1. [REMOVE THIS SLIDE BEFORE PRESENTING] [DSHS logo]Thank you for your partnership with the Texas Department of State Health Services to build a healthier Texas. To ensure you are prepared for your presentation, we recommend: Customizing this presentation to the needs and interests of the audience with whom you will be speaking. Applying your organization’s PowerPoint template to this presentation so that it visually reflects the identity of your organization. This will further communicate your support as a partner to Texas DSHS. If you have any questions, please contact us at info@texasmotherfriendly.org.

2. [Presenter Name] [Presenter’s title or one-sentence bio]

3. Planning a Texas Mother- Friendly Worksite Overview For Committee

4. Goal of Initiative Develop worksite lactation support policies and a program that is: Responsive to needs of employees and their babies. Feasible and sustainable for our business. Beneficial for the health of Texans.

5. SUPPORTING BREASTFEEDING IS A PUBLIC HEALTH PRIORITY

6. Breastfeeding Is Obesity Prevention Breastfed infants have a reduced risk of obesity throughout the life span. Risk of obesity is reduced by up to 4% for each month of breastfeeding (up to 36%) 1. The longer and more exclusively a mother breastfeeds, the greater the risk reduction. Breastfeeding promotion is a cornerstone of the Centers for Disease Control and Prevention’s obesity-prevention efforts.

7. THE CASE FOR BREASTFEEDING SUPPORT

8. Support of Breastfeeding is a Priority Reduced Risk for Infants with Exclusive Breastfeeding 1, 2 : Obesity Ear Infections Respiratory Infections Asthma Gastrointestinal Infections Atopic Dermatitis Type 1 & Type 2 Diabetes Leukemia Sudden Infant Death Syndrome Necrotizing Enterocolitis

9. Public Health Case Breastfeeding is the standard for infant feeding and protects infants and children from many significant infectious and chronic diseases. $13 billion of direct pediatric health-care costs and more than 900 lives would be saved annually if 90% of women were able to breastfeed exclusively for six months as recommended. 2 Women who breastfeed have a reduced risk of breast and ovarian cancer, type 2 diabetes, postpartum depression, and cardiovascular disease. 3-5

10. Work Remains a Barrier to Breastfeeding 6-10 Full-time employment decreases breastfeeding duration by an average of more than eight weeks. Mothers are most likely to wean their infants within the first month after returning to work. Only 10% of full-time working women exclusively breastfeed for six months. 58% of new mothers returning to work in Texas are unable to reach their breastfeeding goals.

11. U.S. Women Achieving Personal Breastfeeding Goals Source: Centers for Disease Control and Prevention, 2007 Infant Feeding Practices Survey http://www.cdc.gov/ifps/results/ch3/table3-35.htm

12. Main Reasons For Weaning

13. Main Reasons For Never Breastfeeding

14. Women Need Worksite Lactation Support 11 Breaks for lactation are similar to other work breaks for attending to physical needs: o Time to eat/drink, restroom breaks, accommodation for health needs (e.g., diabetes) When mother and child are separated for more than a few hours, the woman must express milk. Missing even one needed pumping session can have undesirable consequences: – Discomfort – Leaking – Inflammation – Infection – Decreased Milk Production – Breastfeeding Cessation

15. How to Support Breastfeeding Employees In general, women need 30 minutes (15 to 20 minutes for milk expression, plus time to get to and from a private space and to wash hands and equipment) approximately every 2 to 3 hours to express breastmilk or to breastfeed. Needs may vary from woman to woman and over the course of the breastfeeding period.

16. BENEFITS FOR OUR BUSINESS

17. Business Case 10 Lactation programs are cost-effective, showing a $3 return for every $1 invested. By supporting lactation at work, employers can reduce turnover, lower recruitment and training costs, cut rates of absenteeism, boost morale and productivity, and reduce health-care costs. Lactation accommodation is not one-size-fits-all. Flexible programs can be designed to meet the needs of both the employer and employee.

18. Breastfeeding reduces illness of the baby = fewer absences of parent employees = immediate return on investment. Breastfeeding support in the workplace helps families meet their breastfeeding and childrearing goals = higher job satisfaction, increased loyalty, increased ability to focus on job responsibilities, higher return to work postpartum, and lower turnover = immediate return on investment. Breastfeeding prevents chronic disease in women who breastfeed and contributes to a healthier future workforce through reduction of obesity and chronic disease = long- term payoff that keeps on giving. Breastfeeding = Increased Productivity 11

19. Fair Labor Standards Act Section 7 of the Fair Labor Standards Act was amended effective March 2010:  Employers are required to provide “reasonable break time for an employee to express breast milk for her nursing child for one 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, that may be used by an employee to express breastmilk.” Legal Basis

20.  Family Medical Leave Act: Job protection can help women take maternity leave to establish breastfeeding.  Texas Health & Safety Code 165: Affirms a woman’s entitlement to breastfeed in any location in which she “is authorized to be.” Provides the basis for Texas Department of State Health Services (DSHS) Mother-Friendly Worksite Designation. Other Relevant Legal Standards

21. TEXAS MOTHER-FRIENDLY WORKSITE DESIGNATION

22. Texas Mother-Friendly Worksite Designation Minimum Requirements for Designation: Have a written breastfeeding support policy that provides for: o Flexible scheduling to allow time for the expression of milk. o Accessible, private space other than a bathroom. o Accessible, clean water source. o Accommodation of milk storage. TexasMotherFriendly.org

23. Definition of Worksite Lactation Support A comprehensive Mother-Friendly program assures: Private space for women to breastfeed or express breastmilk when they are at work Flexible return-to-work options and time to express breastmilk at work Education and access to professional lactation support Support from supervisors, colleagues, and other mothers TexasMotherFriendly.org

24. Program Components 10

25. TASKS AND MILESTONES

26. Initial Planning — Key Milestones Create, educate, and engage committee. Conduct an employee Needs Assessment, including Worksite Assessment and Survey. Target Completion Date: XXX Develop recommendations for Texas Mother-Friendly Worksite designation based on assessment. Target Completion Date: XXX

27. Strategy Planning — Key Milestones Consider program options and develop plan based on needs and feasibility. At minimum: Allow flexible options for time. Construct, renovate, or convert a designated space for lactation room OR find flexible space alternatives. Plan for equipment, milk storage, and handling. Gain buy-in from other employees. Track and consider feedback mechanism. Inform, educate, communicate. Target Completion Date: XXX

28. Program Development — Key Milestones Present strategy to decision makers to gain approvals and buy-in. Create committee for program development (nuts and bolts) and sustainability planning. Develop regional/site-specific protocols. Complete physical improvements. Target Completion Date: XXX

29. Program Implementation — Key Milestones Plan a coordinated approach to announce and promote the program. Orient department heads and supervisors to the program. Communicate about the program to employees. Provide brief training orientation about the program to program participants. Initiate protocol and procedures. Target Completion Date: XXX

30. Program Tracking and Evaluation — Key Milestones Establish a feedback system for breastfeeding employees, co-workers, and supervisors to gain ongoing input into streamlining the process (maintenance). Review impact and communicate findings with management and key stakeholders. Target Completion Date: Ongoing

31. References (1-3) 1.Harder T, Bergmann R, Kallischnigg G, Plagemann A. Duration of breastfeeding and risk of overweight: A meta-analysis. Am J Epidemiol. 2005; 162:397-403. 2.Bartick M, Reinhold A. The burden of suboptimal breastfeeding in the United States: A pediatric cost analysis. Pediatrics. Vol. 125, No. 5, May 2010, e1048-e1056. Available from:http://pediatrics.aappublications.org/cgi/content/abstract/125/5/e1048http://pediatrics.aappublications.org/cgi/content/abstract/125/5/e1048 3.Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J. (Tufts-New England Medical Center Evidence-based Practice Center). Breastfeeding and maternal and infant health outcomes in developed countries. Evidence Report/Technology Assessment No. 153. Rockville (MD): Agency for Healthcare Research and Quality; 2007 Apr. AHRQ Publication No. 07-E007. Contract Nu. 290-02-0022. 415 pp. Available from: http://www.ahrq.gov/Clinic/tp/brfouttp.htm http://www.ahrq.gov/Clinic/tp/brfouttp.htm

32. References (4-7) 4. Schwarz EB, Ray RM, Stuebe AM, Allison MA, Ness RB, Freiberg MS, Cauley JA. Duration of lactation and risk factors for maternal cardiovascular disease. Obstet Gynecol. 2009;113(5):974-982. 5.Gunderson EP, Jacobs DR, Chiang V, et al. Duration of Lactation and Incidence of the Metabolic Syndrome in Women of Reproductive Age According to Gestational Diabetes Mellitus Status: A 20-Year Prospective Study in CARDIA—The Coronary Artery Risk Development in Young Adults Study. Diabetes. Published online before print December, 2009. Available from: http://diabetes.diabetesjournals.org/content/early/2009/11/12/db09-1197 http://diabetes.diabetesjournals.org/content/early/2009/11/12/db09-1197 6.Fein B, Roe B. The effect of work status on initiation and duration of breastfeeding. Am J Public Health.1998;88(7): 1042-1046. 7.Cardenas R, Major D. Combining employment and breastfeeding: Utilizing a work-family conflict framework to understand obstacles and solutions. J Bus Psychol. 2005;20(1): 31-51.

33. References (8-11) 8. Galtry J. Lactation and the labor market: Breastfeeding, labor market changes, and public policy in the United States. Health Care Women Int. 1997;18:467-480. 9. Texas Department of State Health Services, WIC Infant Feeding Practices Survey, 2009. 10.Department of Health and Human Services (US). The Business case for breastfeeding. Steps for creating a breastfeeding friendly worksite: Bottom line benefits [Kit]. US Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau. 2008. HRSA Inventory Code: MCH00254. Available from: http://www.womenshealth.gov/breastfeeding/programs/business-case/index.cfm http://www.womenshealth.gov/breastfeeding/programs/business-case/index.cfm 11.United States Breastfeeding Committee. Workplace Accommodations to Support and Protect Breastfeeding. Washington, DC: United States Breastfeeding Committee; 2010. Available from: http://www.usbreastfeeding.org/Portals/0/Publications/Workplace- Background-2010-USBC.pdfhttp://www.usbreastfeeding.org/Portals/0/Publications/Workplace- Background-2010-USBC.pdf