Advancing Public Health and Equity: Breastfeeding Accommodations for Professional Credentialing Examinations

Both the World Health Organization and the American Academy of Pediatrics recommend that infants be exclusively breastfed for the first 6 months of life with continued breastfeeding with the introduction of appropriate complementary foods up to 1 or 2 years of age or beyond.¹

Breastfeeding offers a wealth of health benefits for both infants and mothers. Infants who are breastfed have a lower risk of asthma, obesity, Type 1 diabetes, gastrointestinal infections and sudden infant death syndrome (SIDS), among other conditions.² Mothers who have breastfed their infants have a lower risk of Type 2 diabetes, high blood pressure and some forms of breast and ovarian cancers.³

Clearly, breastfeeding provides significant public health benefits.

Breastfeeding, and its accommodations, are also an issue of equity and inclusion. According to an April 2021 report from the U.S. Bureau of Labor Statistics (BLS), as of 2019, women accounted for a majority, or 51.8%, of all workers employed in management, professional and related occupations.⁴

Women also constituted a decided majority within occupations in which a professional credential is mandatory or preferred, such as registered nurses (88.9%), elementary and middle school teachers (80.5%), and accountants and auditors (61.7%). As of 2021, in professional occupations historically dominated by men, such as lawyers (36.4%), chief executives (27.6%) or software developers (18.7%), women constituted significant percentages of those professions.⁵

As of 2021, even within medicine, a profession historically strongly dominated by men, and a significant sector within professional credentialing, women represented 49.1% of Diplomates of the American Board of Medical Specialties (ABMS) in the cohort under 35 years of age.⁶

These data make clear that appropriate lactation accommodations during professional credentialing examinations are imperative from the public health, equity and inclusion, and business perspectives.

What are some best practices for the accommodation of certification candidates who are breastfeeding or pumping? How can your organization structure its certification program to optimize the testing experience for this important, and likely growing, segment of its candidate population?

There are a number of key considerations you will wish to take into account as you structure your certification program and examination for breastfeeding candidates:

• Do Your Research: Analyze your candidate population, volumes and anticipated needs with respect to lactation accommodations. To establish a benchmark, or when launching a new program, disseminate a survey on candidate lactation preferences or expectations.
• Design Your Examination: Consider how best to structure your examination to accommodate breastfeeding/lactation breaks while maintaining examination security and integrity. One strategy for lengthier exams is to publish a multi-part examination in which candidates cannot return to a completed portion of the examination. Allow adequate time for the breastfeeding break; 30-minutes is a good rule of thumb.
• Plan On-Site Logistics: Some candidates will breastfeed their child while some may use a breast pump or express milk. Your procedures should contemplate how you will facilitate the delivery/return of the child from the caregiver to the testing candidate and back, or how the testing candidate can access and use a pump and safely store breast milk. 
• Ask Lactation-Specific Questions of Your Potential Testing Vendors: Here are just a few:
  • Are there lactation rooms? (A bathroom is not a lactation room!)
  • Are these dedicated lactation rooms or are they also used as private testing rooms? If the rooms are dual-purposed, how will breastfeeding candidates be accommodated?
  • Are these rooms in all testing locations? If not, what is the maximum distance of travel for candidates?
  • If there are not dedicated lactation rooms in each testing location, are lactation pods or privacy screens made available?
  • Are these pods or screens maintained at each center or shipped to the center prior to the scheduled examination?
  • Are there working electrical outlets for breast pumps in lactation rooms or breastfeeding areas?
  • What will the child’s caregiver need to gain access to the testing center?
  • How are testing appointments with breastfeeding accommodations scheduled and by whom? Program or vendor staff or the candidate? Via an online portal or toll-free number? Is there support in languages other than English?
  • What training is provided to staff regarding breastfeeding/lactation accommodations, and at what intervals?
  • Can you publish the examination with lactation breaks coded for designated candidates?
  • Can you meet our program’s lactation logistical requirements?
• Memorialize in Key Vendor Documents: Include key points regarding lactation breaks and arrangements, including examination publication, in your vendor agreements, scopes of work and client reference documents.
• Create Policies and Procedures: Ensure you have clear policies and procedures to accommodate breastfeeding, pumping and expression. Carefully consider all relevant accreditation standards, such as those pertaining to examination security and administration as you craft policies and procedures related to lactation accommodations.
• Communicate Early, Clearly and Comprehensively: Include information about  policies and procedures related to lactation accommodations in your candidate handbook for both examination centers and live remote proctoring (if that is an option). At the time of initial application, ask whether lactation accommodations are sought and what kind (breastfeeding, pumping, expression). To avoid potential issues, make breastfeeding candidates a priority in application review and examination seating.