Texas Mother-Friendly Worksite Program

Texas Department of State Health Services


The Texas Mother-Friendly Worksite Program (TX MFWP) is a PSE Change, employer recognition program that designates worksites as “Mother-Friendly” if they voluntarily develop and submit to Department of State Health Services (DSHS) a written policy that supports employees’ efforts to combine continued breastfeeding with employment. At a minimum, the policy must ensure:

  • Flexible work scheduling to allow time for breast milk expression,
  • Access to private locations for breast milk expression,
  • Access to a clean, safe water source to wash hands and clean pumping equipment, and
  • Access to hygienic options for workplace storage of expressed breast milk.

This intervention functions at two levels: at the state-level and at the worksite level. DSHS provides resources and support to worksites wanting to be designated and the worksites must implement their individual plans for achieving and sustaining designation.

NOTE: Activities must be in approved worksites where more than half of employees are low-wage workers.

Target Behavior: Breastfeeding

Intervention Type: PSE Change

Intervention Reach and Adoption

The Texas MFWP has the potential for broad reach to employees across Texas. Collectively, the 30 employers that participated in the Mother-Friendly Employer Technical Assistance Pilot Project represented hundreds of worksites across the state employing over 118,500 employees. The MFWP outside of the technical assistance pilot is reaching hundreds of thousands of employees. Since implementation of the marketing campaign, the number of adopting worksites has increased from 233 in 2010 to 1,120 in 2012. Since 2012 the number has continued to rise. Participating worksites are scattered throughout Texas, with most of them in the more populated regions.

Setting: Worksite

Target Audience:  Pregnant/Breastfeeding Women, Parents/Mothers/Fathers, Adults

Race/Ethnicity: All

Intervention Components

The TX MFWP includes the following components:

State-level: Statewide coordinating agency

  • Completes formative assessment process to define and understand key audiences and effective strategies/messaging to motivate behavior change,
  • Works with partners and stakeholders to align and integrate the program into existing infrastructures,
  • Develops and formalizes criteria, guidelines, processes, and branding for worksite recognition (designation) program,
  • Adapts or develops then tests, refines and disseminates resources to support worksite-level implementation,
  • Spearheads a targeted statewide media/communications campaign to increase community and employer awareness of and interest in the initiative,
  • Cultivates strategic local-level partnerships to extend integration, dissemination and reach of the program, and
  • Develops program monitoring and statewide surveillance to provide ongoing assessment of program.

Worksite-level: Worksites and worksite committees

  • Apply for designation by submitting qualifying written and communicated policy (Develop policy using model policy guidance from statewide coordinating agency)
  • Implement the policy in the worksite.
  • For an effective and sustainable worksite lactation support program:
  • Generate employee buy-in for the program by using resources from the statewide coordinating agency.
  • Create a diverse committee to plan and implement program development and implementation steps.
  • Complete baseline assessment to understand employees’ needs using resources from statewide coordinating agency.
  • Plan for worksite lactation support program implementation and evaluation by using resources from the statewide coordinating agency.
  • Implement the program/plan using implementation tools from the statewide coordinating agency.

Intervention Materials

Tools available to help in implementation can be found on the Center TRT website in PDF format.

  • Texas Mother-Friendly Worksite Implementation materials, including formative assessment findings, sample marketing materials, and the evaluation report can be found in the Public Health Partners section of the Texas MFWP website: http://www.texasmotherfriendly.org/public-health-partners
  • Texas Mother-Friendly Worksite Program Welcome Packs: These include items such as a designation certificate and window cling decal, web and publication-ready logo files, and comprehensive communications toolkit.
  • The Texas Mother-Friendly Worksite Employer Build Your Program Toolkit includes materials that were developed, tested and refined to assist employers in implementing comprehensive, sustainable worksite lactation support programs. Includes resources such as Get People on Board, Communication Tools, Additional Resources, and FAQ sections: http://www.texasmotherfriendly.org/program/getting-started
  • The Texas Mother-Friendly Worksite Employer Toolkit was developed to assist in recruiting and equipping local community partners to spread awareness, interest and support for worksite lactation support programs and for the Texas Mother-Friendly Worksite Program: http://www.texasmotherfriendly.org/outreach-partner-toolkit
  • Texas Mother-Friendly Worksite Program Community Page highlights employer success stories developed during through the initiative: http://www.texasmotherfriendly.org/community#all/
  • Breastmilk: Every Ounce Counts Website, a working mother’s one-stop breastfeeding resource: http://www.breastmilkcounts.com/ad-campaign/

Intervention Costs

Materials available at no cost

Evidence Summary

The state is tracking worksites that submit and receive designation and has added questions related to breastfeeding to statewide surveillance systems. From 2010 to 2012, the number of adopting worksites increased from 233 to 1,120. Data on awareness, attitudes, and practices related to women breastfeeding at work is being collected through questions added to the BRFSS and the biennial Texas WIC IFPS. Data on the impact of the policy in those areas is not yet available.

Evaluation of the pilot included review of the 30 employer policies, operating plans (submitted by 55% of the pilot worksites), and progress reports and in-person or phone interviews with 108 individuals representing all 30 employers. A number of employers also submitted photographs to document their breastfeeding support activities. Findings from outcome evaluation include:

  • 100% of employers adopted formal mother-friendly policies.
  • 100% of employers had functional lactation rooms and/or plans for flexible provision of lactation space for all of their worksites.
  • 73% of employers explicitly addressed provision of education and support in their Mother-Friendly policies.
  • 100% of employers had work plans and activities for enhanced education and support.

Although some of these data are self-reported, reports were verified through site visits to most locations and many worksites provided photographs of the new lactation space.

Classification: Practice-tested

Evaluation Indicators

Based on the SNAP-Ed Evaluation Framework, the following outcome indicators can be used to evaluate intervention progress and success.

Readiness and Capacity – Short Term (ST) Changes – Medium Term (MT) Effectiveness and Maintenance – Long Term (LT) Population Results (R)
Environmental Settings ST5, ST6 MT5 LT5
Sectors of Influence MT7

Evaluation Materials

Center TRT developed an evaluation logic model and evaluation plan for the Texas MFWP, a designation program for worksites that have 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). The logic model is intended to guide the evaluation process (as opposed to the planning process); the evaluation plan focuses on the implementation and effectiveness of an approach like the MFWP in changing practices and policies to support breastfeeding women and families. The evaluation addresses the reach, adoption, extent of implementation and effectiveness of the MFWP. The evaluation is a pre-post design with no comparison group. This evaluation plan provides guidance on evaluation questions and types and sources of data for both process and outcome evaluation. Several tools created by Texas MFWP staff are available for your use in evaluation efforts. These tools have been incorporated into the evaluation plan that Center TRT developed.

Additional Information

Website: The TX MFWP website (http://texasmotherfriendly.org/) includes information on the program, why the program matters, how to start the program, and other resources.

Contact Person(s):
Julie Stagg
State Breastfeeding Coordinator
State Women’s and Perinatal Health Coordinator and Nurse Consultant
Texas Department of State Health Services
PO Box 149347, MC 1922
Austin, Texas 78714-9347
Email: Julie.Stagg@dshs.state.tx.us
Phone: 512 656 6809