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Results Of The Survey On Satisfaction With Breastfeeding Protections in PPACA

Editor’s Note: From time to time, LLL USA shares information about research studies relating to breastfeeding/chestfeeding/human milk feeding. The researcher agrees to provide the results of the study in a reader-friendly format so that we can share it with the community that participated. New Beginnings is pleased to publish this report from Dr. Penders on a recent study. 


image of pump room signThank you to everyone who responded to the Penders’ Breastfeeding Survey during November and December of 2019. This survey explored employed mothers’ level of satisfaction with the Breastfeeding Provisions in the Patient Protection and Affordable Care Act (PPACA).

An amazing response: 1,429 people responded! After missing data were removed, this left 748 responses from the salaried employees and 507 responses from the hourly employees. Demographic data and methodology can be found within the reference below. The highlighted results below are for the 507 hourly employees, those directly affected by the Breastfeeding Provisions. The survey responses from salaried workers will be completed next and reported separately at a later time. Participants were asked to select their level of agreement to five statements.

  • 77% (392/507) agreed, “I am satisfied with the Breastfeeding Provisions in the PPACA.”
  • 64% (324/507) agreed, “I am satisfied with an area that is a place to pump.”
  • 62% (316/507) agreed, “I am satisfied with the break time allowed for milk expression that I have at my worksite.”
  • 88% (446/507) agreed, “I am satisfied with my duration of breastfeeding.”
  • 79% (400/507) agreed “I am satisfied with my exclusive use of breast milk.”
1. “I am satisfied with the Breastfeeding Provisions in the Provisions in the Patient Protection and Affordable Care Act.”
2. “I am satisfied with an area that is a place to pump at my worksite.”
3. “I am satisfied with the Break Time allowed for milk expression that I have at my worksite.”
4. “I am satisfied with my duration of breastfeeding (In other words, I met my intended goal or I am still breastfeeding my child).”
5. “I am satisfied with my exclusive use of breast milk (In other words, I have not needed to supplement my breast milk with formula, juice or water).”

For each of the satisfaction questions the survey allowed for additional space on the survey to explain the answer. In addition, two other questions allowed for a free space to respond; these questions were:

  • If applicable, why did you stop breastfeeding or pumping?
  • Do you have anything else you would like to share about your breastfeeding or pumping at work experience?

From these free space responses many women discussed physical pain, lack of privacy, interrupted break time or no breaks due to work or job demands, and co-workers and employers who were demeaning and disrespectful. Viewed in context of both Accommodation and Resistance, as ways of viewing relationships and power structures, eight emerging themes developed to the open-ended responses. The themes were: Break Time, Area for Pumping, Job Specific, Formula or Supplements Utilized, Continuation or Cessation of Breastfeeding, Positions of Power, Emotional Components, and Reactions to the PPACA Law.

Conclusions from the research collected from the 507 hourly employees: This select sample of women varied in experiences indicating the need for more research among employed mothers, employers and policy evaluation.

Other considerations included improving workplace areas to include on-site daycares; offering paid maternity leave; enhancing existing workplace lactation support; and supporting legislation, including the PUMP for Nursing Mothers Act (S. 3170, H.R.5592) and Support for Working Mothers Act (S. 2155, H.R. 3255).

For questions, please contact me, Rebecca Penders, PhD, RNC-OB at [email protected]. If you would like to cite this work: Penders, R.A. (2020). Employed mothers’ satisfaction with the breastfeeding provisions in the Patient Protection and Affordable Care Act. (Doctoral dissertation, University of Massachusetts, Boston, MA.)


Rebecca Penders, along with her husband Tony, have four children. The kids are now 9, 11, 13 and 14 years and the family lives in Washington state. Rebecca has firsthand experience combining breastfeeding with employment and going to school. She pumped during work breaks as a labor and delivery nurse and in between classes throughout graduate school; and whenever possible, Tony would bring the children to her for a breastfeeding session. She completed her PhD in Nursing Health Policy and works in Perinatal Quality Improvement.


Please send your story ideas to Amy at [email protected].


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