Testimony in Support of Oregon Senate Bill 783
Relating to Breastfeeding in the Workplace

by Cynthia Good Mojab, MS, IBCLC, RLC

Chair Corcoran, members of the General Government committee, my name is Cynthia Good Mojab. I am a mother, breastfeeding advocate, author, educator, Research Associate in the Publications Department of La Leche League International, La Leche League Leader, and International Board Certified Lactation Consultant. I am pleased to join you today to talk about why your support of Oregon Senate Bill 783 is so important.

Infant feeding is a major health, environmental, economic, and political issue. 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.
 

Breastfeeding: A Health, Economic, and Environmental Issue

Formula feeding poses many risks to the health of mothers and their children in both developed and developing countries (Lawrence 1997). For example, formula-fed children have a higher risk of SIDS, juvenile diabetes, ear infections, allergies, obesity, heart disease and childhood leukemia. Mothers who formula feed have higher rates of breast and ovarian cancer, anemia and osteoporosis. The health risks of formula have economic as well as human consequences. Looking only at three 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).

In recognition of the risks of formula feeding, 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). The American Academy of Pediatrics (1997) 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). 

In addition to increasing health risks and healthcare costs, formula feeding causes waste and uses valuable resources. The production, shipping and preparation of artificial substitutes for human milk requires large amounts of water, fuel, paper, glass, rubber, and plastic (Michels, Good Mojab & Bromberg Bar-Yam 2001). Feeding infants with formula produces significant amounts of solid waste. Over half a million women in the US formula feed their infants from birth. If these formula-feeding mothers breastfed their babies for a full year (introducing solids after six months), we would save:

• 25 million pounds of steel from formula cans
• 6 million gallons of oil used in production, transportation and refrigeration 
• 135 million pounds of carbon dioxide (produced by the use of those 6 million gallons of oil), requiring 35,000 acres of forest to absorb
• 2.5 million pounds of paper
• 2.5 million pounds of HDPE from plastic milk containers
• 27 million gallons of milk (and the 465 million pounds of dairy feed needed to produce it) (Michels, Good Mojab & Bromberg Bar-Yam 2001).

Barriers to Breastfeeding

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.

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 not breastfeed. 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). Barriers to breastfeeding include misinformation, lack of breastfeeding role models, lack of family support, insufficient maternity leave, and inadequate training of healthcare providers on the importance and management of breastfeeding. Barriers include the unethical marketing of human milk substitutes by formula companies who profit from our declining health. And barriers include workplace policies that force women to choose between making a living and breastfeeding their children.
 

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. Women are facing discrimination and harassment for breastfeeding their children. 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 economic, environmental, and health consequences of formula feeding are far too great to fail to enact legislation supporting breastfeeding in the work place.

I spoke about breastfeeding at the first annual Washington County WIC Breastfeeding Open House in Hillsboro, Oregon in August of 2002. After my presentation, a young Latina woman in her fourth month of pregnancy approached me asking for information about combining work and breastfeeding. She had heard that it was very difficult to breastfeed in most work situations—yet she wanted to breastfeed her baby and she needed to work. She wanted to know: How could she maintain her milk supply if her employer wouldn't provide time for her to express her milk? How could she collect and store her milk if her employer wouldn't provide facilities for her to do so? I gave her information, referred her to resources and support, and gave her suggestions on how to negotiate with her employer. Yet I could not tell her that Oregon law would protect her needs as a breastfeeding mother in the workplace, because, as of that moment, it did not.
 

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 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.

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. Oregon Senate Bill 783 (Relating to Breastfeeding in the Workplace) 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 and to allow employees to temporarily change job duties. It prohibits discrimination in the workplace against mothers who breastfeed. It permits employers to receive certification as a "Breastfeeding Mother-Friendly Employer." 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, economic stability, and environmental protection. Breastfeeding mothers are worthy of the greatest protection and support that any of us can provide, including in the workplace. Please help pass Senate Bill 783. Thank you very much for the opportunity to testify before you today.
 

This testimony is dedicated to the memory of Elizabeth Baldwin, Esq., Director of La Leche League International’s Legal Associates Program, who passed away March 12, 2003. Liz was a steadfast supporter of the legal rights of breastfeeding mothers in the US and elsewhere.

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About the Author

Cynthia Good Mojab, MS clinical psychology, is a private researcher, author, educator, and International Board Certified Lactation Consultant. She writes 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 LLLI Editorial Review Team for The Breastfeeding Answer Book (3rd edition), and has been a La Leche League Leader 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. Her website, Ammawell (http://home.attbi.com/~ammawell/), provides breastfeeding information and support. She lives in Oregon with her husband and their young daughter. 
 

References

American Academy of Pediatrics. Breastfeeding and the Use of Human Milk (RE9729). Pediatrics December 1997; 100:6:1035-1039. Online: http://www.aap.org/policy/re9729.html

Bachu, A. and O'Connell, M. Fertility of American Women: June 2000. Current Population Reports (20-543RV). Washington, DC: US Census Bureau 2001.

Ball, T. M and Wright, A. Health care costs of formula-feeding in the first year of life. Pediatrics 1999; 103 (4 Pt 2):870-6. 

Bromberg Bar-Yam, N. What every breastfeeding employee should know. Breastfeeding Annual International 2001. Platypus Media: Washington, DC 2001, pp. 72-81.

Cohen, R. and Mrtek, M. The impact of two corporate lactation programs on the incidence and duration of breast-feeding by employed mothers. American Journal of Health Promotion July/August 1994, 8:6:436-41.

Cohen, R., Mrtek, M., and Mrtek, R. Comparison of maternal absenteeism and infant illness rates among breastfeeding and formula-feeding women in two corporations. American Journal of Health Promotion Nov/Dec 1995, 10:2:148-53.

Dettwyler, K. Beauty and the breast. In P. Stuart-Macadam and K. Dettwyler (Eds.) Breastfeeding: Biocultural Perspectives. New York: Aldine de Gruyter 1995; p. 168.

Good Mojab, C. The real breastfeeding issue goes far beyond mere guilt. The Oregonian. Thursday, July 25, 2002. Online: http://home.attbi.com/~ammawell/realbreastfeedingissue.html

Lawrence, R. A Review of the Medical Benefits and Contraindications to Breastfeeding in the United States (Maternal and Child Health Technical Information Bulletin). Arlington, VA: National Center for Education in Maternal and Child Health 1997. Online: http://www.mchlibrary.info/pubs/PDFs/BreastfeedingTIB.pdf 

Maloney, C. Foreword. Breastfeeding Annual International 2001. Platypus Media: Washington, DC 2001, pp. xv-xix.

Michels, D., Good Mojab, C. and Bromberg Bar-Yam, N. Breastfeeding at a Glance: Facts, Figures and Trivia About Lactation. Washington, DC: Platypus Media 2002.

UNICEF. Facts for Life 2002. New York: UNICEF 2002. Online: http://www.unicef.org/pubsgen/ffl/factsforlife-en-full.pdf

U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000. Online: http://www.healthypeople.gov/document/

Reference: Good Mojab, C. Testimony in Support of Oregon Senate Bill 783: Relating to Breastfeeding in the Workplace. Oregon Senate General Government Committee Hearing, Salem, Oregon. March 31, 2003.

© Cynthia Good Mojab, 2003. All rights reserved. This testimony may be printed once for individual use.