Journal of Public Health | Vol. 28, No. 3, pp. 183–191 | doi:10.

1093/pubmed/fdl012 | Advance Access Publication 22 July 2006

Breastfeeding works: the role of employers in supporting

women who wish to breastfeed and work in four
organizations in England
Joanna Kosmala-Anderson1, Louise M. Wallace2
1
Health Services Research Centre, CWG04, Coventry University, Priory Street, Coventry CV1 5FB, UK
2
Health Services Research Centre, GE404, Coventry University, Priory Street, Coventry CV1 5FB, UK
Address correspondence to Louise M. Wallace, E-mail: l.wallace@coventry.ac.uk

ABSTRACT

An important factor influencing duration of breastfeeding is mother’s employment status. The main aim of this study was to determine the experi-
ence and views of employees (n = 46) in four large public sector organizations concerning breastfeeding support at work. Participants were
recruited if they were employed by one of four public service employers and if they were planning to go on maternity leave in the next 6 months,
on maternity leave or within 6 months of return from maternity leave. They completed a questionnaire anonymously. Almost 80% of women
wanted to continue breastfeeding after returning to work. However, 90% of all respondents were not aware of any employer policy nor offered
any information concerning support to enable breastfeeding after returning to work, despite two organizations having a range of maternity- and
breastfeeding-related policies in development and some facilities in place. Almost 90% of respondents stated the employers should do more to
support breastfeeding. This should include providing pregnant staff with information about breastfeeding support that they should expect and
could therefore plan to use, including access to facilities to express and to store breast milk, to enable them to work flexible hours and to take rest
breaks during working hours. Recommendations are made for employers.

Keywords breastfeeding, emploment, infant feeding, infamt nutrition, maternal health

Introduction developing ovarian cancer, premenopausal breast cancer and

osteoporosis.6
The nutritional, immunological, psychological and economic
The early introduction of other foods is of public health
benefits of breastfeeding are well documented.1 Both
concern because it exposes infants to increased infection,
UNICEF and The World Health Organization2,3 recom-
particularly diarrhoeal diseases. In some cultures, it may lead
mend mothers should breastfeed exclusively for at least 6
to poorer infant nutrition and adversely affect growth rates.7
months. However, the full benefits of breastfeeding will not be
As work can be essential to economic survival for some famil-
realized if breastfeeding is curtailed by unsupportive employ-
ies, it is likely that work will take precedence over breastfeed-
ment practices. We report on a survey of the employees of
ing, leading to early introduction of artificial food and early
four public sector organizations in England and the recom-
weaning. Of interest to employers, however, is likely to be the
mendations made to address the deficiencies which may have
impact on staff absence resulting from higher rates of respira-
benefits to mothers and babies and to their employers.
tory, ear and gastrointestinal infections, often a cause of child-
There are important differences in health outcomes between
hood illness and maternal work absence.8 Potentially, enabling
those mothers and babies who breastfeed and those who artifi-
female employees to breastfeed when they return to work
cially feed.4 Babies who are breastfed are less likely than for-
could impact on absenteeism. Employers may also benefit
mula-fed babies to suffer from constipation or diarrhoea5 and
from retaining skilled female employees, who may consider
also are less prone to childhood diseases including juvenile
returning to work rather than leaving, if they are enabled to
diabetes, allergies, asthma, eczema, gastrointestinal, urinary
and respiratory tract infections. They are less likely to be
obese and have high blood pressure later in life.5 Breast-
Joanna Kosmala-Anderson, Research Fellow in Psychology
feeding also confers health advantages on the mother by
Louise M. Wallace, Professor of Psychology and Health, Director Health Services
helping her regain her figure and long-term reduction of risks of Research Centre

© The Author 2006, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. 183

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 184 JOURNAL OF PUBLIC HEALTH
continue breastfeeding when they work.9 Therefore, it is in the
interest of mothers, babies and employers that mothers are
enabled to continue to breastfeed when they return to work.
Yet, there is evidence from surveys of breastfeeding duration
that employment status and associated employment practices
may adversely impact on breastfeeding duration. The UK
national infant feeding survey10 found that 19% of those who
stopped breastfeeding by 4 months attributed this to the need to
return to work, and it was the most often cited reason for cessa-
tion (19%) by those who breastfed but ceased between 4 and 6
months (39%). A Scottish Infant Feeding Survey in 2002 found
that 28% of new mothers stopped breastfeeding because of
returning to work.11 In a Spanish study by Escriba and col-
leagues, 32% of mothers attributed ‘occupational reasons’ as the
cause of stopping breastfeeding.12 Similar results were obtained
by Ong and colleagues in a study conducted in Singapore. Work-
ing mothers were significantly more likely to stop breastfeeding
than non-working mothers, and they most often attributed this
to the need to work.13 In a survey conducted in Turkey by Ylmaz
and colleagues, the two most important influences on duration
of breastfeeding were conditions at work and maternal leave
period.14 Results from a study in Brazil show that duration of
exclusive breastfeeding was longer among women with support
for breastfeeding at work and shorter for those working week-
ends or shifts.15 A recent study of female military personnel in
the United States showed that similar rates of initiation were
achieved by active and non-active duty personnel, but signifi-
cantly more active duty mothers stopped breastfeeding at 4
months.16 However, a cross-sectional study in Kenya showed
that among the lowest socioeconomic group of working women,
nearly all breastfed (99%), and 89% of the higher socioeconomic
group breastfed, but shift patterns compared with fixed hours
influenced exclusivity of breastfeeding.17 These results show that
the issue of continuing breastfeeding after returning to work is
important in different countries. See Table 1.
A national survey of family growth conducted in the
United States in 1988 showed that one-quarter of women
employed post-partum made attempts to breastfeed; how-
ever, most gave it up about a month after their return to
work.18 Another influential factor is the availability of mater-
nity leave. Several studies show that women who breastfed
also had longer maternity leave in comparison with women
who formula fed from the beginning.19–21 For examp1e,
mothers who breastfed had averaged 3.4 months of mater-
nity leave, whereas those who formu1a fed averaged 2.3
months.19 The duration of breastfeeding is also influenced by
the duration and flexibility of employment.14,15 Women who
were employed part-time achieved longer duration rates than
those who worked full-time.19,20 In Nairobi, Kenya, mothers
surveyed between 4 and 12 months postpartum achieved
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94.1% breastfeeding, supported by opportunities to feed
their child in breaks or while at work.17 Such flexible work
practices are generally not available in developed countries.
While allowing more flexibility in organizing the total hours
worked and shortening the hours worked in the immediate
period after return to work are obvious remedies open to most
employers, there are studies that describe the active health pro-
motion efforts of employers. It is suggested that women are
more likely to continue to breastfeed after entering employ-
ment when lactation rooms and breast pumps are available in
their workplace.8,21 Job-related stress may limit women’s ability
to express breast milk for an infant feeding.1 Cohen and Mrtek
describe the positive impact on breastfeeding of an employer
providing lactation rooms and breast pumps as a part of sup-
port programme, such that breastfeeding duration among
employees matched women who do not work.8 Approximately
75% of mothers who took part in their survey were able to
maintain breastfeeding for at least 6 months after returning to
work. A more intensive prenatal, perinatal and postnatal pro-
gramme is described by Cohen and Mrtek, as summarized in
Table 1.22 Five Californian companies provided lactation sup-
port including a preparatory class about breastfeeding,
information to supervisors, access to a lactation consultant and
access to rooms and equipment for pumping and storage of
breast milk. Results showed that 97.5% of those enrolled initi-
ated breastfeeding and 57.8% continued for at least 6 months,
whereas maternity leave was on average 2.8 months. A pro-
gramme to support fathers is described by Cohen and others.23
Ortiz and colleagues describe a lactation programme offered to
five corporations, which shows the positive impact of lactation
support and the provision of equipment and facilities.24 How-
ever, in none of these workplace intervention studies are there
baseline data nor were there control groups, limiting the con-
clusions that can be drawn (see Table 1).
The regulatory framework of each country provides a con-
text for employers’ duties towards the health of pregnant and
lactating workers and employees rights. See Table 2 for a
description of legislation in countries comparable to the
United Kingdom. In the United States, breastfeeding legisla-
tion has been enacted in over a half of the states.25 In three
states (Connecticut, Illinois and Minnesota), it is mandatory
for employers to provide reasonable work time breaks for
expressing milk, and they must provide a suitable room in
proximity to the employee’s work area. By contrast, in the
United Kingdom, there is less legislative support to protect
women’s right to breastfeed after returning to work. Women
have the right to facilities to express at work, to reasonable
work time breaks, facilities to express and store breast milk
and to rest to maintain breast milk production. More
recently, direct benefits to breastfeeding may be enabled

Table 1 The review of research regarding the relationship between duration of breastfeeding and support for breastfeeding at workplace
References Country Methods/sample
Escriba et al.12 Spain 602 primiparous and
secundiparous employed women
who delivered their babies in a
large public hospital in Valencia.
Personal interviews were
conducted in the hospital 2 days
after delivery
Rea et al.15 Brazil Interviews of 69 factory workers
during pregnancy and after
returning to work
Lakati et al.17 Kenya Cross-sectional survey of 444
working mothers with infants aged
4–12 months
Ylmaz et al.14 Turkey Descriptive study of 301 working
mothers
Ong et al.13 Singapore Interviews of 2149 women who
delivered in eight hospitals with
obstetric services in Singapore
conducted at 2 and 6 months
postpartum
Rischel and United States A sample of records of mothers
Sweeney16 delivered of live births in three
military facilities. 261 records were
examined in two facilities with a
lactation consultant and one
without, 6 months after birth
Intervention studies
Cohen and United States 187 female employees of Los
Mrtek22 Angeles Department of Water and
Power and Space Corporation
completed a questionnaire
regarding breastfeeding
behaviours. The duration was
reported by a lactation professional available in the workplace were
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BREASTFEEDING WOMEN WORKERS IN THE ENGLISH MIDLANDS
Workplace intervention
None
None
None
None
None
None
Lactation program involved support
by a lactation professional during
three phases: prenatal, perinatal and
on return to work. During prenatal
classes, issues of parenting,
breastfeeding and support services
discussed. During the perinatal phase, mothers who took part in their survey were
a corporate lactation consultant was
available to women and her family.
Two weeks before return to work,
women were provided with electric
breast pump, visited lactation room.
On return to work, lactation
consultant was available to mothers
185
Results
32% of responding mothers report that they
stopped breastfeeding because of occupational
reasons. The type of employment influences
mother’s tendency to use her maternity leave:
very few women employed in public sector
tend not to use their maternity leave (5%). This
figure increased among private sector (22%),
family businesses (55%) and domestic services
workers (51%)
Duration of exclusive breastfeeding is longer
among women with support for breastfeeding
at work and shorter for those working
weekends or shifts
Prevalence of breastfeeding was 94.1%, with
lower social class 10% more likely to be
breastfeeding. Logistic regression showed
mode of working (fixed versus shift hours) was
associated with exclusive breastfeeding at
1 month [odds ratio (OR) = 0.45 and at
2 months (OR = 0.39)]
Two main factors influence duration of
breastfeeding: conditions at work and
maternal leave period
Working mothers are significantly more likely
to stop breastfeeding than non-working
mothers, citing need to return to work
Significantly more active duty mothers stopped
breastfeeding at 4 months, compared with
non-active duty mothers (P < 0.05)
Mothers who breastfed had averaged 3.4
months of maternity leave, whereas those who
formula fed from the beginning averaged 2.3
months. When lactation rooms and breast
pumps are available at work, breastfeeding
duration among employees matches women
who do not work. Approximately 75% of
able to maintain breastfeeding for at least 6
months after returning to work. Inflexible work
hours and restrictive policy regarding using
breaks by employees are the organizational
barriers for breastfeeding. Emotional and
educational workplace support is related to
longer breastfeeding duration while employed
 186 JOURNAL OF PUBLIC HEALTH
Table 1. Continued
References Country Methods/sample
Cohen et al.23 United States 128 male employees of Los Angeles The Fathering Program offered fathers Infants of fathers who participated in the
Department of Water and Power
and their partners. 66% of female
partners were employed either full- lactation counselling for both parents
time or part-time
Ortiz et al.24 United States Retrospective records of 462
women employed in five
corporations
through longer maternity leave. The Parental Rights Act
200326 guarantees that all pregnant employees are able to
take 26 weeks of paid ordinary leave followed by 26 weeks of
unpaid additional maternity leave (but only for employees
who worked for the employer for 26 weeks by the 15th week
before the baby is due). Fathers are entitled to 2 weeks of
paid paternity leave. This legislation also states that parents
of children aged under 6 can apply for flexible working hours
that can be refused only if there is a clear business reason.
However, it is unlikely these measures will impact on
breastfeeding if employees are unaware of their rights, and
employers do not publicize policies to support breastfeeding.
Within a health scrutiny review of health services to support
breastfeeding undertaken by two local government authorit-
ies in England,27 a survey was undertaken of four large public
sector organizations to determine the awareness, experience
and views of relevant female employees and their partners.
The aims of the study were to determine (i) the awareness of
employees of their legal rights, (ii) the awareness of employees of
their employer’s policies, where these existed, (iii) the views and
experiences of employees in relation to the breastfeeding sup-
port provided by their employers, and (iv) to make recommen-
dations for changes in the policy and practice of the four large
public sector organizations surveyed to support the public health
goals of the health services of Coventry and Warwickshire.
Two of these organizations provide hospital and com-
munity health care to mothers and infants, one was one of
the two local authorities conducting the health scrutiny, the
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Workplace intervention Results
and their partners breastfeeding Fathering Program breastfed for average of 8
education classes, full individual months; 69% of the infants were still breastfed
at 6 months
and breast pumps to use at home and
at work for mothers
Lactation program included a choice Breastfeeding was initiated by 97.5% of the
of (i) class on benefits of participants, with 57.8% continuing for at
breastfeeding, (ii) access to lactation least 6 months. Of the 435 (94.2%) who
counsellor by visit and phone call in returned to work after giving birth, 343
pregnancy and throughout return to (78.9%) attempted pumping milk at work, and
work while breastfeeding and 336 (98%) were successful. They expressed
(iii) facilities and equipment to pump milk in the workplace for a mean of 6.3
at work months The mean postnatal maternity leave
was 2.8 months. The proportion of women
who chose to pump at work was higher
among women who were salaried than among
those who were paid hourly wages (P < 0.01)
fourth was a local University. It was ascertained before the
study that all the four organizations were developing prac-
tices to support breastfeeding, but that explicit statements of
employees’ rights and the availability of facilities were not yet
enshrined in formally adopted policies at the time of the sur-
vey. The results of the survey would therefore inform the
adoption of such policies.
Procedure
Permission for access to staff was sought from each organi-
zation. A senior member of staff in each organization under-
took to distribute the survey to eligible staff. These were
employees in the Coventry City Council who expressed an
interest and staff in the other organizations (Coventry Uni-
versity, South Warwickshire Primary Care National Health
Service Trust and South Warwickshire General Hospitals
National Health Service Trust) who were planning to go on
maternity leave in the next 6 months, on maternity leave or
within 6 months of return from maternity leave. Those on
paternity leave were included on a similar basis.
Results
Characteristics of the sample
Forty-six employees completed the questionnaire. They were
employed by four organizations: Coventry Council (n = 19),
 BREASTFEEDING WOMEN WORKERS IN THE ENGLISH MIDLANDS 187

Table 2 The comparison of US, Australia, Europe and UK legislation regarding support for breastfeeding after returning to work

Country Legislative act Regulations

Australia National Breastfeeding Strategy
to encourage breastfeeding awareness
and increase breastfeeding rate (2000)24
The Equal Opportunity for Women in
Workplace Act, 199924
United States Labor Code, Part 3 of Division 2, 200122
United Kingdom Management of Health and Safety at
Work Regulations, 1999 and Employment
Rights Act, 200229,30
Workplace (Health, Safety and Welfare)
Regulations, 199929
EU Council Directive 92/85/EEC29 applies
only to mothers who work in public sector with place to lie down if women wish to do so) for breastfeeding mothers to rest
Parental Rights, 200329
EU countries The Maternity Protection Convention,
2000 (No. 183)31
The Maternity Protection
Recommendation, 2000 (No. 191)31
The issue of breastfeeding at work is left up to the women to discuss with the employer on
individual basis. However, employers are encouraged to support breastfeeding women and
offered benefits (family friendly workplace status) if they decide to do so
Employer can support women who want to combine breastfeeding and work in the context
of an equal opportunity program. Employers who wish to do so are advised to develop a
breastfeeding and workplace policy and make it known to all employees. They are also
encouraged to consider offering mothers flexible return to work options, discussing lactation
breaks, offering flexible working hours and providing lactation rooms
In over a half of the 52 states, mothers have right to breastfeed anywhere they go. In
Connecticut, Illinois and Minnesota, employers are obligated to support breastfeeding
mothers; in other states, employers are encouraged to do so (by making strong statements to
consider this a health choice, giving employers an opportunity to advertize themselves as
‘mother or infant friendly’)
Where supporting breastfeeding mothers is mandatory, employers are required to provide
reasonable amounts of break time for expressing milk and provide a room or other location
(other than a toilet stall) in proximity to employee’s work area
As long as an employee is breastfeeding, the employer’s duty is to consider whether working
conditions are a risk to mother’s or baby’s health. Protective measures include access to a
private room where women can breastfeed and/or express milk, use of clean refrigerator for
storing expressed milk and facilities for washing, sterilizing and storing receptacles, as well as
time-off to express or breastfeed. If the risk cannot be avoided, the employer is obligated to
offer alternative work with similar terms and conditions
Mothers who work nights can negotiate different shifts while breastfeeding. There is no time
limit on breastfeeding duration
Employer must provide ‘suitable facilities’ (conveniently located near to sanitary facilities and
If work affects employee’s breastfeeding, the employer is obligated to temporarily alter her
working conditions and/or hours or give her alternative work to protect breastfeeding
All pregnant employees are entitled to 26 weeks of paid ordinary maternity leave followed by
26 weeks of unpaid additional maternity leave (only for employees who worked for the
employer for 26 weeks by the 15th week before the baby is due). Fathers are entitled to 2
weeks of paid paternity leave
Both parents of children aged <6 years can apply for flexible working hours that can be
refused only if there is clear business reason
Sets minimum standards for workplace maternity protection that include 14 weeks of
maternity leave, rights to workplace health protection for the women and the child, including
breastfeeding and paid breaks or reductions in working time to breastfeed her child
This recommends that the employer should avoid providing compulsory night work if it is
incompatible with pregnancy or breastfeeding and allow one or more nursing breaks or a
daily reduction of working hours so that a woman can continue breastfeeding when she
returns to work after maternity leave, when practicable

South Warwickshire PCT (n = 11), Coventry University (n = 9)
and South Warwickshire General Hospitals NHS Trust (n = 7).
Two-thirds of the sample (n = 30) were part-time employed and
so may have been benefiting from some flexibility in employed
hours to suit family circumstances. The sample was predomi-
nantly white (n = 41), with only two males, with an age spectrum
quite typical of the postpartum population,10 with a median in
the range 30–35 years, and 72% aged 30–40 years, 61% had edu-
cation after they reached 18 years, and 61% of the respondents
had taken maternity leave in the past 5 years, 31 of 44 women
(70.5%) were currently on maternity leave, one woman was
about to go on maternity leave, and for the two males, this last
question did not apply. In data presented below, relevant data
for breastfeeding are reported for the 44 women.

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 188 JOURNAL OF PUBLIC HEALTH
Information and facilities offered by the employer
about the availability of breastfeeding support on
return to work
A workplace nursery was available to 17 (37%) of respond-
ents, but only 14 (31%) expressed interest in using it, and
only nine women (20.5%) would want to visit their babies
there during work to breastfeed. This suggests that provision
of facilities to support expression and storage and rest breaks
to maintain breastfeeding may be more important for most
mothers.
Only 1 of 44 respondents reported being offered informa-
tion about the support that she might be offered to enable
breastfeeding to continue after returning to work, and she
reported that she obtained this through her work role as a
midwife, not directly as an employee. She obtained informa-
tion about the benefits of breastfeeding and voluntary
groups such as National Childbirth Trust, La Leche League
and Maternity Alliance, rather than specific workplace pol-
icies or facilities available to all employees. She did, however,
report that she was offered a free loan of a breast pump for
use at work and a milk storage flask usually available to
patients.
Only seven respondents (15.9%) were aware of facilities
such as prebooked rooms, where mothers could express and
store breast milk while at work, and only three (6.8%) had
used it. However, no participants, men included, were aware
of information about formula feeding from their employer
nor did they receive promotional literature through work.
None of the respondents were made aware of arrangements
to support flexible working hours or flexible working within
the working day to accommodate childcare and breastfeed-
ing nor information about breast pumps for home use. Just
seven women (15.9%) were aware of some prebookable
rooms in which they could express, and three made use of
them, but comments reveal that these were mostly those
facilities that they found for themselves. One woman stated:
‘I used to sneak into my boss’s office and quickly express
hoping nobody would come in’.
Some mentioned that if the facilities had been available,
they would maintain breastfeeding after returning to work,
for example: ‘I was not aware of this availability, this would
have encouraged me to continue breastfeeding’. Three
women mentioned finding the sole-designated room in the
University by accident, for example: ‘Just because there is a
sign on the door where I walk by daily’. Some women who
decided to express breast milk at work had to do it in
unsuitable places and in stressful conditions: For example:
‘I asked for somewhere to express milk, I was offered a toi-
let cubicle or a shower room which didn’t have a lock on
the door’.
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Factors influencing the decision about returning to
work after having a baby
Eleven (25%) of women respondents stated that the support
offered by the employer regarding breastfeeding would be an
important factor when considering the decision about return-
ing to work after having a baby. This may be a lower rate than
if the sample was exclusively of those women surveyed before
returning to work, because by definition, many respondents
had already decided to return to work in this sample. One
respondent reported: ‘I felt pressured into returning early
from my first spell of maternity leave so was unable to feed
after that – it just wasn’t an option according to my boss. The
nursery at the hospital is very expensive and so I’ve decided
not to return to work after this spell of maternity leave’.
Thirty-five women (79.5%) regarded it as important to con-
tinue to breastfeed on their return to work, for example: ‘I
took eight months maternity leave and was able to breastfeed
my babies for this long. Flexible working hours on return
allowed me to continue one out of three feeds a day, either
before work or on return home’. But some women reported
they decided not to breastfeed to avoid anticipated problems
on their return to work: ‘I would have breast fed if I had more
info and support, however, as none was given I chose to bot-
tle feed as I felt it would be easier knowing I had to return to
work’. Of greater concern is where health and safety issues for
the mother as an employee arose that appeared to influence
her decision to breastfeed: ‘I was asked to work in [the] isola-
tion ward, so [I was] looking forward to it. [But] I had to
wean my baby off the breastfeeding because I did not want to
introduce any infections which I may carry in my body to my
baby. I was/am very unhappy about it’.
On considering whether to return to work, flexible hours
were considered important for 40 (90.7%) of respondents,
and 16 (36.4%) wanted breaks to express and store milk dur-
ing the working day. For example: ‘I was keen to breastfeed
each child which I did till they were 15 and 18 months. I
think because of this determination nothing would stand in
my way. Practical things like finding space in a fridge to store
milk and of course a room where there was no school chil-
dren was important. With my second child there was a new
Head teacher and she kindly gave me her office at lunch
time. I carried on expressing’. A further 14 (31.8%) wanted
breaks to breastfeed the child directly, which required access
to affordable and local childcare.
Awareness of workplace policies that support
breastfeeding by employees
Only four (8.7%) of all respondents were aware of any work-
place policies related to breastfeeding, covering employer
and employees’ rights and duties.
 BREASTFEEDING WOMEN WORKERS IN THE ENGLISH MIDLANDS
Organizational support for breastfeeding
Forty-one (91%) of all participants thought that their
employer should do more to support employees regarding
breastfeeding. Some 38 (82.6%) believed this should include
information in advance of maternity/paternity leave about
how breastfeeding can be managed at work, for example,
‘More information provided earlier on to ensure an informed
choice’. Although some participants were very specific about
what they thought the employer should provide: ‘I don’t
think it is the employer’s responsibility to provide informa-
tion/advice about benefits/practicalities of either breast or
bottle feeding. There are plenty of other agencies who
already do this. However, the availability of a bookable, pri-
vate room and fridges for storage of breast milk would be
useful should women wish to express milk whilst at work’.
Such facilities and equipment were welcomed by 34 (73.9%)
of all respondents. Health promotion information about the
benefits of breastfeeding were welcomed by 22 (48%) of
all participants, but only seven out of all participants were
interested in knowing about formula feeding and five
were interested in the role fathers could take in supporting
breastfeeding.
The best and the worse aspect of experience of the
current employer that affected breastfeeding
Thirty-one women respondents submitted their comments
on the best experience and 22 on the worst experience. The
most often mentioned best experience was long maternity
leave that enabled mothers to finish breastfeeding before
they came back to work, for example, from a healthcare
employee: ‘Employer has shown no interest but I never
expected it! Just pleased that maternity leave has increased.
Breastfeeding [was] finished by [my] return to work after 6
months’. Six participants commented on the support from
their employer (such as access to lactation rooms, breaks for
storing and expressing milk), and three participants men-
tioned flexible work hours after returning from maternity
leave, as the best experience affecting breastfeeding.
The most often mentioned worst experience, reported by
21 women, was the apparent lack of interest, information
and support from their employer. For example, ‘I had to sort
out a lot of things myself – a room, fridge etc. Surprise was
shown that I was planning to breastfeed for longer than six
months – I got the feeling that they expected me to only be
expressing at work for a couple of weeks until my son
reached 6 months. Women should be encouraged to breast-
feed for as long as they/baby wants!’ Four participants felt
pressured to come back to work early after having a baby.
For example, ‘It would have been ideal to have had a year off
work to breastfeed the babies for this long – however, [I] had
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189
to return to work – maternity pay does not last that long!;
Babies [were] transferred to formula milk for 2/3 feeds on
return to work. [I] Did not fancy the idea of expressing at
work’. Four respondents did not feel confident to express
milk at work because of poor facilities, for example, ‘As the
rooms offered to me to express milk were not private or
were not suitable, this meant that I stopped breastfeeding/
offering expressed breast milk on my return to work. The
lack of facilities to express milk was the only reason that I
moved to formula milk for my daughter’. Another added...
‘My husband used to collect my milk in his lunch hour to
take it home to the fridge as there was no storage facilities
either’.
Discussion
Limitations of this study
The sample was relatively small, although it does represent
over a half of the eligible employees in each organization,
according to the personnel departments’ figures. As the
study was mainly concerned with breastfeeding, employees
who did not intend to breastfeed may be under-represented,
although some questions such as those concerning childcare
were relevant to all. Generalization to the circumstances of
those employed in other organizations is not possible to
determine. However, a brief search of the web pages we were
given access to by the personnel departments of three major
local private employers (e.g. an automotive manufacturer)
showed no mention at all of breastfeeding on the employee
welfare aspects of these sites. We have some foundation
therefore for believing the absence of policies may reflect
absence of work site support for breastfeeding.
Main findings of this study
The results show that despite the efforts of the four employ-
ing organizations to develop general policies for mothers’
well-being and two of them having some facilities and breast-
feeding policies in development, forty-two participants
(91%) were unaware of any support that might be offered to
enable breastfeeding after returning to work, yet this is
widely available to employers and the public.28-31 Those
women who accessed bookable rooms and equipment largely
did so through their own efforts, and many experienced
unhealthy conditions in their use. Access to workplace child-
care was only available for a minority. But for three-quarters
of the sample it was or would have been important to con-
tinue breastfeeding after returning to work. It is clear that
these employers are failing to meet their health and safety
obligations and are indirectly hampering public health efforts
to improve the duration of breastfeeding.
 190 JOURNAL OF PUBLIC HEALTH
What is already known on this topic
The research reviewed above suggests that many women per-
ceive work and the continuation of breastfeeding to be
incompatible and that they have low expectations of support.
However, skilled lactation support and workplace policies can
enable many mothers to plan to breastfeed on return to work.
What this study adds
In the UK public sector, there are many skill shortages in
professional posts, so it may be of intrinsic interest to
employers to know that a lack of employer support was per-
ceived to be a major source of dissatisfaction and in some
cases a reason for leaving the employer after maternity leave.
Also, some respondents stayed away from work longer than
they would have wished because they anticipated poor
support on their return. The survey shows that the required
support is within the grasp of most employers if they were to
make their existing policies and practices better known,
provide simple prebookable rooms and equipment and provide
active encouragement of breastfeeding as the norm. This may
take leadership, because one respondent noted ‘It’s not {just}
the employer but the staff members which need educating!’
Recommendations
(i) Employees should have access to information on sup-
port that is offered by their employer, and by local organizations,
to enable breastfeeding to continue after returning to work.
(ii) Suitable, comfortable and stress-free facilities to
express and store breast milk should be provided.
(iii) More flexible arrangements in working within time at
work and in overall working hours are necessary to give
mothers the opportunity to express breast milk or to breast-
feed their baby at local childcare facilities.
Addressing these issues may benefit employees and
employers alike, at very low cost to the employer, and sup-
port local public health initiatives to improve breastfeeding
rates. Research on a wider spectrum of organizations, includ-
ing those operating with similar policies in different coun-
tries, would help show how workplace welfare and health
promotion activities can improve breastfeeding, the com-
pany and the local economy.
Resources relevant to expressing and storing breast milk:
http://www.breastfeedingnetwork.org.uk/pdfs/BFNExpress-
ing&Storing.pdf; http://www.breastfeedingnetwork.org.uk/
pdfs/BreastfeedingAndReturningToWork.pdf.
Resources relevant to maternity rights, flexible working
and other employment rights: http://www.workingfamiliies.
org.uk.
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Resources relevant to employers and employees in relation
to breastfeeding and maternity rights and safety: http://
www.hse.gov.uk/pubns.
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