Breastfeeding and the Workplace

Combining work and breastfeeding can create considerable pressures for working women with newborn babies. As a result, working mothers are less likely to breastfeed their babies than non-working mothers.

Each year an estimated 118,000 Australian women return to paid work within 6 months of delivering a child, that is, at the time when it is recommended that they breastfeed their infant exclusively (feed them breastmilk and nothing else) to provide them with optimal nutrition. For these women, breastfeeding at work is necessary if they are to breastfeed regularly enough to maintain a supply of breastmilk sufficient to enable exclusive breastfeeding and workplace support is necessary to allow them to breastfeed at work. However, some workplaces are not "breastfeeding friendly", that is, there are barriers which prevent women from breastfeeding in these workplaces.

Over 90% of Australian women initiate breastfeeding after childbirth, 56% continue breastfeeding until their child reaches 6 months of age and 30% are still breastfeeding 12 months after childbirth. However, amongst those who continue breastfeeding until 6 months of age, only 20% continue breastfeeding exclusively (use breastmilk as the sole source of infant nutrition and do not feed infants with complementary foods).

While evidence suggests that returning to work is not the key reason women cease breastfeeding, working mothers are less likely to breastfeed than those who do not work. For example, one study found that women working fulltime three months after childbirth had breastfed their infants for a shorter period of time (8.6 weeks less) than women who were not working three months after childbirth. Another reported that women who returned to work within 12 weeks of childbirth were twice as likely not to breastfeed their infants, while women who went back to work within six weeks of childbirth were four times less likely to breastfeed, compared to non-working women. This indicates that women face considerable challenges in providing breastfeeding and maintaining paid employment.

Higher breastfeeding rates amongst women with flexible working conditions (e.g. self employment, flexible hours) and those working <15 hours per week, indicate that workplace flexibility is an important factor influencing a working woman's decision to breastfeed. Breastfeeding rates are higher amongst infants who receive parental care only, compared to those who receive non-parental care. This indicates that childcare facilities (compared to parental care) may not provide adequate opportunities for women to feed their infants with breastmilk.

Encouraging new mothers to breastfeed is important as breastmilk is the optimum source of nutrition for infants. Breastmilk is a living tissue which contains all the nutrients needed by infants. Breastmilk cannot be reproduced artificially. Its nutritional composition changes naturally as breastmilk production progresses (the infant ages) and according to a diurnal rhythm (a daily rhythm, for example the nutritional content of breastmilk may be different in the morning compared to at night). In the first few days after childbirth women secrete a substance known as colostrum, which contains higher concentrations of vitamins A and B and protein and lower concentration of fat compared to mature breastmilk. Lactating women commence secreting mature breastmilk 7-14 days after childbirth.

Breastmilk production is stimulated by infant suckling, as the suckling action of an infant stimulates the release hormones called prolactin and oxytocin. These hormones are produced by the pituitary gland and regulate the production and secretion of breastmilk respectively. When an infant suckles, oxytocin stimulates the secretion of breastmilk and signals the pituitary gland to secrete prolactin, which in turn stimulates the production of more breastmilk.

The amount of breastmilk a woman produces is therefore directly proportional to the extent to which her infant suckles or she expresses breastmilk (the rate at which milk is emptied from the breast). Frequent suckling and on-demand feeding patterns are associated with maintenance of adequate levels of breastmilk to enable exclusive feeding. In order to produce sufficient breastmilk for exclusive infant feeding, a woman must breastfeed regularly throughout the day. Taking long breaks from breastfeeding (e.g. an eight hour break in which the mother is away from the infant for fulltime work commitments) disrupts breastmilk production and exclusive breastfeeding is not possible under these circumstances. Working women therefore need to breastfeed their babies or express their milk while they are at work, in order to maintain adequate breastmilk production for optimal infant feeding.

The rights of women to breastfeed without discrimination and the rights of infants to receive optimum nutrition from breastmilk, are internationally recognised by bodies such as the World Health Organisation and the United Nation Children's Fund (UNICEF).

Under Australian laws, employers are obliged to seriously consider any request from an employee for family-friendly working arrangements (including time for breastfeeding). In addition, employers have an obligation to provide work flexibility to enable parents to maintain a healthy balance between work and life, wherever the nature of the work makes it reasonable to do so.

More information on Work and Parenting.

Despite laws requiring employers to reasonably consider flexible arrangements for working parents, Australian women are not legally guaranteed the right to take breaks from work to breastfeed or to breastfeed in public places (including workplaces). As such, female employees who wish to breastfeed at work must negotiate individually with their employees for the right to do so. In addition, many women do not currently have access to maternity leave immediately after childbirth, the time when breastfeeding patterns are established. However, the introduction of a government funded universal parenting leave benefit in Australia from 1 January 2011 is expected to increase women's access to paid maternity leave.

A breastfeeding friendly workplace is one in which women:

have access to a suitable facility in which they can breastfeed their infant or express their breastmilk; are provided breaks from work in order to breastfeed or express milk; and can discuss their breastfeeding needs with their employer.

The Australian Breastfeeding Association now manages an accreditation program for breastfeeding-friendly workplaces. The program offers consultancy services to assist employers in identifying barriers to breastfeeding in the workplace and accreditation to those employers who successfully remove these barriers and create breastfeeding-friendly workplaces.

Developing a workplace breastfeeding policy

Providing any of the following arrangements or facilities could make the workplace more breastfeeding friendly:

Lactation breaks: to enable breastfeeding women time off work in order to breastfeed. Lactation breaks should occur in addition to, not instead of, normal meal and tea breaks. Two 30 minute breaks per 8 hour working day should be provided, although there is no legal requirement that employees receive pay for lactation breaks;Breastfeeding and expressing facilities: which can be used by breastfeeding employees. The facilities should be clean, comfortable and private and include hand washing and milk storage facilities;Offering flexible working arrangements: including job sharing, extended unpaid maternity leave and part time work which may more easily enable women to return to work and breastfeed simultaneously; andWorkplace support: to ensure that breastfeeding employees feel comfortable to breastfeed in the workplace and do not suffer discrimination or harassment as a result of doing so.

Companies that wish to develop breastfeeding-friendly policies might begin by:

Conducting a safety audit to determine the extent to which it is safe to breastfeed in the workplace;Examining the informal practices which occur in the workplace and how they influence a woman's ability to breastfeed;Ensuring women who have given birth or are planning to have access to flexible work arrangements, such as part time work or job sharing;Ensuring the workplace is free of harassment and discrimination against women who choose to breastfeed, for example by addressing women's right to breastfeed in the workplace as a specific component of workplace training; andExamining measures other companies have taken to make their workplaces more breastfeeding friendly.

Research shows that women who find a balance between work and family are more likely to breastfeed for longer and that longer duration of breastfeeding has potential benefits for employers. Thus creating breastfeeding-friendly workplaces and receiving accreditation as a breastfeeding friendly workplace has numerous potential benefits for employers, as well as for employees and their families.

Reduced maternal absenteeism

Breastfeeding is associated with improved infant and child health, as exclusive breastfeeding for the first six months and continued breastfeeding for at least the first 12 months of life provides infants with optimum nutrition. Because of this, breastfed infants experience fewer health conditions later in life and this may reduce absenteeism amongst mothers in the future, as they will require less time off work to care for sick infants. For example, a study from the United States reported that mothers of breastfed infants were three times less likely to take a one day break from work to care for a sick infant or child, than those who did not breastfeed.

Improved employer-employee relations

Employers may also benefit from making their workplaces more breastfeeding friendly, by improving their relationships with their employees. Creating a breast-feeding friendly workplace is one way in which employers can demonstrate a commitment to equal opportunity and corporate responsibility. It may therefore improve employer-employee relations, as it is a way in which employers can acknowledge and respond to the needs of their employees. This may also contribute to improved staff retention and recruitment and greater workplace diversity.

Staff retention and lower recruitment and training costs

In addition, employers who facilitate breastfeeding will make their workplaces more family friendly. Family-friendly workplaces are also associated with increased staff retention (particularly for skilled staff) and therefore lower recruitment and training costs, improved employee productivity and a more diverse workforce. Women who work in breastfeeding-friendly workplaces may return to work earlier after childbirth. Providing a family-friendly workplace may also improve employee morale.

Be familiar with workplace legislation on breastfeeding

Women have a right to breastfeed at work (although each woman must individually negotiate her entitlements) and employers must grant breastfeeding and lactation breaks to working women if such breaks are reasonable according to the nature of the woman's work. It is important that women wishing to breastfeed at work are aware of this right, so that they are well positioned to negotiate breastfeeding entitlements with their employees.

Negotiating breastfeeding with employers

As laws regarding breastfeeding in Australia are open to interpretation, women need to negotiate individually with their employer. Ideally women should discuss their intention to return to work and breastfeed (or express breastmilk) before they go on maternity leave and contact their employer again at least two months before their intended return to work. Before negotiating with an employer, women should:

Be familiar with the facilities they require to assist them to breastfeed or express breastmilk in the workplace, which may include: A private room (not a toilet);A comfortable place to sit;Storage space for a breast pump; andA refrigerator in which expressed breastmilk can be stored.Be familiar with their breastfeeding or expressing schedule so that they can negotiate breaks for breastfeeding at appropriate times. This might include considering: Whether the infant will be bought to the workplace for feeding, the woman will leave the workplace to go to the infant or breastmilk will be expressed at work for later feeding;How often it will be necessary to express milk or breastfeed;At what times it will be necessary to breastfeed;Whether additional breaks will be needed. It is important for breastfeeding women to note that although Australian laws do not oblige employers to do so, the International Labour Federation recommends that women who need to breastfeed at work should be offered breaks in addition to normal lunch and tea break to enable them do so;Whether they require breaks during work or other types of flexible work arrangements including part time work or working from home;Identify the correct person to negotiate breastfeeding facilities and breaks with. This may be the woman's manager or the company's human resources department or equal opportunity officer.

Arrange childcare close to work

Arranging childcare for the infant close to the mother's workplace may overcome some of the barriers which prevent women breastfeeding whilst at work. It enables the infant to be bought to the workplace (or the mother to move to the childcare facility) at breastfeeding times.

Try expressing milk if it is not possible to breastfeed at work

Women who are unable to move their infant to their workplace for each feed may choose to express and store their breastmilk so that it can be fed to the infant from a bottle or cup. Breastfeeding friendly workplaces should incorporate facilities for expressing and storing milk, as well as for breastfeeding. Women who are considering expressing milk should be advised to start expressing several weeks before they return to work so they can practice and become familiar with how long it takes them to express their milk. They will also need to negotiate with their employer to ensure the necessary facilities, including a comfortable place for expressing and a refrigerator for storing expressed breastmilk, are available in the work place.

Contact an organisation for assistance

Women who are planning to have a child or are currently breastfeeding may find support to combine work and breastfeeding from the Australian Breastfeeding Association. The association has also recently launched a Breastfeeding Friendly Workplace Accreditation scheme, which may enable women to identify breastfeeding friendly workplaces, or give employers greater incentive to make their workplace breastfeeding friendly. Employees who are members of unions should also check to see what support their union provides.

For more information on workplace health including office ergonomics series, useful tips on avoiding injuries in the workplace and costs on the workforce, see Workplace Health.

For more information on breastfeeding including nutrition and contraception during breastfeeding and useful animations, see Breastfeeding.
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Eye Injuries in the Workplace

There are a range of agents found in workplaces that can cause eye diseases, disorders or injuries. While many of these agents are often also found in everyday living environments, exposure at dangerous levels is most likely to occur in the workplace. For this reason, these conditions are commonly referred to as work related eye injuries or diseases.

Traditionally, work related eye injuries have predominately affected individuals working outdoors or in the construction, manufacturing and service industries. Male workers 25-44 years have the highest risk of work related eye injuries.

The increasing use of computers amongst office workers has also lead to an increasing burden of eye disorders amongst workers who spend long periods each day looking at computer screens.

?Chemical eye burns

Both highly acidic (pH <4) and highly alkaline (pH >10) substances are toxic to the eye and cause chemical eye burns if they come into contact with the surface of the eye. Alkaline substances present the greatest risk. Such substances are most commonly found in the workplace, for example in laboratory chemicals or industrial cleaning products.

Invasion of foreign bodies

The eye/s may sometimes be invaded by small foreign particles (e.g. dust from manufacturing activities) which can cause irritation and inflammation. While foreign particles rarely cause lasting damage to the eyes, prompt removal of irritating particles is necessary to avoid permanent eye damage or scarring.

Blunt trauma injuries

Blunt trauma injuries (i.e. injuries which do not penetrate the skin and do not result in external bleeding) to the eye occur as a result of being struck by a heavy object. They can cause the eye to bleed internally.

Allergic conjunctivitis

Allergic conjunctivitis is common amongst workers in the food handling and agricultural sectors who are regularly exposed to particular spices, fruits and vegetables. Excessive exposure to ultraviolet radiation (such as sunlight) is associated with working in an outdoor industry and also increases the risk of allergic conjunctivitis.

Eye diseases associated with ultraviolet radiation exposure

Outdoor workers are often exposed to ultraviolet radiation (in the form of sunlight) in excessive quantities. There are numerous eye diseases and disorders associated with the eyes' exposure to ultraviolet radiation, including squamous cell carcinoma of the eye, cataract and ptergyum. Outdoor workers therefore have an increased risk of developing these conditions.

Artificial sources of ultraviolet radiation are also found in a range of workplaces and can damage the eyes. These include welding arcs, germicidal lamps and lasers. Thus the above mentioned diseases can also occur as a result of occupational exposure to artificial sources of ultraviolet radiation.

Computer use disorders

Using a computer for extended periods of time is associated with a range of temporary eye disorders including pain and altered vision.

More than 65,000 work-related eye injuries occur in the United States each year and an estimated 90% could have been prevented. There are a range of measures an individual can take to protect their eyes from work-related injuries and illnesses. In Australia, employees are required to provide their employees with an adequate standard of protective equipment. Protective measures which can be taken to prevent work related eye injuries include:

Providing protective eyewear

In Australia, Occupational Health and Safety legislation now mandates that employers provide protective eyewear to their employees to prevent injuries. The type of eyewear required depends on the job being conducted.

Required standards for protective eyewear to prevent indoor exposure to artificial sources of UV radiation are detailed the Australian Standard AS/NZS1337:1992- Eye Protectors for Industrial Applications. Safety goggles with full face protection are particularly important for welders, who may be exposed to high levels of UV radiation, as well as foreign substances which can invade the eye. In other industrial settings, the use of eye goggles is also required and these should have side shields to protect against the invasion of foreign particles and liquids. It should be noted that such eyewear may not protect against dust, particles and vapours which can cause eye damage.

Individuals who spend time working outdoors or driving should be provided with sunglasses and hats to protect their eyes from harmful UV radiation. The Australian Cancer Council recommends that individuals wear sunglasses with wrap around (i.e. side) protection which comply with Australian Standard AS/ANZ 1067:2003.

Keeping eyewash accessible in the workplace

Initial treatment of many work related eye injuries can prevent serious and long-term eye damage. The single most common approach to treatment is irrigation of the eye with a saline eye wash (i.e. washing the eye out with a salty eye wash), to remove the foreign substance causing eye injury. In workplaces where workers are at risk of exposure to chemicals or small particles, eyewash solutions should be easily accessible so that eyes which have been invaded by foreign substances can be promptly irrigated and the likelihood of permanent eye damage reduced.

Not relying solely on contact lenses for protection

Contact lenses do not provide sufficient protection against work-related eye damage and should be worn in conjunction with other protective eyewear. In addition, contact lens users should be aware that contact lenses should not be worn when working with chemicals as they may increase the risk of injury.

For more information on workplace health including office ergonomics series, useful tips on avoiding injuries in the workplace and costs on the workforce, see Workplace Health.

Peate, W.F.M "Work-related eye injuries and illnesses" in Am Family Physician, 2007, 75(7):1017-24.American Federation of State, County and Municipal Employees (AFL-CIO), Keys to Healthy Computing- An AFSCME Health and Safety Handbook, 2006, [cited 2009, April 15] Available from: http://www.afscme.org/ publications/ 1328.cfm?print=1 ?Vecchio, P. Hietanen, M. Stuck, B.E. et al, Protecting Workers from Ultraviolet Radiation, International Labour Organisation and World Health Organisation, 2007, [cited 2009, April 15] Available from: http://www.who.int/ uv/ publications/ protect_workers/ en/ index.html Australian Cancer Council, Eye Protection from Ultraviolet Radiation, 2006, [cited 2009, April 15] Available from: http://www.cancer.org.au/ file/ policypublications/ pseyeprotectionaug06.pdf ?Australian Radiation Protection and Nuclear Safety Agency, UV Resource Guide- Australian Sunglass and Safety Glass Standard, 2006, [cited 2009, April 15] available from: http://www.arpansa.gov.au /uvrg/ rginfo_p18.cfm

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