Skip Navigation

Strengthen the Evidence for Maternal and Child Health Programs

Sign up for MCHalert eNewsletter

Evidence Tools
MCHbest. Breastfeeding.

MCHbest Logo

Strategy. Family Leave, Workplace Policies, State Laws

Approach. Provide trainings and other supports on workplace Mother-Friendly breastfeeding support policies (e.g., employer-provided break time and private space to breastfeed) across the state/jurisdiction

Return to main MCHbest page >>

Overview. Mother-Friendly breastfeeding support policies in the workplace can range from lactation breaks, private spaces to breastfeed, and access to breastfeeding support to extended maternity leave and paid family leave policies. Studies show that breastfeeding initiation, duration, and exclusivity increase with greater workplace support, family leave policies, and state laws.[1,2,3,4,5,6]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Environmental Health. This strategy improves the impact of physical, chemical, and biological factors in the environment on health.
  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of employers receiving training on Mother-Friendly breastfeeding support policies. (Measures the reach and scale of workforce education efforts.)
  • Number of workplace lactation rooms or spaces established with program support. (Quantifies the environmental changes made to facilitate breastfeeding.)
  • Number of state/local agencies collaborating to promote Mother-Friendly policies. (Tracks the extent of multi-sector partnership and collective action.)

OUTCOME MEASURES:

  • Number of employees potentially benefiting from Mother-Friendly policies at trained workplaces. (Estimates the number of women reached by the policy changes.)
  • Number of employers that adopt Mother-Friendly breastfeeding policies after receiving training. (Assesses the direct influence of training on policy implementation.)
  • Number of employees who use workplace lactation supports post-policy implementation. (Measures utilization of Mother-Friendly accommodations by breastfeeding women.)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of Mother-Friendly policy training content that is evidence-based and cites current laws/regulations. (Assesses the quality and legal grounding of educational materials.)
  • Percent of workplace trainings that include real-world examples and practical implementation resources. (Measures adult learning principles and decision-support for employers.)
  • Percent of employers receiving technical assistance to develop a written Mother-Friendly policy. (Tracks individualized support for policy codification and systemization.)

OUTCOME MEASURES:

  • Percent of trained employers who report increased knowledge of Mother-Friendly policy rationale and requirements. (Measures the educational effectiveness of trainings.)
  • Percent of employees who continue breastfeeding at 3, 6, and 12 months after returning to a Mother-Friendly workplace. (Assesses policy impact on breastfeeding duration.)
  • Percent of employers with Mother-Friendly policies who report improved employee retention and satisfaction. (Captures benefits to the workplace environment and culture.)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of state/local laws or regulations passed to protect and expand Mother-Friendly workplace policies. (Tracks the advancement of public policies to sustain the work.)
  • Number of breastfeeding coalitions and advocacy groups mobilized to promote Mother-Friendly policies. (Measures community activation and grassroots support for the initiative.)
  • Number of media stories or social media posts raising awareness of Mother-Friendly workplace policies. (Assesses public education and agenda-setting around the issue.)

OUTCOME MEASURES:

  • Number of women reporting use of paid family leave or flexible scheduling to support breastfeeding. (Captures utilization of broader policies that enable breastfeeding.)
  • Number of businesses recognized as Mother-Friendly workplaces through state/local designation programs. (Measures public validation and promotion of model policies.)
  • Number of state/local health plans providing coverage for workplace lactation support services. (Assesses integration of breastfeeding support into employee benefits.)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • - Percent of Mother-Friendly policy training and support targeted to employers of low-wage workers. (Assesses focus on workplaces with fewer resources and greater needs.)
  • - Percent of small businesses and family-owned firms assisted to implement Mother-Friendly policies. (Measures equitable outreach to employers that may face unique challenges.)
  • - Percent of workplace policy efforts that address needs of non-traditional and contract workers. (Evaluates attention to workers who may fall outside typical policy protections.)

OUTCOME MEASURES:

  • - Percent increase in breastfeeding rates among low-income women after Mother-Friendly policy implementation. (Measures policy impact on addressing socioeconomic disparities.)
  • - Percent of women who stop breastfeeding after returning to work, compared to pre-policy baseline. (Assesses shifts in a key barrier to breastfeeding duration and exclusivity.)
  • - Percent of all employers in the state/jurisdiction that provide some form of Mother-Friendly accommodation. (Tracks population-level penetration and cultural norm change.)change.)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Huang R, Yang M. Paid maternity leave and breastfeeding practice before and after California's implementation of the nation's first paid family leave program. Econ Hum Biol. 2015;16:45-59.

2 McCardel, R. E., & Padilla, H. M. (2020). Assessing workplace breastfeeding support among working mothers in the United States. Workplace health & safety, 68(4), 182-189.

3 Delle Donne, A., Hatch, A., Carr, N. R., Aden, J., & Shapiro, J. (2019). Extended maternity leave and breastfeeding in active duty mothers. Pediatrics, 144(2).

4 Wallenborn, J. T., Perera, R. A., Wheeler, D. C., Lu, J., & Masho, S. W. (2019). Workplace support and breastfeeding duration: The mediating effect of breastfeeding intention and self‐efficacy. Birth, 46(1), 121-128.

5 Hamad, R., Modrek, S., & White, J. S. (2019). Paid family leave effects on breastfeeding: a quasi-experimental study of US policies. American journal of public health, 109(1), 164-166.

6 Shumbusho, D. I., Kucera, C. W., & Keyser, E. A. (2020). Maternity Leave Length Impact on Breastfeeding and Postpartum Depression. Military Medicine, 185(11-12), 1937-1940 .

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.