1. Supporting Breastfeeding and Increasing Access to Lactation Support
for Moms and Babies
(Use this slide if you did not add a logo, or the following slide if you did.) Hello. I am Insert Name [List your credentials and role within your organization.] I am here today on behalf of Your local and state coalition . Our mission is to promote, protect, and support breastfeeding mothers and improve access to care for the moms and babies of Texas.
We have been concerned for years about our breastfeeding rates in this state. This is an opportunity to help moms and babies get the help that they want and need to reach their personal breastfeeding goals. I will be discussing our action plan and asking for your support today.

2. Insert your logo Supporting Breastfeeding and
Increasing Access to Lactation Support
for Moms and Babies
(Use this slide if you add a logo, or the previous slide if you did not.) Hello. I am Insert Name [List your credentials and role within your organization.] I am here today on behalf of Your local and state coalition . Our mission is to promote, protect, and support breastfeeding mothers and improve access to care for the moms and babies of Texas.
We have been concerned for years about our breastfeeding rates in this state. This is an opportunity to help moms and babies get the help that they want and need to reach their personal breastfeeding goals. I will be discussing our action plan and asking for your support today.

3. Breastfeeding is not just a lifestyle choice It saves lives
It saves money
&
Supporting Breastfeeding is a
Public Health Imperative
For decades, we’ve treated breastfeeding as just a lifestyle choice. As a simple, relatively uncomplicated choice - “breast or bottle?” But
Breastfeeding is not just a lifestyle choice
It saves lives
It saves money
And
Supporting Breastfeeding is a Public Health Imperative.

4. Please support this breastfeeding legislation
There are 3 things we can do right now to support breastfeeding mothers and babies
license lactation consultants
protect a mother's right to breastfeed in public, &
support working mothers to pump milk at work
Please support this breastfeeding legislation
There are three pieces of legislation we would like for you to support in the 84th session.
To license lactation consultants: IBCLCs (International Board Certified Lactation Consultants) are the only recognized experts in the field of lactation support, and their expertise is frequently required by mothers who wish to breastfeed.
To enforce a mother’s right to breastfeed in public: The law-asserted right of mothers to breastfeed anywhere they are authorized to be is frequently violated.
To support public employees to pump milk for their babies while at work: Existing federal law requires time and a place to express breastmilk, but salaried public employees are exempt.
There are many compelling reasons that we’ll go over - reasons that I’m asking you to
Please support this breastfeeding legislation.

5. Remember when this was the norm?
Remember -- we used to think of smoking as nothing more than a lifestyle choice! Nearly 50% of the population >18yrs old was smoking at the height of tobacco sales and we can see in many advertisements, doctors were mentioned as well. Many people did not understand the health risks associated with this addictive substance. Now that more of the public is educated and cessation programs supported, those numbers have declined dramatically.
Photo copyright: The Bees Knees Daily on Flikr
Breastfeeding is not a lifestyle choice - it is a public health game changer.

6. Today - for many, this is the norm
Today, this is the norm. Babies go with bottles. Think about all of your baby dolls growing up.
The bottle ironically is an iconic image for infancy
By the 1940s & ‘50’s, formula feeding was widely accepted as a safe alternative to breastfeeding by physicians and consumers. Marketing was directed towards physicians In fact in most cases it was advertised as better than breastmilk. It was the “Doctor’s formula” Breastfeeding declined as a result. A movement began in the ‘70’s to promote breastfeeding, but in 1988 formula companies started to market directly to consumers, again having a detrimental impact on breastfeeding rates.
Today, formula use is prevalent.
History Source: Stevens, Patrick, & Pickler, The Journal of Perinatal Education, “A History of Infant Feeding,” Spring can be found at
Some moms even pump milk in order to give a bottle in public
RF photo from dreamstime.com

7. Current Breastfeeding Rates
77.2% of Texas mothers initiated breastfeeding in 2013, but within 3 months, only 35.8% of those mothers were exclusively breastfeeding.
This is the norm.
Source: Stevens, Patrick, & Pickler, The Journal of Perinatal Education, “A History of Infant Feeding,” Spring can be found at

8. Current Recommendations
American Academy of Pediatrics (AAP)
6 months exclusive breastfeedingbreastfeeding with complementary foods to at least 12 months
(thereafter as long as mutually desired by mother & baby)
World Health Organization
6 months exclusive breastfeeding with
complementary foods to at least 2 years.
(Thereafter as long as mutually desired by mother & baby)
The prevalent use of formula is in spite of the recommendations of major health organizations. The American Academy of Pediatrics recommends exclusive breastfeeding for about the first six months of a baby's life, followed by breastfeeding in combination with the introduction of complementary foods until at least 12 months of age, and continuation of breastfeeding for as long as is mutually desired by mother and baby. The World Health Organization (WHO) recommends breastfeeding until a child is at least two years of age.Click to fade in other organizations
Many health organizations recommend breastfeeding. Because while formula use is relatively safe, it is not without risks. Human milk is the optimal nutrition for our infants.

9. These recommendations are recognised by
The American Dietetic Association
The American Academy of Family Physicians
The Association of Women’s Health
The American College of Obstetricians and Gynecologists (ACOG)
The United States Department of Health & Human Services
The Centers for Disease Control (CDC) UNICEF
The US Surgeon General

10. Is this just a lifestyle choice?
Are these low breastfeeding rates just a lifestyle choice? Are moms just choosing to formula feed? Our data tells us that this is simply not the case. The Infant Feeding Practices Survey asked moms Were you able to breastfeed as long as you wanted to?
Nationally and Texas specific data is unmistakable
Among mothers who breastfed less than 3 months 77 and 65% of mothers respectively stated that they were unable to reach their breastfeeding goals.
Overall 60% nationally and 55% statewide stated that they wanted to breastfeed longer.
These are moms that wanted to breastfeed but for one reason or another they stopped.
These are moms that we can and should be reaching with increased access to quality care and policies that support breastfeeding families.
Source: Centers for Disease Control and Prevention, 2008 Infant Feeding Practices Survey can be found at
and 2011 Texas WIC Infant Feeding Practices Survey can be found at
(CDC 2008 Infant Feeding Practices Survey and 2011 Texas WIC Infant Feeding Practices Survey)

11. Breastfeeding Saves Lives
Why is breastfeeding a public health imperative? It may be difficult to integrate this information after decades of increasingly safer formulas, decades of breastfeeding being treated as a lifestyle option - just one of two equal options.
But the simple fact is, breastfeeding literally saves lives.

12. More than 900 deaths could be prevented each year in the US

13. Multiply this by 10

14. 900 lives could be saved if more moms were able to breastfeed to 6 months

15. Infants who are breastfed are at reduced risk for many childhood illnesses
Acute otitis media (ear infection)
50%
Hospitalization for severe lower respiratory infections
72%
Non-specific gastroenteritis (diarrhea)
64%
Celiac disease
52%
Type 1 diabetes
19-27%
Type 2 diabetes
39%
Obesity in adolescence or adulthood
24%
The Agency for Healthcare Research and Quality (AHRQ) is the lead Federal agency charged with improving the quality, safety, efficiency, and effectiveness of health care for all Americans.
The AHRQ 2007 comprehensive systematic review and meta-analysis of breastfeeding outcomes in developed countries concluded that infants who are breastfed are at reduced risk for many childhood illnesses.
The Agency for Healthcare Research and Quality (AHRQ)

16. Infants who are breastfed are at reduced risk for many childhood illnesses
childhood asthma - no family history
27%
childhood asthma - with a family history
40%
atopic dermatitis (a type of allergic skin disorder)
42%
for acute lymphocytic leukemia (ALL)
19%
acute myelogenous leukemia (AML)
15%
The Agency for Healthcare Research and Quality (AHRQ)

17. Reduction in SIDS For any breastfeeding the risk was reduced by 60%
For EXCLUSIVE breastfeeding
the risk was reduced by 73%
Hauck, Fern, John M. D. Thompson et al. Breastfeeding and Reduced Risk of Sudden Infant Death Syndrome: A Meta Analysis Journal of Pediatrics 2010

18. Anti-infective and living components of human milk
Living Cells (macrophages, T and B cell lymphocytes)
Imunoglobulins (Sig A, Sig M, Sig E)
Lactoferrin
Lysozyme
Oligosaccharides
< 150 Long Chain Fatty acids (including DHA & ARA)
monoglycerides
HAMLT (Human Alpha-Lactalbumin Made Lethal to Tumor Cells)
Digestive Enzymes ( amylase, lipase)
Stem Cells!
3/13/2013

19. Human Milk Especially Vital for Premature Infants
Lowers risk of:
necrotizing enterocolitis (77% reduction)
Sepsis
retinopathy of prematurity (blindness)
hospital readmissions in the first year
(AAP March 2012 Breastfeeding Policy Statement)
While breastfeeding does not discriminate, human milk is especially vital for medically fragile babies.
Premature babies receiving breastmilk from their mothers or donor milk from a milk bank have reduced risk for blindness and for being readmitted to the hospital in their first year.
One of the scariest things for parents of preemies is necrotizing enterocolitis. This is where human milk makes the greatest impact on preemies. This potentially fatal disease is reduced by 77% in preemies who are being exclusively fed human milk with human milk based fortifier compared to cows milk based fortifier.
We also see a reduction in sepsis, retinopathy of prematurity and fewer hospital readmissions Not only are risks reduced, as these babies age, the white matter and total brain volumes are greater as breastmilk-fed preemies grow, and their IQs are improved.
Improves IQs:
white matter and total brain volumes are greater as these children age

20. Breastfeeding reduces a mother’s risk of…
Breast Cancer 7% each pregnancy
4.3% each 12 mo. BF
Ovarian Cancer 28% BF > 12mo.
Rheumatoid Arthritis 50% BF >24 mo.
The benefits of breastfeeding are cumulative. The longer a woman breastfeeds the less likely she will be to develop these chronic diseases.
With each pregnancy a mother will have a 7% reduction in breast cancer and an additional 4.3% reduction with each year of breastfeeding.
Lets do a little math.
Lets look at a mom who has 2 kids and breastfed each 1 yr. What would her reduction of risk be? %
The effect is cumulative with each child.
Breastfeeding <12 months (cumulatively) did not have a significant effect on ovarian cancer. But you can see that if a woman breastfed over 1 yr adding up all of her experience with each chid, we see a significand difference in those that develop ovarian cancer compared to mothers who never breastfed.
Sources:
Rheumatology (Oxford) Jan 6
Arthritis Rheum Nov;50(11): Do breast-feeding and other reproductive factors influence future risk of rheumatoid arthritis? Results from the Nurses' Health Study.
AHRQ, Arthritis Rheum Nov;50(11)

21. Many breastfeeing moms also experience
Improved sleep
40 minutes longer
Better quality sleep
Weight loss
500 – 600 calories/day
Decreased insulin need (IDDM)
Along with disease protection moms also experience better sleep.
Do you believe that?! Crazy right? We are always told that if you are breastfeeding you are the only one who can feed your baby in the middle of the night so breastfeeding mothers must be getting less sleep.
This is just not the case.
We are not talking about the first couple of weeks of life, all moms are sleep deprived in the first couple of weeks.
These were very non invasive studies where the researcher went to the moms house and just put on a little bracelet that measured hear rate, temp, and respiration to determine sleep cycles and they found that on average moms got 40 minutes longer and TRIPPLE the amount of slow wave sleep (marker for better quality)
(Results were 63 minutes for no breastfeeding, 182 minutes for breastfeeding moms)
Many moms will also experience returning to their pre-pregnancy size sooner – The average breastfeeding mother will be burning calories a day just for breastfeeding. That is the equivalent of riding your bike for an hour.
Insulin Dependend Diabetic Moms will also typically have a decreased insulin need. They may be able to go days without taking insulin. Breastfeeding is helping to regulate her insulin levels.
40 minutes longer :Doan, T., Gardiner, A., Gay, C. L., & Lee, K. A. (2007). Breastfeeding increases sleep duration of new parents. Journal of Perinatal & Neonatal Nursing, 21(3),
Better quality : Blyton, D. M., Sullivan, C. E., & Edwards, N. (2002). Lactation is associated with an increase in slow-wave sleep in women. Journal of Sleep Research, 11(4),
Insulin need : Riviello, C. Mello G., and Jovanovic LG.
Breastfeeding and the basal insulin requirement in type 1 diabetic women.
Endocr Pract Apr;15(3):187-93
Photographer: Gloria Sanchez
J of Perinatal & Neonatal Nursing, 2007, 21(3),
Journal of Sleep Research, 2002, 11(4),
Endocr Pract Apr;15(3):187-93

22. Maternal Bonding with Breastfeeding Reduces Child Abuse and Neglect
“Rate of abuse/neglect was significantly increased for mothers who did not breastfeed as opposed to those who did.”
(AAP, Pediatrics, March 2012)
When a mother breastfeeds, oxytocin is released. This might be called the “love hormone.” Of course, all mothers love their babies, regardless of the method of feeding. The hormonal involvement of breastfeeding, though, helps a mother feel bonded to her baby.
And the
“Rate of abuse and/or neglect was significantly increased for mothers who did not breastfeed as opposed to those who did.”
according to the American Academy of Pediatrics’ Breastfeeding Policy Statement.

23. Breastfeeding Saves Money...
Breastfeeding doesn’t just improve health and save lives. Breastfeeding saves money.
Saves Money...

24. Breastfeeding Saves Money... for Families
Regular Formula:
$1,500-$1,800 per year
Specialized/Ready to Feed Formula: $3,200 per year
Breastfeeding does not have out of pocket costs. Even with a pump or paid help from an LC, it is cheap compared to formula.
Regular formula is roughly $1,500-1,800 per year.
Specialized formula or ready to feed formula can cost over $3,000 a year.
And breastfeeding is better for the environment, too!

25. More Than $31.2 BILLION/YEAR could be saved
Breastfeeding Saves Money... for the United States
More Than $31.2 BILLION/YEAR could be saved
But it’s not just a matter of saving money on formula.
All those prevented diseases and illnesses save the United States money in healthcare costs.
Click for $13 billion on slide.
If mothers were adequately supported and the majority of moms could meet the recommendation to breastfeed exclusively to 6 months, the US. would stand ti save $13 billion per year in pediatric costs.Click for $18 billion on slide.
And in maternal deaths, direct, and indirect medical costs, the U.S. would save $18.26 billion annually.
Click for $31 billion on slide.
That’s more than $31.2 billion dollars, every year.
Sources: Bartick, M. Reinhold, A. The burden of suboptimal breastfeeding in the United States: A pediatric cost analysis. Pediatrics
Bartick, M. Stuebe, A. et al. Cost Analysis of Maternal Disease Associated With Suboptimal Breastfeeding. Obstetrics & Gynecology
$13 billion in pediatric costs
$18.26 billion in maternal deaths, direct, and indirect medical costs
(Reinhold, A. Pediatrics and Bartick, M. Stuebe, A. et al )

26. Breastfeeding Saves Money... for Texas
An exclusively breastfed WIC infant saves Medicaid and WIC about $960 in the first six months of life!
Medicaid pharmacy costs are about ½ that of formula-fed infants
In addition to the savings that Texas stands to benefit from as the second most populous of the united states, Texas is currently saving money that would otherwise be spent in Medicaid and WIC costs.
In just 6 months, each breastfed baby getting Medicaid is saving the state $960.
That is just the immediate dollar savings—it does not account for the long term health care cost savings.
OLD
Compared with formula-feeding, breast-feeding each infant enrolled in WIC saved $478 in WIC costs and Medicaid expenditures during the first 6 months of the infant's life, or $161 after consideration of the formula manufacturer's rebate. A Medicaid cost saving of $112 per infant was realized by the breast-feeding cohort, and Medicaid pharmacy reimbursement costs for breast-fed infants were significantly lower-half that of formula-fed infants.
Montgomery DL, Splett PL. Economic benefit of breast-feeding infants enrolled in WIC. J Am Diet Assoc. 1997;97(4):

27. Texas Moms Initiation Rates are Good
About 77% of Texas moms try to breastfeed
Duration Rates are Dismal
Only 14.5% are exclusively breastfeeding for 6 months
In Texas, the majority of mothers want to breastfeed.
According to the CDC 2013 Breastfeeding Report Card, 77% of Texas moms initiated breastfeeding.
Click for right side of slide.
But only 14.5% of mothers were still exclusively breastfeeding at 6 months.(Left side will fade.)Source: Centers for Disease Control & Prevention 2013 Breastfeeding Report Card, found at
(CDC 2013 Breastfeeding Report Card)

28. With all of these benefits why do only 14.5% of Texas mothers
exclusively breastfeed their
babies for 6 months?
So what is going on?
Why are only 14.5% of Texas mothers following the AAP’s guidelines and exclusively breastfeeding their babies for 6 mos?
Why are they not reaching their personal breastfeeding goals?

29. Main Reason Moms Started Giving Formula
1. Perceived/Actual Breastfeeding Difficulties
I didn’t think I had enough milk
My baby had trouble sucking or latching on
Breast milk alone did not satisfy my baby
(2011 Texas WIC Infant Feeding Practices Survey)
53%
In the 2011 Texas WIC Infant Feeding Practices Survey, the top three answers from breastfeeding mothers to the question, “What was the main reason that you started feeding your baby formula?” are that mom worried she didn’t have enough milk, that her baby had trouble sucking or latching, or that her baby was not satisfied by breastmilk alone.
These moms aren’t quitting because they think it’s best for their babies.
They have problems, or worry that there is a problem, and the most available solution is formula—when the most available solution ought to be a lactation consultant.
Milk supply is established in the first 2 weeks, so if problems arise and there is no support to resolve them early on, a mother may never have an adequate milk supply for her infant.

30. Major Barrier to Meeting Breastfeeding Recommendations
2. Anxiety Over Nursing in Public
(2012 Lansinoh Breastfeeding Survey)
40%
Another major barrier to breastfeeding is that mothers must overcome anxiety that is fueled by a society so exposed to breasts as... enticing, that it is difficulty for some people to accept that their primary function is to nourish a life.
Frequently mothers face discrimination for breastfeeding their babies in public - a necessity when babies eat very frequently and mothers need to, for example, go grocery shopping.
Some discrimination cases get so much attention in social and traditional media that it seems that harassment is inevitable.
In the 2012 Lansinoh Breastfeeding Survey, almost half of mothers cite nursing in public as their greatest concern.
Source: Lansinoh survey

31. Main Reason For Not Breastfeeding
3. Returning to Work Or School
(2011 Texas WIC Infant Feeding Practices Survey)
21.5%
A third major barrier to breastfeeding is returning to work or school.
In fact, almost a quarter of mothers who never even try to breastfeed list plans to return to work or school as their reason.
Mothers who return to work, if they are supported with time and a place to do it, can express breastmilk and store it to feed it to their babies later.
But often, workplaces make it difficult for a mother to mimic her baby’s feeding schedule.
Without the demand, the supply decreases and may fail to meet Baby’s needs.

32. How do we change this? RF Photo from 123RF
How can we address the barriers to support mothers to meet their breastfeeding goals?
RF Photo from 123RF

33. Main Reason Moms Started Giving Formula
1. Perceived/Actual Breastfeeding Difficulties
I didn’t think I had enough milk
My baby had trouble sucking or latching on
Breast milk alone did not satisfy my baby
(2011 Texas WIC Infant Feeding Practices Survey)
53%
Lets take a look at the top barriers to breastfeeding

34. Mothers and Babies Need Clinical Lactation Evaluation and Care Plans
Poor Latch
Weak Suck
Ineffective Suck
Insufficient milk supply
Excessive Weight Loss in Infant
Engorgement
Plugged Ducts
Mastitis
Oversupply
Oral abnormalities (palate, tongue, lip)
Flat or Inverted Nipples
Damaged Nipples
Breast Refusal
While breastfeeding is a natural act, it is also something of a lost art in our society Breastfeeding rates are so low that we don’t often see mothers nursing their babies There is more to it than merely the following of instincts.
A new mother can encounter many problems that she has no frame of reference for solving Problems that require clinical lactation support and a care plan. Problems might include:
Mastitis (a serious infection that can lead to abcess and surgery)
Tongue Tie
Oversupply
Undersupply
Poor Latch Et cetera(Pause.) And one of the most pervasive, detrimental problems is fear of having a problem - worrying that there is a problem when in fact here may be none. Mothers need someone qualified to assess whether their fears are new-mom jitters or there is truly a breastfeeding issue. Without that qualified help, problems may go undiagnosed, or mothers often allay their fears by supplementing with formula, which most times impacts supply and creates new problems or exacerbates existing ones.
Many problems do not begin until the 3rd day of life.
So a mother who gives birth in a hospital that provides lactation support may be home from the hospital and without support before she becomes concerned.
flickr.com/photos/jesebo/ /
Many complications with breastfeeding do not begin until after the 3rd day.

35. Mothers and Babies Need Clinical Lactation Evaluation and Care Plans
Comprehensive lactation consultation usually takes around 2 hours
Includes: Medical History
Evaluation of Feeding Comprehensive Lactation Care Plan
Report to PCP or Pediatrician
Most physicians do not have the time or the training to solve complex breastfeeding challenges.
Lactation education is not a core requirement for OBs or Pedis
A clinical consultation usually takes two hours, and must include maternal medical history, baby’s history (including problems at birth, stools, urination), physical assessment of baby (signs of dehydration, oral issues), physical assessment of mother’s breasts, direct observation of feeding, before and after weight of baby to determine milk transfer, etc..
Most physicians do not have the time for these lengthy consultations, and the standard training for physicians about breastfeeding is very limited. So where does a mother find qualified expertise?

36. IBCLC Ensure access to services provided by
The Surgeon General's Call to Action to Support Breastfeeding, Action 11:
Ensure access to
services provided by
International Board Certified
Lactation Consultants.
(The Surgeon General's Call to Action to Support Breastfeeding, 2011)
In 2011, then US Surgeon General, Admiral Benjamin, issued a “Call to Action Report“ for the US to bring more focus to our breastfeeding deficits and the costs of not breastfeeding for both families and the country.
In that report the Surgeon General stated, “International Board Certified Lactation Consultants (IBCLCs) are the only healthcare professionals certified in lactation care.
They have specific clinical expertise and training in the clinical management of complex problems with lactation.”
Action 11 includes to “Ensure access to services provided by International Board Certified Lactation Consultants.”
Not every mom needs an IBCLC; the issues some mothers face are resolved fairly easily — but most mothers do need some professional help.
Source: The Surgeon General's Call to Action to Support Breastfeeding, 2011 can be found at

37. How Do We Ensure Access?
Through Licensure and reimbursement for IBCLC care
People become IBCLCs because they have a passion for supporting the health of mothers and babies. Everyone must make a living, of course, so while lactation support is a labor of love, as a healthcare profession, it is also one that requires reimbursement.
The Surgeon General advises that reimbursement for IBCLC care be provided, which can be accomplished by licensing IBCLCs.

38. What Makes An IBCLC Uniquely Qualified?
Prerequisites:
14 college level health science courses 90 hours of lactation specific education hours of supervised clinical care
Must pass a board exam
Must adhere to a Code of Ethics
Must have continuing education
Must recertify every 5 years
What makes an IBCLC uniquely qualified to support breastfeeding mothers and babies?
IBCLCs must complete
8 college level science courses
90 hours of lactation specific coursework
and
hours of supervised clinical care IBCLCs Must pass an international exam that is given in 23 different languages in over 90 countries
They Must adhere to a Code of Ethics, Must have continuing education,
and Must recertify every 5 years.They are Recognized as lactation experts by the US Surgeon General and the CDC.
Recognized as lactation experts by
the U.S. Surgeon General and the CDC

39. Lactation specific education
Title
College requirement
Lactation specific education
Clinical Experience
Credential
IBCLC - Internationally Board Certified Lactation Consultant
14 Health science courses
90 hrs
depending on pathway are required before sitting for the exam.
IBCLC
CLC - Certified Lactation Counselor No
45 hrs
Not required-experience will vary
Certificate Program
PC - Breastfeeding Peer Counselor
26 hrs
Supervised clinical experience will vary
Certificate program
CLE – Certified Lactation Educator
20 hrs + assignments and observation of classes
ALC - Advanced Lactation Consultant
No - unless individual is also an IBCLC
45 hrs + previous completion of CLC course or IBCLC certification
Clinical experience will vary
ANLC - Advanced Nurse Lactation Consultant
Current RN (and) CLC or IBCLC

40. Education and Experience of Others who Provide Breastfeeding Support
Title
Education Time
LLL (La Leche League Leader)
Approximately 1 year of self-study/training
Trained Breastfeeding Educator
28.75 hours
WIC Peer Counselor
26 hours
Lamaze BF Support Specialist
15 hours
Doula
3 hours

41. IBCLCs Help Moms
IBCLCs are uniquely qualified to help mothers to achieve their breastfeeding goals.
Not only do we know IBCLCs are the most prepared to help mothers, we know from studies that they do, in fact, help moms.
flickr.com/photos/seandreilinger/ /

42. IBCLCs Help Medicaid Moms
Medicaid moms who work with an IBCLC in the hospital are 4 times more likely to breastfeed upon discharge.
(Castrucci, 2006)
Medicaid moms who work with an IBCLC in the hospital (as opposed to peer counseling only) are 4 times more likely to breastfeed upon discharge.

43. IBCLCs Help Outpatient Moms
53% of moms with an outpatient IBCLC clinic visit were still breastfeeding at 4-6 months, compared with only 23% of moms who were not seen by an IBCLC.
(Lukac, 2006)
53% of moms with an outpatient IBCLC clinic visit were still breastfeeding at 4-6 months, compared with only 23% of moms who were not seen by an IBCLC.

44. After hospital discharge, how do moms currently get help?
WIC moms have access to
WIC Peer Counselors
WIC Lactation Centers
(only in Houson, Austin, and Dallas)
Everyone else…
Few hospitals run self-pay clinics
Find an IBCLC in their area
May find a “breastfeeding specialist” or other title to help
May turn to the internet or social media for support.
Currently, moms have some different options for getting help, but they fall short of ideal.
Some WIC offices have peer counselors who offer non-clinical support within a very specific scope of practice, which is wonderful for WIC moms, but leaves out a large population.
A few hospitals run self-pay clinics.
Some physicians will give moms referrals, but others will not because of fearing liability for a referrals to unlicensed persons.
Moms may be able to find “breastfeeding specialists” via the internet for an in- home visit, but cannot decipher alphabet soup of “credentials.”
But whether at a clinic or an in-home visit, many moms have to pay for lactation care out of pocket.
Lacking money for help, mothers often turn to other mothers for advice, frequently through social media.
This is a fantastic resource and a vital component of breastfeeding support. But mothers have only their own experience and internet research to go on, and they cannot provide the often-necessary qualified, clinical, in-person support.

45. 48% of all births in Texas are covered by Medicaid
What about Medicaid?
48% of all births in Texas are covered by Medicaid
Medicaid only reimburses care rendered by licensed healthcare providers
Almost half of all births in Texas are covered by Medicaid.
That’s a huge part of the population that has no coverage for lactation support - and it’s the half of the population less likely to be able to pay for it out of pocket.So why doesn’t Medicaid pay for IBCLC care?
Medicaid regulations will allow reimbursement for care rendered by licensed healthcare providers ONLY.
It would literally take an act of Congress to change it.
However, I understand and appreciate this rule.
It would become a slippery slope if Medicaid started making exceptions to that rule.

46. What About Private Insurance?
New Contracts Provide Lactation Benefit but there is no standard for delivery of care.
Lactation support has been defined as an “Essential Health Benefit,” and all new health insurance contracts must now have a lactation benefit.
However, it’s unclear what insurance will provide for, and who can perform the breastfeeding support services.
Private Insurers generally contract only with licensed health care providers. This leaves lactation consultants with few opportunities for being covered by insurance, thereby limiting the availability of IBCLCs to mothers who cannot afford to pay out of pocket.
Even when, in many of the larger hospitals, an IBCLC is employed to provide the service, hospitals aren’t reimbursed for IBCLC care - it comes out of their global fee. And again, most moms do not have problems with breastfeeding until after discharge.
But IBCLCs are not typically found in physician’s offices.
Think about it - a baby has to eat every 2-4 hours. Moms don’t have the luxury of researching their options.
If access to help is not right in front of them, they have to find another way to feed their babies. And this is when many mothers turn to formula, and they stop breastfeeding at that point or over time as their supply dwindles because a bottle is being used and breastmilk supply is not being demanded.

47. 21 Professions Licensed by Dept. of State Health Services
Athletic Trainers
Chemical Dependency Counselors
Code Enforcement Officers
Contact Lens Dispensing Counselors
Professional Dietitians
Dyslexia Therapists and Dyslexia Practitioners
Hearing Instrument Dispensers
Marriage and Family Therapists
Massage Therapists
Medical Physicists
Medical Radiologic Technologists
Midwives
Offender Education Programs
Opticians
Orthotics and Prosthetics
Perfusionists
Personal Emergency Response System Providers
Respiratory Care Practitioners
Sanitarians
Speech-Language Pathologists
Audiologists
Social Worker Examiners
There are many other professions that are licensed. 21 are licensed by the Department of State Health Services, from hearing instrument dispensers to contact lens dispensing counselors.

48. 26 Professions/Fields Licensed by Dept. of Licensing and Registration
Animal Breeders
Auctioneers
Barbers
Cosmetologists
Court Interpreters
Electricians
Identity Recovery Service Contract Providers
Polygraph Examiners
Property Tax Consultants
Property Tax Professionals
Service Contract Providers
Temporary Common Worker Providers
Used Auto Parts Recyclers
Vehicle Protection Product Warrantors
Water Well Drillers and Pump Installers
Air Conditioning and Refrigeration
Architectural Barriers
Boiler Safety
Combative Sports
Elevator / Escalator Safety
For-Profit Legal Services
Industrialized Housing and Buildings
Loss Damage Waivers
Professional Employer Organizations
Tow Trucks, Operators and VSFs
Weather Modification
And the Department of Licensing and Registration provides licensing for another 26 fields, from animal breeders to barbers and cosmetologists.

49. How Would the Law Affect Those Without a
“Lactation Consultant” License?
Lactation consultant licensure would not prevent others from continuing to provide lactation support
Doctors
Nurses
WIC Peer Counselors,
Individual Volunteers or Volunteer Organizations (ex. La Leche League)
Breastfeeding Educators
provided that they do not call themselves Lactation Consultants.
Licensure would not limit the ability of any other persons to provide breastfeeding support, other than that a doctor, nurse, peer counselor, volunteer, etc. could not call him or herself a “Lactation Consultant.”

50. The Benefits of Licensure
Quality access to care
Base standard qualifications
Background checks
Establishes Lactation as a Priority
in the Healthcare System
Eliminates confusion
Creates Jobs for Texans
More IBCLCs in Pediatrician Offices
More Physicians Employing IBCLCs
Career Path for Peer Counselors and Breastfeeding Educators
Attracts new generation of care providers
Licensing IBCLCs communicates that licensees have met standards of excellence, and have passed a background check (a reassurance to women inviting a stranger into their homes to help them with breastfeeding). Licensing eliminates the confusion with non-IBCLC care providers.
It will help promote equal access to IBCLC services for those with private insurance and for Medicaid recipients.
Licensure will help to establish IBCLCs as part of the healthcare system in Texas, creating professional credibility and aligning them with other regulated health professionals.
This coupled with reimbursement by insurance will increase the likelihood of physicians employing IBCLCs in their offices, significantly increasing mothers’ access to specialized lactation support.
Licensure will provide a career path for WIC Peer Counselors, CLCs, LLL volunteers, and others, attract the younger generation to the profession, and create jobs for Texans.

51. Licensure = Access to Care
= Improved Breastfeeding Rates
Each of these benefits equates to improving access to competent clinical care, which equates to improved breastfeeding rates.(Click for “Improve the health…”) So licensure will improve the health of mothers and babies. It will save lives. And it will save money.
Save Lives
Saves Money

52. Major Barrier to Meeting Breastfeeding Recommendations
2. Anxiety Over Nursing in Public
(2012 Lansinoh Breastfeeding Survey)
40%
The second major barrier I mentioned earlier was anxiety over nursing in public. Thankfully, there is a law that helps with this.

53. Existing law passed by bi-partisan legislature in 1995
Texas Health and Safety Code §
RIGHT TO BREAST-FEED.
A mother is entitled to breast-feed her baby in any
location in which the mother is authorized to be.
In 1995, TXBC helped to pass Texas Health and Safety Code § RIGHT TO BREAST-FEED. “A mother is entitled to breast-feed her baby in any location in which the mother is authorized to be.” This law is a great comfort to mothers, who need to be able to shop for groceries and run errands and go out to eat with their families (all the while supporting the economy, it’s worth noting).
And they’re doing this with their babies, who need to eat every couple of hours or even more frequently.

54. A request alone is enough to discourage breastfeeding.
But Why Not...
...plan around Baby’s schedule?
...pump and bring a bottle?
...nurse in the restroom?
...nurse in the car?
...nurse in a private room?
...at least use a cover?
Schedule? What schedule?
Many babies will not take a bottle from a lactating mom
Ew. Would you eat in there?
Heat. Cold. Isolation.
For the comfort of mom?
For the comfort of others?
Overheating/Re-breathing Air, Etc.
Regardless of your commitment to supporting breastfeeding mothers and babies, you may be uncomfortable at the thought of a mother nursing in public.
You may find yourself wondering, “But why not plan outings around Baby’s feeding schedule?” Breastfed babies do not necessarily have a “schedule” - they can be unpredictable.
But even when a mother has a sense of when her baby will need to be fed, it’s at least every couple of hours.
That’s not necessarily even enough time to get through a big grocery shopping trip, let alone run a few other errands while you’re out.
It’s not reasonable to expect a mother to potentially drive home every hour or so to feed her baby.So why not pump and bring a bottle?
Not all mothers respond to a pump.
Or own a pump.
Or want to spend time pumping, storing/freezing/thawing milk, sterilizing bottles and pump parts.
Besides, when a mother is giving a baby a bottle, her body is not receiving the signal to make more milk, and her supply can be impacted.
And when she’s not feeding her baby when her body has milk to give, she risks clogged ducts and mastitis.
On top of this - many breastfed babies will refuse to take a bottle.
This isn’t a three-year-old you can try to reason with, not a child who just needs better discipline to be taught to take a bottle.
Babies who are hungry and not being fed in the way they know to eat, oftentimes will not eat.
Couldn’t a mother go to the restroom to breastfeed?
OK, you’re probably not actually thinking this.
This is unsanitary, and not at all a reasonable request.
And yet it is one that breastfeeding mothers hear all too often.
Well, but couldn’t she go out to her car to feed her baby?
A baby is too new to understand its mother as she tells him or her to just hold on until she gets to the car.
By the time they are there, Baby may be so worked up that he or she has trouble feeding.
Not to mention that it may (albeit rarely, here in Texas) be cold in the car.
It’s very likely that the car will be hot.
Letting the car idle for air conditioning is bad for the environment and the health of the mother and baby.
Besides, it’s isolating. And at a time when mothers are already at risk for postpartum depression, what they don’t need is to be isolated. This is true for nursing in any other private place.
It’s wonderful for a private room to be an option for a mother who is nervous to nurse in public, or for a distractible baby. If a mom is being told that she can not nurse where she would otherwise be authorized to be, this does go against the current law. If it is being mandated by a location simply because they are afraid that others will be uncomfortable seeing a human child drinking human milk - Remember that a baby’s access to his/her mothers milk is a public health issue - not just a lifestyle choice.
So what if a mom stays in a public place - but she could use one of those pretty, stylish new nursing covers, or at least a blanket?
A covered baby is a baby re-breathing his or her own carbon dioxide, and (especially here in Texas), likely to be overheating, as well.
And sometimes when someone says to cover, a mother’s breasts are already completely covered.
What they seem to mean is to cover the baby.
Some people are so uncomfortable that they don’t want to even know a baby is being breastfed.
But not knowing, not seeing babies nursing, is part of the problem with our breastfeeding rates being so low.
Mothers nursing in public are normalizing breastfeeding. This is vital to increasing breastfeeding rates.
A request alone is enough to discourage breastfeeding.

55. This is what humans feeding their babies in public looks like
So, the elephant in the room for some people - BUT, if we see breastfeeding in public, we might see… you know.. (stage whisper) …breasts.
There are people who will say, using rather crude and judgmental language, that women are... exhibitionists.
Breastfeeding in public puts a mother in a very vulnerable position. But those who nurse in public do so to meet the needs of their babies. Their only priority is the needs of their babies.(Click for photo.)
There is more skin to be seen on the cover of any magazine in the grocery store check out line than with the vast majority of nursing mothers.
This is not an issue of modesty, decency, decorum, discretion, or grace.
It is a public health issue.
Society needs to support mothers who are choosing to breastfeed.
We are a culture in which the female form is used to sell things to a degree that overwhelms, in the minds of some, the primary function of the mammary glands.
We need to make of ourselves a culture which prioritizes the health of our infants over the discomfort of cognitive dissonance.
We cannot expect mothers to meet breastfeeding recommendations while worrying that they will be publicly shamed for doing so.

56. A mother is entitled to breast-feed her baby in any
location in which the mother is authorized to be.
But is it
enforced?
And so, we have this law.
It communicates to mothers and society that breastfeeding is valuable, and a legal right.
It’s a huge step in the right direction.(Click.)
But what if someone just plain disagrees?
Or is unaware of the law?
is it enforced?

57. But are mothers’ rights even violated?
No.
The law asserts a right, but it does not state that it is illegal to violate that right.
There is no means to enforce the law,
for it is technically not a law that can be broken.
No.
The law asserts a right, but many businesses are not aware of this and it does not state that it is illegal to violate that right.
It is not a law that says “do this” or “don’t do that.”
There is no means to enforce the law, for it is technically not a law that can be broken.
(Click for text.)
But does that really matter?
Does it need enforcing?
are mothers’ rights even violated?
But are mothers’ rights even violated?

58. Yes - Often Unfortunately, yes. Often. (Click for logos.)
These are just some of the businesses in Texas where employees and managers have moved to restrict the right of a breastfeeding mother.
In some cases, management has been swift to apologize.
Some companies have instituted policies and employee sensitivity training, turning a negative into a positive.
Others have responded slowly or not at all, and as a result have found themselves mired in national or even international media coverage. But in each case, the actions of an uninformed or unenlightened employee have risked the breastfeeding relationship - and all of the health benefits that entails - of a mother and her hungry child.

59. In just a few weeks of searching online and asking through social media, we documented more than 55 mothers, mostly in the 5 years leading up to the 83rd legislative session, who reported having experienced discrimination.
And there have already been several incidents since the end of that session.And the thing is, not all mothers even share an incident with others.
This is just a small sampling of what happens across Texas, far too often.
55 publicised events of moms asked to leave because they were feeding their babies. ...and those are just the ones we found...

60. This Translates to 40% of Women Fear Nursing in Public
17% of People Uncomfortable with a Mother Breastfeeding Near Them in a Public Place(W.K. Kellogg First Food Poll)
This Translates to 40% of Women Fear
Nursing in Public
(2012 Lansinoh Breastfeeding Survey)
In a survey of one thousand three hundred people, the W.K. Kellogg Foundation found that only 17% of people did not agree that they are comfortable with a mother breastfeeding near them in a public place. But, because a nursing mother in the vulnerable position of breastfeeding in public does not know where or when those people might confront and shame her, 40% of women cite fear of nursing in public as their top barrier to breastfeeding.
Sources: W.K. Kellogg First Food Poll - added “partly disagree” & “strongly disagree” responses to question #17. Click “The results” in the article at
2012 Lansinoh Breastfeeding Study
Photo by Gloria Sanchez

61. Many of these incidents occurred because businesses and/or their employees were not aware of the Texas law or company policy.
When employees are not trained
Moms are being told:
“You can go out to the alley, no one ever goes out there.”
“You can not do that in here”
“I’m going to have to ask you to stop doing that”
All of these actual statements were made to moms who were simply feeding their children a life saving, species specific, human milk.
It communicates that what a mother is doing is shameful. When an employee of a business violates a mother’s right to feed her child, the implications are much greater for both parties.
Mothers have more to fear from a discriminating employee:
Will I be kicked out if I refuse to stop/use a blanket/move?
Can I be arrested if I refuse to leave?
Will I ever be able to come here again?
An employee represents an entire business, whether it is a small, locally- owned outlet or a national chain Public opinion of the entire business is affected by the actions of the one employee Too many mothers will feel shamed by a confrontation and will comply.
These mothers may be reluctant to nurse in public again, gradually impacting the breastfeeding relationship.
And some even quit breastfeeding immediately to avoid the possibility of future confrontations.Others will share an incident on social media, where there is a great deal of support for breastfeeding mothers, and the community will rally against the business.
There may be local or even national (or international!) media coverage.
Mothers may stage a peaceful protest.
Because they are standing up for those mothers who find they are unable to stand up for themselves.
Because they do not want anyone else to be shamed for feeding her baby ever again.And so businesses are faced with negative public opinion and financial losses.
Not only are customers lost, employee time is spent managing the media crisis, and businesses may find themselves comping goods and services.
Recently a nursing mother faced discrimination at a Victoria’s Secret in Central Texas. International media coverage lasted weeks. Victoria’s Secret was even mocked on Saturday Night Live.
Attempting to mitigate the fallout, the mother was sent a $150 gift card, and Victoria’s Secret is in the process of making a $5000 donation to a breastfeeding coalition.

62. Consequences of these remarks are widespread
For the Mom
“Will I be kicked out if I
refuse to stop/move/put a
blanket over my baby’s
head?”
Can I be arrested if I refuse
to leave?
Will I ever be able to come
here again?
Am I doing something wrong?
For the Business
Employee = Entire Business Possible ramifications: Negative Public Opinion Media Coverage
Peaceful Protest (“Nurse-In”)
When a customer gives sideways glances or makes rude remarks, it is upsetting and can cause harm, to be sure.
It communicates that what a mother is doing is shameful. When an employee of a business violates a mother’s right to feed her child, the implications are much greater for both parties.
Mothers have more to fear from a discriminating employee:
Will I be kicked out if I refuse to stop/use a blanket/move?
Can I be arrested if I refuse to leave?
Will I ever be able to come here again?
An employee represents an entire business, whether it is a small, locally- owned outlet or a national chain Public opinion of the entire business is affected by the actions of the one employee Too many mothers will feel shamed by a confrontation and will comply.
These mothers may be reluctant to nurse in public again, gradually impacting the breastfeeding relationship.
And some even quit breastfeeding immediately to avoid the possibility of future confrontations.Others will share an incident on social media, where there is a great deal of support for breastfeeding mothers, and the community will rally against the business.
There may be local or even national (or international!) media coverage.
Mothers may stage a peaceful protest.
Because they are standing up for those mothers who find they are unable to stand up for themselves.
Because they do not want anyone else to be shamed for feeding her baby ever again.And so businesses are faced with negative public opinion and financial losses.
Not only are customers lost, employee time is spent managing the media crisis, and businesses may find themselves comping goods and services.
Recently a nursing mother faced discrimination at a Victoria’s Secret in Central Texas. International media coverage lasted weeks. Victoria’s Secret was even mocked on Saturday Night Live.
Attempting to mitigate the fallout, the mother was sent a $150 gift card, and Victoria’s Secret is in the process of making a $5000 donation to a breastfeeding coalition.

63. Strengthening the Right to Breastfeed
Representative Farrar’s 2013 Bill (HB 1706):
Passed unanimously by the Business & Industry Committee
Was set for the House calendar
Strengthening the Right:
Inform business owners of the law (helping to prevent fallout of violations for mothers and businesses)
Make it illegal to violate a mother’s right to feed her baby
Give a mother recourse in the face of discrimination (the right to file suit for violation of the law - $500 max plus attorney fees)
In the 83rd session, Representative Farrar filed a bill (not for the first time) to strengthen the current right to breastfeed law.
It was passed unanimously by the Business & Industry Committee and was set for the House calendar, but was not voted on by the deadline.
The bill would have accomplished three important objectives in support of breastfeeding mothers, and these are key to strengthening support for mothers in the next session.
We need to inform business owners of the law. This can be done with very minimal impact on the budget via from the Comptroller’s office, which had the support of the Comptroller’s office in Informing businesses not only protects mothers and babies, it can help to prevent the fallout of violations for businesses.
We need to clarify that it is illegal to violate a mother’s right to feed her baby. It just doesn’t make any sense for it to technically not be illegal to violate another person’s legal right. And we need to give a mother recourse if her right is violated. HB 1706 afforded mothers the right to file suit for no more than $500 plus reasonable attorney fees.
This enforcement provision would serve to communicate that this law is not optional. A law which can be flouted with impunity weakens the rule of law. Of course, there are red flags raised whenever the word “lawsuit” comes up.
But the time and money involved in a lawsuit, and the unlikelihood of finding representation, are likely to dissuade families from utilizing the enforcement provision.
Especially since what they really want is simply an assurance that measures will be taken to prevent another woman from being shamed.
Without even being used, an enforcement provision takes the existing law from being merely an assertion of a mother’s right to being genuinely protected.
It will serve less as punishment than as prevention.

64. Strengthening the Right to Breastfeed
= Less Fear
= Improved Breastfeeding Rates
If business owners were aware of the law, and encouraged to respect the law, they would develop policies and do sensitivity training with staff.
Fewer mothers would be harassed.
(Fewer businesses would face negative attention.)
More mothers would feel comfortable nursing in public in a changing climate.
And the more everyone sees breastfeeding, the more accepted it would become.
That acceptance will lead to increased breastfeeding rates –
(Click for “Improve the health…”) improving health, saving money, and saving lives.
Save Lives
Save Money

65. Main Reason For Not Breastfeeding
3. Returning to Work Or School
(2011 Texas WIC Infant Feeding Practices Survey)
21.5%
A third major barrier to breastfeeding is returning to work or school.
In fact, almost a quarter of mothers who never even try to breastfeed list plans to return to work or school as their reason.
Mothers who return to work, if they are supported with time and a place to do it, can express breastmilk and store it to feed it to their babies later.
But often, workplaces make it difficult for a mother to mimic her baby’s feeding schedule.
Without the demand, the supply decreases and may fail to meet Baby’s needs.

66. Working Mothers Now Top Earners in 40% of Households with Children
• 3 in 4 adults say women working makes it harder for parents to raise children• 79% of Americans reject the notion that women should return to traditional roles• Women make up nearly half of the American workforce
• Working women who are mothers jumped from 37% in 1968 to 65% in 2011
(Pew Research Center)
Recently the Pew Research Center released data from a study based on analysis of census data as of 2011, the latest available, as well as cell phone or land line interviews with 1,003 adults.
The study showed that working mothers are the breadwinners in a record 40% of homes with children.
That figure is up from just 11 percent in Roughly 3 in 4 adults said the increasing number of women working for pay has made it harder for parents to raise children.
But about the majority of Americans reject the notion that women should return to traditional roles. Women make up 47 percent of the American workforce.
Demographers say the change is all but irreversible.
We’re still following a male-breadwinner model
But we can no longer assume that wives are able to stay home to care for the children.
We must change the model to support families as they live today, not as they lived half a century ago.
Mothers should never have to choose between giving their babies the optimal nutrition, and providing for their families and
contributing to society in the workforce.
Source:
The jump in working women has been especially prominent among those who are mothers – from 37 percent in 1968 to 65 percent in Source:

67. Work As a Barrier to Breastfeeding
With so many mothers working, just how much of a breastfeeding barrier is work? (Click.) As was stated earlier, almost a quarter of mothers who never even try to breastfeed list plans to return to work or school as their reason.
Of those who do initiate breastfeeding, 27% state that work or school is the main reason for weaning.
In fact, full-time employment decreases breastfeeding duration by an average of more than 8 weeks.
Mothers are most likely to wean their infants within the first month after returning to work.
That leaves only 10% of full-time working women exclusively breastfeed for six months,
and 58% of new mothers returning to work in Texas are unable to reach their breastfeeding goals.
Source:

68. Work As a Barrier to Breastfeeding
21.5% of mothers who never try to breastfeed list plans to return to work or school as their reason.
Full-time employment decreases breastfeeding duration by an average of more than 8 weeks.
Mothers are most likely to wean their infants within the first month after returning to work.
Only 10% of full-time working women exclusively breastfeed for six months.
58% of new mothers returning to work in Texas are unable to reach their breastfeeding goals.
With so many mothers working, just how much of a breastfeeding barrier is work? (Click.) As was stated earlier, almost a quarter of mothers who never even try to breastfeed list plans to return to work or school as their reason.
Of those who do initiate breastfeeding, 27% state that work or school is the main reason for weaning.
In fact, full-time employment decreases breastfeeding duration by an average of more than 8 weeks.
Mothers are most likely to wean their infants within the first month after returning to work.
That leaves only 10% of full-time working women exclusively breastfeed for six months,
and 58% of new mothers returning to work in Texas are unable to reach their breastfeeding goals.
Source:
flickr.com/photos/mdvisser/

69. How to Support Breastfeeding Employees
Time
and a Place
It isn’t difficult to support breastfeeding mothers in the workplace.
And for hourly employees, the Fair Labor Standards Act requires that support be provided.
Mothers only need time and a place to express breastmilk.
In general, women need 15 to 20 minutes for milk expression, plus time to get to and from a private space and to wash hands and equipment, approximately every 2 to 3 hours to express breastmilk or to breastfeed.
Timing needs may vary from woman to woman and over the course of the breastfeeding period.
Mothers need a private, non-restroom space in which to pump.

70. Not a lifestyle choice, it’s a medical need
Breaks for lactation are similar to other work breaks for
attending to physical needs:
• Time to Eat/Drink
• Accommodation for Health Needs (e.g., Diabetes)
Taking time to pump milk is providing immuno-protective factors for the baby.
Regular expression of milk is needed to maintain milk supply and prevent breast infection.
We would not call it unfair to an able-bodied person that ramps are installed for use by people in wheelchairs.
Likewise, it is not special treatment to meet the medical needs of mothers and their new babies.
Breaks to pump at work are similar to breaks for attending to other physical needs, such as time to eat, use the restroom, or for health needs such as a diabetic checking his blood sugar.
In fact, mothers are often sacrificing in order to pump at work - missing out on building relationships with co-workers, spending lunches on the tedious task of pumping rather than enjoying a meal without multi-tasking. Pumping is stressful - it’s not a vacation.

71. When the Need Is Unmet Discomfort Leaking Inflammation Infection
Decreased Milk Production
insufficient supply for baby
Breastfeeding Cessation
Missing even one needed pumping session can have consequences:
It can be uncomfortable.
If a duct becomes clogged, that discomfort becomes pain.
A clogged duct can lead to infection, which can become very serious.
When a pumping session is missed, the body thinks that less milk is needed, and supply decreases.
It doesn’t take very many complications before breastfeeding ceases to be an option.

72. Existing Law Employers are required to provide: Reasonable break time
A place, other than a bathroom, shielded and free from intrusion (This does not have to be a “pumping room” but must be available when a mother needs it.)
Because of all of the benefits of breastfeeding for babies, mothers, society and even businesses, there is an existing law to support working mothers.
Fair Labor Standards Act requires:
that employers provide “reasonable break time for an employee to express breast milk for her nursing child” each time the employee has need,
and that employers provide “a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, that may be used by an
employee to express breastmilk.”
So employers are already required to provide accommodations, and are already set up to do so. BUT...

73. But Salaried Employees Are Exempt
Unfortunately, salaried employees are exempt from the FLSA accommodations.
So, as an example, an hourly teacher’s assistant would be provided time and a place to pump under federal law.
However, a teacher would not be guaranteed access to the lactation room, or be guaranteed time to use it.
Schools are not required to provide her with time to pump even though her TA is supported.
This is a loopole in the law that needs to be closed.

74. Is This Accommodation a Burdon on Business?
By supporting lactation at work, employers can:
Businesses report $3 return for every 1$ invested
Decrease Rates of Absenteeism
Cut Reduce Healthcare Costs
Lower Recruitment and Training Costs
Boost Morale and Productivity
Reduce Turnover
Lactation programs are cost-effective, showing a $3 return for every $1 invested.
By supporting lactation at work, employers can cut rates of absenteeism.
Because breastfeeding reduces illness in babies, parents aren’t frequently having to stay home with sick children.
This is an immediate return on an employer’s investment.
And because breastfeeding prevents chronic disease in mothers and contributes to a healthier future workforce through reduction of obesity and chronic disease, employers stand to gain from this long-term payoff that keeps on giving.
The health benefits of breastfeeding also reduce health insurance costs for employers.
And supporting mothers to pump at work lowers recruitment and training costs because turnover is reduced when morale is boosted.

75. Worksite Accommodations
Representative Walle’s 2013 Bill (HB 741), co-authored by Representatives Hernandez Luna, Lucio, and S. King:
Passed unanimously by the Business & Industry Committee
Passed in the House 90-46
Accommodating Working Mothers:
Extend FLSA support to currently exempt salaried public employees
In 2013 Representative Walle filed HB 741, which Representative Hernandez Luna signed co-authored. And Representatives Lucio and Susan King also signed on as co-authors. We will work for passage of this bill when it is re-introduced in the 84th session in 2015.

76. Worksite Accommodations
= Improved Breastfeeding Duration
= Improved Breastfeeding Rates
Each of these benefits equates to improving access to competent clinical care, which equates to improved breastfeeding rates. So licensure will improve the health of mothers and babies. It will save lives. And it will save money.
Save Lives
Save Money

77. Please Register Your Support For
Bill 1: IBCLCs (International Board Certified Lactation Consultants) are the only recognized experts in the field of lactation. They provide high quality and cost effective care. In fact one study shows that moms who receive help from an IBCLC are 4X more likely to continue. In order to provide breastfeeding support to all mothers, IBCLCs must be licensed and fully integrated into the health care system. Licensure will ensure that these professionals
Bill 2: 40% of women report that their top barrier to breastfeeding is fear of breastfeeding in public. Texas currently has a law recognizing this right, but there is currently no enforcement provision to this law.
Bill 3: _To support public employees to pump milk for their babies at work. Existing federal law requires time and a place to express breastmilk but salaried public employees are exempt.
TXBC and our local coalition are promoting licensure of International Board Certified Lactation Consultants in the state of Texas in order to ensure that qualified and competent clinical lactation services are available to all moms. We are also supporting a mom’s right to breastfeed anywhere, and appropriate worksite accommodations for working mothers.
Breastfeeding saves lives, saves money and supporting breastfeeding is a public health imperative.

78. Thank You

79. Action Items Join TXBC or your local breastfeeding coalition.
Sign up for our action alerts.
Share this information within your networks.
Support Breastfeeding Legislation when it is introduced.
Attend our legislative action day in Austin in Feb
Write to your legislators when you hear of a Texas mother who faces discrimination for public breastfeeding, or who lacks support to pump at work.
Encourage businesses to join Family Friendly Business Initiative.
Develop a relationship with your legislators.
Please modify this slide to meet your audience.
Meet with your legislator in your home district while they are in office locally - May 2014, Dec – Jan. 2015
Join TXBC for a capital visiting day in Austin in Feb. 2015
Iowa – Family Friendly Business Initiative