- FLSA —
- Fair Labor Standards Act
On March 23, 2010 President Obama signed into law the Patient Protection and Affordable Care Act, which included an amendment to Section 7 of the Fair Labor Standards Act (FLSA).1 This amendment requires employers to provide reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child’s birth, each time the employee has a need to do so. Employers are also required to provide a place, other than a bathroom, shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk. Some elements of the “reasonable break time law” are listed in Table 1.2,3
Why did the law specify that the workplace should offer a location other than a bathroom? Bathrooms often lack privacy, electrical outlets for breast pumps, and adequate space for the mother to sit. More important, providing your baby’s next meal in an unsanitary setting can be not only unhealthy but also humiliating.
Developing breastfeeding support for working women has been described as a beneficial practice for both the employees and their employers.4,5 For a small investment, the employer stands to gain by retaining more satisfied, experienced, and loyal employees; having parents take fewer days of leave to care for their sick infants; and incurring lower health care and insurance premium costs. Despite this, to be more accommodative, the new break time legislation offers an exemption to employers with <50 employees only “if such requirements would impose an undue hardship by causing the employer significant difficulty or expense when considered in relation to its size, financial resources, nature, or structure of the employer’s business.”2,3 Such employers need to receive exemption approvals from the Wages and Hour Division of the US Department of Labor.
Whether the full implementation of this law has a potential to improve all components of the national breastfeeding statistics is unknown, in part because the legislation is new and many health care providers, employers, and employees are unaware of the law. Specific studies should be carried out to demonstrate the effect of compliance with this law on regional and national breastfeeding statistics.
According to the Breastfeeding Report Card, United States 2013, issued by the Centers for Disease Control and Prevention, for infants born in 2010 the national rates (Table 2) and state-specific breastfeeding initiation rates have reached an all-time high.6 However, the report also notes that breastfeeding rates drop during the postpartum months in all regions of the country, and more significantly, dramatic disparities continue to exist in all components of breastfeeding statistics among the states.6 It is possible that in states with high rates of maternal employment, the implementation of this new legislation to the extent that is possible may help improve regional breastfeeding rates, which may come close to achieving the Healthy People 2020 goals (Table 2). This assumption is based on reports which show that early return to work is one of the major factors impeding both initiating and continuing breastfeeding.4,5
What is the value of knowing at least some components of this seemingly obscure legislation? I believe that with the knowledge of this legislation, obstetricians, pediatricians, general practitioners, lactation consultants, nurses, and midwives may initiate a dialogue with working women during counseling about their intentions to initiate or continue to breastfeed through the infant’s first year of life. It is possible that women can also choose to engage their employers in productive conversations for developing mutually agreeable solutions to help them continue to breastfeed and to keep their jobs. Such dialogues may lead the employer to seek specific compliance assistance from the Wages and Hour Division of the Department of Labor.4
Along with the full implementation of the FLSA law, if a more sympathetic, accommodating, and supportive work environment is fostered, it will not only help to improve employee morale but also encourage breastfeeding through the first year. Collectively, these efforts can have public health impact.
- Accepted April 16, 2014.
- Address correspondence to Tonse N. K. Raju, MD, DCH, 6100 Executive Blvd, Room 4B03, NICHD/National Institutes of Health, Bethesda, MD 20892-MS7510. E-mail:
The views expressed in this commentary are those of the author alone; they do not necessarily reflect those of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institutes of Health, or the US Department of Health and Human Services.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
- 1.↵US Department of Labor, Wage and Hour Division. Break Time for Nursing Mothers provision, section 7(r) of the Fair Labor Standards Act. Available at: www.dol.gov/whd/nursingmothers/Sec7rFLSA_btnm.htm. Accessed March 8, 2014
- 2.↵US Department of Labor, Wage and Hour Division. Break Time for Nursing Mothers. Available at: www.dol.gov/whd/nursingmothers/. Accessed March 8, 2014
- 3.↵US Department of Labor, Wage and Hour Division. Reasonable Break Time for Nursing Mothers. Federal Register. 2010;75(244):80073–80079
- 4.↵US Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: US Department of Health and Human Services, Office of the Surgeon General; 2011
- 5.↵US Department of Health and Human Services. Health Resources and Service Administration. Business case for breastfeeding. Available at: http://mchb.hrsa.gov/pregnancyandbeyond/breastfeeding/. Accessed March 8, 2014
- 6.↵US Department of Health and Human Services, Centers for Disease Control and Prevention. Breastfeeding report card United States/2013. Available at: www.cdc.gov/breastfeeding/pdf/2013breastfeedingreportcard.pdf. Accessed March 8, 2014
- 7.↵US Department of Health and Human Services, Centers for Disease Control and Prevention. Healthy people 2020. Available at: www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=26. Accessed March 8, 2014
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