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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Breastfeeding.

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Strategy. Workplace Supports for Breastfeeding

Approach. Support the establishment of worksite lactation policies that comply with federal standards

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Overview. Workplace policies and practices to support breastfeeding include encouraging breastfeeding breaks to nurse or express milk, allowing babies at work, offering flexible schedules, telework options, or extended maternity leave with or without pay. The 2010 Fair Labor Standards Act (FLSA) requires employers to provide a private space, other than a bathroom, and reasonable break time to breastfeed or express milk. Employers can also equip lactation rooms with a high quality pump, microwave to sterilize equipment, refrigerator, sink, and comfortable furniture; offer onsite or nearby childcare; or provide professional lactation services. Workplace supports vary depending on company resources, size, and budget.[1,2]

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. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

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

  • 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).
  • Environmental Health. This strategy improves the impact of physical, chemical, and biological factors in the environment on health.
  • Policy. This strategy helps to promote decisions, laws, and regulations that promote public health practices and interventions.

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 educated about the FLSA requirements and benefits of lactation support policies. (Measures outreach efforts)
  • Number of worksite assessments conducted to evaluate the availability and quality of lactation accommodations. (Assesses workplace readiness)
  • Number of employees who received information about their rights and options for lactation support in the workplace. (Evaluates employee awareness)

OUTCOME MEASURES:

  • Total number of employers that have implemented FLSA-compliant lactation support policies. (Captures policy adoption)
  • Number of lactation rooms or designated spaces established in the workplace. (Measures infrastructure changes)
  • Number of employees who utilized the lactation support services or accommodations provided by their employer. (Assesses program utilization)

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

PROCESS MEASURES:

  • Percent of lactation rooms that meet the minimum requirements for space, privacy, and amenities as outlined in the FLSA. (Measures quality of accommodations)
  • Percent of managers and supervisors who completed training on implementing and supporting lactation accommodation policies. (Evaluates leadership engagement)
  • Percent of employees who reported receiving adequate break time and a suitable space for lactation in the workplace. (Assesses policy implementation)

OUTCOME MEASURES:

  • Percent of breastfeeding employees who reported satisfaction with the lactation support provided by their employer. (Measures employee experience)
  • Percent of employees who continued breastfeeding for at least 6 months after returning to work. (Captures breastfeeding duration)
  • Percent of employers who reported improved employee retention, morale, and productivity after implementing lactation support policies. (Assesses business impact)

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

PROCESS MEASURES:

  • Number of collaborations formed between employers and community organizations to enhance lactation support resources and services. (Measures community partnerships)
  • Number of best practice sharing sessions or webinars conducted for employers to learn from exemplary lactation support programs. (Evaluates peer learning)
  • Number of workplace wellness initiatives that integrated lactation support as a key component. (Assesses program integration)

OUTCOME MEASURES:

  • Number of employees who reported a successful transition back to work while continuing to breastfeed with the support of workplace accommodations. (Captures work-life integration)
  • Number of sick days or healthcare costs avoided due to the health benefits of continued breastfeeding for both mother and child. (Measures cost savings)
  • Number of employers recognized or certified as "breastfeeding-friendly" based on their exemplary lactation support policies and practices. (Assesses employer recognition)

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

PROCESS MEASURES:

  • Percent of small businesses and employers in low-wage industries that received targeted outreach and support to implement lactation accommodations. (Measures equitable outreach)
  • Percent of workplace lactation support policies that included provisions for part-time, temporary, and contract workers. (Evaluates inclusion)
  • Percent of lactation support resources and materials that were adapted for different languages, literacy levels, and cultural backgrounds. (Assesses cultural competence)

OUTCOME MEASURES:

  • Percent reduction in breastfeeding disparities among working mothers from different racial, ethnic, and socioeconomic groups. (Measures equity impact)
  • Percent of low-income or hourly wage-earning mothers who reported being able to continue breastfeeding after returning to work due to lactation accommodations. (Captures social justice)
  • Percent increase in the proportion of employers providing FLSA-compliant lactation support, particularly in industries with historically low rates of accommodation. (Assesses system-level 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 CDC-Breastfeeding 2013 - Centers for Disease Control and Prevention (CDC). The CDC guide to strategies to support breastfeeding mothers and babies. Atlanta: US Department of Health and Human Services (US DHHS); 2013.

2 US DOL-Nursing - US Department of Labor (US DOL); Wage and Hour Division. Break time for nursing mothers.

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.