AAP Voices Blog

Celebrating a Job Well-done

Looking back on the days of pumping breastmilk at work and while travelling to professional meetings, I am grateful that I worked among pediatricians, who not only understood but supported these efforts. Conversations with students and residents have helped me to understand that the normative expectations of breastfeeding among pediatricians ironically does not pervade our profession of medicine. Recalling the rhythmic whirring sounds of my electric pump and the abrupt knock on my cubicle door despite the prominent “Do Not Disturb” sign, and the numerous beeps on my pager during my short 15 minutes of pumping, I have not forgotten the complex emotions associated with obstacles that had to be overcome while pumping at work.

The challenges professionals face seems relatively small when we consider working mothers in the military, those working frontline jobs, and those paid by the hour. As Pulitzer-Prize-winning journalist, Jodi Kantor pointed out in her 2006 New York Times article, “On the Job, Nursing Mothers Find a 2-Class System,” there remains a stark contrast between women working behind counters who must pump in the bathroom during timed breaks and executives who pump in their private offices at flexible times. Kantor further highlights the disparity by saying, “It is a particularly literal case of how well-being tends to beget further well-being, and disadvantage tends to create disadvantage – passed down in a mother’s milk, or lack thereof.”

During my 30-plus years of clinical practice, I have heard the struggles of too many women who want to breastfeed but feel unsupported at work. Some avoid breastfeeding, saying in their initial postpartum days, “I don’t want to start something I can’t finish.” Others, like Cate Colburn-Smith of The Milk Memos, tell woeful stories of having to pump in a closet while at work. These barriers to breastfeeding for working mothers are compounded by persistent geographic, income, and racial and ethnic disparities in breastfeeding rates throughout the U.S.

Workplace challenges remain the most common reason for women to never initiate breastfeeding or stop breastfeeding earlier than recommended. That's why policies, programs and actions to enable breastfeeding make such a difference.

--US Breastfeeding Committee Inspiration Guide (See https://new.express.adobe.com/webpage/IWchAMGL3Cybp ) #WBW2023, #WABA, #breastfeeding, #SDGs, #worldbreastfeedingweek2023

We’ve made great progress over several decades. Thanks to certain federal agencies, employers have access to an updated toolkit on how best to support breastfeeding mothers in diverse work environments. The passage of the Affordable Care Act in 2010 was groundbreaking in requiring certain employers to provide time and space to express breastmilk. Subsequently many states and cities passed similar laws to strengthen accommodations for working breastfeeding mothers. More recently, the Providing Urgent Maternal Protections (PUMP) for Nursing Mothers Act, passed in December 2022, expands workplace protections to cover an additional nine million salaried employees and other types of workers not covered, considers pumping time as work time, and extends accommodations from one to two years. The PUMP Act along with the Pregnant Workers Fairness Act, which requires covered employers to offer reasonable accommodations to pregnant workers, are the result of unwavering advocacy by the AAP, bipartisan policy makers, and many others. Earlier this year, AAP President Sandy Chung, MD, FAAP, traveled to Washington to attend a White House event celebrating the PUMP Act and the Pregnant Workers Fairness Act becoming law.

Breastfeeding requires more than strong laws. It requires hard work, dedication, sleepless nights, and support from friends, neighbors, family members, employers, and coworkers. Employee-centered policies that aim to achieve pay equity, improve parental leave, and raise minimum wage have the potential to positively impact breastfeeding. Human resources departments that welcome and educate new employees about lactation rooms and breaks to support breastfeeding are needed. Innovative approaches include improving signage so that breastfeeding persons feel welcomed, educating ourselves about ways to partner with local businesses, providing awards and recognition to breastfeeding-friendly employers and businesses, and allowing for remote work. One unintended consequence of the COVID-19 pandemic is the opportunity for many breastfeeding employees to work remotely and feed their babies during the workday obviating the need to pump.

At the forefront of our efforts should be approaches and policies that achieve breastfeeding equity. The breastfeeding disparities between Black and white infants has gone on far too long and urgently needs to be addressed to reduce disease and infant mortality rates. Hiring lactation consultants who share identities with breastfeeding persons, ensuring that each workplace has representation in leadership, connecting new parents with peer support networks, and distributing culturally competent resources are among the ways we can reduce breastfeeding disparities.

The 2023 World Breastfeeding Week theme, “Let’s make breastfeeding and work, work!” calls for us to ensure families, communities, workplaces, and clinicians make every effort to support working breastfeeding mothers. August is National Breastfeeding Month with the theme of “This is Our Why” to illuminate why our work to promote and support breastfeeding optimizes health for babies, mothers, and families. The related weekly observances celebrate breastfeeding and remind us that our work to achieve equity is far from done.