Despite Affordable Care Act regulations, employers still aren't proactive about giving women the time and space they need.

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Despite national requirements designed to protect the rights of breastfeeding moms in the workplace, many women still face an uphill battle when it comes to pumping on the job.

Most employers in rural, low-income communities are aware of breastfeeding regulations, finds a new study by University of Missouri researchers, but aren’t making resources available to their employees unless they’re directly asked. The study also found that many women are met with unsupportive attitudes—even ridicule—when they do bring it up.

This shouldn’t be the case, of course: The Affordable Care Act requires companies of more than 50 employees to provide space and time for mothers to breastfeed during the first year of their babies’ lives. That means designated lactation rooms and “reasonable breaks” for pumping; bathrooms aren’t good enough, the law states, not even private ones.

But four years after the ACA’s implementation, when researchers interviewed 17 workplace managers and 17 female employees in a rural Missouri community, they found that employers often did not comply with the law, did not provide information to new mothers about their rights, and did not foster environments that were accepting or encouraging of breastfeeding.

The study focused on low-income mothers: All of those interviewed were beneficiaries of the federal WIC assistance program who had breastfed in the past two years. They all had at least a high-school education, were between 20 and 30 years old, and worked in a variety of job sectors, including education, health, retail, and manufacturing.

While new moms of all demographics and economic status can face challenges to breastfeeding—including rude coworkers and lack of accommodations—this group may be particularly vulnerable, says study co-author Wilson Majee, Ph.D., assistant professor of health sciences in the MU School of Health Professions.

“I think most of it has to do with the education of these women, and them not knowing what their rights are,” he says. “Many of their coworkers are not well educated, as well, so the value they attach to breastfeeding is of less importance when compared to people with more education.”

Most of the employers interviewed said they wanted to provide assistance to their employees, but only did so on a case-by-case basis. “If requested, most of them are willing to support breastfeeding,” Majee says. “But they’re looking at it from a business and a financial perspective: If they don’t ask for it, why worry about it.”

None of the managers interviewed proactively encouraged the practice of pumping at work. “We found that employers often saw breastfeeding as a personal decision, and therefore were unwilling to bring up the issue to their employees,” Majee says, “even at crucial moments, such as when mothers file the required paperwork for family medical leave.”

In some cases, bathrooms were offered as spaces for women to pump. (In others, employers volunteered the use of their own offices.) Some mothers reported being reprimanded for taking longer than their allotted 15 minutes off-the-clock, or having to choose between pumping and eating during their one break of the day.

One of the study’s most disturbing interviews comes from a woman who worked at a retail grocery store. “[My coworkers] use it as a joke,” she wrote. “When I’m pumping they... knock on the door and... move my stuff ... I have to pump in a bathroom, I …  have an extension cord from our break room into the bathroom, and … they … unplug it on me.” Her supervisor also reportedly told her, “Must be nice to … sit in the bathroom and not have to do anything …”  

Majee says that collaborations between rural health agencies and local employers are needed to help create family-friendly environments. He also says that workplaces should initiate discussions with their employees before they give birth, instead of relying on new moms to bring it up themselves. “These women often feel that their breastfeeding needs are a burden for their employers, rather than a workplace right,” he says.

He also encourages employees in all types of workplaces to speak up. “Women need to be informed and be able to ask if they need support from their employer—they should have that voice to be able to get the services required for them,” he says.

Just over half of American infants born in 2012 were breastfed for six months, and only 29 percent for a full year. (The American Academy of Pediatrics recommends breastfeeding exclusively for the first six months of life, with continued breastfeeding up to a year or longer.) Rural mothers are less likely than their urban counterparts to breastfeed in the first place, especially those participating in the WIC program.

“Although the decision to breastfeed is usually a personal one, the choice not to breastfeed is often shaped by an interplay of multiple factors,” the study authors wrote. Among those factors, they cite poor education and living conditions, lack of workplace support, and lack of community collaboration on social issues.  

And while there are a lot of myths and misconceptions about breastfeeding out there, the science is clear that there are real health benefits—for both baby and mom.

In fact, a new study from the University of North Carolina suggests that breastfeeding could literally save lives: Those researchers estimated that, compared with the United States' current “suboptimal” breastfeeding rates, breastfeeding as recommended could prevent more than 3,340 premature deaths every year.


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