Master's Project Title:

Helping Ramsey County Become a Breastfeeding Friendly Workplace (Executive Summary)

MCH Student:

Carolina Ramirez

Date of Defense:

Friday, February 21, 2020


Introduction: Breastfeeding is an important public health issue because of its capacity to prevent disease and reduce health disparities. Human milk provides numerous significant benefits to the health of mothers and infants. The American Academy of Pediatrics (AAP) recommends that babies receive human milk exclusively for their first six months of life and continue receiving human milk for at least their first year (Breastfeeding and the Use of Human Milk, 2012). However, only one in four infants is exclusively breastfed for the first six months (Centers for Disease Control and Prevention, 2019). Moreover, in the U.S., low breastfeeding rates add more than $3 billion a year to healthcare costs for the mother and infant (Centers for Disease Control and Prevention, 2019). While there are many factors affecting exclusive-breastfeeding duration, such as hospital practices and access to community support, the factor I chose to study is breastfeeding support in the workplace. According to a recent study, only 40% of mothers reported having access to both break time and a private space to pump and, among women who work fulltime, only 10% of those who started breastfeeding their infants will still be breastfeeding six months later (Rocheleau et al., 2019).

Experience: As an intern with Saint Paul – Ramsey County Public Health’s (SPRCPH) Statewide Health Improvement Partnership (SHIP), I had the opportunity to assist Ramsey County’s efforts to be recognized by the Minnesota Department of Health (MDH) as a Breastfeeding Friendly Workplace through demonstrating its commitment to breastfeeding families by creating a workplace lactation support program. The primary objectives of my learning experience were to (1) participate in the planning, delivery, and analysis of a breastfeeding support survey for employees; (2) conduct physical assessments of lactation rooms in Ramsey County employee worksites; and (3) to create teaching aids and materials to disseminate information to professional and nonprofessional audiences of a multidisciplinary team.

I achieved my objectives by meeting with the Ramsey County Breastfeeding Friendly Task Force, made up of representatives from the county manager’s office, human resources, property management, and public health, to collaborate on the development of a countywide survey on breastfeeding support in the workplace. This survey was adapted from an earlier version created exclusively for staff in the county’s public health department. I also identified all Ramsey County employee physical worksites for the purpose of conducting on-site physical assessments of existing spaces used as lactation rooms by nursing employees. I achieved my third objective by creating a visual aid on the results of the countywide breastfeeding support survey to be shared internally within all Ramsey County departments as well as externally with community partners and supporting agencies.

Over the course of three months, I updated the SPRCPH’s survey on breastfeeding support in the workplace to include 21 Ramsey County departments and conducted 58 out of 64 on-site physical assessments of lactation rooms in Ramsey County employee worksites. The results from the survey and the physical assessments will be used by the County’s Breastfeeding Friendly Task Force to identify the current availability and condition of lactation spaces, learn more about the support nursing parents receive from departments and supervisors, and prioritize actions needed to become a countywide Breastfeeding Friendly Workplace.

Organization: SPRCPH’s SHIP program, funded by MDH, works with a variety of partners to improve the health of communities by creating policy, system, and environment changes. To support breastfeeding initiatives, SHIP provides funding to organizations committed to becoming a Breastfeeding Friendly Public Space; provides funding for workplaces to create lactation spaces, is a founding member of the Twin Cities Breastfeeding Coalition; partnered with SPRCPH’s WIC program to start four Baby Café drop-in breastfeeding groups; earned MDH’s gold-level designation as a Breastfeeding Friendly Health Department; and is now working to become a Breastfeeding Friendly Workplace.

Results: The survey focused on three areas: knowledge of expressing human milk at work; workplace culture and environmental support; and condition of lactation rooms. Three major findings were: (1) a lack of consistent support from human resources to help pregnant employees prepare and nursing parents learn information about expressing human milk at work; (2) 33% of mothers reported work-related factors (e.g. breaks and accommodations) positively impacted their decision to express human milk at work while 31% reported a negative impact on their decision; (3) and a lack of a central database where nursing employees can learn about the location of lactation rooms in all employee worksites and how to access and reserve those rooms. Results from physical assessments of lactation rooms in Ramsey County buildings indicated all rooms met the MDH criteria for Breastfeeding Friendly Workplace lactation rooms by being in an accessible location; being a private space other than a bathroom; including an electrical outlet, chair, and table; and having or being near a refrigerator and a clean washing space. However, not all Ramsey County buildings had a lactation room available to staff, including facilities such as libraries, golf courses, and ice arenas.

Lessons Learned: Although I have been an employee of SPRCPH for over five years, it was not until my learning experience with SHIP that I fully realized the magnitude of Ramsey County, as a local government agency, and its numerous departments, divisions, and programs. Perhaps the biggest realization, however, is the extent of the disconnect between departments and programs despite overlapping goals and work in some cases. Because of the County’s tendency to work in silos, I faced challenges in determining the actual number of Ramsey County employee worksites, identifying the appropriate contacts to schedule physical assessments of lactation rooms, and cautious apprehension from supervisors, employees, and building managers regarding my authorization and intentions for assessing their worksites.

Recommendations: Based on the survey results and lactation room assessments, I developed three recommendations: (1) establish a policy for disseminating information on breastfeeding policies and locations of lactation rooms from human resources to pregnant and nursing staff; (2) implement workplace learning opportunities for supervisors, employees who are pregnant, nursing parents, and for staff who support a breastfeeding parent to develop a strong support network and positive workplace environment; and (3) ensure all employee worksites without a lactation room can provide staff with access to a space that meets MDH’s criteria for a lactation room to express human milk.

Conclusion: My learning experience with SHIP provided me with invaluable opportunities to collaborate across departments and to increase the potential for information-sharing. Through this experience, I developed my skills in problem-solving, networking, influencing, and persuasion.



Breastfeeding and the Use of Human Milk. (2012). PEDIATRICS, 129(3), pp.e827-e841.

Centers for Disease Control and Prevention. (2019). Facts About Nationwide Breastfeeding Goals. [online] Available at:

Rocheleau, C., Santiago-Colon, A. and Hudson, H. (2019). Promoting Worker Well-Being through Maternal and Child Health: Breastfeeding Accommodations in the Workplace. [online] Available at: