Quyết định 5175/QĐ-BYT năm 2021 phê duyệt tài liệu “Hướng dẫn triển khai phòng vắt, trữ sữa mẹ tại nơi làm việc” do Bộ trưởng Bộ Y tế ban hành

DECISION

ON APPROVAL FOR THE GUIDE FOR LACTATION ROOMS IN THE WORKPLACE

MINISTER OF HEALTH

Pursuant to the Government’s Decree No. 75/2017/ND-CP dated June 20, 2017 defining the functions, tasks, powers and organizational structure of the Ministry of Health;

Pursuant to Government’s Decree No. 145/2020/ND-CP dated December 14, 2020 on elaboration of and guidelines for implementation of the labor code on working conditions and labor relations;

At the request of the Director of the Department of Pediatric and Maternal Health affiliated to Ministry of Health,

HEREBY DECIDES:

Article 1. Approval for the Guide for lactation rooms in the workplace hereto appended.

Article 2. The Guide for lactation rooms in the workplace prevails as a basis for employers that hire female employees to implement.

Article 3. This Decision enters into force upon signing and promulgation.

Article 4. Chief of Ministry Office, Director of Pediatric And Maternal Health, Director of Medical Examination and Treatment Management; heads of relevant affiliates of Ministry of Health; Directors of Health Departments of provinces or central-affiliated cities; heads of relevant entities shall implement this Decision./.

GUIDE

FOR SETTING UP AND OPERATING LACTATION ROOMS IN THE WORKPLACE
(Issued together with Decision No. 5175/QD-BYT dated November 9, 2021)

TABLE OF CONTENTS

I. Bases for the Guide

II. Guidelines for setting up and operating a dedicated room for expressing and storing breastmilk in the workplace (hereinafter referred to as lactation room)

1. Location of lactation room

2. Quantity of lactation room

3. Criteria for a lactation room

4. Communications and training in setting up and operating lactation room

5. Management of lactation room

6. Schedule for using lactation room and substitutes for female employees who take short breaks for expressing and storing breastmilk

7. Oversight, evaluation and collection of employees’ feedback

Appendix 1. List of communications materials

Appendix 2. Instructions for expressing, storing, and preserving breastmilk

Appendix 3. Daily hygiene checklist

Appendix 4. Registration form to use the lactation room

Appendix 5. Regulations in lactation room

Appendix 6. Survey on the use of lactation room

Appendix 7. Quarterly report on operation of lactation room

I. Bases for the Guide

Today, an increasing number of women have joined the workforce. In Vietnam, female employees make up nearly half (48 per cent) of the country's labor force. The rate of women participating in the labor force in Vietnam is high - about 72 per cent, significantly higher than that in East Asia - Pacific region (61 per cent) and the world (50 per cent). Women need support when they have to perform both work and childcare roles at the same time. Especially, during pregnancy and raising children under two years old, female employees need practical support policies and measures from the state, health facilities, workplaces, families, and communities to take care of their maternity health and enable them to carry on breastfeeding, ensuring the best source of nutrition for children.

The revised Labor Code in 2012 stipulates that female employees are entitled to 6 months of maternity leave to help mothers have better conditions to exclusively breastfeed their babies for the first 6 months and take better care of their babies. The good implementation of policies and interventions to support and encourage breastfeeding has contributed to significantly improving the rate of exclusive breastfeeding in the first 6 months (increasing from 19 per cent in 2010 to 45 per cent in 2020). However, the percentage of mothers who continue to breastfeed their children until the age of two is still low, at only 26 per cent (in 2020). One of the reasons is that female employees have not been supported at work to maintain breastfeeding when returning to work after maternity leave. These supports include the employer's facilitation, the trade union's support in setting up the lactation room and arranging time for female employees to express and store milk at work.

One of the effective investments of the enterprise to ensure the family life of employees is to support female employees to carry on breastfeeding through setting up a lactation room in the workplace. Breastfed babies have the best nutrition, reducing the risk of disease for the mother and child. Families can also save about 12 per cent of their income when they do not have to buy infant formula and greatly reduce medical costs. Paying attention to improving working conditions and taking care of women's health, especially setting up a lactation room in the workplace, help female employees focus and increase work efficiency, create a stable workforce for businesses.

The Government’s Decree No. 145/2020/ND-CP dated December 14, 2020 on elaboration of and guidelines for implementation of the labor code on working conditions and labor relations, Article 80 Clause 5 stipulates that "Employers are encouraged to set up lactation rooms suitable with actual conditions in the workplace, the needs of female employees and the capabilities of the employers. In case the employer hires 1,000 female employees or more, it is mandatory to set up lactation rooms in the workplace"; Clause 6 stipulates that "Employers are encouraged to enable female employees who are raising children aged 12 months or older to express and store breastmilk in the workplace. Breaks for expressing and storing breastmilk shall be negotiated by the employee and the employer".

Article 76 stipulates that “The lactation room is a private area that is not a bathroom or toilet cubicle; it should have a power and water source, table, chair, fridge that is secure and clean, electric fan or air conditioner. The room must be conveniently located and will not be overlooked by the public and other employees so that female employees can breastfeed or express and store their breastmilk”.

Based on Article 87, Clause 4, (c) of the Decree, the Ministry of Health shall provide guidelines for initiation of a dedicated room for expressing and storing breastmilk in the workplace.

II. Guidelines for setting up and operating lactation room in the workplace

1. Location of lactation room

Ensure that the lactation room is no more than 10 minutes walk from the workplace of the majority of female employees. It is necessary to consult breastfeeding female employees and trade union officials to choose a suitable position. All female employees should be informed of the location of the lactation room.

It is probable to renovate one of the following areas to set up a lactation room:

- A part of the infirmary

- An unoccupied space of the office

- A well-ventilated part of a warehouse after the renovation

- Repair a space that is currently not being used effectively

- Separate a corner of an existing room with a masonry wall or a movable partition

2. Quantity of lactation rooms

Table 1. Quantity of lactation rooms by number of female employees1

 (*) Employers are recommended to set up lactation rooms in accordance with the actual conditions in the workplace, the needs of female employees and the employer's capabilities.

 (**) Lactation rooms are mandatory.

3. Criteria for a lactation room

Criteria for a lactation room are divided into two categories: basic and full. Based on the company’s resources and actual circumstances, the employer that hires female employees shall set up lactation rooms at appropriate levels.

Table 2. Criteria for a lactation room

4. Communications and training in setting up and operating lactation room

Based on the actual circumstances, the employer assigned the task of setting up the lactation room shall build awareness and provide training for female employees in the establishment and operation of the lactation room.

a) Communications for female employees

- Objectives: Facilitate communications at work to highlight the importance of breastfeeding, instruct on how to express and store breastmilk, and further inform female employees of their labor rights and benefits so that they know and use the lactation room in an effective manner.

- Persons in charge: Employers coordinate with the trade union, health authorities and related organizations to carry out communication programs to raise awareness about breastfeeding in the workplace.

- Contents: Benefits of breastfeeding; how to express, store and preserve breastmilk effectively, how to maintain and increase breastmilk supply; location of the lactation room(s); how to clean breast pump and storage equipment.

- Eligible entities: Female employees who are pregnant and raising children under 24 months old.

- List of communications materials (Appendix 1); instructions for expressing, storing and preserving breastmilk (Appendix 2).

b) Training in initiation of the lactation room

- Objectives: Raise awareness of employees' rights and interests in breastfeeding, operation of the lactation rooms at work.

- Persons in charge: Employers in coordination with the trade union, health authorities and related organizations

- Contents: Policies for female employees, operation of the lactation rooms at work.

- Trainers: HR staff, infirmary staff, trade union and relevant staff.

5. Management of operation of lactation room

- The employer that sets up and operates the lactation room shall assign the staff in charge and assign responsibilities for managing the operation of the lactation room.

- Management duties include:

+ Make occupancy and cleaning schedule of the lactation room for users.

+ Instruct and manage the use, preservation, inspection and proposed replacement of equipment in the lactation room.

+ Instruct users to clean the breast pump equipment after each use.

+ Inspect and supervise the use and general hygiene of the lactation room (Appendix 3. Daily hygiene checklist).

+ Save and replace the hygiene checklist after each inspection.

+ Monthly report (Appendix 7).

6. Schedule for using lactation room and substitutes for female employees who take short breaks for expressing and storing breastmilk

- Arrangements should be made for female employees to take alternate breaks to express milk.

- Based on specific conditions, the employer shall make arrangements in a manner that it does not affect the production; suitable for the capacity of the lactation room, avoiding overload; suitable to the biological needs of female employees in lactation (Appendix 4. Registration form for using the lactation room.

7. Oversight, evaluation and collection of employees’ feedback

- The relevant departments of the employer shall periodically and irregularly monitor the usage and feedback of the users on the reasonableness of the frequency of use, availability and usage conditions of the equipment (Appendix 6. Survey on the use of lactation room).

- Propose to the employer’s management solutions to remove difficulties and inadequacies in the process of using, if any.

Appendix 1. List of communications materials

1. Movie about the importance of breastfeeding and the harmful effects of infant formula

• The importance of breastmilk:

+ Breastmilk is a priceless gift: https://tinyurl.com/suamemonquavogia

+ The importance of the lactation room at work: https://tinyurl.com/Phongvattrusuame

+ Why should stop marketing infant formula rampantly: https://tinyurl.com/Ngungquangcaosuacongthuc

• Report on the benefits of breastfeeding support programs in the workplace:

+ https://tinyurl.com/DaitruyenhinhHanoi

+ https://tinyurl.com/PhongsuVTV3

• Educational videos

+ Instructions on how to breastfeed correctly: https://tinyurl.com/Chotrebudung

+ How to express milk by hand: https://tinyurl.com/vatsuabangtay

2. Large posters about breastfeeding and the harmful effects of infant formula

• Set of three posters about breastfeeding:

https://tinyurl.com/ncbangsuame: The more your baby feeds, the more breast milk you will produce. https://tinyurl.com/ncbangsuame2: Breastmilk has all the nutrients a baby needs for the first 6 months of life.

https://tinyurl.com/ncbangsuame3: Babies do not need extra water because breastmilk has enough nutrients

• Poster Breastmilk has full nutrition: https://o91.short.gy/Suamedayduduongchat

• Set of three posters about complementary food when babies are 6 months old:

Early nutrition is the most importance: https://tinyurl.com/DDdaudoi

6 months old, baby is ready to eat solid food: https://tinyurl.com/6tandam

Children need to eat food rich in iron: https://tinyurl.com/thucangiausat

• A handbook on nutrition and health for children, and maintaining breastfeeding combined with appropriate complementary feeding when the child is over 6 months old (for reference in the soft copy):

Nutrition and health handbook: https://tinyurl.com/sotaydinhduong

Supplemental weaning handbook: https://tinyurl.com/sotayandam

Posters about the harmful effects of using formula, bottles and pacifiers for babies:

Poster of harmful effects of feeding bottles and pacifiers: https://tinyurl.com/tachaibinhbu

Poster of harmful effects of infant formula: https://tinyurl.com/tachaiSCT

Appendix 2. Instructions for expressing, storing and preserving breastmilk

1. Instructions for expressing breastmilk

- Female employees, when returning to work after maternity leave, can maintain breastfeeding by expressing milk by hand or using a breast pump at work.

- Expressing milk by hand:

+ Use this method in case the lactation room does not have enough breast pumps.

+ Wash hands before each expression with soap under running water. Wash and rinse the milk containers with boiling water. Relax. Massage the breast and stimulate the nipple before expressing to stimulate milk flow. Place the thumb above the nipple and areola, the index finger and the rest of the fingers below the nipple and areola, opposite the thumb. Squeeze thumb and index finger gently toward chest wall; press on the back of the nipple and areola between the thumb and index finger. Squeeze and then release. Squeeze around the areola so that milk flows from parts of the breast into the clean container. Avoid rubbing the surface of the skin, which can scratches the skin, and avoid squeezing the nipple as it can block the flow of milk. Express milk from one breast for 3 to 5 minutes until the flow stops, switch to express on the other side and then repeat. Each expression session takes 20 to 30 minutes.

- Expressing milk by breast pump:

+ There are two types of pumps: manual and electric pumps.

+ Read instructions for use before expressing milk. Practice hand washing, lactation stimulation, expressing and storing milk similarly to hand expression.

- How to maintain milk supply:

+ Spend more time breastfeeding before leaving the child and right after coming home.

Increase the frequency of feedings around the baby such as increasing the number of feedings at night and on days off.

+ Practice expressing breastmilk immediately after giving birth and even during regular breastfeeding and direct breastfeeding. When returning to work, female employees need to express milk and store expressed milk before going to work so that the childminder or nursery carer can give breastmilk to the child. It is recommended to maintain an expressing schedule at work and when away from home, ensuring 3-4 hours between expressions to help maintain milk supply and prevent engorgement.

2. Number of expression times per day

Express milk every 3-4 hours to maintain lactation, each expression takes from 20 to 30 minutes, excluding the time to move to the lactation room and to clean equipment.

3. Guidelines for labeling, storing, preserving and using expressed breastmilk

- After expressing, store milk in clean and covered containers or breastmilk storage bags. It is not recommended to store milk in bottles because it is unsafe, difficult to clean and prone to infection.

- Label on the container of expressed milk or write directly on the breastmilk storage bag, including four entries: Full name of the expressing female employee, date of expressing, and time of expressing.

- Expressed breastmilk should be stored according to the instructions below.

Table 3. Instructions for storing expressed breastmilk

- Using expressed breastmilk:

+ The expressed breastmilk must be thawed and warmed up.

+ Thaw milk: Move milk from the freezer to the cooler/refrigerator to prevent freezing. Then leave at room temperature to melt all the ice, shake the milk well and warm the milk. Once the milk completely thaws, use it within 24 hours.

+ Warm milk: Soak milk in hot water for a few minutes, when the milk is warm, it is okay. Do not reheat milk and do not use microwave. Warm milk should be used within 4 hours.

+ Leftover milk, if not used within 2 hours, must be discarded. Therefore, take only the right amount of milk from a clean container with a lid to a feeding cup.

+ Give the child the expressed milk from a cup and spoon.

Appendix 3. Daily hygiene checklist

The staff in charge shall clean the lactation room at the beginning of each day, record the date and sign the checklist, showing that the tasks of items 1-6 have been performed; when the task in item 6 is due, the manager must be notified one week in advance.

The manager shall check the hygiene on an ad-hoc basis, at least once a week, and then sign for certification.

Other noticeable problems that may be reported by cleaning staff or users.

Appendix 4. Registration form to use the lactation room

Appendix 5. Regulations in lactation room

Operating time:

- Based on the shifts’ time of staff

- The cooler/refrigerator operates 24/7 to ensure a stable temperature

For staff in charge of daily cleaning:

- Clean, record the operating condition and warranty period of the equipment daily

- Report to management staff one week in advance before the 6-month inspection comes due

- In case of any problem, report it to the manager immediately and record it

For management staff:

- Undertake surprise inspection, at least once a week to control the hygiene condition and equipment in the lactation room and number of female employees, time for booking the lactation room

- Absolutely do not inspect the room if no female employee is expressing breastmilk, in order to respect their privacy.

- Immediately handle the problem that arises

For female employees using the lactation room:

- All female employees who are breastfeeding and wishing to express and store breastmilk are entitled to book the lactation room.

- They need to fill in the registration form to use the lactation room, to avoid crowd in the room

- They may use their personal breast pumps or be provided with breast pumps in the lactation room

- They must keep general hygiene, self-clean and sterilize all personal equipment before and shortly after expression

- Keep quiet while using the room; avoid bothering other coworkers who are expressing

- Write full name, expressing time, and milk volume on the bottle or bag that stores freshly expressed milk before putting it in the shared cooler/refrigerator

- The freshly expressed milk stored in the shared cooler/refrigerator should be brought home when the female employee finishes her shift.

- Any problem arising during the use of the room should be recorded on the board of daily hygiene checklist or reported to the management staff for timely actions./.

Appendix 6. Survey on the use of lactation room

Questionnaire for female employees raising children under 24 months old

1. Do you have a break to express milk?

□ Yes                                            □ No

If not, why? (Choose multiple options)

□ The line manager does not allow

□ Too much work, cannot arrange a break

□ Uncomfortable to use (room is too far away, not hygienic, not private).

Clarify: …

□ Do not know about this policy

□ Others (Specify): …

2. Do you use a breast pump?

□ Yes                                            □ No

If not, why? (Choose multiple options)

□ Inadequate

□ Broken

□ Others (Specify): …

3. Do you store milk after expressing?

□ Yes                                            □ No

If not, why? (Choose multiple options)

□ No refrigerator

□ Not enough space in the refrigerator

□ Broken refrigerator

□ Others (Specify): …

Appendix 7. Quarterly report on operation of lactation room

*The report is made at the end of the month, saved in excel file.

*Forms in appendices 3,4,6 need to be saved to prove the data and information reported

1 Based on the statistics of the Vietnam General Confederation of Labour in May, 2020 on efficiency of operation of lactation rooms.