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MANAGING BEST PRACTICES: Uncertainty over an emerging risk

July 1, 2004
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The December 2002 issue of Pediatrics reports that breastfeeding among full-time employed U.S. women is now 25 percent, nearly double its rate from 1996, and the highest rate ever recorded. Breastfeeding is no longer considered a lifestyle choice, but an important health choice for both mother and infant.

That’s because breast-milk is superior to baby formula because it includes the mother’s disease-fighting antibodies along with great nutrition. And there’s benefit for the mother, too. Women who breastfeed have a 50 percent less chance of developing breast cancer, according to new research – though more studies are needed to determine why.

So employers can expect continued growth in breastfeeding among working women. Mothers may pump and store their breast-milk at work and provide it to their infants at another time.

But along with the rise in breastfeeding comes concern over chemicals in breast-milk. The U.S. Food and Drug Administration recognizes and advises which pharmaceuticals should not be used while breastfeeding, such as aspirin. Meanwhile, little research and guidance exists regarding workplace chemicals in breast-milk.

Recent developments

That’s bound to change. Biomonitoring (measuring chemicals in human tissues and fluids) is a rapidly evolving technology, and breast-milk is a popular body fluid to monitor because it is the least invasive and best means to sample for chemicals stored in body fat. Consider these developments:

  • Two U.S. studies of breast-milk conducted in 2003 found levels of polybrominated diphenyl ethers (PBDEs), used as flame-retardants in products such as electronics, at 10 to 20 times higher than those in Europe. The European Union banned PBDEs in 2004 due to concerns that these chemicals might cause developmental problems in breastfed children.

  • This year, California is expected to become the first state to pass legislation requiring the monitoring of chemicals in breast-milk to determine a possible linkage between chemical exposures and health effects. Germany and Sweden already have such a law.

  • Media reports on chemicals in breast-milk are growing. In January 2004, The Wall Street Journal published an article, “Toxins in Breast-Milk: Studies Explore Impact of Chemicals on Our Bodies.” Soon after, the American Chemistry Council posted online an issue brief on “Human Milk and Biomonitoring.”

  • A Google search for “toxic chemicals breast milk” yielded 21,000 hits in December 2002. By March 2004 the same search turned up more than 63,000 hits. Awareness of chemicals in breast-milk is clearly on the rise, and you can expect your employees to be asking more pointed questions.

  • When toxic chemicals are found in breast-milk, criminal penalties can come into play. A woman in California was sentenced to life in prison in 2003 when methamphetamines in her breast-milk were found to be the cause of death for her three-month old son.

    Knowledge gaps

    But despite growing awareness and potential liabilities, how much do U.S. employers know about the topic of breastfeeding? Are they taking a consistent approach to control risks?

    After all, no regulations exist that require U.S. employers to assess risks for workers who are breastfeeding. Employers in Europe, though, are required to assess and control this risk following guidelines established by Council Directive 92/85/EEC.

    I was able to get a snapshot of current attitudes among safety and health professionals by conducting a survey of industrial hygienists attending a course on “Implementing Reproductive and Developmental Health Programs” at the 2004 American Industrial Hygiene Conference. Bottom line: There’s a lot of uncertainty about how to best protect breastfeeding employees and their infants:

    Will breast-milk be safe for infant consumption if an employer is in full compliance with OSHA chemical exposure standards? In my workshop, zero IH’s answered “yes,” 12 said “no,” and 30 said “don’t know.”

    Do supplier material safety data sheets provide enough information to determine if a chemical may concentrate in breast-milk? “No,” answered all 42 IH’s.

    Has the American Conference of Governmental Industrial Hygienists recommended any Biological Exposure Indices for workplace chemicals in breast-milk? One IH said “yes,” 22 said “no,” and 19 didn’t know.

    Has the FDA set safe limits of industrial/environmental chemicals in breast-milk? Zero IH’s said “yes,” 22 said “no,” and 20 didn’t know.

    Opinion was divided over this question: Does an employer have a legal obligation to protect an employee’s breast-milk from contamination caused by exposure to workplace chemicals? Twelve IH’s said “yes,” ten said “no,” and 20 didn’t know.

    Opinion was also divided over this question: Should an employer abide by all recommendations from an employee’s pediatrician regarding the safeguarding of breast-milk from contamination at work? “Yes,” answered 15 IH’s. “No,” said 10. And 17 answered “don’t know.”

    Emerging consensus

    Here is where professionals were pretty much of one mind regarding potential risks of women breastfeeding while possibly exposed to toxic chemicals on the job:

    Employers do have a moral obligation to protect an employee’s breast-milk from contamination caused by exposure to workplace chemicals, according to 34 of the 42 IH’s surveyed.

    Employees who breastfeed have a right to know if workplace chemicals might be in their breast-milk, said 34 of the 42 IH’s polled.

    It is in the employer’s best interest to address health concerns arising from information that an employee finds online, said 39 of the 42 IH’s.

    An infant is not biologically equivalent to a small adult, agreed 41 of the IH’s.

    The concentration of chemicals in breast-milk can be higher than found in the mother’s blood plasma, said 26 of the IH’s surveyed. Sixteen said they didn’t know.

    Infant health problems alleged to result from breast-milk contaminated with workplace chemicals will not be handled through the employer’s workers’ compensation program, 41 of 42 IH’s agreed.

    If an employee is not satisfied with an employer’s position on protecting breast-milk, she should have more options available to her than simply quitting work, said 35 IH’s.

    And finally, 26 of the IH’s believe that research within the next two years will discover infant health problems that result from breast-milk contaminated by a common industrial chemical. Not one IH would deny the possibility.

    Policies in the making?

    So there you have it. In my very much unscientific sampling of professionals from major corporations, small businesses, universities, and other organizations, most believe breastfeeding risks are an issue that will only become more problematic for employers in time. They see the stakes as being high, with liabilities and settlements falling outside the workers’ comp shield for employers. And you can see professionals laying the groundwork for policy positions: Breastfeeding employees have a right to know about risks, there is a moral if not legal obligation to address their concerns, and OSHA chemical exposure standards and MSDSs are inadequate for conducting risk assessments.

    It’s also clear that professionals have knowledge gaps when it comes to assessing the risks of toxic chemicals in breast-milk. We all need to ramp up our knowledge of breastfeeding employees and the risks they might encounter on the job.

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