Development and piloting of an instrument that measures company support for breastfeeding

Breastfeeding duration among women employed full-time is lower than for women who do not work outside the home or are employed part-time. There is limited research from the perspective of breastfeeding, working women on what the barriers to and facilitators of breastfeeding while employed are. There are also few studies identifying support provided by employers, which could assist breastfeeding employees. Prior to this study, no instrument was available that measured the level of formal breastfeeding support in companies. The purpose of this study was to develop an instrument to be used in companies which measures the amount of formal breastfeeding support based on the existence of policies, programs, and benefits that may help women combine breastfeeding and employment. Survey design and item development was done through an iterative process. Items and formatting followed the Tailored Design Method (TDM). Expert reviews (n=9) and cognitive interviews (n=4) were performed to ensure validity of the measures of the instrument. The final instrument had 28 items collecting information on formal breastfeeding support; employee demand for breastfeeding support; family-friendly, wellness, and health benefits; and company demographics. The instrument was pilot-tested in 151 companies in Michigan. The results indicated that although few companies had written breastfeeding policies, most allowed women to express milk at work and provided space other than a restroom for this purpose. However, the majority of companies did not provide many other supports such as lactation consultants or electric breast pumps.