Access to Workplace Accommodations to Support Breastfeeding after Passage of the Affordable Care Act

Abstract

Objectives This study examines access to workplace accommodations for breastfeeding, as mandated by the Affordable Care Act, and its associations with breastfeeding initiation and duration. We hypothesize that women with access to reasonable break time and private space to express breast milk would be more likely to breastfeed exclusively at 6 months and to continue breastfeeding for a longer duration. Methods Data are from Listening to Mothers III, a national survey of women ages 18–45 who gave birth in 2011–2012. The study population included women who were employed full- or part-time at the time of survey. Using two-way tabulation, logistic regression, and survival analysis, we characterized women with access to breastfeeding accommodations and assessed the associations between these accommodations and breastfeeding outcomes. Results Only 40% of women had access to both break time and private space. Women with both adequate break time and private space were 2.3 times (95% CI 1.03, 4.95) as likely to be breastfeeding exclusively at 6 months and 1.5 times (95% CI 1.08, 2.06) as likely to continue breastfeeding exclusively with each passing month compared to women without access to these accommodations. Conclusions Employed women face unique barriers to breastfeeding and have lower rates of breastfeeding initiation and shorter durations, despite compelling evidence of associated health benefits. Expanded access to workplace accommodations for breastfeeding will likely entail collaborative efforts between public health agencies, employers, insurers, and clinicians to ensure effective workplace policies and improved breastfeeding outcomes.

Maternity Leave Length and Workplace Policies' Impact on the Sustainment of Breastfeeding: Global Perspectives

“…All three studies reviewed found that women were twice as likely to breastfeed when there was a private space for lactation. One study found pump breaks resulted in women being twice as likely to breastfeed, whereas a subsequent study found women to be six times as likely to breastfeed with guaranteed pump breaks (Kozhimannil et al, 2016;Tsai, 2013). Workplace policies that support lactation by providing a private space, guaranteed breaks as well as employer and coworker support were consistent themes in all studies reviewed.…”

“…In addition, while the federal law only requires break times up to 1 year, Oregon's policy allows for 18 months, Colorado's for 2 years and New York guarantees this provision for 3 years. Despite passage of the access to workplace accommodations to support breastfeeding, a recent survey of over 500 employed women in the United States reported that only 40% of the women had access to both break time and private space (Kozhimannil, Jou, Gjerdingen, & McGovern, 2016). Those employed women with adequate break time and space were 2.3 times as likely to breastfeed exclusively at 6 months.…”

“…Most of the studies reviewed were descriptive in design. Only three survey studies reported any association with potential for prediction when evaluating workplace policy (Basrowi et al, 2015;Kozhimannil et al, 2016;Tsai, 2013). All three studies reviewed found that women were twice as likely to breastfeed when there was a private space for lactation.…”

Making Milk and Money: Contemporary Mothers' Orientations to Breastfeeding and Work

“…This assumes (1) that a workplace is aware of the breastfeeding status of all employees and (2) that it can easily designate space should the need arise. A recent study by Kozhimannil et al (2016) found that only 40% of new mothers who returned to work had access to workplace accommodations for breastfeeding (reasonable break time and private, nonbathroom space). Thus, even if women's orientations to the breastfeeding, mothering, and work relationship are shifting over time, the institutional response continues to lag behind.…”

Examination of Maternal Assets and Breast Milk Expression

“…The theory of planned behavior (TPB) is often utilized to understand breastfeeding behaviors. [20][21][22][23][24] This theory posits that behavior is directly linked to the intention to perform the behavior. The intention, in turn, is influenced by three direct constructs: attitude, subjective norm, and perceived behavioral control.…”