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Chapter 7 - Lactation Support Program

Part 4 - Staff Services/Special Programs

Title Section
Introduction 4-7.1
    Purpose 4-7.1A
    Background 4-7.1B
    Policy 4-7.1C
    Authorities 4-7.1D
    Definitions (See also 42 CFR §136.21) 4-7.1E
Responsibilities 4-7.2
    Director, Indian Health Service 4-7.2A
    Supervisor 4-7.2B
    Employee 4-7.2C
Procedures 4-7.3
    Lactation Program 4-7.3A
    Exceptional Accommodations 4-7.3B
Exhibit Description
Manual Exhibit 4-7-A "Frequently Asked Questions (FAQ) for Employees Who have Questions About Breastfeeding"
Manual Exhibit 4-7-B "Frequently Asked Questions (FAQ) for Supervisors Who have Employees Who Wish to Work and Pump Their Breasts or Express Milk"
Manual Exhibit 4-7-C "Frequently Asked Questions (FAQ) for Managers Establishing a Lactation Support Program"
Manual Exhibit 4-7-D "Resources"


  1. Purpose.  The purpose of this chapter is to update the Indian Health Service (IHS) policy and revise guidance for managers and supervisors in recognition of the documented health advantages of breastfeeding for infants and mothers and what the benefits to the employer are.
  2. Background.  Breastfeeding protects an infant from a wide array of infectious and noninfectious diseases.  Breastfeeding also facilitates maternal infant attachment and enhances infant mental health. Continued breastfeeding offers a variety of noted benefits for mothers, their babies and their employers.  When working mothers receive workplace education and support; such as adequate space and time to express milk, support from supervisors and colleagues, etc., they are often able to continue to successfully breast-feed their child.  Many companies report greater employee loyalty following adoption and promotion of a lactation support policy.  Employers have reported reduction in turnover rates, with 86 to 92 percent of breastfeeding employees returning to work after childbirth when a lactation support program is provided compared to the average of 59 percent.  The IHS benefits when their working mother employees breast-feed their child.  Breastfed infants are sick less often, therefore, maternal absenteeism from work is significantly lower in agencies with breastfeeding-friendly promotion programs.  As a rule, research has demonstrated that medical costs are reduced and employee productivity is improved for women with breastfed infants.
  3. Policy.  It is IHS policy that all managers and supervisors shall provide the support needed to allow time for nursing mother employees to pump and store breast milk while on duty.
  4. Authority.

    Section 4207 of the Patient Protection and Affordable Care Act, Public Law 111-148, amending section 7 of the Fair Labor Standards Act of 1938 (codified at 29 U.S.C. § 207(r))

  5. Definitions.
    1. Breastfeeding.  Breastfeeding is the ideal method of feeding and nurturing infants:  human breast milk is the most complete form of nutrition for infants.
    2. Lactation.  Lactation is a scientific word for the basic physiology of milk synthesis.  For the purposes of this chapter, lactation is sustained by regular periodic expression of breast milk either by pumping or breastfeeding to stimulate milk production.
    3. Pump or Express Breast Milk.  Breast milk can be expressed manually by hand or by using a hand held, non-mechanical or electric breast pump.
    4. Private Space.  There are no specific space or permanency requirements for a privacy space area to pump or express breast milk.


  1. Director, Indian Health Service.  The Director, IHS is administratively required to provide working mother employees, who choose to breast feed their child by participating in the IHS Lactation Support Program, with a clean, private space that is in close proximity to the employees' work station.
  2. Supervisor.  The supervisor is required to provide working mother employees who choose to breast feed their babies and participate in the IHS Lactation Support Program with:
    1. Defined work expectations.
    2. Defined action taken against the employee if the employee is abusing this policy.
    3. Reasonable break time in accordance with the Section 4207 of the Patient Protection and Affordable Care Act, Public Law 111-148, codified at 29 U.S.C. § 207(r)) and the United States Office of Personnel Management memorandum on Nursing Mothers in Federal Employment dated December 22, 2010.
    4. A place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public which may be used by the employee to express breast milk in accordance with regulations cited above.  The place designated for this purpose must be private and kept clean.
    5. "As needed" lactation support resources, i.e., prenatal outreach/contact, consultation prior to the employees return to work, and consultation with the employee's spouse per request.

      Additional information is available for supervisors:  please see Manual Exhibit 4-7-B, "Frequently Asked Questions (FAQ) For Supervisors Who Have Employees Who Wish to Work and Pump Their Breasts Or Express Milk."

  3. Employee.  Employees may participate in the IHS Lactation Support Program for one year after the birth of their child and are required to:
    1. Notify their immediate supervisor of their intent to participate in the IHS Lactation Support Program prior to taking maternity leave or as soon as possible upon returning to duty.
    2. Express and store her breast milk in the designated location.
    3. Submit a leave request if the time for expressing milk exceeds the time allowed for compensated breaks.

      Additional information is available for employees:  please see Manual Exhibit 4-7-A, "Frequently Asked Questions (FAQ) For Employees Who Have Questions About Breastfeeding."


  1. Lactation Support Program.  The IHS Lactation Support Program facilitates the continuation of breastfeeding and helps nursing mothers to better integrate their work and family needs.  It is the aim of the IHS to go beyond the requirements of the legislation to actively support nursing mothers through the IHS Lactation Support Program.  The IHS is committed to the promotion of this proven and culturally consistent health promotion and disease prevention strategy.  Section 7(r) of the Fair Labor Standards Act requires employers to provide nursing mothers with:
    1. Reasonable break time to express milk for one year after her child's birth each time such employee has need to express breast milk.
    2. A clean private space, other than a bathroom, that is shielded from view and free from intrusion of others, to express breast milk.  A clean, private space.  The clean, private space must have:
      1. A lockable door to ensure privacy and prevent intrusion.
      2. An electric outlet.
      3. Good lighting.
      4. Proper ventilation.
      5. Adequate temperature.
      6. A comfortable chair.
      7. A flat surface for storage for the employees' supplies and equipment.  None of the employee's supplies or equipment may be stored on the floor.
      8. A trash can.
      9. Paper towels or hand wipes.

        Additional information is available for managers:  please see Manual Exhibit 4-7-C, "Frequently Asked Questions (FAQ) For Managers Establishing A Lactation Support Program."

  2. Exceptional Accommodations.  Exceptional private space accommodations may include an IHS facility-provided electric hospital grade breast pump; refrigerator; microwave for sterilization of breast pump parts; a clock; mirror, and sink with a hot water faucet for washing the employee's hands and cleaning equipment. Additional information is available:  please see Manual Exhibit 4-7-D, "Resources" which will provide information on community resources that can be of assistance to managers, supervisors and employees regarding breastfeeding.