A mother-to-be spends a lot of time in anticipation: she daydreams about her baby; she hopes that all will go well with the birth; she imagines herself in her new role; she thinks a lot about how to get what she needs. Will she be enough for the baby? Can she feed her baby the way she wants to? Will she be a good mother?  And, of course, she has to figure out how to juggle these dreams, thoughts, and plans with the reality of her life. Part of that reality is her work life – will it support or hinder her new role as a mother?

We cannot get away from it: mothers work and that means family decisions are tied up with their work lives. We might think of them as separate, but the question of whether or not she will breastfeed is therefore also tied up with the kind of support her workplace offers. Family leave policies – too short, unpaid, or non-existent – and workplace policies have an impact on the decision to breastfeed or the ability to persist once a breastfeeding relationship has been established.

In Indiana, what do we do for working mothers? 

• In the private sector, state law requires a company with 25 or more employees to provide a place to pump (other than a toilet stall) to the extent reasonably possible and a place with convenient cold storage for the pumped milk or to allow a mother to bring her own cold storage.
• If a mother is a state employee, then she can expect reasonable paid break time for pumping, along with a place other than a toilet stall to pump, unless doing so would unduly disrupt the employer’s operations.
• State employees who earn sick leave can use that time to care for family members who are sick or to deal with pregnancy-related illness.

Let’s face it – even though our breastfeeding law for working mothers goes beyond the federal requirements – we have a long way to go to ensure that all women have sufficient support to be able feed their babies the way that they want to, and this is particularly true for women in low-income families. Nationally, breastfeeding rates tend to be significantly lower among low-income women (57% compared to 74%). Yet we know that when supported, women from low-income families match higher- income women in breastfeeding initiation rates. For example, among women who participate in Indiana’s Women, Infants, and Children program, which is available to individuals below 185% of poverty, breastfeeding initiation rates increased from 58.4% in 2006 to 72.9% in 2015; however, over 20% of breastfeeding women in the WIC program discontinued the practice one week after initiation and half discontinued within six weeks. That drop is almost certainly due in part to the pressures of returning to work and the lack of access to adequate support inside the workplace.

If we look at the reality of low-income work, we find that low-income workers are more likely to:

• work multiple part-time jobs (hence, no benefits),
• work for companies with fewer than 25 employees (neither state lactation law nor federal FMLA apply),
• lack access to sick leave (unpaid or paid),
• lack access to employer provided short-term disability insurance, vacation days, or family-leave.

The women and families who need the most support, therefore, have the least. This lack of support means that we see women going back to work earlier than they should, as early as two weeks postpartum. What of their babies? They are going into childcare at two weeks of age – and many places will not take an infant before six weeks, placing an additional burden on already strained resources as the family searches for someone to care for their baby. This places mothers in an untenable situation, often settling for poor quality or unstable care, or perhaps, forced to quit the workforce, putting her in a more stressful situation. We as a state do not benefit from this kind of stress on families.

Through this system, we are setting all women, but especially low-income women up to fail at breastfeeding. We know that breastfeeding maximizes health for a lifetime, both for the mother and baby. Precious healthcare dollars are wasted because we do not adequately support new families. Businesses could also more wisely allocate their resources: if they would implement simple workplace lactation policies, they would increase employee satisfaction and retention, save businesses money on health benefits, and reduce the amount of time taken off by parents to care for sick children.

We need to shine a light on this key issue for mothers, babies, and their families and the month of August is the perfect time to do so. August is truly Christmas in July for breastfeeding advocates:  The United States Breastfeeding Committee has declared it National Breastfeeding Month, The World Alliance for Breastfeeding Action celebrates World Breastfeeding Week August 1-7, and the 4th annual Black Breastfeeding Week will be celebrated August 25-31. Advocates worldwide are spending this month getting the message out about the benefits of breastfeeding and the laws and cultural shifts that are required to support this practice. The Indiana Institute for Working Families, the Indiana Breastfeeding Coalition, and the Indiana Perinatal Network see this as an opportunity to continue the call for policies that will address the needs of families at all levels of society. It just makes sense.

Indiana Institute for Working Families thanks Georg'ann Cattelona , the Indiana Breastfeeding Coalition, and the Indiana Perinatal Network for co-authoring this post.