Developed by Seabourne Consulting, experts in Bright Spot: Texas Mother-Friendly Worksite Program

Bright Spot: Texas Mother-Friendly Worksite Program

Photo by Jan Kopřiva on Unsplash

This bright spot was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.


Detailed Description

The Texas Mother-Friendly Worksite Program (MFWP) is designed to bestow official recognition upon worksites that adhere to the program's criteria for being "Mother-Friendly," including having a written and communicated policy that provides space for breast milk expression in the worksite, flexible work schedules for breastfeeding mothers, and access to hygienic breast milk storage options (refrigerator or cooler). Additional recognition is given for worksites with more comprehensive worksite lactation support programs. The Texas Mother-Friendly Worksite Program was developed by the Texas Department of State Health Services.

*The Center for Training and Research Translation worked with the intervention developers to review the evidence in support the program and develop detailed guidance on how to implement it in practice*

Expected Outcomes

The intervention has been successful at getting worksites to adopt breastfeeding policies that meet established criteria for flex time and women's access to a pump room, sink, and milk storage. In the 30 pilot sites, the policy led to the specified improvements in the work environments. Evidence is not yet available on population awareness and attitudes towards breastfeeding at work or on the possible impact of the policy on women's breastfeeding practices.


Practice-tested bright spot (good evidence)

Cost Details

As of May 2014, the cost of this intervention is as follows:

  • Cost of modifying existing space/creating new space for mothers to breastfeed/express milk
  • Cost of purchasing supplies and equipment, maintaining cleanliness and functionality of the space
  • Cost of coordination, monitoring, and assessment of worksite breastfeeding lactation activities
  • Cost of printing and distributing educational/promotional materials.

For the latest cost details, please contact the Texas Mother-Friendly Worksite Program directly.

Key Steps for Implementation

State-level planning and implementation. Note that these steps are written linearly, but may occur in a parallel or iterative process.

  • Round up partners. Multiple partners, within and external to DSHS, were involved in supporting the formulation and implementation of the MFWPI. In particular, extensive partnerships were fostered around breastfeeding support activities in general and worksite lactation support in particular. Throughout the initiative, internal marketing communication efforts were heavily employed to keep current partners engaged and to expand the circle of partners aware of and buying into the initiative.
  • Conduct assessment. Gather information about what is currently known about the baseline condition of worksite lactation support in your state. This could include labor analysis, literature reviews about worksite barriers, and stakeholder surveys.
  • Develop strategy. Strategy development includes establishing strategies to administer and sustain the initiative as well as strategies for development of the initiative's framework. As part of strategy development, the project team should define the problem; set project goals, objectives and indicators; and define strategic target audiences. See Resources tab for ideas.
  • Monitor and Evaluate. Regular, ongoing process monitoring, gathering of lessons learned, and communication with partners are critical. Make sure to use these results to adjust the program.
  • Worksite-level planning implementation. Minimum requirements for worksites are less intensive (and some steps may be omitted or delayed), but worksites wishing to develop comprehensive programs should follow these steps. Please see resource tab for steps.
  • Generate buy-in within worksites. Support from all levels of the worksite is important. Identification of senior management champion(s) is particularly important to help overcome barriers and communicate support to staff.
  • Create a planning committee. To integrate diverse perspectives, increase buy-in, and ensure logistics are covered. Make sure to include decision makers and all essential parties.
  • Complete a baseline assessment. To understand how the organization currently supports (or doesn't) worksite lactation.
  • Assess current policies, environments, supports, needs, constraints and employee demographics to help determine the most appropriate type of program for the specific worksite.
  • Develop a policy and apply for designation. The policy should clearly state roles and responsibilities of employers and employees. Once the policy is finalized, apply for the Mother-Friendly Designation!
  • Plan for implementation. Outline options for your Mother-Friendly Worksite employee program in a written operating plan. This operating plan is your road map for action. Implement the program/plan. Don't forget part of this step is to communicate about your program. Don't forget to document lessons learned.
  • Evaluate your program.The Texas Mother-Friendly website provides evaluation planning tools so that sites can consider how to gather feedback.

*For more detailed guidance on implementing,please visit CenterTRT Website.*


Key internal partners may include:

  • State office and regional staff in program areas such as maternal and child health, WIC, obesity prevention, chronic disease prevention and wellness.
  • State agency wellness program
  • Regional and local health services

Key external partners may include: 

  • State and local breastfeeding coalitions,
  • Association of Local WIC Directors,
  • State worksite wellness advisory board,
  • State stroke and heart health program, and
  • Local chronic disease prevention coalitions.

Required Staffing (FTEs)

Number of FTE would vary by how much effort the community partnership would need to spend on raising awareness about Quitline services.

Return on Investment Details

The economic evidence indicates that quitline services are cost-effective across a range of different treatments and promotional approaches. Based on a 13-study economic review: Cost-effectiveness of providing quitline counseling and cessation information: median estimate of $2,012 per quality-adjusted life year (QALY) saved (range of values: $439/QALY to $2,627/QALY; 6 studies) Cost-effectiveness of adding cessation medications to existing quitline services: median estimate $795 per QALY saved (range of values: $272/QALY to $4,110/QALY; 6 studies) Cost-effectiveness of providing a combination of quitline counseling, nicotine replacement therapy (NRT), and media promotion: $7,813 per QALY saved (1 study).

Outcome Measures

Possible outcome measures include, please see Logic Model for more possibilities:

  • Increase in number of worksites designated
  • Increase in breast milk expression rooms in worksites
  • Increase in milk storage facilities in worksites
  • Increased positive communication within worksite regarding breastfeeding
  • Increase in number of work sites designated
  • Increase in breast milk expression rooms in worksites
  • Increase in milk storage facilities in worksites
  • Increased positive communication within worksite regarding breastfeeding

Process Measures

Possible process measures include, please see Logic Model for more possibilities:

  • Number of media impressions
  • Number of website hits
  • Awareness of Designation program
  • Number and representativeness of staff/women reached
  • Number and representativeness of worksites Designated, by sector
  • Number and type of resources developed and distributed
  • Number of technical assistance queries answered
  • Number and type of spaces designated for breast milk expression

 Related Topics

Card image
Parents and Families