FSN 426

Spring 2020

Sophie Willett
Micaela Wu

Executive Summary
 Breastfeeding, especially during the first six months of an infant’s life, is essential for
optimal infant growth and development, establishing maternal-infant bonding and reducing the
risk of disease including sudden infant death syndrome, asthma and diabetes.² The American
Academy of Pediatrics (AAP) recommends mothers to continue breastfeeding until the infant is
at least 12 months old.² The improved infant health outcomes associated with breastfeeding also
confer economic benefit as better health means lower employee absenteeism, higher productivity
and lower healthcare spending.²
For mothers, returning to work often results in the termination of or complication of
breastfeeding.¹ One study found that in the month a mother returns to work, she has 2.18
increased likelihood of quitting breastfeeding as her nonworking counterparts.² Across the US in
2015, 35.5% of mothers of infants under 12 months work full-time and 16.1% work part-time,
while 40% of mothers of children 12-24 months work full-time and 17% work part time.²
Developing and improving worksite lactation programs may create the structural support
to reduce barriers to breastfeeding in working women. And yet, many companies and employers
are unaware of the benefits that breastfeeding has for individuals, their company, and even
society. Furthermore, many companies and employers are not sure how to support their
breastfeeding employees. For this reason, California Workplace Lactation Alliance Company
exists to help companies find cost efficient and effective ways to support their lactating mothers .
California Workplace Lactation Alliance Company is not the first company of its type.
Companies such as Corporate Lactation Services also assist companies as they aim to support
their breastfeeding employees. What makes CWLAC unique is its involvement in the local
community. CWLAC is a small, locally owned company that prides itself on having strong ties
to the surrounding community. By connecting the existing support to the mother with the support
of her company, every aspect of the mother's breastfeeding support grows stronger and more
effective. CWLAC aims to provide mothers with a tight network of people instead of individual
entities supporting her separately.
The oversight of CWLAG at the 12 Walmarts in Fresno County is under Micaela Wu,
MPH and Sophie Willett, RD, IBCLC. The program will be managed by Fresno staff team
consisting of a program director, program supervisors and development interns. For the first year
of this program, it is estimated to cost $105,600.00 and then $59,300.00 by the second year, in
which the program should be self-sufficient by the third year and sustained by the
company/employer.

Mission Statement: To help individual infants, mothers, companies, and communities grow
stronger and healthier by supporting mothers as they achieve their breastfeeding goals.

Program Objectives:
● Increase the number of employers that offer lactation support to breastfeeding employees.
● Increase the quality of breastfeeding support offered by employers so that all employers
lactation support achieves the minimum standard set by the federal government.
● Increase the number of local employers who are in communication with existing local
breastfeeding support resources.
● Keep breastfeeding support financially attainable for companies to ensure the investment
is worthwhile for them.

Company Summary
 Micaela Wu, MPH and Sophie Willett, RDN, IBCLC, are the board members of
California Workplace Lactation Alliance Company. Wu and Willett, both alumni of California
Polytechnic State University, SLO, have collective experience in clinical dietetics, clinical
breastfeeding support, and community health program management . Together, they have used
their experience to effectively and efficiently pilot lactation support programs with CWLAG.
This program targets Walmart employees in the 12 Walmart stores in Fresno County, CA,
specifically female employees of childbearing age.

Layout of Location
Below is an example of a lactation room that could be installed into a workplace.

Budget
Operating Budget: estimated budget to implement the program
Year 1 Year 2
(reduced
hours by
half)

Direct Costs Salaries and Wages Program Director (1) $45,000.00 $25,000.00
 (40 hours/week)

Program Supervisors (2) $25,000.00/ $15,000.00/

(20 hours/week) $50,000.00 $30,000.00

Development Interns (3) $1000.00 $500.00

(10 hours/week) stipend / stipend /
$3000.00 $1500.00

Fringe Benefits Sick leave, subsidized meals $2,000.00 $1,000.00

Materials 5 Laptops $3,000.00 -

Printed materials for $1,000.00 $1,000.00

presentations/administrative tasks

Travel Gas reimbursements ($0.58/mi) $1,600.00 $800.00

TOTAL $105,600.00 $59,300.00

Service to Meet Needs

The CWLAG offers a robust, multi-faceted lactation support program that aims to
improve the health and well-being of women, infants and their families. The CWLAG targets
major employers in communities with low breastfeeding initiation and retention rates. The non-
profit organization helps pilot lactation support programs to maintain compliance with federal
and local regulatory standards and cultivate a better workplace environment. The CWLAG acts
as a liaison between major employers and breastfeeding support resources. The CWLAG
program is three-fold and includes: (1) implementation of portable lactation units, (2) lactation
consulting and (3) prenatal breastfeeding education.
CWLAG ensures that the company/employer meets regulatory requirements for lactation
rooms and spaces, with the appropriate amenities. The California Lactation Accommodation
Labor Code Section 1031 states: (a) “An employer shall make reasonable efforts to provide an
employee with the use of a room or other location, other than a bathroom, in close proximity to
the employee’s work area, for the employee to express milk in private.” If the company that
utilizes CWLAG’s services lacks such a space, a portable lactation unit will be implemented.
CWLAG has been partnering with Mamava, a company that manufactures portable lactation
units outfitted with ergonomic benches, table, outlets, occupancy-activated lighting, ceiling vents
and exhaust fan, and additional amenities like refrigeration units and pumps. CWLAG’s
partnership with Mamava allows for companies to purchase units at a reduced price. If the
existing lactation space is adequate, CWLAG can work with the company/employer to either
improve or maintain the space.
CWALG connects the company/employer with local lactation consultant services. They
work with the HR department of the company to develop policies and procedures regarding
lactation consultations. As part of Walmart’s Inclusivity Initiative, qualifying employees can
receive up to 3 lactation consultations for free or at a reduced cost. CWALG helps the
company/employer streamline the logistics for this service.
Finally, CWLAG offers basic prenatal breastfeeding education and recruits or connects
the company/employer to outside resources. WIC, hospitals and other federal services often offer
free classes. If such classes are not easily accessible to the employee, all CWLAG staff are
trained in breastfeeding education and are licensed to teach classes at the company/employer site.

Market Analysis Summary

Community Needs Assessment
Introduction
A community needs assessment of Fresno County, CA was conducted to outline the
current breastfeeding rates and durations, specifically of working mothers. The assessment
identifies the disparity between average breastfeeding duration and the recommended duration
according to the American Academy of Pediatrics.

Healthy People
Goal: Improve the health and well-being of women, infants, children, and families.

Overview: Improving the well-being of mothers, infants, and children is an important public
health goal for the United States. Their well-being determines the health of the next generation
and can help predict future public health challenges for families, communities, and the health
care system. The objectives of the Maternal, Infant, and Child Health topic area address a wide
range of conditions, health behaviors, and health systems indicators that affect the health,
wellness, and quality of life of women, children, and families.

Healthy People 2020 Objective (MICH-22): Increase the proportion of employers that have
worksite lactation support programs.

Nutrition Problem
In the US in 2015, 57.6% of infants were breastfed through 6 months, and 35.9% were
breastfed through 12
months. 46.9% were
exclusively breastfed
through 3 months, and
24.9% were exclusively
breastfed through 6
months. In California in
2015, 66.7% of infants
were breastfed through 6
months, and 40.2% were
breastfed through 12
months. 53% were
exclusively breastfed
through 3 months and
26.3% exclusively
breastfed through 6 months.
Of the many barriers to breastfeeding in working women, unsupportive work
environment, inadequate time to express and lack of privacy are major contributors. Because a
significant amount of women return to work within the first 12 months of their infant’s lives, it is
imperative to improve the ability of working women to breastfeed or express and store milk in
the workplace. Breastfeeding can be encouraged in the workplace through support services
offered by nonprofit or private organizations, or through government policy and through
employer initiative.
Developing and improving worksite lactation programs may create the structural support
to reduce barriers to breastfeeding in working women. In 2009, 25% of employers reported
providing an onsite lactation room; the Healthy People 2020 proposed target is to increase this
proportion to 38%. Women with both adequate break time and private space were 2.3 times as
likely to be breastfeeding exclusively at 6 months and 1.5 times as likely to continue
breastfeeding exclusively with each passing month compared to women without access to these
accommodations. Additionally, women in specific service-oriented industries reported the lowest
rates of breastfeeding initiation and workplace supports for breastfeeding and pumping.

Background/Environmental Data
There are a number of federal and state laws and policies relating to women’s lactation
rights. The California Lactation Accommodation Labor Code Section 1030 states: “Every
employer, including the state and any political subdivision, shall provide a reasonable amount of
break time to accommodate an employee desiring to express breast milk for the employee’s
infant child. The break time shall, if possible, run concurrently with any break time already
provided to the employee. Break time for an employee that does not run concurrently with the
rest time authorized for the employee by the applicable wage order of the Industrial Welfare
Commission shall be unpaid.”.
If an employer can demonstrate to the department that the requirement to provide the
employee with the use of a room or other location, other than a bathroom would impose an
undue hardship when considered in relation to the size, nature, or structure of the employer’s
business, an employer shall make reasonable efforts to provide an employee with the use of a
room or other location, other than a toilet stall, in close proximity to the employee’s work area,
for the employee to express milk in private.”
Other laws such as The Pregnancy Discrimination Act (PDA), The Family and Medical
Leave Act (FMLA) of 1993 and the Americans with Disabilities Act (ADA) are also considered
in the workplace for breastfeeding women’s rights.

Community Data
Demographics: The average household income in the Fresno area is $49,000 which is $26,000
less than the median household income of California which is at $75,000. Additionally the
poverty rate in Fresno is 28.4% which is 13.3% higher than the California poverty rate which is
at 15.1%. Finally, the median age in Fresno is 31.5 which is 5 years younger than the median age
in California, signifying that there is a high density of younger working age individuals in Fresno
California compared to the state as a whole. Racially, almost 50% of the Fresno area is hispanic
or Latino with the next highest race being white alone which is approximately 28% of the
population. These statistics differ from the whole of California of which almost 40% is hispanic
or Latino and 38% is white alone.

Economic Environment: Fresno employs 219,000 people of which the most people (37,700
individuals) work in health care and social assistance. The next highest amount of people (24,300
individuals) work in retail trade, and the third most employees (21,100 individuals) work in
educational services. Additionally men earn approximately 1.26 times higher salaries than that of
women. The income inequality in Fresno CA is 0.499 (using the Gini index) which is higher than
the national average at 0.490.

Community Behaviors and Attitudes: Fresno County has one of the lowest rates of breastfeeding
in California. Only a third of mothers leaving Fresno County hospitals exclusively breastfeed
their infants. In 2011, according to the California Department of Public Health, 48.8% of women
leaving Fresno hospitals were exclusively breastfeeding. Then once mothers leave the hospitals,
the likelihood of them continuing to breastfeed goes down even further. California Department
of Public Health Maternal and Infant Health Assessment (MIHA) Survey collects “exclusive
breastfeeding, 3 months after delivery” and shows only 18.2% of mothers in Fresno County
report exclusive breastfeeding three months post-partum in 2013-2014. This number has been
steady but remains well below the national goal of 46.2% of infants being exclusively breastfed
through three months. According to the Fresno County Administration, “It is a priority of Fresno
County to promote, protect and support a County employee’s ability to breastfeed her child. The
County recognizes that breastfeeding is the optimal feeding choice and preferred method of
infant feeding for at least the infant’s first year of life. The County also recognizes that
breastfeeding imparts health benefits to both the mother and the child and that regular breast
milk expression is necessary in order to maintain the breast milk supply.”

Community Health: According to a USDHHS survey from 2018, there are multiple factors that
increase a child’s likelihood to become sick and miss days of school. The total percent of
children under the age of 18 in the United States who classify as having fair or poor health is
1.7%. The percent of children who are Hispanic or Latino is much higher at 2.6%. Additionally
among families whose income is $49,999 and less ($49,000 being the average family income in
Fresno) 2.4% of their children have fair or poor health. These statistics reveal that there is a
much higher percentage of children in the Fresno area who have fair or poor health compared
with other areas in California and the United States as a whole. Since breastfeeding is an
effective tool for increasing the health of young children, increasing breastfeeding rates in the
Fresno area could have a dramatic impact on improving the health of children in the Fresno area.

Community Desire for Solution

Contributors: Some known contributors of low breastfeeding rates among working women are
lack of space, lack of time, and a hostile environment towards breastfeeding. Breastfeeding
during work can also cost the employees and employers time and money while the woman
breastfeeds her child or pumps.

Resources and Services

Existing resources and services in Fresno are noted to identify the gap in services provided:

Current Law and Regulations: To see current laws and regulations supporting breastfeeding
women in the workplace, please see Background/Environmental data above

WIC: WIC, a supplemental nutrition program for Women, Infants, and Children, is a federal
assistance program of the Food and Nutrition Service of the United States Department of
Agriculture for healthcare and nutrition of low-income pregnant women, breastfeeding women,
and children under the age of five. WIC’s main services include providing mothers and children
in need with supplemental nutritious foods, nutrition education and counseling, and screening
and referrals to other health, welfare and social services.

Local Support Groups: Local support groups include La Leche League of Fresno, Mother’s
Resource Center, and the WIC Breastfeeding Peer Counselor Program. These programs connect
breastfeeding mothers with each other and with lactation consultants to help them address issues
and barriers that arise when breastfeeding. These groups each offer in person support as well as
phone support and hold regular meetings for mothers to attend and get connected.

Hospital Lactation Support/Services: Local hospitals and medical centers such as the
Community Medical Center, Kaiser Permanente, and Saint Agnes Hospital offer a variety of
breastfeeding resources. These resources include, but are not limited to support classes, support
groups, Lactation Consultant group and private meetings, and telehealth Lactation Consultant
options. There are also a variety of breastfeeding and birthing classes available from these
locations which the mother and her partner or supporter is able to attend.

Target Population
The target population includes retailers, companies and organizations that seek workplace
lactation support in the Fresno County area.

Target Population Data

The target population for this proposed program is Walmart, a global employer that
claims a supportive internal environment for breastfeeding employees. Both full and part-time
workers are given “reasonable accommodations” like breaks during the work shift, modified
hours or time off, and different or less physically demanding work tasks. However, these policies
are, in actuality, often overlooked, especially for part-time employees and those who work
associate positions. For years, Walmart has been accused of failing to implement proper policies
and laws regarding pregnant and lactating women’s rights in the workplace. Walmart has come
under scrutiny by many legal groups and organizations including National Women’s Law
Center, A Better Balance, Mehri & Skalet, LLC, and the Organizational United for Respect, who
have criticized Walmart for its ambiguous policies regarding breastfeeding support. Thus the
California Worksite Lactation Alliance Group has been recruited by Walmart to enact tangible
changes to existing policy to comply with legal regulations and create a supportive environment.
Walmart is a big presence in Fresno County, employing 90,034 people in California. Of
the Walmarts in Fresno County, there are 9 SuperCenters which each employ between 300-400
associates, and 3 Neighborhood Markets which employ between 80-100 associates. Together, an
estimated 2,720 employees work for Walmart in the Fresno area. According to Walmart’s 2014
Diversity and Inclusion Report, 57% of Walmart’s associates are female. Assuming that the rate
of Walmart associates who are female holds true in Fresno County, there are approximately
1,550 women working for Walmart in Fresno County who could be affected by Walmart’s
lactation policies and procedures.
Of the 12 Walmarts in Fresno, only one had a designated lactation room, according to
interviews with key informants and employee testimonials. This lactation room contains one
chair and an outlet, but no other amenities. This room is accessible to both employees and
customers and is solely used by lactating mothers. Four of the Walmarts (one of which was a
Neighborhood Market) designated multipurpose office space for their breastfeeding mothers.
These office spaces have chairs, desks, and outlets, but are also used for storage and
administrative work, including conducting interviews and meetings. Two of the Walmarts (both
Supercenters) have their breastfeeding employees use dressing rooms. These dressing rooms
have mirrors and a bench, but no outlet or tables. Three of the Walmarts had no more than
bathrooms with changing tables to accommodate their lactating employees and customers.

Proposed Program
Purpose: The California Workplace Lactation Alliance Group (CWLAG) was created to support
and promote breastfeeding in the workplace. Though laws exist to protect breastfeeding in the….

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