Employed Mothers’ Satisfaction with the Breastfeeding Provisions in the Patient Protection and Affordable Care Act

Document Type


Publication Date


Publication Title

University of Massachusetts Boston Doctoral Dissertation


washington; spokane


Objective: Guided by the Conceptual Model for Nursing and Health Policy (CMNHP), the purpose of this study was to determine the extent to which employed mothers perceived satisfaction in their breastfeeding experiences after enactment of the Patient Protection and Affordable Care Act (PPACA) breastfeeding provisions. Methods: The participants (N=507) were employed mothers who returned to work after the birth of their infants and reported hourly pay. Convenience sampling was used to recruit women via La Leche USA Facebook account (LLL USA). Participants completed the Penders Breastfeeding Survey in Research Electronic Data Capture (REDCap). The survey consisted of 39-items; including five satisfaction-related and seven qualitative open-ended questions. Results: Sixty-one percent (312/507) had a 4-year college degree or higher, 66% (339/507) had $50,000-$99,999 annual incomes, and 82% (420/507) identified as white/ Caucasian. The majority indicated agreement: relating to satisfaction in the Breastfeeding Provisions in the PPACA (392/507) 77% agreed; relating to satisfaction in the area that is a place to pump (324/507) 64% agreed; relating to satisfaction in break time for milk expression (316/507) 62% agreed; relating to satisfaction in the duration of their breastfeeding (446/507) 88% agreed; and relating to satisfaction with their exclusive use of human milk (400/507) 79% agreed. However, qualitative data demonstrated a narrative of 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, they 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: This select sample of women varied in experiences indicating the need for more research among employed mothers, employers and policy evaluation. Other considerations include improving workplace areas to include on-site daycares, offering paid maternity leave, enhancing existing workplace lactation support; 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).

Clinical Institute

Women & Children


Obstetrics & Gynecology