Lessons Learned From a Student-Led Breastfeeding Support Initiative at a US Urban Public University

Abstract

Despite US laws requiring most workplaces to provide “reasonable” unpaid break time and a private space for female employees to express breast milk, much of the statutory language is vague and open to interpretation, potentially leading to suboptimal implementation. College and university campuses in the US represent a particular concern, as students are typically not employed by their school and thus not protected by state and federal labor laws. This article describes the work of 2 graduate students to successfully establish a dedicated space at their US urban public university for the purpose of expressing breast milk. A 3-pronged strategy was implemented to create a dedicated lactation space: (1) collecting data to support the establishment of the room, (2) raising awareness of legislation related to protection of breastfeeding, and (3) community organizing and advocacy. After nearly 18 months of advocacy and planning, the campus’s dedicated lactation room was opened for use in March 2012. Two years later, the room remains a valuable resource and is used, on average, 8.4 times per weekday during a typical school week. Several lessons learned are described, and the strategies employed can be tested and applied in other US academic settings to assist in advocating for more supports for breastfeeding mothers. However, it is also imperative that US legislation be amended to include language that explicitly protects students so that women do not need to make the choice between continuing their education and continuing to breastfeed.

Background

For women who work without their babies nearby, exclusive breastfeeding requires that mothers express breast milk. US federal law¹ requires employers to provide “reasonable” break time (not required to be paid) and a space near the work area, other than a bathroom, where an employee can privately express milk (often referred to as a lactation room). Employers are required to provide these accommodations until the employee’s baby turns 1 year old. However, much of the statutory language is vague and open to interpretation, potentially leading to actions that, while legally compliant, may be inadequate or inappropriate. In addition, US federal legislation only applies to nonexempt hourly employees, meaning that administrative, executive, and professional employees; outside salespeople; and certain computer employees are not covered by the law if they (1) are paid on a salary rather than an hourly basis; (2) earn at least $455 per week; and (3) are paid fully salary for any week they work, regardless of how much time they work. Likewise, nonemployees have no legal rights to the use of a lactation room when visiting a workplace.

US college and university campuses represent a specific concern, as most students are not employed by their school and thus not protected by labor laws. Little is known about how college students navigate their campuses to find suitable locations for expressing breast milk. This article describes the process that 2 graduate students took to successfully establish a dedicated space to express breast milk while on campus, and highlights the facilitators, barriers, and lessons learned that could help address the needs of breastfeeding mothers attending other US academic institutions.

Process of Establishing a Lactation Room

The initiative to establish a lactation room originated with the experiences of 2 graduate students at a medium-sized, nonresidential US urban public university who became mothers during their studies. Both faced challenges surrounding the lack of access to, and inappropriateness of, shared spaces identified by the university for expressing breast milk. To illustrate, the most hygienic and private space identified was the library of the university’s child care center, though it was accessible only until 5 p.m., well before most evening classes began. Other designated spaces included several highly trafficked and unclean pantries/ recycling centers, and the university’s health center, which required that women make appointments but did not ensure privacy.

Although the university perceived these spaces as in compliance with federal and state laws, the 2 student-mothers sought to advocate for a dedicated lactation space that was accessible, clean, comfortable, and free from intrusion. This was a particularly salient issue given that only a small proportion of females on campus had private offices to express breast milk. To begin this initiative, the students reached out to a local lawyer and lactation room expert. Together, this 3-person team met bi-weekly for approximately 3 months in spring 2011 and worked closely with several key supporters to bring the idea of a dedicated lactation room to fruition. The main initial barriers faced were identifying a location in an already space-limited campus, and building awareness for the need of a dedicated lactation room.

To overcome these barriers, several approaches were taken. One of the first activities was collecting data to document need. Through a student body survey, 101 students indicated that either they or their partners would use a dedicated lactation space on campus either immediately or in the near future. Although this survey did not include staff or faculty, it lent ample support for the need of a lactation room. Attempts were also made by the team to engage all members of the school community by making announcements at regularly scheduled student and faculty meetings, individually approaching students and staff (particularly pregnant women), and reaching out to members of the student council and human resources office. Last, the team organized 2 campuswide meetings to bring all stakeholders together.

The relationships formed through these various venues proved valuable in maintaining pressure on university administration. For instance, a helpful connection was made with a sympathetic peer from the student council who was able to advocate for the room during meetings with the offices of student affairs, provost, and president. In fact, the student council was able to provide much of the initial negotiation with school administrators around necessary funding. Connections with influential faculty provided another way to impact decision making at the highest administrative level. One such example was when the department chair of the 2 student-mothers wrote a letter directly to the university president outlining the importance of a designated lactation room and the obstacles in establishing such a space. This action represented critical leverage in eliciting an administrative response.

Last, the team continued to raise awareness of the issue by writing an article for the school newspaper that exposed the challenges they and other breastfeeding mothers faced at the university. In addition, 1 team member addressed the issue with the university president at one of his open campus meetings. Doing so provided the opportunity for the president to make a statement of support for the lactation room in front of students, staff, faculty, and administration. This public support put additional pressure on the president to ensure that the project was completed.

Through these strategies and months of discussions with administration, a former storage space was offered as the location for the lactation room. Filled with equipment and files, it became necessary to involve staff from the security and facilities departments to ensure the room was properly emptied, cleaned, secured, and compliant (eg, outlets and ventilation). This proved to be the last, albeit one of the largest, barriers to establishing the room, given the reluctance of the university to spend funds on the necessary work. To ensure the work was completed, the team remained cordial yet persistent in requesting status updates, and even offered to aid in finishing the work in whatever way possible.

Outcomes

After nearly 18 months of planning, the campus’s dedicated lactation room was opened for use in March 2012. A grand opening and ribbon cutting celebration, including presentations from supportive faculty members and a tour of the room, marked the room’s establishment. At the time of its opening, the room included 2 desks and 2 comfortable chairs; a small refrigerator; pillows; pregnancy, breastfeeding, and child-related books and brochures; breastfeeding posters; and a bulletin board for women to post pictures of their babies to help stimulate milk let-down.² Over the past 2 years, the room also gained a donated hospital-grade breast pump.

To use the room, women with a campus identification card must register with the university’s office of student affairs. Upon registering, a woman is issued a key to the lactation room. Women are asked to return their keys once their need for the room ends or upon official leave from the university, whichever occurs first. The lactation room is available to any woman with a key at any time during normal building hours, including evenings and weekends. As of March 2014, 39 keys had been issued and 4 keys had been returned. During a typical school week in March 2014, 42 visits were made to the room, averaging 8.4 visits per weekday. Users of the room continue to provide positive feedback, and anecdotal reports indicate an increase in the awareness and usage of the room over time. In the event that 2 or more women seek to use the room simultaneously, several current users report that the women work it out amicably in 1 of 2 ways: either both women will express breast milk at the same time (there is adequate space and privacy for 2 users, though there have been up to 3 women using the room concurrently), or 1 woman will wait until the other(s) has finished. An explicit procedure outlining how more than 1 woman uses the room at a time could help ease any ambiguity or potential scheduling challenges.

Lessons Learned

While the team encountered several challenges to establishing a dedicated lactation room, there were a number of strategies that proved to be critical to the success of the initiative.

Study Legislation Related to the Issue

Legislation related to breastfeeding support in the workplace provided significant leverage when approaching the school administration. However, since the shared spaces identified for expressing breast milk were perceived by the university as in compliance with the law, the problem had to be reframed to maintain that compliance did not equate to adequacy.

Obtain Evidence to Support the Cause and Give Visibility to the Issue

Obtaining data that supported a dedicated lactation space provided support for the team’s efforts and added legitimacy to their claims. Specifically, the results of the student survey, written testimonials and letters of support, as well as the language in the legislation itself, provided ample proof for the need of the room. Through word of mouth, publishing an article in the school newspaper, and raising the issue at the president’s community meeting, the campus population became aware of the need for the room.

Form Alliances, Develop a Collective Voice, and Enlist Support From Influential People

The initiative took a multifaceted approach, which included engaging students, faculty, and staff from various departments. This engagement was done via mass emails, in-person encounters, posting flyers, cold calling, publishing an article in the school newspaper, and arranging stakeholder meetings. Engagement of people of influence was particularly helpful in leveraging resources.

Conclusion

The strategies outlined above proved helpful in leading the university’s administration to prioritize the allocation of space for the lactation room even during times of financial austerity and when confronted with a perceived “shortage of space” at the university. In addition, the idea of a lactation room is a relatively novel, albeit growing, phenomenon. Thus, the initiative strived to give publicity to the early adopters of lactations rooms, namely women at the university who would be using the room. This publicity was imperative to providing a sense of relevance and urgency needed for the administration to place priority on the establishment of the lactation room. In sum, the strategies employed by the coalition members can be tested and applied in other US academic settings to assist in advocating for more supports for breastfeeding mothers. If barriers to adequate accommodations continue to exist in a workplace, women may also file a complaint with the US Department of Labor’s Wage and Hour Division (http://www.dol.gov/whd), who will investigate and work with the employer to identify an acceptable solution. However, it is also imperative that US legislation be amended to include language that explicitly protects students so that women do not need to make the choice between continuing their education and continuing to breastfeed.