothers.
■ Be aware that a business such as a retail store might ask for assistance in establishing a lactation room that might serve a dual purpose for both employees and customers. An employer will want to consider whether breast pump equipment, refrigerator, and other amenities will be available in a lactation room open to the general public. Remember that while providing support for customers is a worthwhile effort, the focus of this MCHB project is addressing barriers of employees, not potential customers.
Slide #24 P = PLACE
Options for Non-Office Jobs
■ Lactation programs in non-office type settings often require creative approaches to providing space for expressing milk. For example:
■ A job requiring travel…could provide a portable electric breast pump with a car battery attachment to use in the car, or a small manual pump that can be used on an airplane. Hand expression is also a viable option for women who will not have access to an electrical outlet.
■ A company with limited privacy…could provide a partition in a corner for privacy, or allow staff to hang a curtain strung on over a tension rod in the opening of a cubicle for privacy when expressing milk.
■ Activity:
■ Instructions:
■ Ask participants to work in groups.
■ Provide each group with a brown business envelope with a photo of a woman working in a non-office job setting.
■ Jobs can include:
■ School teacher
■ Military personnel
■ Police officer
■ Hotel maid
■ Child care center worker
■ Factory assembly-line worker
■ Convenience store clerk
■ Farm worker
■ Retail clerk at a local mall
■ Construction worker
■ Ask each group to remove their photo and identify 1-2 places where a breastfeeding employee in that job setting might be able to express milk while at work.
■ Option: Ask coalition members to identify non-traditional type settings in their community and conduct the activity for those specific settings.
Discussion:
■ What OTHER non-office job settings in your community can be challenging for mothers wanting to express milk?
■ What solutions could be offered to employers for providing mothers with privacy for milk expression?
Slide #25 P = PLACE
Options for Lactation Room Accommodations
■ Accommodations need not be extensive or expensive.
■ BASIC requirements are for a room that is clean, private, and able to be locked or secured, has an electrical outlet for the breast pump, and has a comfortable chair. It is also helpful if the room is near a source of running water so mothers can wash their hands and equipment.
■ Page 11 in the “Easy Steps” booklet provides basic, better, and state-of-the-art options for furnishing a lactation room.
Slide #26 P = PLACE
Options for Milk Expression
■ Worldwide, women find that they can express milk easily and quickly through hand expression. Women who prefer hand expression sometimes choose to express simultaneously into two containers. An ideal lactation room set-up would allow women to adjust the height of the surface holding their collection containers.
■ Many other women prefer to use a quality electric breast pump with double pump capacity, which can also help women efficiently drain the breasts of milk.
■ Options companies can consider:
■ Purchase or rent a hospital-grade multi-user electric breast pump that remains in the lactation room. A company can either provide or subsidize the cost of each employee’s individual milk collection kit, or ask employees to pay for their own kit.
■ Provide or subsidize the cost of a single-user portable electric breast pump that mothers can bring to work with them each day.
■ Ask mothers to make their own arrangements for a breast pump.
■ Check the State Medicaid Office to see if breast pumps are provided.
■ If the company provides a hospital-grade pump, keeping it clean is usually the responsibility of individual users. Most lactation rooms provide anti-microbial wipes.
■ “Easy Steps to Supporting Breastfeeding Employees” provides a complete description of equipment options and costs for employers to consider.
■ The “Resource Guide” section of Folder #3, “Tool Kit,” provides contact information for several breast pump companies. If an employer asks for your advice in selecting appropriate breast pumps, remember to offer at least two options for potential supplies to avoid real or perceived conflict of interest.
Slide #27 P = PLACE
Options for Storing Human milk
■ Because of the unique antibacterial properties in human milk, human milk can be safely stored at room temperature or in an insulated cooler while a mother is at work. The Human Milk Banking Association of North America (HMBANA) guidelines for storing human milk for healthy term infants are:
|Temperature |Healthy Baby |
|Room temperature |Up to 6 hours |
|Insulated cooler with gel pack |Up to 24 hours |
|Refrigerator |Up to 8 days |
|Refrigerator freezer |Up to 6 months |
|Deep freezer |Up to 12 months |
(HMBANA 2006)
■ The Federal Occupational Safety and Health Administration’s (OSHA) regulations at pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=20952 state that human milk is not an “occupational exposure” and is therefore safe to store in a publicly accessible refrigerator.
■ However, many women are not comfortable storing their milk where it can be accessed by the public.
■ Options companies can consider:
■ Provide a small “college dorm room” sized refrigerator in or near the lactation room (Examples: the Pentagon and the California Public Health Foundation Enterprises).
■ Provide a portable single-user electric breast pump, which has a compartment with “blue ice” for storing human milk to each breastfeeding employee.
■ Ask the mothers to take responsibility for storing their milk by bringing their own cooler and ice packs.
Slide #28 Promoting the Program
■ Once the program is established, it is crucial that it is well promoted with supervisors and workers. A lactation program is useless if nobody knows about it, and an unused lactation room and program services send a quick message to management that the effort was not worth the investment. Remember, too, that most employers will implement a program because of the potential return on investment. If this ROI is not realized due to lack of use, the program may disappear.
■ Share with employers some strategies for promoting the program with pregnant and breastfeeding employees, and male employees whose partners might be pregnant or breastfeeding. It can also be promoted with supervisors and co-workers so the company begins to create an environment of support that helps women feel confident about continuing to breastfeed.
■ Some promotion ideas to consider:
■ Kick off the program with a “ribbon-cutting” event with refreshments and an open house to draw widespread attention to the program.
■ Combine the program launch in conjunction with World Breastfeeding Week (celebrated August 1-7 each year).
■ Plan an annual promotion of the program as part of World Breastfeeding Week activities. Ongoing promotion will help workers remember the services when they are in a position to need them.
■ Include information about the program in new employee orientation packets.
■ Display information and photos of the program at company health fairs and wellness events.
■ Suggest that the human resource division identify names of pregnant employees who apply for maternity leave benefits and work with supervisors to provide information about the lactation program.
■ Show employers Folder #3, “Tool Kit,” in The Business Case for Breastfeeding resource kit, which provides a CD-ROM with numerous resources for promoting the program that can be personalized to the company’s needs. These include:
■ A colorful poster to hang in populated areas of the company such as employee lounges and key traffic areas.
■ Promotional fliers that can be personalized to the business and inserted in employee paycheck envelopes, placed on the company Web site, or displayed in prominent areas.
■ Promotional table tents that can be copied onto cardstock paper and placed in employee lounges, cafeterias, and waiting areas.
■ Drop-in messages for company newsletters, Web sites, and in-house memos.
Slide #29 Collecting Feedback and Evaluating the Program’s ROI
■ Collecting ongoing feedback from program participants, co-workers, and supervisors will help assure that important improvements can be made to meet the needs of both the company and the employees.
■ The “Tool Kit” provides sample feedback forms that can be used to gauge the success of the program and needs to address.
■ Usage logs should also be kept within the lactation room to record the number of users and hours the room is used. These logs can help determine when it is time to consider larger or additional rooms, multi-user rooms, etc.
■ Questions about the program can also be added to standard worker satisfaction surveys used within the company.
■ In addition, a company can track such aspect as numbers of employees who attend classes and support group meetings, numbers of IBCLC consultations, numbers of employees who log onto company Web site lactation discussion boards, and supplies that might be used for the room.
■ To evaluate the program’s ROI it will be helpful for a company to collect additional data on absenteeism and turnover rates, employee satisfaction with the company, disability costs, health care costs, and breastfeeding duration of employees who use the program.
Implementing
The Business Case for Breastfeeding
In Your Community
Speaker Notes
Section 4: Supporting Working Women:
Turning Obstacles into Opportunities
Slide #1 Section 4: Supporting Working Women: Turning Obstacles
into Opportunities
Slide #2 Sneak Preview: Section 4
Learning Objective:
Identify at least 3 common challenges to sustaining breastfeeding after women return to work, and a strategy for addressing each.
Topics Covered: concerns that new mothers face when combining employment with breastfeeding, along with solutions that can turn those obstacles into opportunities. Topics addressed include: maternity leave issues, emotional and physical challenges, and workplace limitations.
Handout B: “Solutions for Working Mothers”
Show Trainees:
■ The Business Case for Breastfeeding workplace lactation resource kit
■ Folder #4, Employees’ Guide to Breastfeeding and Working
■ Folder #5, Outreach Marketing Guide and “Lessons Plans” in the CD-ROM Resources
Slide #3 Supporting Working Women
■ The previous sections have dealt specifically with approaching and engaging employers in establishing lactation support programs.
■ This section deals with understanding and addressing the unique barriers that working mothers have.
■ Although this information is not geared to the employer, it is helpful for those who are involved in supporting new families to be aware of the challenges that mothers face, and the range of options that can be shared with her.
■ This information can be used in many ways:
■ Enhance a workplace training program members of your community might offer at a business.
■ Integrate the information into a hospital childbirth class or community prenatal breastfeeding class that might be offered by private practice lactation consultants, physician offices, WIC agencies, La Leche League groups, and other local groups.
■ Guide discussion at support group meetings that may be available at workplaces, hospitals, WIC agencies, and other settings.
■ Use the information in one-on-one counseling with new families.
■ Consider offering training using this section of the curriculum for health care professionals in your community who work with new families, and for other groups such as child care centers.
■ Helpful resources when presenting this section of the training include the background information available in Folder #5, “Outreach Marketing Guide” and Folder #4, “Employees’ Guide to Breastfeeding and Working,” both available in The Business Case for Breastfeeding workplace lactation resource kit.
Slide #4 Your Role in Supporting New Families
■ Lactation consultants, health care professionals, and other educators and counselors should be aware of their role in supporting each working mother.
■ The most important role is to support the family’s goals. Although it is tempting to become frustrated when a woman does not make decisions we feel are best, the bottom line for each mother is what she feels will work best for her family situation. Our role is to ensure that she has evidence-based information to make informed decisions and to support the goals she has set for her family.
■ Another important role is to advocate for her. This means providing her with resources she can share with her family members, supervisors, and colleagues. Coalitions and health care professionals can:
■ Take an active role in encouraging workplaces to provide support.
■ Offer classes and support group meetings at workplaces or other community locations (lesson plans for prenatal and postpartum classes are available in Folder #5, “Outreach Marketing Resources” CD-ROM in The Business Case for Breastfeeding).
■ Share resources that businesses can make available to mothers, as well as helping businesses and mothers access community resources such as lactation consultants, WIC agencies, La Leche League groups, Early Head Start program, and other resources. Note that the Early Head Start program’s national regulations mandate that “information on the benefits of breastfeeding [be provided] to all pregnant and nursing mothers. For those who choose to breast feed in center-based programs, arrangements must be provided as necessary.” Use the “Resource Guide” in Folder #3, “Tool Kit” for a list of resources.
■ Advocate for community changes that will help all women feel more confident breastfeeding.
■ A third role is to serve as a liaison with management. You possess a body of knowledge and experience about lactation and are familiar with what will help protect and support breastfeeding. Use that knowledge and experience by serving as a liaison with managers in the community, offering options and technical assistance that will improve the environment for breastfeeding mothers.
Slide #5 Welcome to My World
■ Activity: Welcome To My World
■ Instructions:
■ Invite participants to work in groups of 6-8 each.
■ Provide each table with one flip chart post-it sheet, a selection of markers, and an item that represents a work setting typical of the most common employers of women in the United States according to Department of Labor statistics. Examples could include hats, shoes, or other small items to represent jobs the jobs listed below:
■ Nurse (nurse cap or shoes)
■ Teacher (mini chalkboard with “#1 Teacher”)
■ Secretary (inter-office memo or work shoes)
■ Hair stylist (hair curler)
■ Waitress (Menu)
■ Retail department store staff
■ Fast food worker (empty French fry container)
■ Grocery store cashier (receipt)
■ Assembly line worker
■ Give each table 5 minutes to discuss this work setting and what potential challenges a breastfeeding employee might encounter.
■ Note COMMON challenges to the job settings such as:
Lack of space/privacy
Limited break time
Discomfort speaking to managers; fear of being replaced
Early return to work
Irregular work schedules
Fear of leaking
Lack of knowledge
Lack of supervisor support
Staff coverage
Lack of confidence/empowerment
Job stress
Slide #6 Cultural Perspectives
■ In conducting outreach with women and their employers, it will be important to consider the cultural context with which these individuals live and work.
■ For instance, research has shown that acculturation affects breastfeeding; the longer new immigrants are in the United States, the more likely it is that they will choose formula feeding for their infants.
■ Although it is inappropriate to make generalizations or stereotypes about population groups, it is nevertheless important to be sensitive to the unique cultural practices and perspectives of your community so that your information and outreach strategies are more likely to be accepted.
■ Discuss:
■ What are the major cultural groups of your community?
■ What are common practices and beliefs that might affect a mother’s infant feeding decisions? What beliefs and practices might affect her employment decisions?
■ What common practices and beliefs might affect the practice of support offered by an employer for his or her employees?
Slide #7 Balancing Breastfeeding and Employment
■ For many women the delicate balance of employment, motherhood, and a personal life can be challenging.
■ Adding breastfeeding to the mix can make that delicate balance seem even harder to maintain for many women.
■ In addition, the abundance of infant formula company advertising may contribute to the belief among many women, family members, health care professionals, and workplace colleagues that artificial baby milks and human milk are nearly identical.
■ When women are faced with challenges and the alternatives to breastfeeding seem like easy and obvious solutions, breastfeeding can seem like the one dispensable thing that will make life a little less overwhelming.
■ Although barriers are different for each woman and each job setting, there are some common obstacles that many mothers face.
■ Turning those obstacles into opportunities with practical solutions will help breastfeeding women gain confidence in their ability to meet their breastfeeding goals.
■ Present those solutions as a menu of options that mothers can choose from. The reality is that health behavior changes are obtained more rapidly when individuals decide to change. Giving them options helps them select choices that they believe will work best in their situation.
Slide #8 Ideas that Work: Returning to Work Options
■ Many companies expect employees to provide a return to work plan before going out on maternity leave.
■ During a mother’s pregnancy, talk with her about her maternity leave options to include in that work plan, including FMLA (family medical leave), Temporary Disability Insurance Program benefits (if available in your state) (discussed in Section 3), as well as paid and unpaid leave options that might be available from the employer.
■ Remind mothers that taking a leave of at least 6 weeks and preferably closer to 16 weeks will help her establish milk production.
■ If maternity leave options are limited and a mother must return to work sooner, help her consider in her return to work plan a gradual transition back to work that helps her body and her baby make a smooth adjustment. Some options she can discuss with her supervisor:
■ Return to work part-time for a period of several weeks before transitioning to full-time employment.
■ Work a 4-day work week for awhile, taking off on Wednesdays to rebuild milk supply.
■ Telecommute for part or all of the week for a period of time.
■ Job share with another employee to gain more time at home.
■ Work in “split shifts” (an effective option for restaurant workers and other job settings that extend past the usual 9 a.m. to 5 p.m. work period).
■ Return to work toward the end of the week (on a Wednesday or Thursday, for example) to make the first week back at work a shorter work week and to help her adjust to the separation physically and emotionally.
Slide #9 Emotional Considerations
■ Regardless of her feeding choices, a woman often faces a variety of emotional demands combining motherhood and employment. Some of these stresses may be compounded by general fatigue, sleep deprivation, and/or depression, and can be a special concern for first-time mothers.
■ Mothers on average lose 700 hours of sleep in the first year of their baby’s life (Mass 1998).
■ The good news is that breastfeeding mothers actually get 30-45 minutes of sleep MORE per night than formula feeding mothers, even after factoring in the baby’s father assisting with night feedings (Doan 2007).
■ Competing demands can also be a factor. One study found that 78% of new working women also do the majority of household chores, as well.
■ Other stresses include role conflicts between her role as mother and her role as employee, family stresses, and child care concerns (Nichols 2004).
■ Compounding these stresses can be a feeling of sadness and sense of loss over being separated from her baby. Depression can also be a factor for some women.
■ A longer maternity leave can make a difference in a woman’s ability to cope with some of these challenges.
Slide #10 Ideas that Work: Preparing the Mother for Separation
■ Help women prepare for those emotional ups and downs long before she returns to work. Beginning to think through options during pregnancy helps a woman feel mentally prepared and confident.
■ During a woman’s maternity leave she can make the most of her time with her baby to breastfeed exclusively and build the mother-baby relationship, as well as ample milk production.
■ Getting help with early concerns is also critical. If a woman gets off to a slow start due to early breastfeeding challenges, it can be difficult to sustain her milk supply once she is separated regularly from her baby.
■ She can also begin practicing milk expression so she will feel confident once she is apart from her baby. She can practice pumping or manually expressing milk on one breast while her baby is feeding on the other, allowing the baby to start the milk flowing.
■ Mothers may want to take advantage of early morning feedings, when possible, to practice milk expression. Prolactin levels are highest at night, resulting in abundant milk in the mornings. This is a good time to begin practicing milk expression. Women can begin storing the milk saved as a back-up for when they return to work.
■ Encourage mothers to attend breastfeeding classes at their local hospital or elsewhere in the community to learn appropriate strategies for milk expression and storage.
Slide #11 Ideas that Work: Preparing the Baby for Separation
■ Mothers can also begin preparing their babies for separation during the maternity leave period.
■ Many women feel they must introduce a bottle early so the baby will easily “take it” later; however, most experts believe this is not necessary until around 2 weeks before returning to work.
■ Mothers should be encouraged to breastfeed exclusively during the first 3-4 weeks to establish their milk supply. If mothers choose to offer milk in a way other than direct breastfeeding, they can choose from several options, including a bottle, a cup, dropper, spoon, or syringe.
■ Babies easily take a bottle or cup if offered before 6 weeks, or 2 weeks before returning to work, whichever comes soonest.
■ Although mothers sometimes feel they should teach the baby to take a bottle before they return to work, some lactation consultants recommend that this adds undue stress on the mother and can, instead, be the task of the childcare provider.
■ If the baby is reluctant, several strategies can work (Berggren 2006):
■ Have someone other than the mother offer the bottle or cup so the baby continues to associate the mother with breastfeeding.
■ If the baby resists, don’t make it a battle. Try again later.
■ Try when the baby is not overly hungry or is a little sleepy.
■ Offer a spoon or dropper instead of the bottle.
■ Remind mothers that some babies choose to follow a “reverse cycle feeding” pattern. This means they may sleep more and feed less with the caregiver and breastfeed very often when they are home with their mothers.
■ Encourage the mother to start the baby in child care 3-5 days prior to her return to work to help ease the transition and to allow her time to see how the baby responds to the child care provider. If the care is not acceptable she can make changes or, if necessary, possibly delay her return to work.
Slide #12 Ideas that Work: Dealing with Mommy Sadness
■ It is normal for women to feel sad or guilty about leaving their babies when they return to work. Some women are surprised by the intensity of their feelings.
■ Help women see that breastfeeding gives them many positive ways to remain emotionally connected to their baby even though they are physically separated. Expressing milk during the workday gives mothers the chance to think about their baby and continue to make positive mothering choices.
■ Remind mothers that babies are usually resilient and cope well with the separation. The “reconnection” with the baby at day’s end can also be a fulfilling time for both mother and the baby.
■ It is also common for many women to feel guilty about wanting to return to work. Instead of sadness, women may feel excited to be returning to the work force and following their career path.
■ Affirm the empowerment that comes from their contributions at work, and help them see how that empowerment can help them be even better mothers when they are home.
■ Encourage mothers to connect with other breastfeeding working mothers. Many women find this “sisterhood of support” helps them persevere with breastfeeding when those emotional ups and downs occur.
Slide #13 Ideas that Work: Minimizing Stress after Returning to
Work
■ Once she returns to work, a mother can minimize stress through careful planning and support. Talk with each mother about her individual concerns and offer her options tailored to her unique needs.
■ Help her devise a plan with routines that will help her stay organized. Routines help lower stress by minimizing the amount of energy the brain needs to handle new dilemmas, which alleviates feelings of being overwhelmed.
■ Encourage her to try out those routines in a “practice” or “trial run” day. On this day, a mother should go through her planned morning routine to see how it works, and make modifications as needed so she is comfortable when she really does return to work. Trying out these routines for a few days before returning to work can help ease the transition.
■ In some families the woman’s partner is totally in charge of the work bag: cleaning breast pump equipment, sterilizing (if needed), labeling and storing milk, freezing ice packs, and packing for the next day.
■ Several mothering books and Web sites offer many practical suggestions. (See the resource list in the introduction section to this curriculum.)
■ Some helpful resources offer free downloadable checklists of things to pack the night before and the tasks that can wait until before leaving for work. Examples: and .
■ Encourage a mother to talk about her stresses with her family, and consider joining a support group with other working mothers.
■ Finally, remind each mother that taking care of herself will help her manage motherhood and employment tasks. Encourage her to eat well balanced meals, rest, relax some of her housekeeping standards, and make the most of her time at home with her family.
■ While at work, she can practice deep breathing and other relaxation techniques to reduce fatigue and relieve stress.
Slide #14 Child Care Center Considerations
■ Finding supportive, dependable, and trustworthy child care providers is crucial in alleviating stress for working mothers.
■ Mothers often report that their child care options are limited or they cannot afford it, and rely on family members to save costs.
■ This is a huge consideration considering that the cost of child care is the United States has skyrocketed over the years. According to the National Association of Child Care Resource and Referral Agencies (NACCRR), a non-profit organization providing information to help families access child care services, the cost of child care exceeds housing costs in most areas of the United States! (NACCRR 2007).
■ In 42 states, the costs are more than tuition at a 4-year public university.
■ The average family spends at least 10 percent of their household income on child care; single mothers spend more – around 30 percent.
■ Actual fees range from $10,000/year for children and $14,000 for infants – more than what families spend on food and housing.
■ If a family has two or more children, they often spend up to half their monthly income on child care.
■ If mothers turn to family members to save costs, they may have additional issues sustaining breastfeeding if caregivers are not supportive of breastfeeding, or if mothers feel they are imposing on a family member who is providing free child care.
■ Some child care centers are reluctant to handle human milk, or believe breastfed babies will be too hard to care for.
■ All of these child care stresses can make alternatives to breastfeeding seem attractive.
Slide #15 Ideas that Work: Child Care Options
■ Encourage mothers to arrange child care options early, and remind them of options that might be most conducive to continued breastfeeding:
■ On-site child care if the company provides it. If a company does not provide this, advocate for this on her behalf. Many agencies and companies such as the National Institutes of Health and Patagonia have found that on-site child care works very well and is a valued service among families.
■ Bring the baby to work with the mother. It never hurts to ask! [Note: Section 5,“Outreach to Employers,” will discuss options that can be presented to an employer.] The State of Arizona has a state-wide policy within the department of health allowing mothers to bring their breastfed babies to work with them for the first 6 months. Often smaller companies are more open to this option (SHRM 2007).
■ Bringing the baby to work during the meal period. If the child care provider lives near the workplace, it may be possible to breastfeed the baby during a longer break such as the lunch or dinner meal. If the caregiver cannot bring the baby to the mother, perhaps she can go to her baby.
■ Choosing a child care provider located near the workplace. This way if the mother is not able to be with her baby during breaks in her work day, she might be able to offer extra feedings right before and after work at the child care center. Encourage her to talk to other mothers for recommendations of supportive child care centers. She might even be able to work out a shared child care arrangement with other mothers using a baby sitter or other provider.
Slide #16 Physical Considerations
■ A breastfeeding mother may also face real physical challenges once she returns to work. These can include:
■ Uncomfortable or painful engorgement from overfull breasts that are not drained of milk regularly while she is separated from the baby;
■ Embarrassing leaking of milk from overfull breasts during the workday; and
■ Real or perceived low milk production as a result of inconsistent removal of milk.
■ Available literature reports low milk production as a primary reason for weaning among mothers who return to work (Lewallen 2006). In fact, nearly half of all women say the reason they weaned their baby was because they did not think they had enough milk (Li 2008).
■ Sadly, many mothers face these physical and emotional challenges on their own, or with advice from friends and family members who may not be knowledgeable about sustaining lactation. Inappropriate jokes by co-workers and lack of understanding about her needs can make these physical challenges harder to bear.
■ Lactation support from lactation consultants, breastfeeding counselors, health care professionals, and other breastfeeding mothers during this important time of her life can go a long way towards helping her cope in positive ways.
Slide #17 Idea that Work: Maintaining Milk Production
■ Help each mother access an International Board Certified Lactation Consultant (IBCLC) or other breastfeeding expert while she is in the hospital and during the early days post discharge for help with any issues that might impact milk production. The “Find a Lactation Consultant Directory” at the International Lactation Consultant Association Web site, , provides a list of IBCLCs by state, city, or zip code. The local hospital can also help provide names of breastfeeding experts who can help. Research shows that providing mothers with names of breastfeeding professionals helps increase duration rates (Biagioli 2003).
■ Many mothers are not aware that milk production is a continual process that requires regular and frequent draining of the breasts to keep them from becoming overly full and to help sustain milk production. Mothers need to remove milk early and often through exclusive breastfeeding or expressing milk either by hand or with a hospital grade double-electric breast pump. Mothers should exclusively breastfeed during at least the first 3-4 weeks, feeding babies at least 8 to 12 times every 24 hours (Hornell 1999).
Slide #18 Ideas that Work: The “Magic” Number
■ Once a woman returns to work, she can fully maintain her milk production by either breastfeeding or draining her breasts as many times in 24 hours as she was previously feeding her baby.
■ Nancy Mohrbacher, an IBCLC and author of numerous lactation texts, describes this as the “magic number.” Here’s how it works:
■ Before they return to work, a mother should count the total number of times she breastfeeds her baby in 24 hours by following their babies’ cues for feeding. This gives her an idea of her unique breast storage capacity since mothers with smaller storage capacities often need to feed more often than women with larger storage capacities (Kent 2006).
■ This number becomes a mother’s unique “magic number.”
■ The mother should keep this magic number steady through either feeding or expressing milk once she is apart from her baby. In other words, the total number of feedings and milk expression sessions should total her “magic number,” or the number of times she was breastfeeding her baby before she returned to work.
■ This might require that she feed her baby an extra feeding or two at night or early in the morning, and to express milk every 2-3 hours when she is away from her baby.
■ Remind every mother that if she uses her stock of previously expressed human milk without continuing to breastfeed or express milk to keep up her “magic number,” her production will decline.
■ Refer mothers to Folder #4, “Employees’ Guide to Breastfeeding and Working,” for options that will help her get off to a good start with breastfeeding.
Slide #19 Ideas that Work: How Much Milk a Baby Needs
■ The amount of milk a baby needs depends on many factors, including the age of the baby and whether other foods are being given.
■ Research shows that the average milk production for mothers of exclusively breastfed infants 1-6 months of age is fairly constant at 25-35 ounces per 24 hours (Kent 2006), which averages to around 30 ounces per 24 hours, or around 3-4 ounces per feeding.
■ To figure the amount she should leave for the caregiver, a mother can calculate as follows (Mohrbacher 2007):
■ Divide a 24-hour period into fractions:
■ An 8-hour work day is 1/3 of a 24-hour period.
■ A 12-hour work day is 1/2 of a 24-hour period.
■ Divide 30 ounces into similar fractions:
■ 1/3 of 30 ounces (for an 8-hour work day) is 10 ounces.
■ 1/2 of 30 ounces (for a 12-hour work day) is 15 ounces.
■ For an average work day of 8 hours, mothers would need to leave around 10-12 ounces.
■ These figures are not absolute and the mother will need to work closely with her child care provider to assure that the amount of milk she is leaving is sufficient for her infant.
■ Remind the mother to store her milk in the smallest amounts she thinks her baby will need, including tiny amounts of 1-2 ounces in case the baby just wants a little extra. This will help minimize waste. She can ask caregivers not to prepare large amounts at one time, and to avoid giving a full feeding before the mother arrives to pick up her baby so she can feed the baby directly at her breast instead of using up expressed milk.
Slide #20 Ideas that Work: Rebuilding Declining Milk Production
■ It is very common for a working woman to report that her milk production declines once she is separated from her baby. In fact, real or perceived low milk production is a primary reason women begin supplementing their baby with formula or wean altogether.
■ Reassure each mother that several strategies can help rebuild production if she feels it is declining.
■ Breastfeed more often while at home with the baby.
■ Breastfeed more often at night when prolactin levels are highest.
■ Add a milk expression session in the morning or any time when milk volume seems to be highest.
■ Be aware of the impact of medications such as birth control pills and decongestants on milk production.
■ Check to be sure the pump itself is working properly.
■ Medications and herbal remedies can sometimes be helpful.
■ If mothers are having difficulty with production slowing, health care professionals can refer them to an IBCLC or physician for options to meet their individual needs.
Slide #21 Ideas that Work: Milk Expression Tips
■ Women often need help with practical solutions to quickly get the milk flowing while expressing milk in the midst of a busy work day.
■ Remind mothers that they can:
■ Drink something warm before expressing milk.
■ Place a warm washcloth or disposable diaper over their breasts to help the milk begin flowing.
■ Massage their breasts.
■ Think of their baby and bring items that help appeal to their five senses (examples: soft music, photo of the baby, soft blanket or baby shirt with the baby’s scent on it).
■ Visualize the milk flowing.
■ Mothers should be encouraged NOT to look at the collection bottle while pumping as this can add undue stress.
Slide #22 Workplace Considerations
■ Mothers also describe on-the-job challenges that can make it difficult to continue breastfeeding. These challenges can include:
■ Lack of private space for expressing milk during the work period.
■ Job settings and work schedules that are not conducive to breastfeeding or expressing milk (ex: manufacturing plants, retail stores, and restaurants among others).
■ Occupations where the mother’s physical presence is critical to her job function (ex: physician, teacher, help desk, clerk, etc.)
■ Local, national, or international business travel that requires a mother to be separated physically from her baby for a long period.
■ Work schedule disruptions period that interfere with regular milk expression.
■ Co-worker harassment or inappropriate jokes.
■ Mothers may also feel shy about discussing their breastfeeding needs with their supervisors, and may worry that their coworkers will be critical and unsupportive. In addition, many mothers feel that asserting their breastfeeding needs will put them on the “mommy track,” limiting near and long-term earning and advancement potential.
Slide #23 Considerations of Low-Wage Earners
■ Mothers employed in low-wage job settings have additional challenges that make it hard to sustain lactation.
■ These challenges can include:
■ Physical work environments which are not always conducive to milk expression.
■ Erratic work schedules that can inhibit milk production.
■ Unsupportive family members who might be caring for her children.
■ Lack of job security and the perception that she is easily replaced.
■ In addition, many low wage earners report a lack of confidence in approaching supervisors about their needs, fearing that requesting special privileges may impact their job security (Ehrenreich 2000).
Slide #24 Ideas that Work: Dealing with Supervisors and Colleagues
■ The “Employees’ Guide to Breastfeeding and Working” booklet also provides options for helping women deal with challenges at the workplace, including ways to talk with their supervisors and colleagues.
■ A sample “Dear Supervisor” letter is a template that an employee could use to communicate her concerns.
■ Some state labor and industries bureaus encourage employers to document their needs and experiences, so this letter can be an important way to establish that documentation.
■ The brochure also gives language that an employee can use to speak to the needs of the business in advocating for solutions she needs. For instance, she can remind her supervisor that supporting her lactation needs will mean:
■ Health care costs will be lower, which benefits everyone at the company.
■ She will not have to be absent as much, which means other employees will not have to cover for her as much.
■ She will feel more comfortable returning to work sooner, which can mean less need for temporary staff to cover her work load.
■ Family-friendly benefits help position the company as a desirable employer.
■ Folder 5, “Outreach Marketing Guide,” provides a letter from the mother’s physician that can be personalized and given to the employer to advocate for onsite support.
■ Encourage mothers to approach a company nurse, member of the wellness team, or supervisor about their needs. Sometimes the reason a lactation program does not exist is that no one has ever asked for it before!
Slide #25 Ideas that Work: Dealing with Other Workplace Challenges
■ Schedule Disruptions. Remind mothers to express milk 15 minutes before scheduled meetings to avoid becoming overfull, which can lead to annoying and embarrassing leaking.
■ Places to express milk in privacy. There are many options for helping women gain privacy for milk expression at their workplace, and dealing with the flexible breaks needed. Folder #2, “Easy Steps for Supporting Breastfeeding Employees,” provides ideas that can be shared both with employers and with employees. These will be addressed in the next section of the training curriculum.
■ Keep in mind that a “cookie cutter” approach will not work in all situations. Even a standard office setting can be challenging if women work in a cubicle or open area with other staff and no private areas or flexible breaks are available. Creative brainstorming will be helpful in finding solutions to meet the unique needs of each mother.
■ Support. Mothers report that having access to other mothers who face similar concerns helps them better manage working and breastfeeding (Colburn-Smith 2007). Suggest that mothers seek out or form mother-to-mother support groups at work or in the community, or to find other creative ways to communicate (such as a journal or bulletin board in the lactation room or a company electronic listserv for members of the lactation program).
Slide #26 Resources for Supporting Breastfeeding Mothers
■ ILCA – International Lactation Consultant Association. Provides an online “Find a Lactation Consultant Directory” at to aid women in locating a lactation consultant near them.
■ La Leche League, International. Provides numerous online materials, as well as an online bookstore with books and videos targeted to mothers at .
■ HMBANA – Human Milk Banking Association of North America. Provides storage guidelines for human milk. .
Slide #27 It’s in the Bag
■ Activity: It’s in the Bag
■ Instructions:
■ Divide participants into small groups of 6-8 each and ask them to read a scenario about a working mother. Each group will be given a lunch bag with the following items:
■ Photo of a woman working in a cubicle
■ Photo of a supervisor or colleague
■ Nursing pads
■ Baby bottle
■ Pocket calendar
■ Stop watch
■ Dollar bill
■ Milk storage bag
■ Handout B: “Solutions for Working Mothers”
■ Scenario:
Amy is breastfeeding her 5-week-old baby, and plans to return next week to her job at the hospital, a 10-minute drive from her house. Amy is a file clerk in the hospital’s admissions office. She cannot afford to take a longer maternity leave. She will be working 7 a.m. to 4 p.m. Monday through Friday. Her mother, who lives with her, will be caring for her baby while she is at work. Amy wants to continue breastfeeding. She has a total of one hour per day for break time that she can take for lunch and other breaks. She is shy about talking about breastfeeding with her female supervisor, who has made it known that she did not breastfeed her own children.
■ Group members should pass the lunch bag around their table and allow each person to remove an object inside. The group should discuss the obstacle that object might represent once Amy returns to work, and how that obstacle might become an opportunity in supporting Amy.
Discuss (as a full group):
■ What realistic options did your groups identify for Amy?
Implementing
The Business Case for Breastfeeding
In Your Community
Speaker Notes
Section 5: Effective Outreach with Businesses
Slide #1 Section 5: Effective Outreach with Businesses
Slide #2 Sneak Preview: Section 5
Learning Objective:
Describe at least two motivators of employers and two barriers to implementing a workplace lactation program.
Topics Covered: Common motivators and barriers employers have to implementing a lactation support program, and how to present the business case for breastfeeding to a business.
Handouts:
■ Handout C – “Press Release”
■ Handout D – “Company Profile”
■ Handout E – “Outreach Meeting Guidelines”
■ Handout F – “Role Play Scenarios”
Show Trainees:
■ The Business Case for Breastfeeding workplace lactation resource kit
■ Folder #5, Outreach Marketing Guide
Slide #3 Video Exercise
■ Activity: Video Exercise
■ Instructions:
■ Show a short video clip of a staged encounter between members of a state breastfeeding coalition and a local business employer.
■ Ask training participants to note things in the encounter that went well, and things that could have been improved. Make a note of things the coalition members could have done differently to improve the outcome of the encounter.
■ Suggested improvements:
■ Provide fewer, and more professional materials.
■ Make an appointment first.
■ Do your homework: learn about the company before showing up.
■ Be considerate of the employer’s time.
■ Be careful about language that may be uncomfortable for employers such as “breasts” and “breastfeeding” and use words such as lactation or human milk instead.
■ Begin the encounter by focusing on what is important for the employer, not what is important to mothers.
■ Present the business case.
Slide #4 Exchange Theory in Action
■ Many of the decisions we make in life are based on what social marketers call the “Exchange Theory.” This means that when making decisions, people consider both the potential benefits and the cost of that decision. The costs need not only be financial, and can include other non-financial barriers such as emotional, physical, and social constraints.
■ Employers weigh these perceived costs against potential benefits when considering a lactation support program.
■ Understanding what motivates employers…what program benefits resonate loudest…as well as their perceived barriers…is important when presenting the business case for breastfeeding to an employer.
Slide #5 The Bottom Line: What Motivates Employers
■ Several things might influence an employer to begin a new program, yet each of these is tied directly to a single, underlying motivator: the anticipated Return on Investment (ROI) of the program.
Slide #6 Investing in Proven Programs
■ Because businesses can be reluctant to invest in a program with unknown dividends and risks, it is helpful to provide models of successful lactation programs, particularly in similar companies and/or other companies within the specific community.
■ Offer information about other businesses in your community or state that provide lactation programs. Include contact information if possible.
■ The “Employer Spotlights” section of Folder #3, “Tool Kit” in The Business Case for Breastfeeding workplace lactation resource kit describes several types of companies across the country that have implemented successful programs. Some of the vignettes also include outcome data.
■ Check other sources, such as Working Mother magazine’s list of family-friendly businesses published each year. You can also visit the websites of state breastfeeding coalitions who have recognized and honored businesses for being mother-friendly. Examples:
■ Texas Department of Health - dshs.state.tx.us/wichd/lactate/mother.shtm
■ Washington Breastfeeding Task Force
■ Oregon State Department of Health
■ Rhode Island Breastfeeding Coalition - health.family/breastfeeding/workplaces-friendly.php
■ San Diego Breastfeeding Coalition
■ Vermont Breastfeeding Coalition -
Slide #7 Employer Recognition Programs
■ Another way to garner important recognition for companies is to establish an employer recognition program to acknowledge publicly the companies that are providing support.
■ The “Outreach Marketing Guide” in Folder #5 of The Business Case for Breastfeeding workplace lactation resource kit provides examples of recognition programs that have been effective in Texas and Washington.
■ Sample certificates are included on the CD-ROM in this curriculum.
■ Learn more about recognition programs at the following state websites:
■ Vermont:
■ Texas: dshs.state.tx.us/wichd/lactate/mother.shtm
■ Rhode Island: health.family/breastfeeding/workplaces-friendly.php
■ Options for an employer recognition program include:
■ Establish general criteria for recognition as a breastfeeding-friendly business, and recognize ALL businesses that meet the criteria. Some states that use this model include Oregon, Texas, and Mississippi.
■ Establish a tiered level of support based on “good/better/best” criteria levels. This will allow businesses to be recognized for beginning efforts to support employees. For example, Vermont has established gold, silver, and bronze award levels to recognize varying program models. For more information see family/breastfeed/documents/checklist.pdf.
■ Recognize a single business each year that stands out as the most outstanding program. Some groups that use this model include Washington and the San Diego Breastfeeding Coalition.
■ Recognize businesses that not only provide employee lactation programs, but also a supportive environment for consumers.
■ Options for nominating employees can include self-nomination by the business itself, nominations by coalition members, nominations made by the employees themselves, nominations by community groups and/or a combination of all of the above.
■ Be sure to arrange for publicity of the awards, including inviting the media and posting information on your group’s Web site.
■ Options for Making the Awards include:
■ Make awards at a public business meeting such as at a Rotary breakfast or Chamber of Commerce meeting.
■ Make presentations at an annual breastfeeding conference.
■ Make the announcement a major “event” at the business itself.
■ Create a community-based “event” and invite officials and dignitaries.
Slide #8 The Power of Legislation
■ As of February 2009 21 U.S. States plus Puerto Rico and the District of Columbia have enacted legislation related to working and breastfeeding: California, Colorado, Connecticut, Georgia, Hawaii, Illinois, Indiana, Minnesota, Mississippi, Montana, New Mexico, New York, Oklahoma, Oregon, Rhode Island, Tennessee, Texas, Vermont, Virginia, Washington, and Wyoming.
■ Many of these state laws do not carry penalties for non-compliance, but simply encourage lactation support in the workplace.
■ One state, Oregon, recently enacted comprehensive legislation that requires employers of more than 25 employees to provide a 30-minute unpaid break during each four-hour work period to express milk, and imposes a civil penalty of $1,000 for each instance of non-compliance. Details about the Oregon Breastfeeding Coalition advocacy efforts are available at the project technical assistance website.
■ Folder #5, “Outreach Marketing Guide” in The Business Case for Breastfeeding workplace lactation resource kit includes examples of legislative language on the Outreach Resources CD-ROM.
■ Legislation can be a powerful motivator for employers, particularly if there are financial incentives or civil penalties attached to the law.
■ Become fully aware of your state’s laws, and use caution when talking about legislation with employers so that your discussion does not come across as a veiled threat.
Slide #9 Year 1 Lessons Learned
■ When legislation is in place, media publicity can be widespread in both positive and negative ways. Publicity can help raise awareness as well as heighten fears.
■ In Oregon, concerns arose in the business community about the new law, and immediately public service/emergency personnel groups were dismayed about having to follow the law.
■ The Oregon Breastfeeding Coalition responded quickly by providing strategies for supporting female police officers, fire fighters, and other personnel. Their quick action helped them become integrated as part of a team approach addressing the concerns.
■ In Mississippi, child care legislation was introduced as a companion bill to support working mothers.
■ Although many states print up “Right to Breastfeed” cards and discuss women’s rights to breastfeed, realize that presenting legislation in this way to an employer can backfire.
Slide #10 Barrier: Lack of Awareness and Demand
■ Many employers are generally unaware of the issues surrounding working and breastfeeding, including:
■ The needs of lactating employees, including the fact that milk production is an ongoing process and must be removed regularly
■ The health impact of breastfeeding
■ How a lactation support program can improve their ROI through lowering absenteeism and turnover rates (Dunn 2004).
■ Myths can also abound when information is limited. Common beliefs are that formula and human milk are the same, that breastfeeding employees will be more fatigued than non-breastfeeding employees, that human milk is a potential contaminant in the workplace, and that expressing milk in the workplace will interfere with an employee’s productivity.
Slide #11 Barrier: Breastfeeding is a Non-Issue
■ Employers are also typically unaware of how many of their employees are breastfeeding and often wrongly assume that it is a non-issue (Bridges 1997). Some reasons why this is are as follows:
■ A company may not receive many requests for lactation assistance and wrongly assume there is no need (Dunn 2004).
■ Most breastfeeding women who return to work wean before their first month back at work ends (Cardenas 2005).
■ Only half of female employers themselves have breastfed compared to more than 70 percent of women in the general population (Libbus 2002).
■ If the company does not employ many females, managers may assume there is that lactation services are not relevant. They may be unaware that providing support to female partners of their employees can also bring about positive outcomes in their bottom line.
Slide #12 Strategies for Improving Awareness and Uncovering
Demand
■ Provide information about the rates of breastfeeding initiation and duration at 6 and 12 months among women in your community or state. Explain to employers that one of the reasons duration rates drop is because women return to work.
■ Remind employers that providing support to partners of male employees can result in health care cost savings to the company (Cohen 2002).
■ Gently correct myths, and remind employers that:
■ Little time is actually needed to express milk.
■ The Federal Occupational Health and Safety Administration’s guidelines do not classify human milk as an “occupational exposure.” See: OSHA’s Standard No. 1910.1030, available at: .)
■ Providing a supportive workplace environment can help lower stress and help women feel more productive. This could potentially help minimize the need for Employee Assistance Program (EAP) benefits.
■ Provide information on the ways supporting breastfeeding employees will improve the company’s ROI. (Use Folder #1, “The Business Case for Breastfeeding.”)
Slide #13 Strategies for Improving Awareness and Uncovering
Demand
■ Show employers examples of varied companies with predominantly male or predominantly female workers that have implemented successful lactation support programs. (Use the CD-ROM in Folder #3, “The Tool Kit,” for snapshots of varied programs implemented by many different companies.)
■ The American Association of Health Plans has published additional best practices in lactation programs among health management groups. Their findings, “Advancing Women’s Health: Health Plans’ Innovative Programs in Breastfeeding Promotion,” are available at their website at: .
■ If possible, interview one or more breastfeeding mothers within the company and present their statements verbatim to show that there is a demand for the program and it would be well received.
■ Offer to provide training for managers and supervisors. (Use the PowerPoint presentation on the Outreach Resources CD-ROM provided in Folder #5, “Outreach Marketing Guide.”)
Slide #14 The National Business Group on Health
■ Remind businesses that by implementing lactation support they are following the lead of the National Business Group on Health, which represents Fortune 500 and large companies across the United States.
■ The National Business Group on Health provides online information on the importance of a lactation support program and in 2007 published a health plan benefit model, “Investing in Maternal and Child Health,” which includes lactation program benefits. The plan is available as a free download on their Web site:
■ The National Business Group on Health has published an online version of The Business Case for Breastfeeding materials for their member organizations. Because the project was funded by the Maternal and Child Health Bureau the materials are public domain and available on the public side of their website.
■ NBGH has also conducted webinars on the subject of working and breastfeeding for employers.
Slide #15 Barrier: Discussing “Intimate” Issues at Work
■ Although breastfeeding is natural and normal, many people in the United States view it as personal and private.
■ Some employers are reluctant to discuss breastfeeding, and feel it is an activity that belongs at home, not in the workplace.
■ Some employers say it is uncomfortable for them to think of their employees as breastfeeding women.
Slide #16 Strategies for Addressing Intimate Issues
■ Identify a breastfeeding mother or other “champion” in the workplace willing to address the issues with managers.
■ Consider your language and select words that will be more comfortable for employers. For instance, “lactating employees” might be preferable to “breastfeeding mothers” and “milk” or “human milk” might be preferable to “breast milk.”
■ Avoid using images in materials that show exposed breasts or women breastfeeding, which can reinforce feelings of discomfort about the role of lactation support. (Refer to materials in The Business Case for Breastfeeding resource kit, which pictures women in diverse job settings functioning as productive employees.)
■ Offer to provide training for managers and supervisors to help them grow comfortable with supporting lactating employees.
Slide #17 Barrier: Lack of Space
■ Employers are keenly aware that space equals money, and space is nearly always at a premium in workplaces.
■ Employers are also generally unaware that a space as small as 4’ x 5’ is usually sufficient for a lactation room, and incorrectly assume that a full office space must be made available.
■ Employers may also be concerned about compliance costs and effort involved through the Americans with Disabilities Act (ADA) of 1992.
■ Other employers help mothers make the transition back to work easier by allowing young infants who are mostly quiet to remain near their mothers at their work station. This helps mothers sustain their milk production, and allows infants to reap the enormous benefits of direct feeding at the breast.
■ The State of Arizona has a state-wide policy within the Department of Health allowing mothers to bring their breastfeeding babies to work with them for the first 6 months.
■ A California-based company, Patagonia, began allowing employees to bring their infant to work with them many years ago. Today, the program has expanded with onsite child care facilities to keep mothers and babies closer together during the work day (refer to the “Employer Snapshots” in Folder #3, “Tool Kit,” in The Business Case for Breastfeeding workplace lactation resource kit).
Slide #18 Strategies to Address Space Needs
■ Reassure employers that lactation rooms can be simple and low cost, and that disability compliance need not be difficult. Grants are often available for helping organizations address ADA requirements.
■ Refer to Section 3, which provides creative options to consider for establishing private areas to breastfeed or express milk.
■ Folder #2, “Easy Steps for Supporting Breastfeeding Employees,” in The Business Case for Breastfeeding workplace lactation resource kit provides many options. The CD-ROM in Folder #3, “Tool Kit,” also provides employer snapshots with stories of diverse ways businesses support their breastfeeding employees.
■ Approach the building manager in facilities that lease space to several businesses to see if they can provide a lactation room for all breastfeeding tenants to use.
■ Many medium and large businesses have facilities managers who are responsible for organizing space, changing locks, ordering furniture, etc. If the lactation program needs to convert an existing space into a lactation room, it would be beneficial to include the person responsible for physical changes in the design of the space.
■ The American Institute of Architects provides guidelines for lactation room design in their document, “Best Practices for Lactation Room Design.” The document is available at their website at . Showing employers that other reputable organizations have policies and best practices to share can help them feel reassured.
Slide #19 Making it Work: Even in Difficult Settings
■ Remind employers that there are always options to consider in supporting employees with breastfeeding or expressing milk.
■ Before visiting a company, imagine what a typical day might be like for mothers working in that environment and be prepared to offer solutions.
■ Think outside the box! For example:
■ A pop-up beach cabana (similar to a pop-up camping tent) could be helpful in difficult settings such as agricultural settings, construction sites, and even open warehouse settings to create private space.
■ In Oregon, when public safety personnel wanted to be exempt from their new legislation, the coalition assisted them with options that included assigning women to desk jobs while breastfeeding.
■ Consider approaching businesses that might be willing to be a community breastfeeding site for workers in difficult settings such as UPS drivers, police officers, and other more mobile jobs, or fast food workers, chicken plant workers, and other settings that might not be conducive to milk expression.
Slide #20 Babies at Work
■ Don’t be shy about proposing a “Babies at Work” program for a business in difficult settings where a lactation room might not be Papossible.
■ Integrating babies at work is not a new phenomenon, and many parents and employers find that this arrangement works well, especially in communities where childcare resources are scarce (Secret 2006).
■ More than 100 businesses in the United States now offer comprehensive “Babies at Work” programs for their employees, allowing both mothers and fathers to bring small infants who are not yet mobile to the workplace.
■ The Parenting at Work Institute () provides resources and information on companies that provide babies-at-work options (Moquin 2008).
■ Numerous benefits to employers can be offered, including:
■ Improved employee loyalty and retention
■ Lower absenteeism rates
■ Lower healthcare costs
■ Enhanced teamwork and morale
■ Enhanced employee recruitment and attraction of customers
■ An unexpected outcome that many of the companies experienced was the effect of oxytocin on ALL employees, not just the parent, when babies are held at work.
■ In addition, there are numerous benefits to families, including
■ Enhanced bonding
■ Better socialization for the infant who is able to be better stimulated in the safe environment of his parent’s arms
■ Lower stress levels in both mothers and babies
■ Higher rates of breastfeeding exclusivity and duration (Fein 2008)
Slide #21 Presenting Babies at Work as a Viable Option for Employers
■ In presenting a “Babies at Work” program to as employer, point out the advantages to businesses, co-workers, and parents.
■ Emphasize that for most parents this is a temporary need. Many companies with babies at work programs allow infants until they are mobile, or up to 6 months to 1 year.
■ Cost outlay is low: for most companies, the cost of a baby changing table in the women’s restroom is the primary expense.
■ Companies that succeeded with the program have clear guidelines for employees to follow. Many of these can be downloaded from the website of the Parenting at Work Institute.
■ A list of companies that provide babies-at-work programs is available at the website, as well.
■ Arizona Department of Health is one of these companies. Their policy is available on their website at:
■ In dealing with liability concerns:
■ Group coverage is available through a broker established by the Parenting at Work Institute.
■ Mothers typically contribute 3-4 weeks of the amount they would have paid their childcare provider for the privilege, which can reduce or eliminate the cost to the employer.
■ Mothers assume responsibility for the infant; waiver forms are available.
■ There are legal precedents available that relieve companies from liability if the parent voluntarily brings his or her child to work.
(Moquin 2008)
Slide #22 Barrier: Lack of Flexible Scheduling Options
■ Some companies have rigid scheduling systems that do not allow for flexible break schedules. Examples include manufacturing plants, schools, restaurants, and companies where “flex time” is not an option.
■ In addition, regulated industries such as telecommunication companies, emergency dispatchers, utility companies, hospitals, etc. are bound by law to retain a certain number of people “on the floor” at all times. A woman stepping out to breastfeed or express milk for even short periods of time can be problematic for employers.
■ Many employers are generally unaware of the actual amount of time that might be needed for expressing milk, and assume employees would have to be away from their work station for long periods.
Slide #23 Strategies to Address Scheduling Needs
■ Remind employers that:
■ Breaks are predictable; absences are not. It is far easier to plan for breaks since absences due to a sick infant can happen anytime and are much more inconvenient for both employers and co-workers. Providing flexible scheduling for breastfeeding employees to express milk at work can help ensure they are at work more often.
■ Milk expression can usually be handled during regular breaks and meal periods at work.
■ Milk expression needs are different from woman to woman depending on the age of her baby and other factors.
■ Lactation support is a temporary need, and the number of breaks needed usually begin to diminish once a baby is eating solid foods.
■ In dealing with regulated industries, keep in mind that a “stricter” plan between the employer and her supervisor may be necessary. All employees are allowed to take breaks, but a greater degree of communication will be necessary given the stricter time constraints. The good news is that these special constraints make it even more important for companies to provide private lactation rooms so employees are not taking valuable time trying to find available locations. These companies should also be encouraged to follow a more “advanced” model of support by providing hospital-grade electric breast pumps to minimize the total amount of time needed for employees to express milk.
■ Folder #2, “Easy Steps for Supporting Breastfeeding Employees,” provides options for covering extra time that might be needed.
Slide #24 Barrier: Potential Resistance from Other Employees
■ In considering new programs, most employers take into account the impact of that program on other employees. Employee benefit programs, in particular, are often weighed on the basis of perceived fairness by co-workers (Colella 2001).
■ Employers know that if other workers perceive a program is unfair to them, it can affect both their trust in management and their willingness to take on extra tasks (Seijts 2004).
Slide #25 Strategies to Gain Co-Worker Buy-In
■ Research shows that most co-workers support family-friendly policies and programs, including lactation programs, especially if these workers have children of their own (whether or not they or their partners breastfed) (Suyes 2008)
■ Co-workers do have concerns that arise, however, and sensitivity to these concerns will help a lactation program succeed. Some colleagues, for instance, might resent the amount of time a breastfeeding colleague might be taking to express milk, and may be concerned that they may have to cover for her. Others may simply be unaware of the reasons their colleagues need to express milk regularly.
■ Establishing relationships with co-workers is important regardless of how a woman is feeding her child. Team-building, an important priority in any business, can actually be enhanced through supporting breastfeeding because parents of breastfed babies are less likely to miss work
■ Remind employers/co-workers that companies offer many programs that are relevant for and used by a narrow group (ex: flex-time, physical accommodations for employees with disabilities, religious observances, etc.). Employees have different needs and thus individualized programs are essential. Furthermore, programs that promote the health of employees and reduce health care costs benefit everyone.
■ Help employers see that:
■ Breaks are predictable; absences due to a sick child are NOT predictable. Supporting colleagues with continuing to breastfeed helps everyone in the long run.
■ Family-friendly policies benefit all employees by creating an environment that helps workers feel good about the company and also positions the company favorably in the eyes of customers and prospective employees;
■ Positive benefits of a lactation program (such as lower absenteeism and turnover rates and lower health care costs), as well as the positive public relations a company might receive benefit all employees.
■ Involving co-workers in the planning, implementation, and feedback stages of a program will help gain buy-in and support.
■ Offer to provide a short training presentation to employees using the PowerPoint presentation in Folder #5, “Outreach Marketing Guide.”
Slide #26 Presenting the Business Case: Do Your Homework!
■ Handout D: Company Profile
■ Before talking with businesses, do your homework to learn as much about the business as you can.
■ Gather background information on the company by reading the company’s Web site and talking to people who might work there. Be sure to look for company newsletters that might be posted on their Web site.
■ In particular, note the company’s
■ Size of workforce
■ Employer demographics
■ Existing benefits and work/life programs
■ Revenue
■ Read about the history of the company. This can give you background information on the foundation principles of the company and how they relate to the current mission and vision.
■ What work/life programs and family-friendly benefits are already provided by the company? Does the company offer a fitness program, on-site child care, or other wellness and family-friendly benefits?
■ Identify the key players within the company. Who provides oversight for these programs? Who manages the human resource department? What medical staff are employed?
■ Search the company’s site and the Web in general for any news articles about the company. What publicity has the company received for special programs? What awards has the company received? What events have taken place?
■ Other resources that may assist you include: Small Business Administration, Bureau of Labor and Industry, the local Chamber of Commerce, Better Business Bureau, and relevant Web sites.
Slide #27 Presenting the Business Case: Prepare Your Message
■ Use the information you know about business priorities and what you learned about the company you researched to craft brief talking points that tie your message about a lactation program to the goals and current activities of the company.
■ Consider soundbites that include:
■ How a lactation program will help the company achieve its goals.
■ How many people are likely to be impacted by the program.
■ Options for lactation support that are realistic given the priorities and infrastructure of the company.
■ How a lactation program can blend with the company’s existing work/life programs.
Slide #28 Presenting the Business Case: Outline a Contact Plan
■ Implement a personal contact plan for the contact you have identified. This includes following a typical business protocol, which includes the following steps.
■ Conduct personal visits rather than phone or email meetings.
■ Schedule visits rather than just showing up. Contact the administrative assistant, receptionist, or other similar person to arrange the meeting.
■ Keep visits short and provide information that “cuts to the chase.”
■ Avoid mailings. Mailing resources can be expensive, are generally ineffective, and are often disregarded or discarded by employers.
Slide #29 Presenting the Business Case: Gather Materials
■ Identify materials to provide, including:
■ Information about other companies offering lactation support programs
■ Resources from The Business Case for Breastfeeding
■ Community resources available to companies
■ Handout F: Community Resource Flyer can be used to create a resource handout for companies. This flyer can include names of individuals and groups in your community who can assist a business in:
■ Implementing lactation support services
■ Teaching classes for pregnant and breastfeeding employees and their partners
■ Providing direct lactation assistance to mothers through prenatal and postpartum consultations
■ Identifying sources for quality breast pumps (remember to offer businesses more than one option to avoid potential conflicts of interest)
■ Obtaining educational materials for employees such as books, videos, and online resources
Slide #30 Presenting the Business Case: Who to Approach
■ Who to approach in the company will depend on what you discovered about the company during your initial research.
■ Remember that usually the CEO (chief executive officer) is not the first person to approach. Instead, it is helpful to begin by approaching staff who are most likely to share your goals, and have the inside connections to know how to present the program to decision-makers. These go-to resources may include:
■ Human resource directors
■ Wellness program staff
■ Occupational health nurses
■ Employee Assistance Program staff who have a keen interest in health and well-being of employees, as well as keeping costs contained
■ Facilities managers
■ Managers in the company who have a particular stake in employee retention
■ Employees who are breastfeeding
■ Other champions within the company
■ Generally, it is best to begin by contacting somebody you or someone in your group already knows or has an “in” with at the company. Think about who you, your family, friends, and acquaintances already know. Do any of them have current or previous experience working at any of the businesses you would like to contact? They may be able to give you an “in” or recommend the best person at the company to contact.
■ Don’t forget the benefit of knowing pregnant or breastfeeding mothers within the company who can be your “in” with employers.
■ “Cold” calls are a last resort.
■ Contact your state obesity task force and/or worksite wellness council. These groups are already working on worksite wellness issues and may have established partnerships already underway.
Slide #31 Presenting the Business Case: What to Say
■ Handout E: Outreach Meeting Guide
■ The Outreach Meeting Guide was adapted from a script developed by Rhode Island Breastfeeding Coalition. The guide provides concrete steps before the meeting, things to cover during the meeting, and follow-up efforts to consider. The template is a guide; incorporate your language and details to fit your unique situation.
■ Start off the meeting with a polite, firm handshake This shows that you are professional and are familiar with business etiquette.
■ When you walk in the door for the meeting, introduce yourselves and the group you represent, and explain the purpose for the visit. Let the employer know that you won’t be taking much of his/her time.
■ Present the business case for breastfeeding by focusing on the things the employer is concerned about: lowering health care costs and improving employee retention.
■ Discuss the advantages of a lactation program in helping the employer meet the needs of the company. Use Folder #1, “The Business Case for Breastfeeding” as your primary resource to give to the employer.
■ Use active listening principles to listen to the employer’s concerns and perceived barriers.
■ Offer possible solutions for creative ways to support breastfeeding employees given the particular environment and challenges of the company.
■ Offer examples of other companies similar to the company that have successfully provided lactation support.
■ Describe the assistance your group will be able to provide, recognition programs your group may be establishing, and available community resources.
■ Thank the employer for the time given, and promise to follow up with an email or phone call.
■ Send a thank-you note to let the employer know you appreciate the time given for the meeting.
Slide #32 Case Example: Hawaii Breastfeeding Coalition
■ The Hawaii Breastfeeding Coalition followed these guidelines in approaching a large insurance company on the islands.
■ Collecting information on the company before the meeting enabled them to identify areas of common goals and interests, and helped them to make the wisest use of the time available.
■ The company was very interested in the program, and offered numerous strategies for the coalition to consider, including attending employee health fairs.
Slide #33 Year 1 Lessons Learned: Go to the Businesses
■ States in Year 1 of the project offer valuable insights as to strategies that can work best.
■ One of the key strategies that emerged is to go to the business, rather than waiting for businesses to come to you.
■ The Fresno Healthy Start program scheduled a business networking luncheon at their training event, and although it was very well received, reported that it was a very labor intensive way to reach businesses.
■ Indiana found that by providing an exhibit at the annual meeting of their state’s Society for Human Resource Managers they were able to reach nearly 1,000 businesses.
■ New York staff in the obesity program’s “Healthy Heart” program provide brief 5-10 minute presentations at local SHRM chapter meetings.
■ Indiana has also found that going to Chamber of Commerce meetings and meetings of other service organizations is also an effective way to get the information out to more businesses.
■ Employee Assistance Programs at companies may also be an underutilized avenue for collaboration.
Slide #34 Year 1 Lessons Learned: Think Outside the Box
■ Be willing to think outside the box when considering options for conducting outreach with employers. For example:
■ The Georgia Breastfeeding Coalition contacted the airport authority for the Atlanta airport, and discovered they were very open to working with them to provide support not only for employees, but travelers. The coalition is now a part of their team in addressing the issues.
■ The Central Louisiana Breastfeeding Coalition worked in collaboration with the State WIC Program to offer mini-grants to businesses, and found that this approach helped improve openness among businesses. Mini grants are small in amount but can be used to help defray at least some of the costs such as the cost of providing a breast pump, a comfortable chair, and other amenities.
Slide #35 Other Project Promotion Ideas
■ Promotion of the project helps raise awareness of the entire community for lactation support services, and can help employers realize that this is normal and acceptable.
■ Employee health fairs help gain entry into a company. Providing an exhibit helps raise awareness about breastfeeding among employees, helps you gather information about needs within the company, and helps you establish positive contacts with the business.
■ Seek business conferences to attend. Don’t forget women’s conferences! The Hawaii Breastfeeding Coalition president attended a Women and Work conference in Honolulu and although she was not able to get on the agenda as a presenter or exhibitor, she simply attended relevant sessions and when appropriate, offered comments and information during the question-and-answer portion. This opened the door for follow-up with attendees and the companies they represent.
Slide #36 Using the Media
■ In using the media, state breastfeeding coalitions in Year 1 found several things are effective:
■ Birmingham, Alabama timed their training event to coincide with the opening of the 1st lactation room on the campus of the University of Alabama/Birmingham.
■ The Hawaii Breastfeeding Coalition took advantage of their status as a “selected state” to gain a morning interview with the news anchor, who happened to be pregnant.
■ Georgia Breastfeeding Coalition staged an event to recognize businesses in the community and was able to gain media coverage.
■ Connecticut Breastfeeding Coalition provided articles for business related journals in their state and were able to reach many businesses.
Slide #37 Use Active Listening Counseling Tools
■ Whether conducting one-on-one visits with employers in a single outreach visit, at an exhibit booth, at a conference, or business meetings, remember that the same important active listening skills you may be using with clients are also helpful in presenting the business case to employers. These principles include:
■ Be approachable and interested in the employer’s perspective to build trust and openness.
■ Use open-ended questions to engage the employer in a conversation and to allow the employer to share concerns and ideas that are important to know in moving toward solutions.
■ Example: “Tell me some things you have heard about breastfeeding employees/workplace lactation programs.”
■ Example: “What things might make it easy/difficult for your company to implement a program?”
■ Affirm the employer by praising positive programs and services already being provided, and by acknowledging concerns.
■ Example: “It sounds as though your company is very family-friendly!’
■ Example: “What a great company this must be. I can see it is very important to you to address the needs of your employees.”
■ Example: “A lot of employers worry about lack of space, too.”
■ Provide information that targets the specific concerns of employers.
■ Avoid the temptation to do all the talking! Give the employer time to discuss their ideas and concerns.
■ Share strategies that other companies have found helpful.
Slide #38 Recognize the Readiness to Change
■ Remember that employers may be at different levels of readiness to change and target information accordingly.
■ For example, an employer who has never heard of lactation support and is unsure of the idea may not be ready for detailed information on how to implement a program, places to purchase breast pumps, etc. Potential resource for this individual would be the tri-fold brochure in Folder #1, “The Business Case for Breastfeeding.”
■ Someone who has heard of lactation programs and is somewhat interested may be ready to hear more about what is involved, and who can help. Potential resource for this individual would be the tri-fold brochure in Folder #1, “The Business Case for Breastfeeding,” and perhaps Folder #2, “Easy Steps to Supporting Breastfeeding Employees.”
■ Someone who has been thinking of implementing a program may be ready to learn more of the details about first steps. This individual would be ready for Folder #2, “Easy Steps to Supporting Breastfeeding Employees” and Folder #3, “Tool Kit.”
Slide #39 Presenting the Business Case: Practice
■ Activity: Role Play
■ Handout G: “Role Play Scenarios”
■ Instructions
■ Ask participants to pair up with a partner to practice talking with a business about a lactation support program. One person should practice being the outreach worker while the other person plays the role of the business manager.
■ Participants should be reminded to use active listening principles and their “elevator speech” prepared earlier as a basis for their conversation.
■ Allow around 4-5 minutes for the pairs to conduct their role play practice.
■ Ask the pairs to switch roles and use a new scenario and practice again.
Discuss:
■ What was easy? What was difficult?
■ What other information would it be helpful to know about this business before you begin your conversation?
Implementing
The Business Case for Breastfeeding
In Your Community
Speaker Notes
Section 6: Using the MCHB Worksite Lactation Resource Kit
Slide #1 Section 6: Using the MCHB Worksite Lactation Resource Kit
Slide #2 Sneak Preview: Section 6
Learning Objective:
Develop a strategic plan for implementing The Business Case for Breastfeeding in a community
Topics Covered: strategies for using The Business Case for Breastfeeding as part of community-based outreach with businesses
Show Trainees:
■ The Business Case for Breastfeeding workplace lactation resource kit
Slide #3 Implementing The Business Case for Breastfeeding
■ As part of the MCHB training and technical assistance project, State breastfeeding coalitions and Healthy Start grantees participating in the training will implement an outreach program within their state or community to encourage targeted businesses to provide lactation support.
■ Each group will be expected to make contacts with businesses you identify in your community as important prospects for implementing lactation support programs.
■ Using The Business Case for Breastfeeding workplace lactation resource kit should be the central part of your outreach program.
■ In order to implement this, each State coalition and Healthy Start community will devise a plan for addressing the specific needs in your community.
Slide #4 The Workplace Lactation Resource Kit
■ Note that it is not necessary to provide the entire resource kit to each employer. For instance, Folder #5, “Outreach Marketing Guide” is primarily geared to State breastfeeding coalitions, health care professionals, and other outreach personnel who will be involved in contacting businesses. Folder #4, “Employees’ Guide to Working and Breastfeeding” is primarily geared to pregnant and breastfeeding employees.
■ In conducting initial outreach, you may wish to provide only the booklet, The Business Case for Breastfeeding, when meeting with an HR director or other official. Folder #2, Easy Steps to Supporting Breastfeeding Employees, is most appropriate to give to the person involved in actually setting up the program.
Slide #5 Establishing a Comprehensive Outreach Program
■ A comprehensive, coordinated outreach program will help increase the effectiveness of your group’s efforts and help you gain the best return for your investment of time and capital.
■ This comprehensive program can include outreach and support strategies for businesses, for employees, and for other related groups such as child care centers, groups that serve new families in your community, business service organizations, worksite wellness councils, etc.
Slide #6 Foundation of Support
■ An effective outreach program begins by building on what you have already done to support breastfeeding mothers.
■ As a large group we will discuss workplace outreach activities already underway among various groups. As these are discussed, listen for the types of interventions that are already underway in your community or organization, and note activities and approaches that might be helpful to include in your own group’s strategy plan.
■ Activity:
■ Instructions:
■ Ask each individual at the training to think of activities and programs that have recently been implemented by themselves or their organizations to support working mothers or outreach businesses.
■ Provide 3 colors of large sized post-it notes on each table. Assign one color for “Business Initiatives,” one color for “Employee Initiatives” and a third color for “Other Community Initiatives.” Post a flip chart sheet for each category.
■ Ask individuals to write down current and recent activities in each of those 3 areas on the appropriate color post-it note and place the post-it note on the appropriate flip chart sheet.
Discuss:
■ Review the activities already underway for each type of intervention. Clarify any entries as necessary.
Allow 20 minutes
Slide #7 Conducting General Outreach with Businesses
■ Be aware that companies you contact may want information on the lactation program in your particular organization. Be prepared to discuss your company’s support benefits, including a copy of the policy and even photos of your lactation room.
■ If your organization does not provide lactation support, this may be the place to begin!
■ Be strategic about employers you wish to target in your community. Several criteria can be considered, based on the needs of your community.
Slide #8 Low-Hanging Fruit
■ “Low hanging fruit” refers to companies most likely to be easily persuaded. This is an important consideration if your community has very few businesses on board and you need a quick foundation from which to build. Some possible businesses that could be considered “low hanging fruit” according to the 2007 SHRM survey are:
■ Health care agencies and insurance companies (which tend to be more receptive to lactation support programs because they share goals related to health outcomes)
■ Financial institutions
■ Manufacturing (non-durable goods)
■ Service organizations (for profit)
■ Government organizations might also be easy to convince because of Federal mandates to support breastfeeding within many governmental organizations
■ Another “low-hanging fruit” option is companies that are similar to other companies with lactation programs. This gives employers a proven track record to emulate.
Slide #9 Early Adopters
■ Early adopters are those workplaces with a proven record of openness to innovative ideas, or that offer unique employee/company benefits, especially family-friendly programs.
■ Companies that have fitness programs in place can also be approached with the marketing spin focused on the company’s existing commitment to health makes them a prime candidate to consider a lactation support program.
Slide #10 Biggest Bang for the Buck
■ Workplaces with a high employee base that includes women of childbearing age could be important to approach because these employers may be more likely to see lactation support as a relevant health benefit.
■ This can help increase the likelihood of making significant changes that impact larger numbers of employees.
■ For example, Kaiser Permanente in California is a huge organization with numerous divisions throughout the state. The California Breastfeeding Coalition has been working with Kaiser to build on the lactation support services they already have in place at some facilities to become institutionalized. This will have a far-reaching effect in touching many more employees.
Slide #11 Workplaces with Special Needs
■ If the community already has many workplaces offering lactation support, it might be helpful to focus attention on some of the challenging sites where women face particular challenges with breastfeeding.
■ This might include manufacturing plants with less flexibility for breaks allowed, companies where management has traditionally been disinterested in employee lactation needs, companies with predominantly male employee, or sites where physical barriers might pose special challenges for employees.
■ Regulated industries (e.g., telecommunication companies, emergency dispatch centers, utility companies, hospitals, etc.) are bound by law to retain a certain number of people “on the floor” at all times. A woman stepping out to breastfeed or express milk for even short periods of time can be problematic for employers.
Slide #12 Other Workplaces to Consider
■ Workplaces where inside champions are available. Having a contact inside the company who can help you make the process run more efficiently saves time and effort. This can include working through existing pregnant and breastfeeding employees who have the inside track on people to work with and who have a vested interest in having a lactation support program.
■ Large employers. The SHRM survey found that large employers were more likely to implement a lactation program, probably because they are more easily able to see the potential impact on a larger workforce base. However, keep in mind that the National Business Group on Health will be initiating contacts with large businesses at the corporate level, so focus on the large companies with more of a state or local focus.
■ Up and coming businesses. New businesses to an area or those that are expanding rapidly are often more amenable to innovative programs as they build their talent/employee bases. Also, new businesses still involved in constructing the facility may be more likely to work a lactation room into their building plans.
Slide #13 Get the Word Out!
■ Seek publicity for your efforts. Tell local media how you are helping businesses save health care costs, reduce turnover, and attract key talent. Highlight businesses already providing lactation benefits to employees as “models” and arrange spokespersons for follow-up interviews as the companies permit.
■ Develop a visibility program to recognize workplaces that are on board with breastfeeding support. Many State breastfeeding coalitions have established model recognition programs. (See ideas listed in Section #4 of this curriculum.)
■ Check Folder #5, “Outreach Marketing Guide,” for more information about the Texas and Washington recognition programs, and the “Resource Guide” in Folder #3, “Tool Kit,” for Web sites of other groups that offer recognition programs or resources for employers.
Slide #14 Outreach and Support Strategies for Working Mothers
■ Provide the sample lesson plans for prenatal and postpartum classes on the CD-ROM in Folder #5, “Outreach Marketing Resources,” to IBCLCs, WIC agencies, La Leche League Leaders, and other breastfeeding experts in the community who are working with new families.
■ Explore community grants which might help cover any costs associated with offering classes at business locations if the business is not prepared at first to pay for classes.
■ Provide training for community health care professionals and breastfeeding educators who are able to provide specific assistance to working mothers. The “Outreach Marketing Guide” in Folder #5 provides detailed information about the challenges of working mothers and support strategies.
■ Provide the community resource list you prepared for businesses to other health care professionals who work with new families.
Slide #15 Outreach and Support Strategies for Related Groups
■ Provide training for child care centers in the community. The Texas WIC Web site has a child care training program developed by the Mississippi State Department of Health that is available as a free download. See the “Resource Guide” in Folder #3, “Tool Kit” CD-ROM of The Business Case for Breastfeeding workplace lactation resource kit for more information.
■ If your group is involved in legislative advocacy, refer to the “Outreach Marketing Resources” CD-ROM in Folder #5 for examples of language that has been implemented in a variety of states. Note that Mississippi offers additional language related to support from child care centers.
Slide #16 Engage Community Partners
■ A number of community partners can assist you in your efforts, including:
■ Business representatives: Chamber of Commerce, union representatives, service organizations such as the Rotary Club or Kiwanis, or individual champions within a business such as human resource managers, occupational health nurses, and wellness program staff.
■ Child care representatives: child care licensure division, dietitians involved in child care center monitoring, and Early Head Start program directors and local staff.
■ Lactation Consultants, available through local hospitals or through ILCA’s “Find a Lactation Consultant Directory.”
■ Healthy Start programs.
■ Breastfeeding coordinators, dietitians, and peer counselors with the Women, Infants and Children (WIC) program.
■ Lesson Learned: The Georgia SBC collaborated with their Georgia Physical Activity and Nutrition Unit, Worksite Committee and received an additional $18,000 to help them implement their program.
■ Lesson Learned: The Oregon SBC collaborated with WIC and received an additional $10,000 in end-of-the-year funds toward their project.
■ Lactation staff at local hospitals and physician offices.
■ Registered Dietitians at local WIC agencies, hospitals, home extension programs, and health clinics.
■ La Leche League Leaders and local groups.
■ Hospitals.
■ Public and private health clinics.
■ Obesity prevention programs, including state health department chronic disease programs funded for obesity grants through the Centers for Disease Control and Prevention.
■ Community centers (e.g., YMCA, JCC, etc.)
Implementing
The Business Case for Breastfeeding
In Your Community
Speaker Notes
Section 7: Building Your Plan
Slide #1 Section 7: Building Your Plan
Slide #2 Sneak Preview: Section 7
Learning Objective:
Develop a strategic plan for implementing The Business Case for Breastfeeding in a community
Topics Covered: Strategies for preparing a plan, conducting trainings, conducting outreach, collaboration with community partners, and technical assistance options
Handouts:
■ Handout H: Additional Education Options
■ Strategy Planning Worksheets
Show Trainees:
■ The Business Case for Breastfeeding workplace lactation resource kit
Slide #3 Where to Go From Here
■ Following this training, the state breastfeeding coalitions and their partners will be expected to use what they have learned with this Train the Trainer event to conduct outreach with businesses in their community to improve support for breastfeeding families.
■ Other tasks can include providing additional education opportunities with targeted groups, promoting the project with the community, and other activities.
■ We suggest that each State designate a leadership team or steering committee that can provide guidance and oversight to the overall project. Be sure to include State Breastfeeding Coalition members, Healthy Start agency staff, and other key stakeholders in the community who can assist in providing guidance and direction to the project.
■ It will also be helpful to form an implementation team of individuals who will assist you in carrying out the tasks of your plan, including those who are comfortable and skilled in providing outreach, those who are able to assist with planning and/or providing training events, those who will assist with media promotion, and those who can help with other designated tasks.
■ The first and most important task will be to develop a PLAN for how you will use what you learned today to make a difference for working mothers in your community using The Business Case for Breastfeeding.
Slide #4 PIC Funding
■ Each State will be provided with a subcontract from HCDI in the amount of $10,000.
■ These“Participant Implementation Costs” (PIC) are based on a schedule of three deliverables, including:
■ Deliverable #1: The initial strategic plan. Due 60 days after your training ends. $5,000 of the funds will be awarded at this time.
■ Deliverable #2: A revised strategic plan, as well as a mid-course progress report summary of how things are going. Due 6 months after your initial training. $3,000 of the funds will be awarded at this time.
■ Deliverable #3: The draft annual summary report of your activities. Due 12 months after your training ends. The final $1,500 of the PIC funds will be awarded at this time.
Slide #5 Other Requirements for the PIC Funds
■ In addition to the deliverables mentioned above, SBCs accepting the PIC funds will be required to approach at least 10 businesses in their State or targeted community to encourage them to implement lactation programs. There are no requirements as to how many people need to conduct the visits, though it is hoped that many of the training participants will feel this is something they are willing to assist with.
■ SBCs will also be asked to provide at least one additional educational event. A variety of options will be discussed.
■ A representative of the SBC will also be asked to participate in the monthly technical assistance conference calls, as well as other communications needed, and to complete required documents and reports to report on the progress of the outreach efforts.
Slide #6 Components to Your Plan
■ The first deliverable, the strategic plan, will actually begin DURING the training event when SBC members, Healthy Start staff, and other stakeholders and community partners are gathered. The ideas and recommendations that come forth from the group planning effort will help form the basis for the proposed plan.
■ The leadership team/steering committee will want to review the recommendations of the group planning session after this training and discuss additional options to include, and/or to refine the ideas and recommendations to fit coalition resources and priorities.
■ The plan should include the following components:
■ Information about the outreach plan that will be conducted with businesses, including who will be making those contacts, how it will be happening, which businesses you will target and how this outreach will address the identified needs in your state or community.
■ Information about any additional educational events that you feel will be necessary to continue getting out the word and recruiting additional partners.
■ Promotion ideas for increasing awareness about your efforts through media, presentations, exhibits, and other communication avenues
■ Your plan should also include any identified partners you hope to recruit for your project team, as well as anticipated costs to implement your plan.
■ SAMPLE plans from Year 1 states can be made available upon request.
■ We will now break down these major components and discuss them in more detail to provide you with some options to consider and possible ways to use your PIC funds.
Slide #7 Outreach with Worksites
■ Outreach with worksites is a key part of your plan because it is important in encouraging employers to create services and programs that will assist mothers in continuing to breastfeed.
■ There are many options to consider as you formalize your plan, and the strategies discussed in training and identified in the Strategy Planning are a great head start.
■ Options to consider:
■ If your state does not have a recognition program, or your program could be modified/expanded to be more effective, this is a great component to put into place.
■ Mini-grants, as discussed in Module #6, can also be an effective way to get buy-in with employers.
■ Be sure to select outreach workers who are comfortable approaching businesses, or consider having individuals who are new to this kind of outreach accompany more seasoned workers to grow in confidence and skills.
■ Consider targeting “low hanging fruit” (discussed in Module #6) to gain some early, quick successes that you can build on.
■ Engage groups that already understand businesses and/or have a priority to address employee needs.
Slide #8 Allowable Expenses for Worksite Outreach
■ Your PIC funds can be used for a wide variety of things in service to outreach with worksites.
■ These can include certificates for businesses, mini-grants for items in the lactation room, stipends to pay outreach workers, travel expenses, and printing costs.
■ Note that food costs are NOT allowable expenses.
Slide #9 Educational Events
■ Handout H, “Additional Education Options,” provides a list of creative ways some or all of the Train-the-Trainer curriculum materials could be used for additional and ongoing education events.
■ Options to consider:
■ A full 1 or 2-day community-based “Train the Trainer” event in another area of your state not targeted for this initial training
■ Shorter presentations to business groups
■ Workshops or conference presentations at health provider events
■ Training for personnel involved in providing direct services to new families
■ Information to childcare centers and other related groups
Slide #10 Allowable Expenses for Education Events
■ Your PIC funds can be used for a wide variety of activities in support of training and education events.
■ This can include costs associated with hosting the training (facility and audio visual expenses), invitations and mailing expenses, attendee handouts, training props and materials, and travel expenses for trainers.
Slide #11 Project Promotion
■ Many Year 1 States have found that promotion activities in the community and across the State help build and sustain momentum.
■ Options to consider:
■ Employee health fair exhibits, particularly at larger organizations and companies
■ Presentations, posters, and exhibits at conferences
■ Shorter presentations at business related meetings
■ Contacts with the media to cover successes with new lactation programs or to generate interest in the project.
Slide #12 Allowable Expenses for Promotion
■ PIC funds can be used to create and produce exhibit displays and posters, to create local resources, to pay for conference registration/exhibit fees, and to cover travel costs of individuals who will be providing presentations or staffing exhibits.
Slide #13 Related Activities
■ Your plan and PIC funds can also include additional related activities, such as providing information for childcare centers and conducting tracking and/or evaluation of the impact of your efforts.
Slide #14 Tracking and Evaluation
■ State breastfeeding coalitions and Healthy Start programs involved in the project will be expected to conduct program tracking and monitoring to assess changes that might occur in the businesses as a result of the outreach.
■ This tracking is critical to ensure that additional funding can be available, and to document successes.
■ Tracking should include:
■ Recording the number of businesses contacted, follow-up that occurred, results of the contacts, concerns encountered, lessons learned, and opportunities.
■ Noting lactation support benefits available at companies. “Accommodations for Breastfeeding in the Workplace” from the United States Breastfeeding Committee available at is a helpful tool for collecting baseline information and to record changes that occur as a result of the outreach.
■ Collecting qualitative satisfaction data using the Employer/employee satisfaction tools in Folder #3, “Tool Kit” of The Business Case for Breastfeeding workplace lactation resource kit.
■ Monitoring breastfeeding duration and exclusivity data from the National Immunization Survey and the Pediatric Nutrition Surveillance Data (Centers for Disease Control and Prevention). (See breastfeeding.)
■ The use of other data collection forms and documents as provided to you or prepared within your organization.
Slide #15 Collaboration/Partnerships
■ Remember that you have many partners who can assist you with both the development and implementation of your plan!
■ In addition to SBC and Healthy Start agency members, consider recruiting additional partners in your community who might not be present at the training today.
■ This can include WIC state and local agency staff, government agencies, healthcare organizations, business organizations, colleges and universities, Department of Health chronic disease programs, worksite wellness councils, labor unions, Chambers of Commerce, and other groups.
Slide #16 Technical Assistance from HCDI and Every Mother
■ An integral component to the project is the provision of technical assistance to State breastfeeding coalitions and Healthy Start sites selected to participate in the project.
■ This comprehensive assistance plan includes:
■ Monthly teleconferences for a period of 1 year following the initial training. These calls are designed to provide a venue for sharing program progress, issues, concerns, future plans, and other ideas. All selected State breastfeeding coalitions and Healthy Start programs should provide a representative to participate in these important follow-up calls. Calls will begin in the month following the MCHB provided training.
■ On-site technical assistance visit by a representative of the project team to each State or Healthy Start community. The site visits are designed to assess implementation progress, assist with identified needs and concerns, and to assess changes that are occurring in businesses.
■ Ongoing technical assistance. This will include more personal assistance tailored to your group’s needs through telephone and email. Assistance will range from offering help as you develop the initial plan, begin outreach, and address opportunities.
■ Toll-Free Telephone Assistance via a voice mail line that will be monitored by staff from HCD International, Inc. The number is: 1-866-435-4808.
■ Web Site developed specifically for this project: hrsa/worksitelactationsupport/index.html. The site will provide relevant resources, a forum for exchanging ideas and sharing information, project updates, current news and information, and other project related materials.
■ Additional information regarding these resources will be provided to the trainees during or following this training.
Slide #17 Additional Resources
■ The “Resource Guide” found on the “Tool Kit” CD-ROM in Folder #3 provides a detailed list of Web sites providing a wide array of resources that can be helpful in learning more about lactation support.
■ The project Web site established for the project will provide numerous resources and successful strategies.
■ Other resources that may be helpful:
■ The HHS Office on Women’s Health has many useful resources for communities involved in supporting new mothers.
■ The National Business Group on Health provides several excellent resources supporting working and breastfeeding. Their recently issued “Investing in Maternal and Child Health: An Employer’s Toolkit” is available at: healthtopics/maternalchild/investing
■ The United States Breastfeeding Committee has numerous resources for State breastfeeding coalitions and other groups interested in supporting working breastfeeding women at .
■ The Centers for Disease Control and Prevention provides a helpful document on evidence-based strategies for increasing breastfeeding rates that includes a chapter on supporting working mothers. CDC also provides a “Tool Kit” for conducting outreach with workplaces. Both are available at breastfeeding.
■ The International Lactation Consultant Association is implementing an Employer Directory that lists lactation consultants across the United States and globally who can assist employers with setting up a lactation program, and/or who provide direct assistance to working mothers. The Employer Directory is available at: .
Slide #18 Project Webcast
■ HRSA’s Maternal and Child Health Bureau has prepared a webcast to provide an overview of the project, and to outline effective strategies for using The Business Case for Breastfeeding in your community.
■ The webcast has been archived and can be accessed at
Slide #19 Strategy Planning
■ During the Strategy Planning portion of the day, your group will be invited to divide into smaller groups to work on outreach plans that can be implemented in your community.
■ Each group will be addressing different aspects to the overall plan for your state.
Slide #20 Work Groups
■ The workgroups for the strategy planning include:
■ Outreach to businesses
■ Outreach to mothers
■ Outreach to the community
■ Public awareness strategies
■ Training options
Slide #21 Let the Planning Begin!
Slide #22 Group Reports
■ Invite the groups to report on their planning, including identified workplaces, potential challenges and opportunities, and an outreach plan to move them toward improved support for working mothers.
Implementing
The Business Case for Breastfeeding
In Your Community
Speaker Notes
Section 8: Presentation for Businesses
Slide #1 The Business Case for Breastfeeding
This section provides the speaker notes for the business presentation found on the CD-ROM in the “Outreach Marketing Guide.” The presentation, “The Business Case for Breastfeeding,” is a short presentation that can be shared at business meetings, conferences, with managers/supervisors at a company, or at other general informational meetings about the project. Feel free to adapt the slides to fit the needs of your community. Insert photos that are relevant to your community, as well.
Slide #2 Welcome and Introductions
■ Welcome all attendees warmly.
■ Allow businesses in attendance to introduce themselves. Introduce community organizations in attendance, as well.
■ The purpose of today’s presentation is to explore how providing lactation support to breastfeeding employees can improve your company’s bottom line and help families achieve their parenting goals.
■ The new workplace lactation resource kit, The Business Case for Breastfeeding, produced by the U.S. Department of Health and Human Services, Health Resources and Service Administration’s Maternal and Child Health Bureau, is full of valuable information and resources to help make the process of supporting breastfeeding smooth and efficient for employees, as well as beneficial to both employers and employees.
Slide #3 Women in the Workforce
■ 2006 Data from the U.S. Department of Labor show that more women than ever before are joining the work force (U.S. Dept. of Labor 2007b).
■ In fact, mothers with children are the fastest growing segment of the U.S. workforce today. Over 70 percent of women with children are in the work force today, and nearly 60 percent of women with children under the age of 3 are in the work force.
■ Retaining these women as your employees is a growing challenge, especially given two looming trends affecting human resources nationwide: retirement of the “Baby Boomer” generation and an increasing skills gap in disciplines such as science and engineering (Deloitte 2004).
Slide #4 Supporting Breastfeeding is WIN-WIN for Companies and Employees
■ Companies across the United States are discovering that providing a basic lactation support as part of their employee health benefit package can bring about a healthy return on investment (ROI) for business and increase productivity and company loyalty among workers.
■ Rather than draining human resource benefits funds, lactation support programs can actually put money back into benefit funds.
Slide #5 Health Impact of Breastfeeding
■ You might be asking yourself, “What’s the big deal about breastfeeding? Can’t women just use formula?”
■ Research indicates that breastfeeding has a profoundly positive impact on the health of infants and mothers. That impact can have a significant effect on health care costs that businesses incur.
■ The current recommendations of the American Academy of Pediatrics Section on Breastfeeding and other medical and professional organizations is that infants be fed human milk exclusively for the first 6 months of life. From 6 months to 1 year of age infants should continue to receive human milk in addition to other foods and, if possible, breastfeeding should continue even after the baby’s first birthday for as long as the mother and child desire. (American Academy of Pediatrics 2005)
■ Studies show that the positive impact of breastfeeding is greater the longer an infant is breastfed.
Slide #6 Health Impact on Infants
■ Just a few of the illnesses that breastfeeding impacts in infants include ear infections, respiratory infections, gastrointestinal disorders, and dermatitis, or skin allergies. Breastfeeding also lowers the death rate from Sudden Infant Death Syndrome and other major illnesses.
■ One study examining the significance of these illnesses on a business’s health care costs found that for every 1,000 babies NOT breastfed, there are an EXTRA 2,033 physician visits, 212 days in the hospital, and 609 prescriptions filled (Ball 1999).
Slide #7 Impact on Children in Child Care Centers
■ When an infant is enrolled in a formal child care center the impact is even greater.
■ Infants and children placed in child care centers have double the odds of needing antibiotics for infections.
■ However, if infants are breastfed for at least 4 months, that risk is substantially decreased.
■ The protective effect of breastfeeding is still evident well into the child’s second year of life (Dubois 2005).
Slide #8 Impact on Mothers
■ Breastfeeding also positively impacts the woman’s health.
■ Breastfeeding helps mothers recover from their pregnancy and childbirth faster, and reduces their risk of breast cancer, ovarian cancer, Type 2 Diabetes, and osteoporosis, all of which can significantly drive up health care costs for your company.
Slide #9 Breastfeeding Makes Good Business Sense
■ Breastfeeding is so important that more than 70 percent of new mothers in America today choose to breastfeed. [Include relevant state specific data.]
■ Breastfeeding also makes good business sense for companies and their employees because it puts money back into the human resource benefits rather than depleting it.
Slide #10 Lower Absenteeism Rates
■ When infants are healthier, mothers and fathers do not have to leave work as often to take care of sick infants.
■ Case Example: One business found that one-day absences to take care of sick children occurred more than twice as often for mothers of formula feeding infants when compared to breastfeeding mothers (Cohen 1995).
■ When lactation support is available, mothers may return to work sooner after giving birth because they know they are returning to an environment that supports their decision to breastfeed.
Slide #11 Lower Health Care Costs
■ Currently in the United States employers carry the major burden of health care costs.
■ Many companies that have examined their health care costs have found that improved health for mothers and babies results in significant health care savings for the business.
Slide #12 A Lactation Program Gives Your Company Bottom-Line Benefits
■ A comprehensive lactation support program encourages employees continue to breastfeed once they return to work, and helps them meet their breastfeeding goals.
■ A lactation program need not be costly or complicated, and the ROI can be substantial.
■ Case Example: CIGNA, a national insurance agency, conducted a 2-year study of 343 women and compared the health care savings between breastfeeding and non-breastfeeding women. The result: breastfeeding saved them $240,000 annually. CIGNA also discovered that the lower absenteeism rates saved them an additional $60,000 for a total savings of $300,000 (Dickson 2000).
Slide #13 Lower Turnover Rates
■ Currently in the United States only 59 percent of employed mothers return to work following their maternity leave. This means 41 percent of mothers do not return, which translates into significant costs to replace these valuable employees.
■ However, when women know they are returning to a workplace that provides them the support they need to express milk and maintain their milk production, they are significantly more likely to return to work.
■ Case Example: Mutual of Omaha implemented a simple lactation program that included private areas for women to express milk during their regularly scheduled breaks, prenatal information, and support. They found that the program helped them retain 83 percent of their female employees after their maternity leave (Mutual of Omaha 2001).
■ Case Example: A larger study of multiple companies with lactation support programs found that lactation support helped them retain 94 percent of their employees (Ortiz 2004).
Slide #14 Lower Health Care Costs
■ Providing a lactation support program also increases the health care savings for a company.
■ Case Example: Mutual of Omaha’s program provided them a yearly savings of $115,881 in health care claims among the families enrolled in their lactation program. The company spent $2,146 extra in medical costs for each woman who did NOT participate in the program (Mutual of Omaha 2001).
■ Case Example: When Aetna began their lactation program, they saved $1,435 per breastfed baby in the first year of life, for an ROI of 3 to 1.
Slide #15 Other Benefits
■ A lactation support program also helps women decide to return to work sooner, knowing they will have the support they need to continue breastfeeding (Galtry 1997; Cohen 2002).
■ Studies have also found that family-friendly lactation support programs help employees feel better about the company and impact their decision to remain with the company long-term.
■ The recognition your company receives as a “family friendly” business is also a positive way to improve the image of your business in the community.
Slide #16 Easy Ways to Support Breastfeeding Employees
■ Supporting breastfeeding employees is not complicated or costly, and there are many resources in the community available to help you.
Slide #17 U.S. Breastfeeding Rates
■ The U.S. Healthy People 2010 initiative established by the U.S. Department of Health and Human Services has set national goals for health issues that can significantly impact health in the United States. Breastfeeding goals are included in these national goals (U.S. Dept. of HHS Healthy People 2010). These goals include:
■ 75 percent of infants to be breastfeeding at hospital discharge
■ 50 percent to be breastfeeding at 6 months
■ 25 percent to be breastfeeding at 1 year
■ 60 percent of babies to be “exclusively” breastfeeding, or receiving nothing but human milk, at 3 months
■ 25 percent of babies to be exclusively breastfeeding at 6 months
■ Although initiation rates are high, the numbers of women continuing to breastfeed drop off significantly over time. One of the main factors for this drop is that women often return to work and find it difficult to continue breastfeeding.
■ It is estimated that at least $3.6 billion could be saved in health care costs, lost earnings of parents, and costs of premature mortality if breastfeeding rates were in line with the Healthy People 2010 goals (Weimer 2001).
Slide #18 Basic Needs of Breastfeeding Employees are Minimal
■ Fortunately, the needs of breastfeeding employees can be met with just a few simple improvements.
■ To maintain milk production and to stay comfortable during the workday, mothers need to be able to express their milk 2 or 3 times during a regular 8-hour workday.
■ To do that, employees simply need:
■ A place where they can express milk in private;
■ Around 15 minutes to express milk during their regularly scheduled breaks;
■ Information on how to successfully continue to breastfeed after returning to work;
■ Support from their supervisors and colleagues; and
■ Access to lactation consultants and other health professionals who can help them with breastfeeding questions and concerns.
Slide #19 Components of a Lactation Support Program
■ These are the basic components of a lactation support program, and companies can choose from many options to fashion a program that best meets their needs and the needs of their employees.
Slide #20 Gradual Return to the Workplace
■ It’s always best if women can phase back to work gradually. This gives their baby and their body time to adjust to being separated.
■ One option many companies have considered is allowing women to work part-time for a while. When Aetna implemented a policy allowing mothers this option, they found that this sole change led to a 50 percent decrease to their attrition rate and a savings of one million dollars in turnover expenses (Cardenas 2005).
Slide #21 Private Area for Milk Expression
■ It’s natural that a woman would want privacy to express milk during the workday. However, some women enjoy companionship with other women who are also expressing milk.
■ The good news is that a space as small as 4’ x 5’ for a single user is sufficient. The only requirements are that the room has a lock on the door and an electrical outlet so she can connect her electric pump. The lactation room should be located near running water so mothers can wash their hands and their equipment.
■ The pump room at the State Capitol in Des Moines, Iowa pictured on this slide shows that a simple room is sufficient.
Slide #22 Private Area for Milk Expression
■ If a closet or small space is not available, companies can allow women to use their own or a co-worker’s private office, or a conference room.
■ Some companies have invested in their program by constructing walls or partitions to enclose a small space in a larger room or a women’s lounge.
■ Options: closet, supplies room, server/IT room, conference room, dressing room at a retail store, makeshift screens or curtains in front of cubicles, etc.
■ Keep in mind that a restroom is NOT a sanitary place to breastfeed or express milk.
Slide #23 Room Amenity Options
■ Basic needs for the room are that the area be clean, with a simple comfortable chair and a shelf or table for equipment.
■ Some companies like Mutual of Omaha have provided more elaborate rooms with decorative touches that help women feel even more relaxed and comfortable.
■ Breast pumps are another tool that companies can provide. There are several options to consider:
■ Some companies find that renting a durable double electric pump that more than one woman can use makes the best business sense as it helps women express milk faster and more efficiently.
■ Other companies purchase or subsidize personal portable electric pumps that employees own and bring back and forth to work with them.
■ Some companies provide private space and ask women to simply bring their own breast pumps
Slide #24 Milk Storage Options
■ Mothers can use an insulated lunch bag with ice packs to keep their milk cool until they return home. Some portable electric pumps have cooler packs and storage space built into the bag.
■ Some employers, such as the Pentagon and Pizza Hut corporate headquarters, provide inexpensive college dorm room sized refrigerator located in the lactation room so mothers will have a place to keep their milk fresh during the day.
■ If the company has a standard refrigerator, it is acceptable for mothers to store milk since it is considered a food and is NOT considered a body substance or hazard according to OSHA guidelines. However, many mothers are reluctant to put their milk in a public access site.
Slide #25 Time to Express Milk
■ The basic need for mothers is two to three 15-20 minute breaks in an 8-hour work period to express milk. These breaks can usually be taken during the meal hour and at other allotted break times.
■ If mothers need a little more time, many companies allow women to make up the time before or after work, or take a shorter lunch period.
■ Some mothers choose to continue working while expressing milk (reading, doing emails, charting, participating in conference calls, etc.). Although some women are easily able to juggle both, this should not be expected or required as it may interfere with the mother being able to relax enough to adequately express her milk.
Slide #26 Education
■ Many mothers find that prenatal and postpartum information about managing working and breastfeeding is very helpful as they face their maternity leave and ultimate return to work.
Slide #27 Education
■ Some companies provide this information through breastfeeding classes held at the company. There are many breastfeeding experts in the community who can provide these classes for you.
■ Other companies contract with a lactation consultant to help provide classes, support group meetings, and to give one-on-one assistance if mothers face challenges.
■ Some companies simply provide employees with contact information of places to access classes and lactation support in the community. Some hospitals, WIC agencies, and local organizations provide free or reasonably priced classes.
Slide #28 Support
■ Mothers need very basic support from their supervisors and co-workers. A smile and understanding go a long way toward helping women feel good about their decision to breastfeed.
■ Many companies establish a workplace lactation support policy to formalize the support options available at the company. Providing training to supervisors and workers about the policy and the program will help them understand why women need support.
■ Many women also enjoy meeting with other breastfeeding employees to share strategies for success. Mother-to-mother support can be as simple as providing a bulletin board for them to share photos and notes, or as elaborate as offering regular support group meetings or Web-based communication forums for employees.
Slide #29 Model Companies and Public Agencies – Large
■ According to the Society for Human Resource Management’s 2007 survey, 42 percent of large companies in the United States today provide lactation support programs, and the numbers are growing (SHRM 2007). These companies represent many different kinds of businesses.
■ Even companies with primarily male employees (such as the Pentagon, Los Angeles Department of Water and Power, and Texas Instruments) find that lactation support makes good business sense. Studies show that when partners of male employees participate in a lactation support program, companies experience significant health-care savings and lower absenteeism rates among the men, as well (Cohen 1995). Examples of services to female partners of employees include:
■ Access to prenatal classes and postpartum support groups
■ Consultations with an IBCLC
■ Provision of a breast pump
■ Resources (such as books, pamphlets, videos, etc.)
■ [Include examples of local businesses if appropriate]
Slide #30 Model Companies – Medium
■ Examples of mid-sized companies that provide lactation support are Patagonia and a local Sears Roebuck & Co.
■ [Include examples of local businesses if appropriate]
Slide #31 Model Companies – Small
■ Even very small companies with just a handful of employees find that providing support to breastfeeding employees makes good business sense and increases loyalty to the company.
■ [Include examples of local businesses if appropriate]
Slide #32 Beginning a Lactation Support Program in Your Company
■ There are many community resources eager to help you begin a lactation support program in your company.
■ Many companies find that including the program as part of their employee health benefit services is the ideal way to begin, and housing it within their wellness division for program oversight works well.
■ Your community resources will be happy to help you convene a task force to explore the needs in your company, and fashion a program that will best meet those needs in a cost-effective manner.
Slide #33 Who Can Help
■ Lactation consultants, nurses, physicians, government programs, and many other staff are knowledgeable about how to support working mothers, and how to help you start a lactation support program.
Slide #34 How to Get Help in Our Community
■ Some people right here in our community who can help you are: [inset information about local resources.]
■ Implementing
The Business Case for Breastfeeding
In Your Community
Section 9: References
Academy of Breastfeeding Medicine. (2004). Protocol #8: Human milk storage information for home use for healthy full-term infants. Available online at: ace-files/protocol/milkstorage_ABM.pdf. Accessed 1-15-08.
Agency for Healthcare Research and Quality (AHRQ). (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Evidence Report: Technology Assessment, Number 153. Available online at: downloads/pub/evidence/pdf/brfout/brfout.pdf. Accessed 11-14-07.
Alliance for Work-Life Programs. (2007). A business case for work-life: work-life effectiveness can impact your business. Available online at: awlp/library/html/businessimpact.jsp?&printable. Accessed 1-04-08.
American Academy of Pediatrics. (2005). Breastfeeding and the use of human milk. Pediatrics 115(2), 496-506. Available online at: . Accessed 1-15-08.
Anderson D & Shapiro D. (1996). Racial differences in access to high-paying jobs and the wage gap between black and white women. Industrial and Labor Relations Review. 49(2):273-286.
Arlotti J, Cottrell B, Lee S & Curtin J. (1998). Breastfeeding among low-income women with and without peer support. Journal of Community Health Nursing. 15(3):163-178.
Athey R. (2004). It’s 2008: do you know where your talent is? Why acquisition and retention strategies don’t work. Deloitte Development Services L.P. Available online at free/Downloads/hciLibraryPaper_17738.pdf. Accessed 1-03-08.
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Beers T. (2001). A profile of the working poor, 1999. U.S. Department of Labor Bureau of Labor Statistics.
Berggren K. (2006). Working Without Weaning: A Working Mother’s Guide to Breastfeeding. Amarillo, TX: Hale Publishing.
Best Start Social Marketing (2004). Using Loving Support to Implement a Breastfeeding-Friendly Worksite Support Kit. Research brief. Funded by the U.S. Department of Health and Human Services, Health Resources and Services Administration’s Maternal and Child Health Bureau.
Biagioli F. (2003). Returning to work while breastfeeding. American Family Physician. 68(11):2201-2208.
Bridges C, Frank D & Curtin J (1997). Employer attitudes toward breastfeeding in the workplace. Journal of Human Lactation, 13(3):215-219.
Bromberg Bar-Yam N (1998). Workplace lactation support, part II: working with the workplace. Journal of Human Lactation. 14(4):321-325.
Bronner Y L, Bentley M & Caulfield L. (1996). Influence of work or school on breastfeeding among urban WIC participants. Unpublished Manuscript. Abstracts of the 124th Annual meeting of the American Public Health Association. New York, NY: American Public Health Association.
Brown C, Poag S & Kasprzycki C (2001). Exploring large employers’ and small employers’ knowledge, attitudes, and practices on breastfeeding support in the workplace. Journal of Human Lactation. 17(1):39-46.
Burke ME. (2005). 2005 Benefits Survey Report. Alexandria, VA: Society for Human Resource Management.
Burton W et al. (2006). The association between health risk change and presenteeism change. Journal of Occupational and Environmental Medicine. 48(3):252-263.
Cardenas R & Major D. (2005). Combining employment and breastfeeding: utilizing a work-family conflict framework to understand obstacles and solutions. Journal of Business and Psychology. 20(1):31-51.
Caulfield L, Gross S, Bentley M, Bronner Y, Kessler L, Jensen J, Weathers B & Paige D.
(1998). WIC-based interventions to promote breastfeeding among African-American women in
Baltimore: effects on breastfeeding initiation and continuation. Journal of Human Lactation.
14(1):15-22.
Cohen R, Lange L & Slusser W. (2002). A description of a male-focused breastfeeding promotion corporate lactation program. Journal of Human Lactation. 18(1):61-65. Available online at . Accessed 1-03-08.
Cohen P & Bianchi S (1999). Marriage, children, and women’s employment: what do we know? Monthly Labor Review. December 1999. 22-31.
Cohen R, Mrtek MB & Mrtek RG. (1995). Comparison of maternal absenteeism and infant illness
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Cohen R & Mrtek MB. (1994). Impact of two corporate lactation programs on the incidence and duration of breast-feeding by employed mothers. American J of Health Promotion. 8(6):436-441. Available online at . Accessed 1-03-08.
Colburn-Smith C & Serrette A. (2007). The Milk Memos: How Real Moms Learned to Mix Business with Babies – and How You Can, Too. New York, NY: The Penguin Group.
Colella A. (2001). Coworker distributive fairness judgments of the workplace accommodation of employees with disabilities. Academy of Management Review. 26:100-116.
Cricco-Lizza R. (2002). Thirst for the milk of human kindness: an ethnography of infant feeding decisions among black women enrolled in WIC. Doctoral thesis for program in Research and Theory Development, Division of Nursing, New York University.
Deloitte Development Services LLC. (2004). It’s 2008: do you know where your talent is? Why acquisition and retention strategies don’t work. Available online at: . Accessed 1-15-08.
Dickson V, Hawkes C, Slusser W, Lange L & Cohen R. (2000). The positive impact of a corporate lactation program on breastfeeding initiation and duration rates: help for the working mother. Unpublished manuscript. Presented at the Annual Seminar for Physicians, co-sponsored by the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and La Leche League International, on July 21, 2000.
Doan T, Gardiner A, Gay C & Lee K. (2007). Breast-feeding increases sleep duration of new parents. J Perinat Neonat Nurs, 21(3):200-206.
Dubois L & Girard M. (2005). Breast-feeding, day-care attendance and the frequency of antibiotic treatments from 1.5 to 5 years: a population-based longitudinal study in Canada. Social Science & Medicine. 60(9):2035-2044.
Dunn BF, Zavela KJ, Cline AD & Cost PA. (2004). Breastfeeding practices in Colorado businesses. Journal of Human Lactation. 20(2):170-177.
EEO Trust. (2001). New Zealand’s Best Employers in Work and Life 2001. Auckland, NZ.
Ehrenreich B. (2000). Nickel and Dimed. New York: Henry Holt and Company.
Earland J, Ibrahim SO & Harpin VA. (1997). Maternal employment: does it influence feeding practices during infancy? Journal of Human Nutrition and Dietetics. 10(5):305.
Every Mother, Inc. (2006). The Business Case for Breastfeeding: Amended Literature Review. Funded by the U.S. Department of Health and Human Service Health Resources and Services Administration’s Maternal and Child Health Bureau.
Fein S, Mandal B & Roe B. (2008). Success of strategies for combining employment and breastfeeding. Pediatrics, 122:S56-S62.
Fein B & Roe B. (1998). The effect of work status on initiation and duration of breastfeeding. American Journal of Public Health. 88 (7):1042-1046.
Frank E. (1998). Breastfeeding and maternal employment: two rights don’t make a wrong. Lancet. 352(9134):1083-1085.
Galtry J. (2003). The impact on breastfeeding of labour market policy and practice in Ireland, Sweden, and the USA. Social Science & Medicine. 57(2003):167-177.
Galtry J. (1997). Lactation and the labor market: breastfeeding, labor market changes, and public policy in the United States. Health Care for Women International. 18:467-480.
Gerber M. (1995). The E Myth: Why Most Small Businesses Don’t Work and What to Do About It. New York: HarperCollins Publishers, Inc.
Griffith R & Horn P. (2001). Retaining Valuable Employees. Thousand Oaks, CA: Sage Publishing Co.
Guendelman S, Kosa JL, Pearl M, Graham S, Goodman J & Kharrazi M. (2008). Juggling work and breastfeeding: effects of maternity leave and occupational characteristics. Pediatrics, 123(1):e38-e46.
Haider SJ, Jacknowitz A & Schoeni RF. (2003). Welfare work requirements and child well-being: evidence from the effects on breastfeeding. Demography. 40:479-497.
Health Career Agents. (2007). Health care agents: evaluation process – business planning. Available online at: emails/ddBizPlanning_p.asp. Accessed 11-10-07.
Hermann M. (2001). Encouraging breastfeeding among African Americans. Journal of the American Dietetic Association. 101(11): 8.
Heymann J, Earle A & Hayes J. (2007). The 2007 Work, Family, and Equity Index: How Does the United States Measure Up? Institute for Health and Social Policy. Available online at: mcgill.ca/files/hsp/WFEI2007.PDF.
Hofferth S. (2001). The impact of parental leave statutes on maternal return to work after childbirth in the United States. Paper presented at the meeting for the Organization for Economic Cooperation and Development, Paris France, February 12, 2001.
Hornell A, Aarts C, Kylberg E, Hofvander Y & Gebre-Medhin C. (1999). Breastfeeding patterns in exclusively breastfed infants: a longitudinal prospective study in Uppsala, Sweden. Acta Paediatrica. (88):203-211.
Human Milk Banking Association of North America. (2006). Best practice for expressing, storing, and handling human milk in hospitals, homes and child care settings. Raleigh, NC: HMBANA, 2006.
Kamerman SB. (2000). From maternity to parental leave policies: women’s health, employment, and child and family well-being. The Journal of the American Women’s Medical Association. 55, Table 1.0. Table available online at: rmation2850/information_show.htm?doc_id=80908. Accessed 11-14-07.
Kamper J et al. (2006). Population-based study of the impact of childcare attendance on hospitalizations for acute respiratory infections. Pediatrics. 118(4):1439-1446.
Kent JC et al. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics. 117:387-395.
Kim M. (2000). Women paid low wages: who they are and where they work. Monthly Labor Review. September 2000. 26-30.
Kimbro RT. (2006). On the job moms: work and breastfeeding initiation and duration for a sample of low-income women. Maternal Child Health Journal. 10(1):19-26.
Klerman JA & Leibowitz A. (1994). The work-employment distinction among new mothers. Journal of Human Resources. 29(2):277-303.
Lewallen LP et al. (2006). Breastfeeding support and early cessation. Journal of Obstetrical, Gynecological, and Neonatal Nursing. 35(2):166-172.
Li R, Fein S, Chen J, & Grummer-Strawn L. (2008). Why mothers stop breastfeeding: mothers’ self-reported reasons for stopping during the first year. Pediatrics, 122: S69-S76.
Li R, Rock V & Grummer-Strawn L. (2007). Changes in public attitudes toward breastfeeding in the United States, 1999-2003. Journal of the American Dietetic Association. 107:122-127.
Libbus M & Bullock L. (2002). Breastfeeding and employment: an assessment of employer attitudes. Journal of Human Lactation. 18(3):247-251.
Lyness K, Thompson C, Francesco A & Judiesch M. (1999). Work and pregnancy: individual and organizational factors influencing organizational commitment, timing of maternity leave, and return to work. Sex Roles. 41 (7-8):485-508.
Maloney C, Rep., 14th District, New York. Web address: maloney.index.php?option+com_issues&tasks=view_issue=262&parent=20&Itemid=35.
Mass J. (1998). Sleep: The Revolutionary Program that Prespares your Mind for Peak Performance. New York: HarperCollins.
McLeod D, Pullon S & Cookson T. (2002). Factors influencing continuation of breastfeeding in a cohort of women. Journal of Human Lactation. 18(4):335-343.
Mohrbacher N. (2007). Breast pumping: how much milk to leave. . Available online at: breastpumping/employed/leave.aspx. Accessed 1-04-08.
Mohrbacher N & Kendall-Tackett K. (2005). Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers. Oakland, CA: New Harbinger Publications, Inc.
Moquin C. (2008). Babies @ Work: Bringing New Life to the Workplace. Published by Parenting in the Workplace Institute.
Moquin C. (2008). How to Start a Babies-at-Work Program. Published by Parenting in the Workplace Institute.
Mutual of Omaha. (2001). Prenatal and lactation education reduces newborn health care costs. Omaha, NE: Mutual of Omaha.
National Association of Child Care Resource and Referral Agencies. (2007). Parents and the high price of child care: 2007 update. Available online at: policy/background_issues/price_cc_america.php. Accessed 1-03-08.
National Business Group on Health. (2007). Investing in Maternal and Child Health: An Employer’s Toolkit. Available online at: healthtopics/maternalchild/investing/. Accessed 11-14-07.
National Federation of Independent Business (NFIB). 2001. Small business problems and priorities. Available online at: object/2752737.html.
Nichols M & Roux G. (2004). Maternal perspectives on postpartum return to the workplace. Journal of Obstetrical, Gynecological, and Neonatal Nursing. 33(4):463-471.
Ortiz J, McGilligan K & Kelly P. (2006). Duration of breast milk expression among working mothers enrolled in an employer-sponsored lactation program. Pediatric Nursing. 30(2):111-119.
Ortiz J, McGilligan K & Kelly P. (2004). Duration of breast milk expression among working mothers enrolled in an employer-sponsored lactation program. Pediatric Nursing. March-April 2004.
Pagliarini R. 2007. The art of the elevator pitch. Seeking Available online at: money/elevator.htm.
Presser H & Cox A (1997). The work schedules of low-educated American women and welfare reform. Monthly Labor Review. April 1997, 25-34.
Reh FJ. (2007). What good people really cost. Available online at: management.cs/people/a/WhatPeopleCost.htm. Accessed 1-15-08.
Roe B, Whittington L, Fein A & Beck S. (1999). Is there competition between breast-feeding and maternal employment? Demography. 36(2):1042-1046.
Ruhm C. (2000). Parental leave and child health. Journal of Health Economics. 19(6):931-960.
Ryan A, Wenjun Z & Acosta A. (2002). Breastfeeding continues to increase into the new millennium. Pediatrics. 110:1103-1109.
Ryan, A. S. (1997). The resurgence of breastfeeding in the United States. Pediatrics, 99(4).
Sasser A et al. (2005). Economic burden of osteoporosis, breast cancer, and cardiovascular disease among postmenopausal women in an employed poplation. Journal of Women’s Health Issues. 15: 97-108.
Schwartz D. (1996). The impact of work-family policies on women’s career development: boon or bust? Women in Management Review. 11(1):5-19.
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Secret M. (2006). Integrating paid work and family work: a qualitative study of parenting in the workplace childcare experiences. Community, Work and Family, 9(4):407-427.
Seijts G. (2004). Coworker perceptions of outcome fairness of breastfeeding accommodation in the workplace. Employee Responsibilities and Rights Journal. 16(3):149-166.
Seijts GH. (2002). Milking the organization? The effect of breastfeeding accommodation on perceived fairness and organizational attractiveness. Journal of Business Ethics. 40:1-13.
Shamansky S. (2002). Presenteeism…or when being there is not being there. Public Health Nursing, 19(2):79-80.
Slusser W. et al. (2004). Breast milk expression in the workplace: a look at frequency and times. Journal of Human Lactation. 20(2):164-169. Available online at . Accessed 1-03-08.
Society for Human Resource Managers (SHRM). (2007). 2007 benefits: a survey report by the Society for Human Resource Managers. Alexandria, VA: SHRM.
Suyes K, Abrahams S & Labbok M. (2008). Breastfeeding in the workplace: other employees’ attitudes twoards services for lactating mothers. International Breastfeeding Journal, 3:25.
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U.S. Department of Health and Human Services (2000). HHS Blueprint for Action on Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office on Women’s Health.
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Implementing
The Business Case for Breastfeeding
In Your Community
Section 10: Resources
Project Contacts
■ HCD International
Tiffany Pertillar (Project Manager)
tpertillar@
1-301-552-8803
Call-In Number for Conference Calls:
1-866-305-2467 (passcode: 652152#)
■ Every Mother, Inc.
Cathy Carothers
cathy@
662-332-0887 (home) or 662-931-6368 (mobile)
Kendall Cox
kendall@
662-332-9498
■ HRSA Maternal and Child Health Bureau
Isadora Hare (Project Officer)
ihare@
301-443-9720
■ HRSA Information Center (To Order Materials)
ask.
1-888-ASK-HRSA
Business Resources
■ Society for Human Resource Managers:
■ American Institute of Architects:
■ American Association of Health Plans:
■ National Business Group on Health:
Government Resources
■ Healthy Start Association:
■ HHS Office on Women’s Health:
Other Resources
■ Babies at Work/Parenting at Work Institute:
■ Moms Rising:
■ Beach Cabini:
Lactation Resources
■ Human Milk Banking Association of North America:
■ International Lactation Consultant Association “Employer Directory”:
Year 1 State Contacts
|State |Representative One |Representative Two |
|Organization | | |
|CA | | |
| |Karen Peters |Anne Garrett |
|California Breastfeeding |1821A Speyer Lane |1084 Skyline Drive |
|Coalition |Redondo Beach, CA 90278 |Daly City, CA 94015 |
| |310-374-1012 |(415) 999-7176 |
| |kpeters@ |Anngarr950@ |
|CT | | |
| |Jennifer Matranga RN, CCE, IBCLC |Christine Bracken RN, MSN, IBCLC |
|Connecticut Breastfeeding|45 Grist Mill Rd |130 Huckleberry Lane |
|Association |Monroe, CT 06468 |Southington, CT 06489 |
| |203-895-7630 |860-628-0509 |
| |jenmatr@ |brack4@ |
|GA | | |
| |Arlene Toole |Mary Nicholson-Jackson |
|Georgia Breastfeeding |225 DeVilla Trace |2906 Cohassett Lane |
|Coalition |Fayetteville, GA 30214 |Decatur, GA 30034 |
| |404.616.4933 (work) |mnj03@ |
| |atoole@gmh.edu | |
|HI | | |
| |Eiko Cusick |Joan Kaneshiro |
|Breastfeeding Promotion |3056 Felix Street |Parents and Children Together |
|Council of Hawaii |Honolulu, HI 96816 |1485 Linapuni St., Ste 105 |
| |(808) 734-6552 |Honolulu, HI 96819 |
| |(808) 284-2445 |808-223-9082 |
| |cusickj001@hawaii. |fcjkaneshiro@ |
|LA | | |
| |Jessica Maddox, Executive Director |Meshawn Tarver |
|Central Louisiana |Post Office Box 1364 |193 Cityplace Drive Apt. B |
|Breastfeeding Coalition, |Alexandria, LA 71309 |Lockport, LA 70374 |
|Inc. |318-561-7805 |504-296-9209 |
| |jmaddox@ |meshawnt@dhh. |
| | |tarverma@ |
|IN | | |
| |Tina Babbitt RN, MSN, IBCLC |Tina Cardarelli, BsEd, IBCLC, RLC, CLE |
|Indiana Breastfeeding |6303 Landborough N. Dr. |State Breastfeeding Coordinator |
|Alliance |Indianapolis, IN 46220 |1991 E. 56th St. |
| |tbabbitt@ |Indianapolis, IN 46220 USA |
| | |317-924-0825 |
| | |tcardarelli@ |
|OR | | |
| |Amelia Psmythe, Director BCO |Sherri Tobin, MS, RD, IBCLC |
|Breastfeeding Coalition |c/o Community Health Partnership |Central Oregon Breastfeeding Coalition |
|of Oregon |315 SW Fifth Ave, Suite 202 |Deschutes County Health Department |
| |Portland, Oregon 97204 |2577 NE Courtney Dr |
| |503-804-6515 |Bend, OR 97701 |
| |Amelia@ |541-322-7442 |
| | |sherrit@co.deschutes.or.us |
| | |sherritobin@ |
|RI | | |
| |Erin Dugan, MPH, CLC |Kathy Moren, RN, IBCLC |
|Rhode Island |RI WIC Breastfeeding Coordinator |Chair, RI Breastfeeding Coalition |
|Breastfeeding Coalition |Rhode Island Department of Health |37 Castle Rocks Road |
| |3 Capitol Hill, Room 302 |Warwick, RI 02886 |
| |Providence, RI 02908 |(401) 742-1777 |
| |(401) 222-1380 |Kathy@ |
| |Erin.Dugan@health. | |
|TX | | |
| |Alisa Niederstadt |Linda Jackson |
|Texas Breastfeeding |2636 South Loop West, #625 |216 S. Windomere Avenue |
|Coalition |Houston, Texas 77054 |Dallas, Texas 75208 |
| |713-728-8590 x14 |214-289-6830 |
| |alisa.niederstadt@uth.tmc.edu |linda.jackson@parknet. |
|UT | | |
| |Judith Harris, MPH, RD, IBCLC |Elizabeth Smith |
|Utah Breastfeeding |Utah Department of Health WIC Program |50N Medical Drive Room AA209 |
|Coalition |288 N 1460 W |Salt Lake City, UT 84132 |
| |PO Box 141013 |801-581-2896 |
| |Salt Lake City, UT 84114-1013 |Elizabeth.Smith@hsc.utah.edu |
| |801-538-6122 | |
| |801-386-2812 | |
| |judyharris@ | |
|Healthy Start Site |Representative One |Representative Two |
|Baltimore, MD |Alma Roberts, MPH, FACHE |Dana Gaskins |
| |President/CEO |Director of Health Education and Marketing |
|Baltimore City Healthy |Baltimore City Healthy Start, Inc. |410-396-7318 |
|Start, Inc. |2521 N. Charles St. |Dana.gaskins@ |
| |Baltimore, MD 21218 | |
| |410-396-7318 office | |
| |410-916-3266 cell | |
| |410-366-2855 fax | |
| |Alma.roberts@ | |
|Birmingham, AL |Rickey Green |Kelley Swatzell, MPH |
| |Project Director |Assistant Professor |
|Birmingham Healthy Start |205-324-4133 |UAB School of Health Professions |
| |Rickey.green@ |Chair, Breastfeeding Friendly Workplace |
| | |Subcommittee |
| | |Alabama Breastfeeding Committee |
| | |1705 University Blvd., RMSB 461 |
| | |Birmingham, AL 35294-1212 |
| | |205-975-2924 |
| | |205-516-1946 |
| | |ksw@uab.edu |
|Dublin, GA |Margaret Turner |Doris Donaldson |
| |Director/Coordinator |Lactation/Perinatal Educator |
|Heart of Georgia Healthy |Heart of Georgia Healthy Start |478-274-7616 |
|Start |912 Bellevue Ave. |dtdonaldson@dhr.state.ga.us |
| |Dublin, GA 31021 | |
| |mmturner@dhr.state.ga.us | |
| |478-274-7616 | |
| |478-274-7622 fax | |
|Fresno, CA |Laurie Misaki, RN, BSN | |
| |Perinatal Services Coordinator | |
|Babies First |Breastfeeding Promotion Coordinator | |
| |Maternal, Child, and Adolescent Health | |
| |Fresno County Department of Public Health | |
| |1221 Fulton Mall | |
| |Fresno, CA 93721 | |
| |559-445-3307 | |
| |559-445-3237 fax | |
| |lmisaki@co.fresno.ca.us | |
|Washington, DC |Karen Watts, RNC, FACHE, FAHM, PMP |JoAnn Smith |
| |Bureau Chief, Perinatal and Infant Health |Community Health Educator |
|DC Healthy Start Wards 5 |Department of Health, Community Health Administration |202-698-7350 |
|&6 |825 North Capitol St. NE 3rd Floor |Joann.smith1@ |
| |Washington, DC 20002 | |
|Healthy Families, Healthy|202-698-7031 |Laura Charles Horne |
|Start |202-698-7028 fax |202-420-7140 |
| |202-834-2853 cell |lcharlesh@ |
| |Karenp.watts@ | |
State-Specific Resources
[Insert contact information shared during the training event here]
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