title: Access to Workplace Accommodations to Support Breastfeeding after Passage of the Affordable Care Act.
abstract: OBJECTIVE
  This study examines access to workplace accommodations for breastfeeding, as mandated by the Affordable Care Act, and its associations with breastfeeding initiation and duration. We hypothesize that women with access to reasonable break time and private space to express breast milk would be more likely to breastfeed exclusively at 6 months and to continue breastfeeding for a longer duration.
  
  
  METHODS
  Data are from Listening to Mothers III, a national survey of women ages 18 to 45 who gave birth in 2011 and 2012. The study population included women who were employed full or part time at the time of survey. Using two-way tabulation, logistic regression, and survival analysis, we characterized women with access to breastfeeding accommodations and assessed the associations between these accommodations and breastfeeding outcomes.
  
  
  RESULTS
  Only 40% of women had access to both break time and private space. Women with both adequate break time and private space were 2.3 times (95% CI, 1.03-4.95) as likely to be breastfeeding exclusively at 6 months and 1.5 times (95% CI, 1.08-2.06) as likely to continue breastfeeding exclusively with each passing month compared with women without access to these accommodations.
  
  
  CONCLUSIONS
  Employed women face unique barriers to breastfeeding and have lower rates of breastfeeding initiation and shorter durations, despite compelling evidence of associated health benefits. Expanded access to workplace accommodations for breastfeeding will likely entail collaborative efforts between public health agencies, employers, insurers, and clinicians to ensure effective workplace policies and improved breastfeeding outcomes.
authors.affiliation: Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota. Electronic address: kbk@umn.edu.
authors.forename: Katy B
authors.initials: KB
authors.lastname: Kozhimannil
authors.affiliation: Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota.
authors.forename: Judy
authors.initials: J
authors.lastname: Jou
authors.affiliation: Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: Dwenda K
authors.initials: DK
authors.lastname: Gjerdingen
authors.affiliation: Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: McGovern
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D004651:Employment / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D009035:Mothers; D016134:Organizational Policy; D058991:Patient Protection and Affordable Care Act; D012456:Salaries and Fringe Benefits; D011795:Surveys and Questionnaires; D014481:United States; D014931:Women, Working / Q000523:psychology / Q000706:statistics & numerical data*; D017132:Workplace