in Support of Oregon Senate Bill 618
to Breastfeeding in the Workplace
Cynthia Good Mojab, MS, IBCLC, RLC, CATSM
Chair Monnes Anderson, members of the Senate
Health Policy, my name is Cynthia Good Mojab. I am a mother, maternal
health advocate, author, educator, private researcher, Research
the Publications Department of La Leche League International, volunteer
breastfeeding counselor with La Leche League International,
Certified Lactation Consultant, and Registered Lactation Consultant. I
pleased to share information with you about why I personally support
and why your support of Oregon Senate Bill 618 is so important. My five
points are that 1) formula feeding has significant health risks, 2)
mothers active in the paid workforce often encounter barriers to
3) workplace policies supporting breastfeeding increase employee morale
retention, protect mothers and their children from exposure to the
of breastmilk substitutes and early weaning, and help employers avoid
that formula feeding poses to them via greater employee absenteeism and
insurance expenditure (due to greater infant illness), 4) legislation
protecting breastfeeding mothers in the workplace is needed to ensure
ability to breastfeed, and 5) your support is needed to help pass Bill
Implications of Infant Feeding
Infant feeding is a major health issue that
overstated but is routinely underestimated. The information included in
testimony is just a small excerpt from our current wealth of research
demonstrating the importance of breastfeeding and the importance of
protecting breastfeeding mothers in the workplace. Formula feeding
risks to the health of mothers and their children in both developed and
developing countries (Lawrence 1997; Walker 1992, 1998, 2004; National
Institute of Health 2004):
- Formula fed infants are at greater risk of
illness, disease, and hospitalization than breastfed infants. In
formula-fed infants are 10 times more likely to be hospitalized for
bacterial infections (Fallot, et al. 1980). The added health risks of
formula feeding account for 7% of all infants hospitalized for
respiratory infections (Howie, et al. 1990). Inner ear infections
(otitis media) are 3 to 4 times more prevalent among formula-fed
infants than among breastfed infants (Saarinen 1982). In industrialized
nations, formula-fed infants have a 3 to 4 fold greater risk of
diarrheal illness and a five times greater risk of severe rotavirus
gastroenteritis (Duffy, et al. 1986). Formula feeding accelerates the
development of celiac disease, is a risk factor for ulcerative colitis
and Crohn’s disease in adulthood, and accounts for 2 to 26% of insulin
dependent diabetes mellitus in children (Greco, et al. 1988; Koletzko,
et al. 1989; Whorwell, et al. 1979; Mayer et al., 1988). North American
formula-fed infants are 4 to 16 times more likely to develop H
influenzae bacteremia and meningitis (Cochi, et al. 1986). The risk of
lymphomas (childhood cancers) in children under 15 years of age is 5 to
8 times greater for those fed formula or breastfed less than six months
(Davies, et al. 1988).
- The consumption of formula is associated
with learning and cognitive deficiencies in children aged one through
18 years of age (Morley, et al. 1988; Morrow-Tlucak, et al. 1988; Bauer, et al. 1991; Taylor & Wadsworth
1984; Lucas, et al. 1992; Johnson, et al. 1996; McCreadie 1997; Horwood
- Formula exposed infants have greater and
more severe allergic manifestations than infants not exposed to formula
(Merrett, et al. 1988; Ellis, et al., 1991; Saylor & Bahna 1991;
Israel et al. 1989; Harris, et al. 1989; Host, et al. 1988; Bahna
1987). Formula-fed infants are nearly 5 times more likely to show
symptoms of allergy than breastfed infants (Harris, et al. 1989).
- Formula-fed infants in the United States are more likely to die than breastfed
infants. Out of every 1000 infants born each year in the United
States, four die because they are not
breastfed (Rogan 1989). Formula fed infants are 25% more likely to die
between 28 days and one year of life than infants who were breastfed
(NIH 2004). Out of every 1000 infants born each year in western
industrialized nations, one sudden infant death (SIDS) occurs as a
result of failure to breastfeed (Damus, 1988). Necrotising
enterocolitis (NEC), a potentially fatal condition, is 20 times more
common among premature infants fed formula only; it is rare among
preterm infants whose diets include breastmilk (Lucas & Cole 1990).
- Mothers who formula feed have higher rates
of disease, including breast and ovarian cancer, anemia and osteoporosis
of Pediatrics 2005).
More health risks than can be included in
this testimony are
increased for both mother and child when infants are formula fed (e.g.,
summaries in Walker 1992,
2004; American Academy
of Pediatrics 2005). And, of course, the health risks of formula have
as well as human consequences. Looking only at three infant illnesses
respiratory tract illnesses, otitis media, and gastrointestinal
excess cost of health care services due to more office visits,
and hospitalizations in formula-fed infants in the first year of life
between $331 and $475 per infant (Ball & Wright 1999).
People rarely hear about the risks and costs
feeding. Instead, they hear about the "benefits" of breastfeeding, as
though they are special perks above and beyond what mothers could want
themselves and their children (Good Mojab 2002). These "benefits" are
measured against the poorer health outcomes of formula feeding—outcomes
common in the United States
that they are seen as the "norm" by which we measure health (Good
Mojab 2002). Accurate comparisons of breastfeeding and formula feeding
nothing less than a paradigm shift: there are no "benefits" of
breastfeeding. In reality, breastfeeding is the foundation of
normal—not superior—human health and development. Learning about the
formula feeding can be an emotionally difficult experience, especially
information might have changed past decisions about infant feeding: why
someone tell us before? Yet without this information, mothers are
from making truly informed decisions about infant feeding. In no other
health care is information about risk so routinely withheld from people.
In recognition of the risks of formula
feeding, the American Academy of Pediatris (2005) recommends that
breastfeeding continue for at least
one year. Breastfeeding a child for at least two years is recommended
by the United Nations Children's Fund; World Health Organization;
United Nations Educational, Scientific and Cultural Organization;
United Nations Population Fund; United Nations Development Programme;
Joint United Nations Programme on HIV/AIDS, World Food Programme, and
the World Bank (UNICEF 2002). All of these institutions, including the
American Academy of Pediatrics, recommend exclusive breastfeeding
(i.e., no water, juices, teas, formula, solids, etc.) during the first
six months of life, with appropriate table foods gradually introduced
after about six months of age. While such recommendations may be
surprising or even shocking to members of the general American and
Oregon public accustomed to our nation's current cultural norms of
early weaning and widespread use of breastmilk substitutes, they
support biologically normal patterns of health and development among
The objectives of Healthy People 2010 include
breastfeeding initiation rates from 64% to 75%, the percentage of women
continue to breastfeed at six months from 29% to 50%, and the
women who continue to breastfeed at 1 year from 16% to 25% (US
Health and Human Services 2000). Oregon
was one of six states to achieve these goals (Centers for Disease
Prevention 2004). However, the mothers of infants at highest risk of
health and development—those under 21 years of age and those with low
educational levels—are least likely to breastfeed (US Department of
Human Services 2000). In June 2004, the US Department of Human Health
Services (HHS) and the Ad Council launched the media campaign portion
National Breastfeeding Awareness Campaign. With its slogan of “Babies
to be breastfed,” the media campaign is founded on the recommendations,
objectives of the HHS Blueprint for Action on Breastfeeding. It targets
time parents who would not normally breastfeed, informing them—and the
public—about some of the many risks of formula feeding.
While Oregon’s rate of breastfeeding
initiation (88.0% [tied
with Washington state]), of any breastfeeding at six months (54.1%),
and of exclusive
breastfeeding at six months (26.8%) are the highest in the nation
Disease Control and Prevention 2004), they still indicate that a
portion of Oregon infants are exposed to the health risks of breastmilk
substitutes and of early weaning.
A woman's decision not to breastfeed must
respected. Yet women can know all the risks of formula feeding, have
to breastfeed, and still not breastfeed, or not breastfeed exclusively
the first six months, or not breastfeed for very long. When this
often happens—it's time to stop and ask: "What is it about our society
that is preventing so many women from breastfeeding?"
Decisions about infant feeding and
are embedded in a historical, cultural, economic and political context
(Dettwyler 1995; American Academy of Pediatrics 2005). Barriers to
- lack of breastfeeding
- lack of family support
- insufficient maternity
- inadequate training of
healthcare providers on the importance and management of breastfeeding
- hospital routines,
policies, and practices that undermine breastfeeding
- unethical marketing of
human milk substitutes by formula companies who profit from our
- workplace policies that
force women to choose between making a living and breastfeeding their
Your support of Senate Bill 618 will remove
some of the
barriers to breastfeeding that women face in the workplace. These
significant and their removal is essential if we are to decrease the
Oregon mothers prevented by workplace policies from breastfeeding—at
all or as
long as they might have or as exclusively as they might have during the
six months, if they had only had adequate support from their employers.
recognition of the barriers that workplace policies frequently pose to
and the health risks of formula feeding, the American Academy of
(2005) encourages “employers to provide appropriate facilities and
adequate time in the workplace for breastfeeding and/or
expression” and encourages the “development and approval of
policies and legislation that are supportive of a mother's choice to
Harassment in the Workplace
Congresswoman Carolyn Maloney (2001)
breastfeeding is being discouraged in many ways in the workplaces of
country. They have been fired, told "we don't want that kind of thing
our premises," and asked by male coworkers for milk to put in their
coffee. They have pumped milk in their cars and in bathrooms because
employers fail to provide clean, private, and appropriate space in
express their milk. The story is no different in Oregon:
breastfeeding mothers are at the mercy of workplace policies that vary
employer to employer across the state. But the health and economic
of formula feeding are far too great to fail to enact legislation
breastfeeding in the work place.
Nearly six out of every ten mothers in America
with a child under one year of age are employed in the workforce (Bachu
O'Connell 2001). The separation of mothers and children during the
routine (Maloney 2001). Women working outside their homes want to do
their children as well as to do right by their employers. Yet many
not recognize the importance of breastfeeding or the expense to their
businesses from failing to support breastfeeding in the workplace. The
workplace is like a minefield or an obstacle course to mothers
find the best path by which to maintain employment while obtaining
support for breastfeeding. Research shows that maternal employment is a
to breastfeeding, especially in the presence of workplace policies
of breastfeeding (Gielen, et al. 1991; Ryan & Martinez 1989;
& Auerbach 1985).
Even women who hold relatively powerful
positions in the
workplace often lack adequate support for breastfeeding. I know a staff
who has led several projects for her company in Oregon.
She must clean her pumping equipment in a dirty break- or bathroom
limited break time first cleaning that sink. Two breastfeeding
before her were offered only bathroom stalls as pumping facilities.
engineer is grateful and proud that she was able to persuade her
employer to finally
create a “Mom’s Room” in which to pump. However, she finds it awkward
embarrassing to have to clean her pump parts in the bathroom or break
also finds it difficult to ensure adequate pumping breaks during her
day. Meetings regularly run over time. Yet, she feels that she may
her job security or status in the workplace if she were to repeatedly
that the meeting end on time so that she can pump her milk when needed.
she will experience some type of harassment or discrimination if she
any more support than she has already requested. I also know a vice
who served as sales manager of a high wealth management group of a bank
Oregon while she was a breastfeeding mother. This breastfeeding mother
choose between pumping her milk in a room devoted to sick employees or
in a bathroom stall. Though she requested appropriate facilities, these
the only options provided to her. She was required to have business
lunch, preventing her from pumping during her lunch break. She even had
pump while driving to client meetings, risking a traffic accident or
breast health and decreased milk supply if she couldn’t pump in a
She kept several business suits in her car for the frequent clothing
required by milk leaking from her overly full breasts when she was
to pump on time. She, too, feared harassment and discrimination if she
on the support she needed in the workplace.
The difficulty that relatively powerful women
face in the
workplace pales in comparison to the difficulty faced by many women
powerful and more poorly compensated positions, for example, clerical
workers, waitresses, child care providers, and janitorial staff.
passage of Senate Bill 618, these women have little recourse when they
barriers to breastfeeding, harassment, and discrimination in the
such situations, breastfeeding frequently stops so that employment can
continue. Low breastfeeding rates among women with lower educational
reflect this dilemma: they either do not begin breastfeeding at all,
breastfeeding when they return to work, or stop breastfeeding soon
to work. Many Oregon women simply do not have the luxury of finding a
employer or of exiting the paid workforce in order to continue to
in the Workplace: A Win-Win Situation
Do women really have to choose between
working outside the
home and breastfeeding? Is it really so difficult for employers to
support for breastfeeding mothers? The answer is clearly: No! Providing
accommodations for breastfeeding mothers in the workplace is a win-win
Studies have shown that mothers who continue to breastfeed after
work miss less time from work because of illness in their infant, and
shorter absences when they do miss work, compared with women who do not
breastfeed (which really means that formula-feeding mothers miss more
breastfeeding mothers) (Cohen, Mrtek, and Mrtek 1995). Aetna, Inc.
in medical claims and three days of sick leave per breastfed baby
means that every formula-fed baby cost Aetna $1,435 in medical claims
days of sick leave); Bankers Trust, Cigna, Kellogg's, Chase Manhattan
Eastman Kodak, PricewaterhouseCoopers and Electronic Data Systems are
other companies who have found supporting breastfeeding in the
workplace to be
good business (Maloney 2001). Workplaces that value women's roles in
as well as in employment increase their workers' morale, dedication,
and productivity (Bromberg Bar-Yam 2001). In one study, worksite
were shown to increase breastfeeding rates among employed women to a
similar to rates among women not employed outside the home—which really
that the lack of support for breastfeeding in the workplace has been
decrease breastfeeding rates (Cohen & Mrtek 1994).
What do breastfeeding mothers need to
breastfeeding when they return to work outside the home? Time and a
private, nearby location in which to express their milk or to
formal and informal support at the workplace, gatekeepers at the
make sure that this support happens, and legislation to make sure that
they are able to continue breastfeeding isn't based on the luck of the
(Bromberg Bar-Yam 2001). The amount of milk a mother makes is based on
and demand. The more she nurses or expresses her milk, the more milk
breasts will make. Milk supply will gradually decrease if a mother is
breastfeed or express milk during her workday, which can mean premature
of the nursling, increased health risks for mother and child, and
healthcare costs. Mothers are also at risk for the development of
(painful swelling of the breasts) if they cannot express milk or
during their workday. Engorgement can result in milk leaking onto the
clothing, the development of plugged milk ducts, the development of
(breast inflammation or infection that causes fever and flu-like
use of antibiotics, and the need for bed rest.
Oregon Senate Bill 618 requires employers to
rest periods if doing so does not cause undue hardship on the operation
employer's business. It requires employers to make reasonable efforts
provide a private area in which employees can breastfeed or express
prohibits discrimination in the workplace against mothers who
it provides breastfeeding mothers with legal recourse if they do not
this support. Enactment of this legislation would increase the
duration of breastfeeding in Oregon, help employers avoid the business
resulting from mothers being forced by workplace policies to formula
help change public opinion about breastfeeding.
When barriers to breastfeeding are removed,
enabled to make a significant contribution to human health and
well as to economic stability. Breastfeeding mothers in Oregon
are worthy of the greatest protection and support that any of us can
including in the workplace. Please help pass Senate Bill 618. Thank you
much for the opportunity to testify before you today.
Cynthia Good Mojab, MS
clinical psychology, is a private
researcher, author, educator, International Board Certified Lactation
Consultant, and Registered Lactation Consultant. She writes and speaks
issues related to psychology, culture and the family—particularly as
relate to breastfeeding. Ms. Good Mojab is Research Associate in the
Publications Department of La Leche League International, was a member
of the La
Leche League International Editorial Review Team for The Breastfeeding Answer Book (3rd edition), and has been
Leche League Leader (volunteer breastfeeding counselor) since 1998. She
member of the Expert Panel on Mothering magazine's
website, answering questions about breastfeeding, and is an Affiliate
of the Alliance
for Transforming the Lives of Children. Ms. Good Mojab co-authored Breastfeeding at a Glance:
and Trivia about Lactation (Platypus Media 2001). She
holds the position of
Lactation Educator at Tuality Healthcare in Hillsboro,
Oregon, where she teaches
how to breastfeed. Her website, Ammawell
provides breastfeeding information and support. She lives in Oregon
with her husband and their young daughter.
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Good Mojab, C. Testimony in Support
of Oregon Senate Bill 618: Relating
to Breastfeeding in the Workplace. Oregon Senate Health Policy
Hearing, Salem, Oregon. March 30, 2005.
Cynthia Good Mojab, 2005. All rights reserved. This testimony may be
once for individual use.