Multifaceted intervention reduces physician lactation barriers in workplace

ByJennifer R. Southall

Fact checked byMindy Valcarcel, MS

Key takeaways:

Physician faculty reported improvements in finding time to devote to pumping.
The intervention resulted in an overall lactation time reimbursement total of $242,744.37 among childbearing faculty.

A multifaceted lactation support intervention improved faculty perceptions of institutional support for pumping breastmilk, addressed the impact of lactation time on productivity and provided a supportive culture of lactation.

The findings, published in JAMA Network Open, backed interventions to improve physician lactation accommodations across academic medical centers, researchers concluded.

Known challenges

Numerous studies point to the challenges with lactation accommodations across academic medical centers, Michelle Mourad, MD, vice chair of clinical affairs and value, and professor in the department of medicine at UCSF, told Healio.

“Faculty are surveyed annually at UCSF using a metric regarding their satisfaction as a place to work, in addition to other measures of faculty satisfaction and wellbeing,” Mourad said. “In 2019, we noticed the gap between faculty identifying as women and those identifying as men increased 20 points [-1 vs. 19]. Diane Sliwka, MD, chief faculty experience officer and clinical professor in the division of medicine at UCSF Medical Center, encouraged several medical directors to partner with her in exploring the sources of this gap. We conducted faculty focus groups and identified return from childbearing leave, and lactation resources specifically, as one of the sources of dissatisfaction. As UCSF already offered 12-week parental leave for both childbearing and childrearing, we began our initiatives to improve lactation accommodations.”

Researchers compared the physician experience before and after a July 2020 intervention that included the creation of functional lactation spaces, a redesign of communication regarding lactation resources, establishment of physician-specific lactation policies and the development of a program to reimburse faculty for time spent expressing breastmilk in the ambulatory setting.

They surveyed 70 clinical faculty (mean age, 34.4 years) who went on childbearing leave during the preintervention period (between July 1, 2018, and June 30, 2020) and 52 faculty (mean age, 34.8 years) who went on leave during the postintervention period (between July 1, 2020, and Nov. 30, 2021).

Researchers collected survey data using a 5-point Likert scale to assess physician perceptions of institutional support. Researchers compared responses collected during the preintervention period with those collected during the postintervention period using unpaired t tests.

The lactation accommodation program’s space improvements, use and costs and an ad-hoc survey of physicians’ reported experience with lactation accommodation support before and after the intervention served as main outcomes.

Supportive culture

Overall, 58 physicians completed the preintervention survey and 48 physicians completed the postintervention survey.

Results showed faculty reported improvements in finding time in their clinical schedule to devote to pumping (mean response, 2.5 for preintervention period vs. 3.6 for postintervention period; P < .001), as well as initiatives to address the impact of lactation time on productivity (mean response, 2 vs. 3; P = .001), and a work culture supportive of lactation (mean response, 2.8 vs. 3.4; P = .047).

Researchers additionally found that the 40 childbearing faculty who took advantage of lactation time reimbursement received an overall reimbursement total of $242,744.37. Those who returned to work during the year the study was conducted received financial support for lactation for a mean of 8.9 months at an average reimbursement of $9,125.78.

“Our study, like many others that have come before us, identified four main areas where increased lactation support is needed,” Mourad said. “These include the need to provide information about lactation accommodations, such as policies, pumping locations, and available equipment; cleanliness, availability, functionality, and proximity of lactation spaces; protecting time for lactation during clinical work and accounting for lactation in measures of productivity; and a work culture supportive of lactation. Our study resulted in the creation of more functional lactation spaces, improvements in communication around lactation resources, and a program to reimburse faculty for time spent lactating in the ambulatory setting.”

Positive changes

This study is the first to demonstrate that a focused effort to improve lactation support can result in positive changes, Mourad told Healio.

“We note that the challenges faced by lactating physicians are multifaceted and require collaboration with physician leadership, finance, facilities and hospitality,” she said. “Changing culture requires discussing expectations around lactation accommodations with chairs, medical directors and managers, and consistently communicating lactation support policies to both leaders and those returning from childbearing leave. We hope that our program can serve as a model for other academic institutions seeking to improve physicians’ experience with lactation.”

Outreach from other academic institutions has been tremendous, Mourad added.

“Before the publication of our article, we spoke with at least 10 other universities curious about our program, how we garnered support and what we found,” she said. “We would love to partner with other academic institutions to study the impact of similar programs at their institutions. Still, the work is not done at UCSF — we have many older buildings where we need more designated lactation spaces. As we expand our clinical footprint, we need to ensure these new buildings meet our standards. We are also looking at outside institutions served by our trainees, to ensure that our policies regarding lactation support extend to those sites as well. We are so lucky at UCSF to have a fabulous lactation specialist, Caroline Wick, IBCLC, who has been an essential partner in this work and who continues to advocate for improving lactation accommodations.”