Developing Worksite Wellness Programs: The Lactation Support Model

Katherine Shealy, MPH, IBCLC, RLC

Nutrition Branch

Carol MacGowan, MPH, RD, LD

Program Development and Evaluation Branch

Division of Nutrition, Physical Activity, and Obesity

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Worksite Health Promotion

Definition:

A combination of educational, organization, and environmental activities & programs designed to motivate & support healthy lifestyles among a company’s employees and their families.

Source: Chenoweth, 2007

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Worksites as Environments for Health Behavior Change

● Employees spend at least 50% of waking hours at worksite

● Employer reasons: Decrease costs

• Attract and retain good employees• Reduce health care spending

Improve morale

● Examples from other areas: Physical activity, tobacco cessation, stress

management, etc.Source: Chenoweth, 2007

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Breastfeeding as a Public Health Issue for the United States

Infants in the US who are not breastfed face significantly increased risk of:

● Chronic diseases (eg.: Type 1 & type 2 diabetes, obesity)

● Infectious diseases (eg.: Atopic dermatitis, otitis media, lower respiratory tract infections, gastrointestinal illness)

● Rare events (eg.: Childhood leukemia, SIDS, necrotizing enterocolitis)

Mothers in the US who do not breastfeed face significantly increased risk of:

● Breast cancer

● Ovarian cancer

● Type 2 diabetes

Sources: Chen & Rogan, Pediatrics – 2004Agency for Healthcare Research and Quality, USDHHS – 2007

0102030405060708090

100

%

Ever bf 6 mo any bf 12 mo any bf 3 mo exc bf 6 mo exc bf

Hispanic NH White NH Black Am Indian/AK Native Asian/Pac Isl

Healthy People 2010 Goals

Breastfeeding Rates Among 2004 BirthsData from CDC National Immunization Survey

Per

cen

t

25%

75%

50%

40%

17%

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Breastfeeding Worksite Interventions: Why?

● Women make up 46% of the total US labor force

67 million women (60% of all women) are employed

• Most mothers work full-time (78%)

• Most mothers of young children work (55%)

• Mothers are the fastest growing workforce (80% growth over past 20 yr)

Source: US Department of Labor – 2006

70.663

59.9

76.171

66.266.660.2

56.860.5

5248.1

0

10

20

30

40

50

60

70

80

With Children Children Under Age 6 Children Under Age 3

All Women NH African American Asian Hispanic

Employment Rates Among MothersData from US Department of Labor – 2006

Source: US Department of Labor – 2006

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Breastfeeding Worksite Interventions: Why?

● Postpartum return to work is an identified barrier to breastfeeding Lower rates of initiation, exclusivity & duration Cited by mothers as a reason for weaning

● Postpartum return to work overlaps critical period for exclusive breastfeeding ⅓ return within 3 months

⅔ return within 6 months

Low-income women return to work earlierSources: CDC Guide to Breastfeeding Interventions – 2005

Fein & Roe Am J Pub Health – 1998Fein et al. Pediatrics – forthcoming

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Identified Issues in Worksite Lactation Support

● Concerns with ad-hoc programsInstabilityLack of active management supportSelf-selecting

● Concerns with work settingsCube vs. officeFactory line, service industryHospitals, schools

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● Better meets employers’ needs than ad hoc programs

● Provides active protection and support for employees who are breastfeeding

● Can be used as template for additional areas of wellness promotion

● Can be integrated into larger wellness programs

Formal Breastfeeding Worksite Interventions

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Workplace Lactation Support

• Increases:

• Breastfeeding duration

• Staff productivity and loyalty

• Public image of employers

Decreases:

• Absenteeism

• Employer health care costs

• Employee turnover

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Basic Needs of Breastfeeding Employees

● Time and space to express milk regularly

● Support from supervisors and colleagues

● Information on how to successfully combine breastfeeding with employment

● Access to health professionals who can assist with breastfeeding questions and concerns

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Worksite Lactation Programs Resources

●CDC – Healthier Worksite Initiative Lactation Support Toolkit

●MCHB – The Business Case for Breastfeeding

●US Breastfeeding Committee – Checklist for Accommodations for Breastfeeding in the Workplace

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The CDC Guide to Breastfeeding Interventions

●Maternity Care Practices

●Workplace Support

●Peer Support

●Educating Mothers

●Professional Support

●Media and Social Marketing

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Origins of the CDC Healthier Worksite Initiative (HWI)

● October 2002

Tasked with developing a WHP initiative to complement CDC’s Lifestyle Program

● Spring 2003

Program staffed

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HWI Scope

● Based on HealthierUS “pillars”

Nutritious eating

Physical activity

Preventive health screenings

Healthy choices

● All CDC employees nationwide

● Share lessons learned

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HWI Vision and Mission

Vision….A worksite where healthful choices are easy choices.

Mission…The Healthier Worksite Initiative will develop, evaluate, and disseminate science-based programs that promote worksite health for all CDC/ATSDR employees, and serve as a model and resource for other [federal and state] worksites.

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LSP Toolkit: Introduction

● Toolkit scopeHow to create a comprehensive

worksite LSP

● Health challengeWin-win-win situation:

• benefits employers

• new moms

• infants

● Toolkit components

What?

Why?

How?

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HWI Web Resources

• Homepage URL: http://www.cdc.gov/nccdphp/dnpa/hwi/

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Lactation Support Program (LSP) Toolkit

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LSP Toolkit Example: Planning

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HRSA Maternal and Child Health Bureau (MCHB) Project

The Business Case for Breastfeeding

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The Business Case for Breastfeeding (BCB)

● MCHB project to produce a resource kit on lactation support in the workplace

● Focuses on a business perspective

● Designed for:

Employers

Human Resource Managers

Employees

Lactation Consultants/Advocates

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Scope of BCB Resource Kit

● Increase awareness among employers of the economic benefits of breastfeeding

● Outline manageable, flexible, models for implementing or enhancing a worksite breastfeeding support program

● Increase number of U. S. employers that utilize a worksite breastfeeding support program

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Components of BCB Resource Kit

Five ModulesBrochure focused on cost savings, targeted

to management staff

Easy Steps to Support Breastfeeding Employees

Tool Kit with templates that can be adapted for individual businesses

Employees’ Guide to Breastfeeding and Working

Outreach Marketing Guide and templates

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Implementation Training

● MCHB and HHS Office of Women’s Health have funded the development of a curriculum for implementing the Resource Kit

● Curriculum entitled: Implementing the Business Case for Breastfeeding in YOUR Community

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Status of BCB Resource Kit

● FY 2008-2010 Train-the-Trainer (TTT) Workshops for:

State Breastfeeding Coalitions (SBC)

Healthy Start Communities

● First TTT workshop held January 2008

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Pilot BCB Resource Kit TTT Sites

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MCHB Business Case for Breastfeeding

● Project Officer:Isadora Hare, MSW LCSWDivision of Healthy Start and Perinatal ServicesMaternal and Child Health BureauE-mail: ihare@hrsa.gov

● Web release: Spring 2008

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US Breastfeeding Committee – Checklist for Accommodations for Breastfeeding in the Workplace

●Environment: Space

Facility location

Pumps

Pump personal supplies

Furnishings

●Policy:Leave

Other accommodations

Breaks for expressing milk

Workplace education

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Potential Action Steps

● Be an example – establish a model lactation support program for all state employees

● Celebrate successes – recognize employers who support their breastfeeding employees

● Use resources wisely – find out about existing policies and legislation that support your work

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Resources

● CDC Breastfeeding Website

http://www.cdc.gov/breastfeeding

● CDC Healthier Worksite Initiative

http://www.cdc.gov/hwi

● HRSA Maternal Child Health Bureau

http://www.mchb.hrsa.gov

● US Breastfeeding Committee

http://www.usbreastfeeding.org

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References● Agency for Health Care Research and Quality. Breastfeeding and Maternal

and Infant Health Outcomes in Developed Countries 2007. Available Online at http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf Accessed March 6, 2008

● Chenoweth, DH. Worksite Health Promotion, 2nd Ed. Champaign, IL: Human Kinetics Publishers, 2007.

● Chen A and Rogan WJ. Breastfeeding and the Risk of Postneonatal Death in the United States. Pediatrics 2004; 113: e435-e439

● Fein SB, Roe B. The effect of work status on initiation and duration of breastfeeding. American Journal of Public health 1998; 88(7): 1042-6.

● Healthy Workforce 2010: An essential sourcebook for employers. Available online at

http://www.acsworkplacesolutions.com/documents/Healthy_Workforce_2010.pdf. Accessed February 2007

● U.S. Department of Labor Women’s Bureau. (2006). Statistics and Data: Quick Stats. Available online at http://www.dol.gov/wb/stats/main.htm. Accessed February 2007.

● U.S. Department of Labor Women’s Bureau. (2006). Employment status of women and men in 2005. Available online at http://www.dol.gov/wb/facthseets/Qf-ESWIM06.htm. Accessed February 2007.

● Shealy K, Li R, Benton-Davis S, Grummer-Strawn L. The CDC guide to breastfeeding interventions. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005.

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Thank You

Contact information:

Katherine Shealy: KShealy@cdc.gov

Carol MacGowan: CMacGowan@cdc.gov