National Survey of Convention Centers’ Lactation Facilities

Well Established

There are limited data available on public facilities accessible for nursing mothers. Current literature searches elicit designated breastfeeding rooms in the workplace and airports, but no other large public spaces have been surveyed and recorded.

Newly Expressed

This study demonstrates the urgent need for lactation accommodations to be permanently integrated into the infrastructure of public facilities such as convention centers. Without appropriate measures available, women will continue to be challenged to fulfill long-term breastfeeding recommendations.

Background

The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of life, with continued breastfeeding for 1 year or longer. ¹ However, breastfeeding in public and return to work are well-documented reported barriers to continued breastfeeding. As many mothers return to work after maternity leave, clean, private areas are needed in order for women to continue to breastfeed or pump. Since the 2010 enactment of the Patient Protection and Affordable Care Act (ACA), employers are required to provide reasonable break time and “a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breastmilk.” ² Although some facilities may claim that bathrooms or baby-changing rooms are appropriate areas for mothers to breastfeed, these do not meet ACA standards.

Subsequently, the Surgeon General declared a Call to Action to Support Breastfeeding, expecting employers, child care centers, and health centers to eliminate breastfeeding barriers. ³ Evidence indicates that women returning to full-time employment have increased odds of terminating or reducing the duration of breastfeeding for the infant, often due to workplace-related barriers. ⁴ For Healthy People 2020, in addition to achieving revised Healthy People 2010 infant breastfeeding targets, a new goal to increase the proportion of employers that have worksite lactation support programs was set. ⁵

In our city, in 2014, Mayor Michael Nutter of Philadelphia signed an ordinance requiring city employers to provide “reasonable accommodations” to express human milk (The Philadelphia Code). ⁶ However, there are gaps in policies in supporting breastfeeding women. Mothers who are outside of work and home and are in public areas such as shopping centers, airports, or convention centers are extremely limited regarding lactation facilities. One study showed that only 8 of 37 airports surveyed provided appropriate breastfeeding accommodations, including an electric outlet and chair for women to pump. ⁷

Our city has also sought to improve breastfeeding for mothers visiting Philadelphia. Philadelphia International Airport recently unveiled designation of private rooms for mothers to breastfeed and pump. ⁸ In 2015, Pennsylvania Convention Center installed a permanent lactation unit. ⁹ Previously, it was up to the event planners to provide such accommodations or it was expected that mothers would use the bathroom. When the second author of this article was interviewed about these 2 mechanisms to support breastfeeding mothers, it led to the consideration of this survey.

This study examines if and what breastfeeding accommodations are available at national convention centers across the United States. Currently, there are limited studies on lactation facilities in public spaces, such as restaurants, shopping malls, sporting arenas, and theaters. The lack of designated private areas is a barrier for breastfeeding mothers who travel outside of the home for extended periods of time, whether for work or recreation, and may influence a mother’s ability to reach her personal breastfeeding goals.

Methods

This study was submitted and reviewed by the University of Pennsylvania Institutional Review Board in September 2015. It was determined that this is not human subjects research, based on the study design, and therefore, exempt status was granted.

A list of national convention centers was collected from meetings-conventions.com and recorded in an Excel spreadsheet, with the name of the center, total meeting square feet, number of meeting rooms, address, and telephone number. Each convention center was contacted by phone and administered the survey from October to December 2015 (Figure 1). Questions were asked as to what type of lactation accommodations were available, if any. If there were no designated spaces available, questions were asked if event coordinators made temporary spaces available for specific occasions. Survey responses were recorded in an Excel spreadsheet. Two attempts were made to contact a facility for a response or return of voicemail.

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Figure 1.

National Survey of Convention Centers’ Lactation Facilities Questionnaire.

Sites that identified family bathrooms in addition to medical/EMT rooms were labeled as medical rooms. These were more likely to have chairs and an electric outlet, although it may not have the locked door privacy. Sites that listed more than 1 option, such as family restroom and medical room, were assigned the “better” option that was least like a public restroom.

Results

This phone survey achieved a 78.7% response rate (326 of 414 convention centers answered the survey) (Figure 2). Of the 414 convention centers contacted, there were 74 nonresponses and 14 locations that were permanently closed or no longer convention centers. Convention centers from all 50 states are represented, as well as the District of Columbia. Total meeting area ranged from 3000 to 1 300 000 square feet, with meeting room numbers of up to 197 and total meeting capacity of up to 275 000. There were facilities that were affiliated with universities, state fair expositions, performing arts, hotel resorts, and athletic competitions.

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Figure 2.

Are Convention Centers Accommodating Nursing Mothers?

A mere 5.5% (18 of 326) of the convention centers interviewed offered a designated, private lactation space other than a bathroom with an electric outlet, table, and chair (Figure 3). None of the facilities offered a hospital-grade breast pump for public use. Two of the 18 lactation accommodations were portable Mamava™ booths (http://mamava.com/): the Pennsylvania Convention Center and Austin Convention Center. The other facilities were located in Minneapolis; Los Angeles; Atlanta; San Antonio; Denver; Phoenix; Raleigh (n = 2); Washington, DC; Austin; Waltham, Massachusetts; Arlington; Knoxville; Hattiesburg, Mississippi; Seattle; and Columbus, Ohio (Figure 1).

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Figure 3.

14 Convention Centers with Designated Lactation Rooms.

The responses were categorized as designated lactation room, temporary lactation room, medical/EMT room, family restroom, women’s restroom with adjunct, restroom, or none (Table 1). Almost one-third (n = 103) of the centers provided some sort of temporary location that would be available only by request of the individual or the event organizer, whereas another one-third (n = 109) directed breastfeeding mothers to some sort of restroom or enhanced restroom with private space and/or special adjunct. Thirty-three facilities referred women to the medical/EMT room where there would be chairs and electric outlets but often limited private space. There was no type of accommodation available in 19% (n = 63) of the convention centers.

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Table 1.

Type of Lactation Accommodations at Convention Centers (n = 326).

Type of Lactation Accommodation	No.	%
Mamava booth	2	1
Lactation room	16	5
Family restroom	56	17
Medical/EMT room	33	10
None	63	19
Temporary room	103	32
Restroom	45	14
Women’s restroom with adjunct	8	2
Total	326	100

Qualitative responses were also noted during the phone interviews, and the range of responses demonstrates that this is an issue that needs attention. A few quotes are provided as exemplars:

We could set up a sleeping room for her free of charge if she were here for a meeting. It would be by request with the person that is organizing [the event], and she would have a card key to go in and out. (northeast region of United States)

During the fair, the Breastfeeding Coalition of Lane County come in and man the room in the front. Otherwise different events will arrange if that front room is available or another space. There are public restrooms, also. (northwest region of United States)

No, we don’t. I guess you can go to the car? (southern region of United States)

If she is not comfortable with the restroom, we do have what’s basically a closet—without any windows—where she can go and have some privacy, but it’s not a breastfeeding station or breastfeeding room per se. It’s only been requested once. (southern region of United States)

Discussion

A mere 5.5% of convention centers in the United States are providing accommodations that meet the minimum requirements of a lactation room: clean, private, with a chair and electric outlet, and not a restroom. Although many respondents indicated that they would attempt to accommodate persons if they needed a separate facility from what is available, many reported that they did not see requests or consider this an issue that they needed to address. The lack of attention to lactation accommodations in convention centers is concerning, as breastfeeding mothers who are attending work-related meetings or conferences at the convention centers should be entitled to a clean, private space as recommended by the ACA. To meet national and international recommendations that women exclusively breastfeed for 6 months, access to dedicated spaces must be made available.

Event spaces such as convention centers may overlook workplace requirements such as lactation rooms, since it is a temporary space where people may attend a session for only a day or several days. However, they can have thousands of attendees at any event, with a high likelihood of a breastfeeding or pumping woman. Thus, it is all the more essential that, like an airport, with a tremendous number of visitors yearly, convention centers integrate designated lactation rooms into their building setup. Even if a new room cannot be constructed or redesigned, the centers can be more proactive about setting up a permanent room that is well advertised for breastfeeding women.

Furthermore, other spaces where women may spend extended periods of time, whether for work or leisure, must address the needs of women who may desire a private space to breastfeed or pump. Such areas include, but are not limited to, shopping malls, sporting venues, museums, and theaters. The poor results from this list of convention centers make clear that places where women may frequent and pass through, but not be a permanent employee of, are overlooking breastfeeding rights of nursing women and impeding public health initiatives.

Conclusion

Not only do lactation accommodations need to be made available, but staff needs to be educated in order for them to inform and direct persons to use the facilities. Only 5.5% of convention centers in the United States provide designated lactation rooms and only 32% make temporary accommodations. This survey provides a call to action to convention centers and policy makers to ensure that all breastfeeding mothers attending events at convention centers have the appropriate accommodations.