Lactation Rooms, Mothers Only Rooms, Breast Feeding at Work. What's Up?

A Collection of Articles with Insights on the Benefits of Breast-Feeding and the Increase of Lactation Rooms in the Workplace...

Breast-Feeding Is Good for the Mother, and Not Just the Baby

Women who breast-feed are less likely to develop breast cancer, ovarian cancer, Type 2 diabetes and rheumatoid arthritis and may have improved cardiovascular health.

By Roni Caryn Rabin, NY Times
Oct. 26, 2018

Most women know breast-feeding is good for their babies’ health. But doctors and midwives rarely tell moms-to-be that it’s also good for nursing mothers.

Nursing mothers reduce their relative risk of breast cancer by 4.3 percent for every 12 months they breast-feed, in addition to a relative decrease of 7 percent for each birth. Breast-feeding is particularly protective against some of the most aggressive tumors, called hormone receptor-negative or triple-negative tumors, which are more common among African-American women, studies show. It also lowers the risk by one-third for women who are prone to cancer because of an inherited BRCA1 mutation.

Women who breast-feed are also less likely to develop ovarian cancer, Type 2 diabetes and rheumatoid arthritis and may have improved cardiovascular health.

Yet only 16 percent — or fewer than one in five women surveyed — said their doctors had told them that breast-feeding is good for mother as well as baby, according to a new study published in Breastfeeding Medicine.

“We have an ounce of prevention that could save lives,” said Dr. Bhuvaneswari Ramaswamy, the paper’s senior author and an associate professor of medical oncology at Ohio State University in Columbus. “But are we fully educating the mothers when they make this difficult choice? Because it is not an easy choice.”

While companies market infant formula by claiming their products are effective substitutes for breast milk, Dr. Ramaswamy said, “formula is not going to help women live longer and be there for their families.”

The new study surveyed 724 women aged 18 to 50 who had given birth to at least one child. The vast majority of them had breast-fed.

Just over half knew before they gave birth that breast-feeding reduced the risk of breast cancer, and over a third of those said the information influenced their decision to breast-feed.

But only 120 of the women said that their health care providers had informed them about the implications for their own long-term health. Most of those who knew about the health advantages to nursing moms had gleaned the information from popular media or the internet. And these women tended to breast-feed for much longer — 13 months on average — than women who did not know about the health implications, who breast-fed for only nine months on average.

While 60 percent of white women surveyed knew breast-feeding could cut their breast cancer risk, only 47 percent of the African-American women knew, and 54 percent of women of other or unknown race knew.

Nationwide, among racial groups, African-American mothers have the lowest rates of breast-feeding and are least likely to nurse for at least six months, according to government health statistics. Sixty percent have “ever” breast-fed, and only 28 percent are still breast-feeding at six months.

In comparison, 77 percent of white mothers, 80 percent of Hispanic mothers and 86 percent of Asian mothers have “ever” breast-fed, with rates of breast-feeding at six months at 45 percent, 46 percent and 58 percent, respectively.

Scientists do not entirely understand why lactation helps prevent breast cancer, but say the breasts undergo changes during pregnancy as they develop more milk ducts in preparation for breast-feeding.

The breasts eventually go through a process called involution that returns them to their pre-pregnancy state and involves massive cell death and tissue remodeling. That transition can occur slowly through gradual weaning, or abruptly if there is no breast-feeding or only brief breast-feeding. When it happens abruptly, it creates an inflammatory condition that is conducive to cancer, Dr. Ramaswamy said.

Dr. Marisa Weiss, the founder of the website BreastCancer.org, who has done research in this area, often describes pregnancy and lactation as a “bat mitzvah” for the breasts, saying that breast-feeding “forces the breasts to finally grow up and get a job, and make milk, and show up for work every day, and stop fooling around.” That maturation process triggers changes in the milk ducts that make the breast more resistant to cancer.

Breast-feeding also appears to reset the body’s metabolism after pregnancy, improving glucose metabolism and insulin sensitivity, burning calories and mobilizing stores of fat that have accumulated during pregnancy, which may explain why women who breast-fed have lower rates of diabetes and other problems.

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Section 7(r) of the Fair Labor Standards Act – Break Time for Nursing Mothers Provision

Effective March 23, 2010, the Patient Protection and Affordable Care Act amended the FLSA to require employers to provide a nursing mother reasonable break time to express breast milk after the birth of her child. The amendment also requires that employers provide a place for an employee to express breast milk.

Section 7 of the Fair Labor Standards Act of 1938 (29 U.S.C. 207) is amended by adding at the end the following:
(r)(1)
An employer shall provide—a reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child’s birth each time such employee has need to express the milk; and a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk.

(2)
An employer shall not be required to compensate an employee receiving reasonable break time under paragraph (1) for any work time spent for such purpose.

(3)
An employer that employs less than 50 employees shall not be subject to the requirements of this subsection, if such requirements would impose an undue hardship by causing the employer significant difficulty or expense when considered in relation to the size, financial resources, nature, or structure of the employer’s business.

(4)
Nothing in this subsection shall preempt a State law that provides greater protections to employees than the protections provided for under this subsection.

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Frequently Asked Questions – Break Time for Nursing Mothers

About the Law
The Patient Protection and Affordable Care Act (P.L. 111-148, known as the “Affordable Care Act”) amended section 7 of the Fair Labor Standards Act (“FLSA”) to require employers to provide “reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child’s birth each time such employee has need to express the milk.” Employers are also required to provide “a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk.” See 29 U.S.C. 207(r). The break time requirement became effective when the Affordable Care Act was signed into law on March 23, 2010. TheFact Sheet #73: Break Time for Nursing Mothers under the FLSA and the Frequently Asked Questions below provide basic information about the law.

Questions & Answers
Who is entitled to reasonable break time and a space for expressing breast milk at work under the law?

ANSWER: The federal law provides that employees who work for employers covered by the FLSA and are not exempt from section 7, which sets forth the FLSA’s overtime pay requirements, are entitled to breaks to express milk. While employers are not required under the FLSA to provide breaks to nursing mothers who are exempt from the requirements of section 7, they may be obligated to provide such breaks under State laws. The Department encourages employers to provide breaks to all nursing mothers regardless of their status under the FLSA.

What types of employers are covered by the law?

ANSWER: All employers covered by the FLSA must comply with the break time for nursing mothers provision. As explained further below (see “Does the nursing mothers break time provision apply to small businesses?”), all such employers are subject to the FLSA break time requirement unless they have fewer than 50 employees and can demonstrate that compliance with the provision would impose an undue hardship.

Many U.S. states, Puerto Rico, and the District of Columbia have laws related to breastfeeding and expressing milk in the workplace. Are these state laws preempted by the new federal break time requirements?

ANSWER: The FLSA requirement of break time for nursing mothers to express breast milk does not preempt State laws that provide greater protections to employees (for example, providing compensated break time, providing break time for exempt employees, or providing break time beyond 1 year after the child’s birth).

What must an employer provide to workers who need to express breast milk in the workplace?

ANSWER: Employers are required to provide a reasonable amount of break time and a space to express milk as frequently as needed by the nursing mother, for up to one year following the birth of the employee’s child. The frequency of breaks needed to express breast milk as well as the duration of each break will likely vary. The space provided by the employer cannot be a bathroom, and it must be shielded from view and free from intrusion by coworkers or the public.

Does the nursing mothers break time provision apply to small businesses?

ANSWER: All employers covered by the FLSA, regardless of the size of their business, are required to comply with this provision. However, employers with fewer than 50 employees are not subject to the FLSA break time requirement if the employer can demonstrate that compliance with the provision would impose an undue hardship. Whether compliance would be an undue hardship is determined by looking at the difficulty or expense of compliance for a specific employer in comparison to the size, financial resources, nature, or structure of the employer’s business.

For purpose of the undue hardship exemption, how will the Department determine whether an employer has fewer than 50 employees?

ANSWER: All employees who work for the covered employer, regardless of work site, are counted. Consistent with the FLSA definition of employee, “any individual employed by an employer” must be counted, including full-time employees, part-time employees, and any other individuals who meet the FLSA definition of employee found at 29 U.S.C. 203(e)(1).

Does the break time have to be paid break time?

ANSWER: Employers are not required under the FLSA to compensate nursing mothers for breaks taken for the purpose of expressing milk. However, where employers already provide compensated breaks, an employee who uses that break time to express milk must be compensated in the same way that other employees are compensated for break time. In addition, the FLSA’s general requirement that the employee must be completely relieved from duty or else the time must be compensated as work time applies. See Wage and Hour Division Fact Sheet #22, Hours Worked under the FLSA.

Do employers need to create a permanent, dedicated space for use by nursing mother employees?

ANSWER: No. A space temporarily created or converted into a space for expressing milk or made available when needed by the nursing mother is sufficient provided that the space is shielded from view, and free from any intrusion from co-workers and the public. The location provided must be functional as a space for expressing breast milk. If the space is not dedicated to the nursing mothers’ use, it must be available when needed in order to meet the statutory requirement. Of course, employers may choose to create permanent, dedicated space if they determine that is the best way to meet their obligations under the law.

Do employers have to provide a lactation space even if they don’t have any nursing mother employees?

ANSWER: No. The statute requires employers to provide a space for a nursing employee “each time such employee has need to express the milk.” If there is no employee with a need to express breast milk, then the employer would not have an obligation to provide a space.

If the only space available at a work site is a bathroom, can employers require employees to express breast milk there?

ANSWER: No. The statute specifically states that the space provided for employees to express breast milk cannot be a bathroom.