Thank you for supporting Missouri breastfeeding mothers.

1. Thank you for supporting Missouri breastfeeding mothers. • This presentation is designed to provide information about: • Benefits of breastfeeding • Federal legislation relating to milk expression in the workplace • Providing support to working mothers • Missouri Breastfeeding Friendly Worksite Program • Please alter the presentation to fit your audience’s needs. • Contact the State Breastfeeding Coordinator if you have questions about the content. Kathy Mertzlufft (573) 526-4792 or kathy.mertzlufft@health.mo.gov **REMOVE THIS SLIDE BEFORE GIVING THIS PRESENTAION**

2. Healthy Moms. Healthy Babies. Healthy Business.

3. Topics • Making the Case for Worksite Lactation Support • Provisions of the Worksite Lactation Accommodation Law • Going Beyond the Law • Missouri Breastfeeding Friendly Worksite Program and Award

4. Supporting Breastfeeding is WIN-WIN for Companies and Employees

5. Bottom-Line Benefits ROI = 3 to 1

6. Women in the Workforce 2011 data from U.S. Department of Laborshows: • 58% of women work outside the home • 61% with children under age 3 are employed • 64% with children under age 6 are employed • Growth rate has increased by 80% over the last 20 years http://www.bls.gov/cps/wlf-databook-2012.pdf

7. Breastfeeding Impacts Infants • Short-Term Health Benefits • Fewer ear infections • Fewer respiratory infections • Fewer gastrointestinal disorders • Lower risk of Sudden Infant Death Syndrome • Long-Term Health Benefits • Improved growth and development • Lower risk of obesity • Improved cardiovascular disease through life • Higher IQ • Lower risk of childhood cancer (including leukemia) • Lower risk of Type 1 and Type 2 diabetes

8. Impact on Children in Daycare Health impact is even greater on infants enrolled in daycare centers • Daycare attendance is associated with double the odds of needing antibiotic therapy • Infants breastfed at least 4 months significantly decreased those odds • Protective effect of breastfeeding on children in daycare persists well into child’s second year of life Dubois, L & Girard, M. (2004). 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 and Medicine, 60(9): 2035-2044.

9. Breastfeeding Impacts Mothers • Short-Term Health Benefits • Faster recovery from pregnancy and childbirth • Faster loss of pregnancy weight • Greater sleep at night! • Long-Term Health Benefits • Lower risk of breast cancer • Lower risk of ovarian cancer • Lower risk of Type 2 diabetes • Lower blood pressure • Lower risk of cardiovascular disease past menopause

10. Making a Difference for Families

11. National Health Care Savings If 90% of women breastfeed exclusively to 6 months, the U.S. could save annually >$13 billion and prevent the deaths of nearly 1,000 infants Bartick M & Reinhold. (2010). The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics, e1048-e1056.

12. Making it WORK for Business

13. Lactation Support Lowers Health Care Costs • For every 1,000 babies who are NOT breastfed compared to exclusively breastfeeding babies, there are an extra: • 2,033 physician visits • 212 hospitalization days • 609 prescriptions Ball T & Wright A. (1999). Health care costs of formula-feeding in the first year of life. Pediatrics. 103(4):871-876.

14. Case Study: Mutual of Omaha • Newborn health care costs were THREE TIMES LESS for mothers in the program ($1,269 vs. $3,415) • Annual savings: $115,881 total • Annual Savings per participant: $2,146 (Mutual of Omaha 2001)

15. Lactation Support Reduces Absenteeism • One-day absences occur twice as often for employees whose babies are not breastfed (Cohen 95) • Absenteeism rates are lower for male employees when female partners breastfeed (Galtry 97) Employee breaks are predictable. Absences are NOT!

16. Case Study: CIGNA • Lactation program resulted in a 77% reduction in lost work time due to infant illness • Annual savings: $60,000 (Dickson 2000)

17. Lower Turnover RETAIN vs. RETRAIN 6 out of 10 women return to work when no support services are offered 8.5 out of 10 women return to work when breastfeeding support services available

18. Lactation Support Satisfies Employees Employees of companies providing lactation support feel more productive and loyal to the company. (Galtry 97; Frank 98)

19. Break Time for Nursing Mothers Under the Fair Labor Standards Act Section 4207 amended Section 7 of the FLSA—requires employers to provide nursing employees with: • Reasonable break time to express breast milk • A place, other than a bathroom, that may be used to express milk • For up to one year after the child’s birth New requirement became effective March 23, 2010, when President Obama signed the Affordable Care Act

20. Other Provisions • Applies to non-exempt (over-time eligible) employees • Does NOT cover salaried employees, teachers, military and transportation workers • Employers with less than 50 employees can apply for exemption if they can prove “undue hardship” • Support must be provided for up to a year after child’s birth

21. Department of Labor Fact Sheet #73

22. What Women Need to Express Milk at Work • Milk production is an ongoing process; if it is not removed, production will decline • Breaks every 2-3 hours (15-20 minutes) • Physical and psychological factors • Privacy • Ability to relax • Information about how to make it work • Support

23. Busting a Few Myths • Breast milk is NOT considered a “bio hazard” according to OSHA; it is considered FOOD • Human milk can be stored in a cooler or insulated lunch bag • Nursing employees are NOT more fatigued • It is NOT okay to make jokes about breastfeeding moms

24. Beginning a Lactation Support Program in Your Company • Establish as part of company health benefit services • House within the wellness division • Convene a task force with key company stakeholders to identify needs and solutions • Gain assistance from community resources • Promote the program with all employees and supervisors to gain buy-in and support

25. What is Reasonable? • Most women need 2-3 milk expression sessions per 8-hour period • Around 15-20 minutes needed + time to get to the lactation room • Nursing needs change over time! • Most women use their usual breaks and meal period • Paid vs. unpaid breaks • Options if extra time is needed

26. Support Basic Needs • Support from company managers, supervisors and co-workers • Mother-to-mother support Flexible Options • Worksite lactation support policy • Training for supervisors and co-workers • Mother-to-mother support group • Electronic list serves or company web-based connection network

28. Private Place Other than a Bathroom “Shielded from view and free from intrusion from co-workers and the public.”

29. How Big Should the Space Be? • Large enough for a chair and a flat surface for the pump • Electrical outlet is preferred • Lock is not required, but privacy must be ensured

30. What Goes IN the Space? • Basic amenities: • Chair (not a rocker) • Flat surface to put pump • Electrical outlet for pump • Anti-microbial wipes • Amenities mothers value: • Small refrigerator • Artwork • Bulletin board for baby photos • Breast pump • Sink • Clock • Breastfeeding information

31. Breast Pump

32. Examples of Single User Rooms

33. Multi-Use Rooms

34. Lactation Rooms Within Ladies’ Lounge University of Alabama at Birmingham

35. Shared Room in a Building Medical Mall Health Department, Jackson, MS

36. Cubicle Walls

37. Partitions

38. Rolling Partitions

39. Retail Stores

42. Convenience Stores

43. Easy Space Solutions

44. Dressing Rooms

45. Restaurant Accommodations • Space: • Manager’s office • No camera • Locked HR files • Time: • “no problem” • “as needed”

46. K-12 Schools • Create a space within a larger space • Private offices (teacher, principal, guidance counselor) • School clinic/nurse office

47. Going Beyond the Law

48. Gradual Return to the Workplace • Gradual phase back to work to allow mother and baby time to adjust to the separation Longer Term Options • Part-time for a period of time • Job sharing • Telecommuting • Flexible scheduling (ex: taking off Wednesdays for a period of time)

49. Education Find a Lactation Consultant Directory www.ilca.org

50. Babies at Work • Direct access to baby increases duration of breastfeeding (Fein 2008) • Babies at Work Programs: • Lower absenteeism and turnover • Lower health care costs • Improve productivity and morale (www.babiesatwork.org)