' Indian Health Manual (IHM) - Circular 06-05
Skip to site content

Indian Health Service The Federal Health Program for American Indians and Alaska Natives

Scroll To Top

     Indian Health Manual

Circular 06-05

Indian Health Service
Rockville, Maryland 20852

Refer to: OCPS


Effective Date:  July 07, 2006


  1. PURPOSE.  The purpose of this circular is to establish Indian Health Service (IHS) policy and implement the IHS Lactation Support Program that would allow women who choose to breast feed their infants to express breast milk while on duty.

  2. BACKGROUND.  Breastfeeding is the ideal method of feeding and nurturing infants: human breast milk is the most complete form of nutrition for infants; Breastfeeding protects an infant from a wide array of infectious and noninfectious diseases.

    Many American Indian/Alaska Native (AI/AN) families and communities are facing escalating rates of obesity and diabetes, and breastfed infants are less likely to become obese or diabetic later in life.  Nursing moms return to their pre-pregnancy weight more quickly.

    Employers also benefit when their employees breastfeed; companies with established lactation programs have shown significantly lower maternal absenteeism as breastfed babies are sick less often.  In addition, employer medical costs are lower and employee productivity is higher.  American Indian/Alaska Native women comprise over fifty percent of the IHS workforce in both clinical (nursing, medicine, pharmacy social services, etc.) and business office type settings.  Most of the women are of childbearing age.  Diverse issues, such as insufficient leave accrual and income needs, often require women to return to work well before six months postpartum.  As a result, 1 out of 3 women returns to work within 3 months of giving birth and 2 out of 3 women return to work within 6 months of giving birth.  Exclusive breast feeding for the first four to six months is recommended by the Department of Health and Human Services (HHS), World Health Organization, American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists.

    Overwhelmingly, IHS’ greatest success has been a result of application of public health strategies.  A breast feeding workplace policy is an integral piece in health promotion for AI/AN.  The IHS is committed to promotion of this proven culturally consistent health strategy.  Further development of supportive local policy that enables breast feeding or breast milk expression in the workplace is an essential step to accomplish this important goal.

  3. POLICY.  It is the policy of the IHS to allow women who choose to breastfeed their infant, to express breast milk during their tour of duty, provided they have obtained prior approval.


    1. Public Law 103-3, Family Medical Leave Act (FMLA) of 1993. http://http://www.dol.gov/dol/topic/benefits-leave/fmla.htm Exit Disclaimer: You Are Leaving www.ihs.gov

    2. Department of Health and Human Services “Blueprint for Action on Breastfeeding,” Office of Women’s Health, 2000.

    3. “An Easy Guide to Breastfeeding for American Indian and Alaska Native Families,” Office of Women’s Health, 2003.

    4. Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Breastfeeding, (2000), Healthy People 2010 Objectives for the Nation, Section 16: Maternal, Infant, and Child Health, Objective 16-19.   http://www.healthypeople.gov/2010/Document/HTML/Volume1/toc.htm. Exit Disclaimer: You Are Leaving www.ihs.gov

    5. Porter, D., Breastfeeding:  Impact on Health, Employment and Society.  Congressional Research Service (CRS) Report for Congress, July 18,2003.

    6. Weimer, D. Summary of State Breastfeeding Laws, CRS Report for Congress, Updated July 23,2003.

    7. The American Academy of Pediatrics, Policy Statement:  "Breastfeeding and the Use of Human Milk," Pediatrics, 100(6) 1997, 1035-1039. http://pediatrics.aappublications.org/content/100/6/1035. Exit Disclaimer: You Are Leaving www.ihs.gov

    8. Cohen R., Mrtek, M., and Mrtek, R. (1995), “Comparison of Maternal Absenteeism and Infant Illness Rates Among Breast-feeding and Formula-feeding Women in Two Corporations,” American Journal of Health Promotion, 10,(2): 148-153.


    1. Expression of Milk.  Expressing milk (taking milk from the breast using special equipment and storing it for later use) allows an infant to continue to have all the nutritional benefits of breastfeeding at a time when it is most needed.  The expression of milk can be accomplished by manual expression or a pumping device at the breast.

    2. Hospital Grade Electric Pump.  A hospital grade electric pump is a standardized and effective electric device used to extract milk from the breast.  It is commonly used in newborn intensive care nurseries and hospital settings and is effective to maintain lactation if used regularly.  The pump:

      1. may be dual sided or single;

      2. is designed for multiple users with disposable personal attachments; and

      3. may be rented or leased for personal use at home, travel or work settings.

    3. Lactation.  Lactation is the chief function of the mammary glands or breasts and is a scientific word for the basic physiology of milk synthesis, storage, and expression.

    4. Lactation Consultant.  A lactation consultant may be qualified as a ”peer counselor” or a formally trained and certified professional with a background as a nurse or registered dietitian.  Certification in lactation counseling is provided by the International Board Certified Lactation Counselor organization.

    5. Manual Pump.  A manual pump is a hand held and operated device that extracts milk from the breast.  Many types are not standardized.


    1. Flexible Schedule.  Women who choose to breastfeed their infant should be allowed a flexible schedule for milk expression or pumping.  No leave time should be charged for breastfeeding or pumping during lunch and breaks.  If additional time to complete the task is required (beyond the time period for the normal break and/or lunch break), then the employee must use sick leave, annual leave, or unpaid leave to account for the time.

    2. Breastmilk Expression and Equipment Space and Facilities.  When possible, the IHS will provide the facility or space accommodation necessary for the employee to express breastmilk:

      1. The employee should have unlimited access to a fixed or floating space for milk expression.

      2. The accommodations to express breast milk should ensure the employee's privacy by having a lockable door, accessible electrical outlets for an electric breast pump, a sink close by for hand washing and rinsing out storage containers, a comfortable chair, and a small table.

      3. The employee is responsible for the proper storage of all equipment and supplies.

    3. Breastfeeding Information.  Breastfeeding information should be readily available.  Information regarding this policy will be provided to new employees and by supervisors to pregnant employees upon notification of their pregnancy (See Circular Exhibit 2006-05-A, B, and C, regarding Frequently Asked Questions.)


    1. Supervisors.  Supervisors will:

      1. enumerate the work expectations of the employee;

      2. grant leave in accordance with applicable regulations;

      3. wherever feasible, the supervisor will refer families to a lactation support resource on an "as-needed" basis; and

      4. take appropriate action if an employee is found to be abusing this policy.

    2. Lactation Consultant.  The Lactation Consultant, if available, may provide:

      1. prenatal outreach/contact;

      2. consultation prior to the employees return to work; and

      3. consultation with the employee’s spouse.

    3. Employee.  The employee will provide written notification to their immediate supervisor of their intent to breastfeed and express milk upon return to work, prior to taking maternity leave, or as soon as possible, post-delivery.  The employee will:

      1. submit a leave request if the time for expressing milk exceeds the time allowed for a break period or lunch;

      2. notify the supervisor of any problems experienced with the facility or accommodation provided; and

      3. abide by the policy otherwise they may jeopardize their participation.

  8. EVALUATION.  Lactation support programs in the workplace can be monitored in each facility by completing a program evaluation, for example, a “Customer Satisfaction” survey.

  9. SUPERSEDURE.  None.

  10. EFFECTIVE DATE.  This circular is effective on the date of signature.

/Charles W. Grim, D.D.S./
Charles W. Grim, D.D.S., M.H.S.A.
Assistant Surgeon General
Director, Indian Health Service

Back To Top  |  Previous Page
CPU: 24ms Clock: 0s