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The fourth section of The Surgeon General’s Call to Action to Support Breastfeeding focuses on Employment, calling for four specific actions:

"Employment" excerpt from Executive Summary: The Surgeon General’s Call to Action to Support Breastfeeding:

Employment is now the norm for U.S. women of childbearing age (20–44 years). In 2009, half of all mothers with children younger than 12 months were employed, and more than two-thirds of those employed worked full-time (35 or more hours per week).

Employed women have been less likely to initiate breastfeeding, and they tend to breastfeed for a shorter length of time than women who are not employed. Most employed mothers who are lactating have to pump milk at work for their children and need to be provided with accommodations to do so.

In 2010, the Affordable Care Act (ACA) included a provision for employers to provide workplace accommodations that enable employees who are breastfeeding to express their milk. Specifically, the ACA amends the Fair Labor Standards Act of 1938 by having employers provide reasonable, though unpaid, break time for a mother to express milk and a place, other than a restroom, that is private and clean where she can express her milk.

Given that 26 percent of mothers employed full-time in 2003 were breastfeeding when their infant was aged six months, it is clear that a substantial percentage of U.S. mothers manage to combine breastfeeding and paid work. However, U.S. mothers overall have less support for continuing to breastfeed after returning to work than is recommended by the International Labor Organization. In 2009, 15 U.S. states required that employers support breastfeeding employees when they return to work.