Health Care Reform Boosts Support for Employed Breastfeeding Mothers

Frequently Asked Questions

With the inclusion of this provision in health care reform legislation, the U.S. joins the rest of the industrialized world in recognizing breastfeeding as the natural outcome of pregnancy, and workplace lactation programs as the natural outcome of a society where the majority of mothers and infants are separated due to work.

What does the Reasonable Break Time for Nursing Mothers law do?

Section 4207 of the Patient Protection and Affordable Care Act (also known as Health Care Reform), states that employers shall provide breastfeeding employees with “reasonable break time” and a private, non-bathroom place to express breast milk during the workday, up until the child’s first birthday.
Download the text of Section 4207 only.

What types of employers are covered?

All employers are covered but those with less than 50 workers do not have to comply if they show that complying with the law would cause “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.”

What types of workers are covered?

The law is an amendment to our nation’s existing minimum wage and overtime laws, so it covers the workers subject to those laws, so-called “non-exempt workers.” Generally, this means hourly workers (many retail workers, factory workers, restaurant workers, and call center workers, for example) and other employees who work on an hourly basis and who are subject to overtime laws.
“Exempt” workers are those on a salary (“exempt” from overtime), often in managerial positions. They are not covered by the new federal law. Many of these workers, particularly those employed by large companies, have workplace accommodation as part of company policy. The National Business Group on Health has recently published case studies highlighting several of these.

When does the law take effect?

The law was effective immediately upon President Obama’s signing of the Patient Protection and Affordable Care Act, however, the rules for enforcement have not yet been put in place. Breastfeeding employees should be assured that the Department of Labor is working swiftly to establish these rules, and should give their employers time to comply once those rules take effect.
While the Department of Labor works to define terms and processes for enforcement of the law, USBC stands ready to support employers and breastfeeding employees with tools, information, and resources. View resources for employers and managers and resources for breastfeeding employees.

Why is the law necessary?

The longer a woman breastfeeds her child, the lower her risk of serious diseases such as diabetes, heart disease and breast cancer, and the lower the child’s risk of infections, obesity, diabetes, and other diseases and conditions.
That’s why medical experts agree with the Department of Health and Human Services in recommending exclusive breastfeeding for six months and continued breastfeeding for the first year of life and beyond.
Mother-child separation due to work presents a serious challenge to meeting breastfeeding goals when employers do not meet the relatively simple needs of breastfeeding employees: time to regularly express milk (approximately every three hours), in a clean, private space.
Women now comprise half the U.S. workforce, and are the primary breadwinner in nearly 4 out of 10 American families. The fastest growing segment of the workforce is women with children under age three.
The Centers for Disease Control and Prevention’s National Immunization Survey indicates that nearly 75% of women initiate breastfeeding, but breastfeeding rates at six months and 12 months drop precipitously.
Returning to an unsupportive work environment has been identified as a major reason for the avoidance or early abandonment of breastfeeding. Workplace support can bridge this gap and help more women to balance working and breastfeeding.
While there are increasing numbers of worksite lactation programs, low-wage earners have had less access to this support. A mother’s decision to breastfeed her child should not be predetermined by where a mother works.

Aren’t there state laws that already protect employed breastfeeding mothers?

Currently, 24 U.S. states, Puerto Rico, and the District of Columbia have legislation related to breastfeeding in the workplace. One of the strongest and most detailed was passed in Oregon in 2007. The Oregon law served as a model for the federal provision, i ntroduced into health reform legislation in 2009 by Senator Jeff Merkley (D-OR). A federal law was needed to cover the many states without worksite protection for breastfeeding mothers. The new federal law will provide a minimum level of support in all states, but if an existing state law provides stronger protections, the state law will prevail.

What does an employer stand to gain?

The Business Case for Breastfeeding, published in 2008 by DHHS, demonstrates an impressive return on investment for employers that provide workplace lactation support, including lower health care costs, absenteeism, and turnover rates. Employees whose companies provide breastfeeding support consistently report improved morale, better satisfaction with their jobs, and higher productivity. As part of The Business Case for Breastfeeding initiative, coalitions in 32 states and territories received training to assist employers in establishing lactation support programs.
The National Business Group on Health, a nonprofit organization representing large employers on national health policy issues, says that creating a breastfeeding-friendly work environment reduces the risk of long-term health problems for women and children, decreases employee absenteeism, reduces health claims to employers, and increases retention of female employees.
Research shows that worksite lactation programs are good for business: there has been a steady trend of growth in worksite lactation programs over the last ten years.

Level of Support	Components of Program	Return on Investment
Basic Accommodation	Reasonable time Clean, private space	$1 investment $2 return
Comprehensive Accommodation	Supportive policy Lactation consultations Pump provision Flexible schedule On-site childcare	$1 investment Up to $3 return

What do the time and space requirements in the new law mean?

The Department of Labor will define terms used in the law, such as “reasonable break time” and “significant difficulty or expense.”
An example of how the Department of Labor might interpret the law can be found in Oregon’s Rest Breaks for Breast Milk Expression law, which served as the model for the federal law. In Oregon, the Bureau of Labor and Industry Administrative Rules defined the time and space provisions as follows:

In Oregon, “reasonable” time for milk expression is defined as: “a 30-minute rest period to express milk during each four-hour work period, or the major part of a four-hour work period, to be taken by the employee approximately in the middle of the work period.” This matches wage and hour law, and also covers exempt and part-time employees.

The effort is to match the biological rhythm of a breastfeeding mother and child to the structured rhythm of the workday as closely as possible. A breastfeeding employee needs to express milk regularly to maintain her milk supply. Research and experience have shown that a 30-minute break in every four-hour work period is the minimum time needed for the employee to get to the designated space, set up the pump, express adequate milk, clean pump parts, get the milk to cold storage, and return to the work station.

The Oregon law’s definitions have provided great flexibility in designating space for milk expression, while still meeting the threshold of the law. Unlike the Americans with Disability Act, businesses in Oregon are not required to make major changes to the built environment. Examples of creative solutions include:

Designated, permanent space, at least 4’ x 6’ with a chair, sink, and electrical outlet.
Space designated with a sign or reserved on a calendar that rotates throughout the workspace between offices, conference rooms, clinic rooms, etc.
Temporary use of manager office space in fast-food restaurants, police departments, or settings that lack other spaces with a locking door.
A curtained-off area that is non-accessible to the public, and meets privacy threshold because of clear, well-communicated policy with co-workers. This can even mean a chair behind a curtain in an employee-only bathroom lounge, if there is truly no other space available.
A designated space that serves employees from several employers, located in the employee-only areas of malls, airports, and retail strips.
An agreement between worksites, where a breastfeeding employee can visit a neighboring business to access a designated space within.
Privacy panels to block the windows of work vehicles such as patrol cars or construction vehicles on the road.
Use of City or County buildings by public employees on route, such as police on patrol, bus drivers, or meter readers.

What about complaints, enforcements, penalties, and “undue hardship”?

These are some of the important questions the Department of Labor will be working to answer in the coming months. USBC and Senator Merkley’s office will be closely monitoring and supporting this process.
There are many resources available with tools to help employers implement the law. Bookmark this page and check back often!

Resources for employers and managers:

Resources for breastfeeding employees:

Source: USBC