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Why does breastfeeding make a difference?

Increasing numbers of women are now spending their childbearing years in active employment. Based on current scientific evidence about the health effects of breastfeeding, UNICEF and the World Health Assembly state that the optimum duration of exclusive breastfeeding, that is, giving no other foods or drinks, is six months. Thereafter, the infant should receive complementary food in addition to breastmilk. Ideally, breastfeeding continues until the age of two years or beyond. This pattern of infant feeding benefits not only infants and their mothers but also families, employers and society as a whole.  

How do families benefit from breastfeeding?

Replacements for breastmilk are expensive, in many countries costing 25% or more of the daily wage. The money saved when mothers provide milk for their babies can be spent on other family members, especially on food for older children. Optimal breastfeeding reduces fertility, allowing longer spacing between pregnancies and contributing to better health for the mother and her children. Breastfed babies have a lower risk of sickness, again saving money which might otherwise be spent on health care.

How do employers benefit from breastfeeding?

Employers who cover health care for workers' families have lower costs for doctor visits, hospitalization, and medications when babies are optimally breastfed. When children are healthier, productivity goes up because parents miss fewer work days, worry less and concentrate more on their work. If a woman knows her employer supports breastfeeding, she may come back sooner after maternity leave, thus reducing the employer's retraining and replacement costs.  Finally, workplace support for a woman's “mother-work” gives her a compelling reason for loyalty to her employer.  

How does society as a whole benefit from breastfeeding?

• Human milk is a unique natural resource. It is the best food for babies and young children, building brain power as well as health.  The only way to obtain it is through breastfeeding.  If a community does not give women the support they need in order to breastfeed, this valuable resource can be lost. Replacing human milk is expensive, inefficient and risky—an economically unsustainable alternative. For developing countries, imported milk siphons off precious dollar reserves. On top of the obvious costs to the health care system due to associated illness, society pays hidden costs of environmental degradation and the loss of learning potential in children.   
• Breastfeeding is a key component of child-care. It encourages the development of a close, nurturing relationship between mother and child. Additionally, the hormones of lactation improve women's well-being, lower the rates of anaemia by reducing blood loss after childbirth and during lactation, and lessen the risk of osteoporosis and certain cancers later in life. Breastfeeding is the primary method of child spacing for families in situations where contraception is unavailable, unaffordable or unacceptable.
• While breastfeeding women may make up only a small proportion of the workforce at any one time, protection for breastfeeding is important to all. Child-bearing and breastfeeding are vital social functions that only women can carry out, yet they benefit everyone. Each generation of breastfed children lays the foundation for a future generation of healthy and productive workers. Working women in particular need protection against discrimination and harassment because they often face obstacles to breastfeeding at their jobs.

Breastfeeding mothers at work

According to UNICEF, breastfeeding is recognized in Article 24 of the Convention on the Rights of the Child as “an essential component in assuring the child's right to the highest attainable standard of health.... This means that governments are under an obligation to ensure an environment that empowers women to breastfeed their children if they choose to do so. Working women do not lose the right to this enabling environment because they are in paid employment.” 1

Breastfeeding rates vary from nation to nation. Most nations have a goal of increasing breastfeeding as a means of improving public health and reducing rates of disease and death in children under five. When creative solutions are found that enhance breastfeeding protection at work, mothers are able to breastfeed longer and better and thus improve health, development and well-being.

What is worksite protection for breastfeeding? 

Maternity protection provides the support women need in order to satisfactorily harmonize their productive and reproductive lives. Maternity protection addresses the health needs of women workers and their children, at the same time making it possible for women to remain in the workforce throughout their childbearing years.

Breastfeeding protection was a fundamental component of maternity protection when the International Labour Organization (ILO) was founded in 1919. In June 2000, the ILO adopted a revised Convention 183 and Recommendation 191 on Maternity Protection. The key elements of Convention 183 for breastfeeding women are non-discrimination, employment protection, maternity leave, and breastfeeding breaks. Nations that implement and monitor these provisions in national law and practice are working to ensure that women and men have equal employment opportunities, job security, and conditions of work whilst enabling them to continue providing optimal care for their babies.

• Non-discrimination: Convention 183 says that maternity (including breastfeeding) should not constitute a source of discrimination in employment or in access to employment. Furthermore, the Convention makes it unlawful for an employer to fire a woman during pregnancy, maternity leave or for a period following her return to work, except on grounds unrelated to maternity.

• Employment protection: A mother returning to work is entitled to the same job and salary as before her leave.

• Maternity leave: The minimum length of paid maternity leave is 14 weeks.

• Breastfeeding/Nursing breaks: After maternity leave, women workers who are breastfeeding have the right to paid breastfeeding/nursing breaks or a reduction of work hours.

How does maternity leave affect breastfeeding?

Childbearing requires a major investment of time and energy from women. In 2000, after reviewing the scientific literature, the World Health Organization (WHO) concluded that for optimal maternal and infant health, women need four to six weeks of leave before giving birth and at least sixteen weeks afterwards, with adjustments for increased leave if the woman or her child is sick. 2 After giving birth, a mother needs time to recuperate from the natural course of pregnancy and childbirth and to begin breastfeeding and caring for her infant. Paid maternity leave enables her to take that time without suffering economic loss.

What is a breastfeeding break?

A breastfeeding break is a period that a breastfeeding mother takes during her work day for either breastfeeding her child or expressing her milk. Breastfeeding breaks are paid time.

Do women have a right to breastfeeding breaks?

Yes! In Convention 183 language establishing a right to nursing breaks appears for the first time. In previous maternity protection conventions women were “allowed” nursing breaks or were “entitled to interrupt their work for this purpose.”

Why are breastfeeding breaks needed?

Breaks enable mothers to keep up a good supply of breastmilk. A lactating (breastfeeding) mother makes milk 24 hours a day. Normally, her baby breastfeeds around the clock as well, and her breasts respond to the baby's demand by making the amount of milk that the baby takes, for the times the baby usually takes it. If her baby begins to space feedings farther apart (for instance, by sleeping longer at night), her body will adjust by making less milk at those times.

When the mother's job takes her away at a time the baby normally breastfeeds, her baby can drink milk that she has expressed (by hand or with a pump) and left with the care-giver. In order to continue making enough milk for her baby's needs, the mother must also express the milk that gathers in her breasts during the time that she and her baby are apart. In addition, a woman who expresses milk is taking care of her own health, keeping her breasts comfortable and protecting them from infections.

When are breastfeeding breaks needed?

Breastfeeding breaks are most important during the period of exclusive breastfeeding, until the baby is six months old . Even after the baby begins to eat complementary foods, breastmilk is still the major part of his or her diet for many more months, and breastfeeding breaks are needed to maintain the mother's milk production at the highest level.

How long does a breastfeeding break last?

An experienced mother can express her milk in 15-20 minutes. Because she needs additional time to go to the place where she will express, clean her hands and any equipment she needs to use, prepare the milk for storage, and get back to her work station, 30 minutes is a realistic length for a breastfeeding break. If the baby is available for breastfeeding, 30 minutes is a reasonable break time, but more flexibility might be needed, since babies are less predictable than adults!

How can breastfeeding breaks be adapted to individual needs?

Mothers and babies are individuals. No single rule will fit them all. Some women will not need a full half hour. Some may need more frequent breaks. ILO Recommendation 191 calls for breastfeeding breaks to be adapted to individual needs by means of a medical certificate or “other appropriate certification.” Breastfeeding is part of a woman's personal life; it is not really a “medical” matter. Various options should be developed for certifying a woman's need for breastfeeding breaks. These might include a certificate from a worksite or community nurse, a union welfare officer, or a workplace breastfeeding committee that includes both workers and management.

Working together, women and employers can develop a whole range of creative solutions for adapting the workplace or the breastfeeding breaks to accommodate the needs of both parties.

When are breastfeeding breaks no longer needed?

Babies' breastfeeding patterns vary according to the intensity of their need for milk. For the best health and nutrition, the global standard is to sustain breastfeeding at least until the age of two years . To support this standard, in June 2000 UNICEF called on the ILO to include one daily breastfeeding break for the baby's second year when the Maternity Protection Recommendation was revised.

In reality, by the time a child reaches one year of age, many women can maintain an adequate milk supply without needing to express while away from the baby. Once a baby stops breastfeeding, the mother no longer needs breastfeeding breaks.

What is a daily reduction of hours of work for breastfeeding?

If a woman lives far from her job or has no facilities for child care at or near the workplace, she may prefer to add her breastfeeding breaks together and take that time at the beginning or the end of her normal work day. This allows her to work a shorter day and have an extra hour at home with her baby. She might still choose to express milk during her usual lunch break as an additional method for keeping up her milk supply.

What facilities are needed for breastfeeding or expressing milk in the workplace?

ILO Recommendation 191 says that “where practicable, provision should be made for the establishment of facilities for breastfeeding under adequate hygienic conditions at or near the workplace.” A breastfeeding woman needs access to a small, clean space with room to sit down and a door, screen, or curtain for privacy, access to clean water, and a secure storage place for milk, such as a locker, or space for a container at her work station.

Basic cleanliness, accessibility and security are the most important features of a “breastfeeding facility.” A worker needs to know that the space will be available when she needs it. More than one mother can use the space at the same time, if all agree. In fact, they may find it helpful for mutual encouragement.

The level of cleanliness is similar to that needed for preparing or eating food, thus, a toilet is not an appropriate location! Although a refrigerator is useful, it is not essential. The mother or the employer can provide a small coolbox or thermos flask. Milk can also be safely stored for 4 to 10 hours at room temperature.

Why should a breastfeeding woman get support from her employer and co-workers?

A breastfeeding mother invests time and energy providing food and care for her family. This is rewarding, but it can also be stressful. Milk expression in particular becomes more difficult when women are under stress. A supportive attitude from the employer, supervisors, union, and co-workers can lessen the stresses of balancing job and family needs. Since everyone benefits when babies are breastfed, everyone has a social responsibility to support breastfeeding workers. 

Endnotes:

1. Statement by UNICEF to the Committee on Maternity Protection, 88th Session of the International Labour Conference, Geneva, 30 May to 15 June 2000

2. World Health Organisation Statement to the International Labour Conference, 2 June 2000

Resource: 

1. Breastfeeding, Women and Work - the Maternity Protection Campaign: a report of the NGO advocacy efforts at the 88th ILO Conference , 2000, WABA

The Maternity Protection Campaign is organized by the Maternity Protection Coalition (MPC), comprising groups from the World Alliance for Breastfeeding Action (WABA), the International Baby Food Action Network (IBFAN), the International Lactation Consultant Association (ILCA) and the LINKAGES project, with technical assistance from the United Nations Children's Fund (UNICEF) and International Maternal & Child Health, Uppsala University, Sweden (IMCH). The MPC supports women's right to breastfeed and work, through international instruments, national legislation and local agreements that strengthen maternity entitlements. 

This sheet was developed for the information of trade unions, employers and governments as part of the Maternity Protection Campaign. Authors: Chris Mulford (ILCA) and Amal Omer-Salim (IMCH). For more copies, contact the WABA Secretariat. 14 May 2002