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Testimony in Support of Oregon Senate Bill 618
Relating to Breastfeeding in the Workplace

by Cynthia Good Mojab, MS, IBCLC, RLC, CATSM

Chair Monnes Anderson, members of the Senate Committee on Health Policy, my name is Cynthia Good Mojab. I am a mother, maternal and child health advocate, author, educator, private researcher, Research Associate in the Publications Department of La Leche League International, volunteer breastfeeding counselor with La Leche League International, International Board Certified Lactation Consultant, and Registered Lactation Consultant. I am pleased to share information with you about why I personally support Bill 618 and why your support of Oregon Senate Bill 618 is so important. My five main points are that 1) formula feeding has significant health risks, 2) breastfeeding mothers active in the paid workforce often encounter barriers to breastfeeding, 3) workplace policies supporting breastfeeding increase employee morale and retention, protect mothers and their children from exposure to the health risks of breastmilk substitutes and early weaning, and help employers avoid the costs 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 their ability to breastfeed, and 5) your support is needed to help pass Bill 618.

The Health Implications of Infant Feeding

Infant feeding is a major health issue that cannot be overstated but is routinely underestimated. The information included in this testimony is just a small excerpt from our current wealth of research demonstrating the importance of breastfeeding and the importance of legislation protecting breastfeeding mothers in the workplace. Formula feeding poses many 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 the US, 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 1998).
  • 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 (American Academy 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., see the summaries in Walker 1992, 1998, 2004; American Academy of Pediatrics 2005). And, of course, the health risks of formula have economic as well as human consequences. Looking only at three infant illnesses (lower respiratory tract illnesses, otitis media, and gastrointestinal illness), the excess cost of health care services due to more office visits, prescriptions, and hospitalizations in formula-fed infants in the first year of life is between $331 and $475 per infant (Ball & Wright 1999).

People rarely hear about the risks and costs of formula feeding. Instead, they hear about the "benefits" of breastfeeding, as though they are special perks above and beyond what mothers could want for themselves and their children (Good Mojab 2002). These "benefits" are measured against the poorer health outcomes of formula feeding—outcomes so 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 require nothing less than a paradigm shift: there are no "benefits" of breastfeeding. In reality, breastfeeding is the foundation of biologically normal—not superior—human health and development. Learning about the risks of formula feeding can be an emotionally difficult experience, especially if new information might have changed past decisions about infant feeding: why didn’t someone tell us before? Yet without this information, mothers are prevented from making truly informed decisions about infant feeding. In no other area of 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 human beings.

Barriers to Breastfeeding

The objectives of Healthy People 2010 include increasing breastfeeding initiation rates from 64% to 75%, the percentage of women who continue to breastfeed at six months from 29% to 50%, and the percentage of women who continue to breastfeed at 1 year from 16% to 25% (US Department of Health and Human Services 2000). Oregon was one of six states to achieve these goals (Centers for Disease Control and Prevention 2004). However, the mothers of infants at highest risk of poor health and development—those under 21 years of age and those with low educational levels—are least likely to breastfeed (US Department of Health and Human Services 2000). In June 2004, the US Department of Human Health and Services (HHS) and the Ad Council launched the media campaign portion of the National Breastfeeding Awareness Campaign. With its slogan of “Babies were born to be breastfed,” the media campaign is founded on the recommendations, goals, and objectives of the HHS Blueprint for Action on Breastfeeding. It targets first time parents who would not normally breastfeed, informing them—and the general 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 (Centers for Disease Control and Prevention 2004), they still indicate that a substantial 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 always be respected. Yet women can know all the risks of formula feeding, have the desire to breastfeed, and still not breastfeed, or not breastfeed exclusively during the first six months, or not breastfeed for very long. When this happens—and it 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 breastfeeding behavior are embedded in a historical, cultural, economic and political context (Dettwyler 1995; American Academy of Pediatrics 2005). Barriers to breastfeeding include:

  • misinformation
  • lack of breastfeeding role models
  • lack of family support
  • insufficient maternity leave
  • 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 declining health
  • workplace policies that force women to choose between making a living and breastfeeding their children.

Your support of Senate Bill 618 will remove some of the barriers to breastfeeding that women face in the workplace. These barriers are significant and their removal is essential if we are to decrease the number of 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 first six months, if they had only had adequate support from their employers. In recognition of the barriers that workplace policies frequently pose to breastfeeding and the health risks of formula feeding, the American Academy of Pediatrics (2005) encourages “employers to provide appropriate facilities and adequate time in the workplace for breastfeeding and/or milk expression” and encourages the “development and approval of governmental policies and legislation that are supportive of a mother's choice to breastfeed.”

Discrimination and Harassment in the Workplace

Congresswoman Carolyn Maloney (2001) documents how breastfeeding is being discouraged in many ways in the workplaces of our country. They have been fired, told "we don't want that kind of thing on 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 their employers fail to provide clean, private, and appropriate space in which to express their milk. The story is no different in Oregon: breastfeeding mothers are at the mercy of workplace policies that vary from employer to employer across the state. But the health and economic consequences of formula feeding are far too great to fail to enact legislation supporting 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 workday is routine (Maloney 2001). Women working outside their homes want to do right by their children as well as to do right by their employers. Yet many employers do not recognize the importance of breastfeeding or the expense to their own businesses from failing to support breastfeeding in the workplace. The workplace is like a minefield or an obstacle course to mothers struggling to find the best path by which to maintain employment while obtaining adequate support for breastfeeding. Research shows that maternal employment is a barrier to breastfeeding, especially in the presence of workplace policies unsupportive of breastfeeding (Gielen, et al. 1991; Ryan & Martinez 1989; Frederick & Auerbach 1985).

Even women who hold relatively powerful positions in the workplace often lack adequate support for breastfeeding. I know a staff engineer who has led several projects for her company in Oregon. She must clean her pumping equipment in a dirty break- or bathroom sink—or lose limited break time first cleaning that sink. Two breastfeeding colleagues before her were offered only bathroom stalls as pumping facilities. This 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 and embarrassing to have to clean her pump parts in the bathroom or break room. She also finds it difficult to ensure adequate pumping breaks during her long work day. Meetings regularly run over time. Yet, she feels that she may jeopardize her job security or status in the workplace if she were to repeatedly request that the meeting end on time so that she can pump her milk when needed. She worries she will experience some type of harassment or discrimination if she asks for any more support than she has already requested. I also know a vice president who served as sales manager of a high wealth management group of a bank in Oregon while she was a breastfeeding mother. This breastfeeding mother had to choose between pumping her milk in a room devoted to sick employees or pumping in a bathroom stall. Though she requested appropriate facilities, these were the only options provided to her. She was required to have business meetings at lunch, preventing her from pumping during her lunch break. She even had to hand pump while driving to client meetings, risking a traffic accident or impaired breast health and decreased milk supply if she couldn’t pump in a timely manner. She kept several business suits in her car for the frequent clothing changes required by milk leaking from her overly full breasts when she was regularly unable to pump on time. She, too, feared harassment and discrimination if she insisted 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 holding less powerful and more poorly compensated positions, for example, clerical and sales workers, waitresses, child care providers, and janitorial staff. Without the passage of Senate Bill 618, these women have little recourse when they face barriers to breastfeeding, harassment, and discrimination in the workplace. In such situations, breastfeeding frequently stops so that employment can continue. Low breastfeeding rates among women with lower educational levels reflect this dilemma: they either do not begin breastfeeding at all, stop breastfeeding when they return to work, or stop breastfeeding soon after returning to work. Many Oregon women simply do not have the luxury of finding a more supportive employer or of exiting the paid workforce in order to continue to breastfeed.

Breastfeeding Support 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 provide support for breastfeeding mothers? The answer is clearly: No! Providing accommodations for breastfeeding mothers in the workplace is a win-win situation. Studies have shown that mothers who continue to breastfeed after returning to work miss less time from work because of illness in their infant, and have shorter absences when they do miss work, compared with women who do not breastfeed (which really means that formula-feeding mothers miss more work than breastfeeding mothers) (Cohen, Mrtek, and Mrtek 1995). Aetna, Inc. saved $1,435 in medical claims and three days of sick leave per breastfed baby (which really means that every formula-fed baby cost Aetna $1,435 in medical claims and three days of sick leave); Bankers Trust, Cigna, Kellogg's, Chase Manhattan Bank, Eastman Kodak, PricewaterhouseCoopers and Electronic Data Systems are among other companies who have found supporting breastfeeding in the workplace to be good business (Maloney 2001). Workplaces that value women's roles in mothering as well as in employment increase their workers' morale, dedication, loyalty and productivity (Bromberg Bar-Yam 2001). In one study, worksite lactation programs were shown to increase breastfeeding rates among employed women to a level similar to rates among women not employed outside the home—which really means that the lack of support for breastfeeding in the workplace has been shown to decrease breastfeeding rates (Cohen & Mrtek 1994).

What do breastfeeding mothers need to successfully continue breastfeeding when they return to work outside the home? Time and a clean, private, nearby location in which to express their milk or to breastfeed, formal and informal support at the workplace, gatekeepers at the workplace who make sure that this support happens, and legislation to make sure that whether they are able to continue breastfeeding isn't based on the luck of the draw (Bromberg Bar-Yam 2001). The amount of milk a mother makes is based on supply and demand. The more she nurses or expresses her milk, the more milk her breasts will make. Milk supply will gradually decrease if a mother is unable to breastfeed or express milk during her workday, which can mean premature weaning of the nursling, increased health risks for mother and child, and increased healthcare costs. Mothers are also at risk for the development of engorgement (painful swelling of the breasts) if they cannot express milk or breastfeed during their workday. Engorgement can result in milk leaking onto the mother's clothing, the development of plugged milk ducts, the development of mastitis (breast inflammation or infection that causes fever and flu-like symptoms), the use of antibiotics, and the need for bed rest.

Oregon Senate Bill 618 requires employers to provide unpaid rest periods if doing so does not cause undue hardship on the operation of the employer's business. It requires employers to make reasonable efforts to provide a private area in which employees can breastfeed or express milk. It prohibits discrimination in the workplace against mothers who breastfeed. And it provides breastfeeding mothers with legal recourse if they do not receive this support. Enactment of this legislation would increase the incidence and duration of breastfeeding in Oregon, help employers avoid the business expense resulting from mothers being forced by workplace policies to formula feed, and help change public opinion about breastfeeding.

When barriers to breastfeeding are removed, women are enabled to make a significant contribution to human health and development as well as to economic stability. Breastfeeding mothers in Oregon are worthy of the greatest protection and support that any of us can provide, including in the workplace. Please help pass Senate Bill 618. Thank you very much for the opportunity to testify before you today.

About the Author

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 about issues related to psychology, culture and the family—particularly as they 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 a La Leche League Leader (volunteer breastfeeding counselor) since 1998. She is a 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: Facts, Figures and Trivia about Lactation (Platypus Media 2001). She holds the position of Lactation Educator at Tuality Healthcare in Hillsboro, Oregon, where she teaches expectant mothers 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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Suggested Citation: Good Mojab, C. Testimony in Support of Oregon Senate Bill 618: Relating to Breastfeeding in the Workplace. Oregon Senate Health Policy Committee Hearing, Salem, Oregon. March 30, 2005.

© Cynthia Good Mojab, 2005. All rights reserved. This testimony may be printed once for individual use.

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