The Texas Mother-Friendly Worksite program (TMFW) is a Policy Systems and Environmental (PSE) Change, employer recognition program that designates worksites as "Texas Mother-Friendly" if they voluntarily develop and submit to the 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, non-bathroom location 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.
Intervention Target Behavior: Pregnant/Breastfeeding
SNAP-Ed Strategies: PSE Change
The TMFW program has the potential for broad reach to employees across Texas. During the Texas Mother-Friendly Employer Technical Assistance Pilot Project in 2010-2012, the 30 employers that participated represented hundreds of worksites across the state employing over 118,500 employees. The TMFW program outside of the technical assistance pilot is reaching hundreds of thousands of employees. Participating worksites are scattered throughout Texas, with most of them in the more populated regions and represent various workplace sectors. There are currently over 3,500 designated Texas worksites. You can find the current total of TMFW designated worksites can be found on the program website here: https://www.dshs.texas.gov/maternal-child-health/programs-activities-maternal-child-health/texas-mother-friendly-worksite/directory
Settings: Worksites
Age/Population Group: Pregnant/Breastfeeding, Parents/Caregivers, Adults
Race: All
Ethnicity: All
The TMFW program 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,
- Maintains a directory of designated worksites throughout the state,
- 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.
Tools available to help in implementation can be found on the Texas Mother-Friendly Worksite Program website at the respective links below or by reaching out to program staff at TexasMotherFriendlyWorksite@dshs.texas.gov
- The Texas Mother-Friendly Worksite Employer Resources including 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 here: https://www.dshs.texas.gov/maternal-child-health/programs-activities-maternal-child-health/texas-mother-friendly-worksite/employers
- The Texas Mother-Friendly Worksite Outreach Partner Tools assist community partners to spread awareness, interest and support the TFMW program located here: https://www.dshs.texas.gov/maternal-child-health/programs-activities-maternal-child-health/texas-mother-friendly-worksite/outreach-partners
Additional information support provided by partners at the Texas Health and Human Services Commission Texas WIC program website:
Breastmilk: Every Ounce Counts, a working mother's one-stop breastfeeding resource: https://www.breastmilkcounts.com/
Evaluation of the 2010-2012 pilot included review of 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.
The state continues to track worksites that submit and receive designation and has added questions related to breastfeeding to statewide surveillance systems. During the pilot 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 has been collected through questions added to the Texas Behavioral Risk Factor Surveillance System (BRFSS) and the DSHS-led Texas WIC Infant Feeding Practices Survey, last conducted in 2018: https://www.hhs.texas.gov/providers/wic-providers/wic-breastfeeding.
Evidence Base: Practice-tested
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) | |
| Individual | ||||
| Environmental Settings | ST5, ST6 | MT5 | LT5 | |
| Sectors of Influence | MT7 |
Center TRT developed an evaluation logic model (Please contact the original developer for access to this resource. For additional questions, please contact snap-edconnection@usda.gov) and evaluation plan (Please contact the original developer for access to this resource. For additional questions, please contact snap-edconnection@usda.gov) for the TMFW program. 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 TMFW program in changing practices and policies to support breastfeeding women and families. The evaluation addresses the reach, adoption, extent of implementation and effectiveness of the TMFW program. 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 TMFW program staff are available for your use in evaluation efforts. These tools have been incorporated into the evaluation plan that Center TRT developed.
Website: The TMFW program website (https://dshs.texas.gov/TexasMotherFriendly/) includes information on the program, why the program matters, how to start the program, and other resources.
Contact Person(s):
Texas Mother-Friendly Worksite Program Coordinator
Maternal and Child Health Unit Texas Department of State Health Services
PO Box 149347, MC 1922 Austin, Texas 78714-9347
Email: TexasMotherFriendlyWorksite@dshs.texas.gov
Phone: 512-834-4542
*Updated as of November 2, 2023