Breastfeeding and Health Policy

Currently I'm playing a minor role in a very large obesity prevention program being conducted by the Louisville Metro government, through the Metro Health Department.  Funding for this program is from the Communities Putting Prevention to Work program, part of federal stimulus spending.  The title is a double entendre: it is hoped that as a result of the program, disease prevention and health promotion forces will devise ways to make communities healthier (and thinner), but it is also hoped that the program will help to kick start the economy, with local spending supporting existing and creating new jobs.  It will be some time before we know if either objective is achieved in Louisville and the other U.S. cities receiving similar funding.

One of the initiatives in the obesity program is to establish policies in city government that will make it easier for women with newborns and infants to breastfeed while continuing their employment.  The focus initially is on city government alone, because Metro government has no control over what other employers do; it is hoped that if the experience of city government is successful, other employers will see the wisdom and value of following suit.  By the way, there certainly are local companies that make some provisions to support breastfeeding by female employees, but no inventory exists.

Though the evidence regarding the importance and value of breastfeeding has been established for years, there is still a lot of ignorance surrounding the practice; ignorance is perpetuated by the infant formula industry, that promotes their products with mothers while they are still in the maternity unit of the hospital.  Several medical and health organizations have official policies encouraging breastfeeding.  For example, the American Academy of Pediatrics suggests that babies only receive breast milk through the first six months, and that mothers continue breastfeeding at least through the first year of life.  Benefits of breastfeeding accrue for both babies and mothers.  The interest of the obesity project is on the weight control value of breastfeeding for babies and mothers.

Nursing mothers can lose small but significant amounts of weight because they are transducing their own diets into a food supply for the baby, rather than energy and stored fat for themselves.  Obviously, other factors will determine if there is a net weight loss during nursing: food intake, physical activity, and genetic tendencies and metabolism.  Likewise, there is reliable evidence that babies who are breast fed tend to have a lower prevalence of obesity in childhood.  The same caveat applies, that other factors, such as diet and exercise, can swamp the weight control value of breastfeeding.  Given the proportions and consequences of the obesity epidemic, even small influences on mothers and children are worth pursuing.

The key questions for the obesity project are 1) What can employers do to support breastfeeding and 2) Why should they care?  A business case can be made to support workplace provisions to support breast feeding.  Note that we are talking about either actually nursing in the place of employment or mothers expressing or pumping milk which is stored for others to use to feed her baby while she must be away at work.  Actually nursing on the job is not common, though may be increasing with more flexible patterns of work productivity.  However, mothers and employers are increasingly recognizing that workplace pumping is not only feasible, but has some advantages for the employer.

Because breastfed babies are healthier, it can be expected that medical costs will be lower and absenteeism by mothers caring for sick children will be less.  There is also the belief that when employers support mothers who want to keep breastfeeding, they are strengthening employee retention; worker turnover and retraining are very costly.  Data to support these claims are limited but evidence is growing.

What can employers do to support breast feeding by women?  The first is to establish a social norm or a corporate culture which establishes breastfeeding as something the company values.  It will take some social change before most workplaces are really on board with this concept.  Nevertheless, employers can provide a place on site where women can go to pump milk; the room should be clean, quiet, appropriately furnished, and secure for privacy.  Ideally, this room should have a sink, and an electrical outlet to power a breast pump.  Employers can offer flexible lunch and break schedules to better accommodate the needs of these women.  They can provide a refrigerator for milk storage.  As mothers and human resource units work together to meet this need, other policies and provisions will be identified over time.

Don't miss the important point.  This is an example of creating structural support for healthful living.  We can't entirely rely on education to persuade people to make healthy choices.  Health promotion also requires attention to supportive circumstances.