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For the Babies: Last Year’s Lactation-at-work Law Needs Broader Support

Published on 1/13/2024
“Breast is best,” midwives and OBGYNs began to say in the 1990s. Infant formula had for decades been touted as the way to nourish newborns, but new evidence supported nature’s tried and true method. 

Funny to consider, but the adoption of formula may be one factor that has allowed women to have careers. Its invention in 1865 had a powerful impact, not only on saving the lives of orphaned infants and babies whose mothers couldn’t nurse, but on world economies, national GDP, and household income from the Industrial Revolution to the present. Suddenly poor women didn’t have to leave their infants in a foundry to become wet nurses to wealthier families. Poor and wealthy women had a dry nursing option, providing wealthy women who didn’t want to nurse and women desperate to work with a stable source of nutrition for their infants. Formula afforded women choices, giving them flexibility to work. 

Over one hundred years later, the overwhelming evidence supports breastfeeding, whenever possible, as the superior means to help little humans thrive, and its benefits last a lifetime, which has left working mothers with a conundrum. How long can they nurse infants before they must return to work? When they return, can they sustain a practice of pumping and storing milk? How long? Will their FMLA or parental leave, in combination with employer support help facilitate the recommended 2 years of nursing recommended by pediatricians, the CDC and World Health Organization (WHO)? Until the passage of national standards in 2023, workplace regulations were spotty, varying state by state.

70% of employed mothers with children under three work full-time. In the U.S., most employers provide no more than six weeks of paid maternal-parental leave - some pay even less! - after which most women need to return to work to keep their households financially stable. The CDC reports that one-third of mothers return to work within three months of giving birth and two-thirds return to work within six months, and once they do, breastfeeding drops off. Lower-income women, who are mostly African American and Hispanic American, work service jobs and in blue-collar industries, making breastfeeding a challenge, even as their children are at higher risk for the very conditions that breastfeeding helps to prevent. Infant formula is an adequate, but less-than-ideal solution.

Early on formula provided a means to fatten up babies, but doctors knew it lacked vitamins. Older readers may recall mixing evaporated milk, karo syrup and vitamin supplements daily to create their supply. In 1980, the FDA regulated formula and many shelf-stable brands came ready to mix with water. Unsafe tap water and shortages in recent memory have plagued its usage, but at least formula helped women whose workplaces failed to accommodate lactation.

Yet formula cannot replace the unique benefits of breastmilk.  According to thousands of studies examined by the medical journal Lancet, breast milk

naturally has all the nutrients babies need to grow and develop. It adapts with an infant, balancing proteins, fats, and healthy sugars as the baby grows.

has antibodies that improve “passive immunity” to prevent sickness. Formula-fed babies are sick more often, leading parents to take off more time from work and seek medical help more often.

helps prevent health problems such as allergies, eczema, ear infections, and stomach problems. 

may prevent one-third of respiratory infections and half of all diarrhea episodes. 

prevents 800,000 child deaths a year, based on over 1300 studies. 

helps reduce obesity and diabetes.

helps prevent sudden infant death syndrome (SIDS).

eases post-pregnancy weight loss.

Increases oxytocin which helps improve mood for many women.

helps lower the risk for breast and ovarian cancers, diabetes, and certain other diseases in mothers.

saves nearly $1,000 a year.

is safer to use than formula when water is not safe.

In some countries and industries, women receive extended paid time off to establish a strong breastfeeding routine, which is critical to producing enough breast milk. When it comes to breastfeeding, demand sustains supply, and when women don’t have frequent, long enough, private, quiet spaces as well as tools to pump breast milk, they are more likely to abandon nursing. In the absence of appropriate parental leave, nursing mothers need supportive workplaces to maintain a healthy breastfeeding routine. 

To standardize the workplace, the 2023 Omnibus Spending Act included a measure requiring companies to provide space and time for women to pump breast milk. The new regulation covers hourly workers eligible for overtime pay who work for companies with more than 50 employees. It requires companies to provide the time and a place to pump.

Before last year’s law, the workplace lacked uniformity, with some states and exemplary organizations helping lactating women. Even after its passage, lactation at work may continue to be a challenge. Women who are unaware of their rights may be employed by organizations that do the bare minimum to meet OSHA requirements. 

Purdue professor Elizabeth Hoffman co-wrote a 2022 study published on lactation at work, finding that employers in states required to provide breaks and places to express breast milk varied in how well they followed the laws. Her study found that some employers provide robust accommodations - private rooms with pumps and fridges close to the workspaces of employees, plenty of regular breaks, lactation education and support groups. Hoffman found some employers publicize or recruit saying they support lactating mothers, but may be omitting all of the elements of a quality implementation. The least cooperative employers follow the mere letter of the law. Women may have limited break time with lactation rooms so far from workstations that most of the break is spent in travel to and from the space. Without enough time, appropriate support, and tools, breastfeeding mothers more quickly abandon their resolution to work and breastfeed. 

Thus parents must know about and speak up for their rights, knowing the benefits of being able to pump at work improves health and life in multiple ways. Change often brings resistance or reticence, even when the law requires it, but if parents band together and speak to their HR departments, companies will need to comply.