Quyết định 5175/QĐ-BYT 2021 phê duyệt tài liệu “Hướng dẫn triển khai phòng vắt, trữ sữa mẹ tại nơi làm việc”

DECISION

On approving “Guidelines for the implementation of lactation rooms in workplaces”

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 detailing and guiding the implementation of a number of articles of the Labor Code regarding working conditions and industrial relations;

At the request of the Director of the Department of Maternal and Child Health under the Ministry of Health,

HEREBY DECIDES:

Article 1. Approving “Guidelines for the implementation of lactation rooms in workplaces” issued together with this Decision.

Article 2. “Guidelines for the implementation of lactation rooms in workplaces” shall be the basis of implementation for establishments which employ female employees.

Article 3. This Decision takes effect from the date of signing.

Article 4. Chief of Ministry Office, Director of the Department of Maternal and Child Health, Director of the Department of Medical Services Administration; Heads of relevant units under the Ministry of Health; Directors of provincial and centrally-run Departments of Health of provinces and centrally run cities; Heads of relevant units shall be responsible for implementing this Decision./.

For the Minister

Deputy Minister

Nguyen Truong Son

MINISTRY OF HEALTH

GUIDELINES FOR THE ESTABLISHMENT AND OPERATION OF LACTATION ROOMS IN WORKPLACES

 (Issued together with the Decision No. 5175/QD-BYT dated November 09, 2021)

2021

TABLE OF CONTENTS

I. Basis for developing the guidelines

II. Guidelines for the establishment and operation of lactation rooms in workplaces

1. Identification of the location for lactation rooms

2. Number of lactation rooms

3. Criteria for lactation rooms

4. Communications and training on the establishment and operation of lactation rooms

5. Management of lactation rooms

6. Schedule for using lactation rooms and replacement for female employees who are taking short break for expressing and storing breastmilk

7. Monitoring, assessment, and collection of laborers’ feedbacks

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 rooms

Appendix 5. Regulations on using lactation rooms

Appendix 6. Survey on the use of lactation rooms

Appendix 7. Quarterly report on the operation of lactation rooms

I. Basis for developing the guidelines

Nowadays, there is an increasing number of women who have joined the workforce. In Vietnam, female employees make up almost half (48%) of the country's workforce. The rate of women participating in the workforce in Vietnam is high - approximately 72%, significantly higher than that in East Asia - Pacific region (61%) and the world (50%). 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 establishments, workplaces, families, and communities to take care of their maternity health and enable them to do the breastfeeding, thereby ensuring the best source of nutrition for children.

The revised Labor Code in 2012 prescribes that female employees shall be entitled to 06 months of maternity leave to enable mothers to 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% in 2010 to 45% in 2020). However, the rate of mothers who continue to breastfeed their children until the age of two is still relatively low, at only 26% (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 creating favorable conditions for laborers, the support of trade unions in establishing lactation rooms and arranging time for female employees to express and store breastmilk at workplaces.

One of the effective investments of enterprises to ensure the family life of laborers is to support female employees to carry on breastfeeding by establishing lactation rooms in the workplace. Breastfed babies have the best nutrition, reducing the risk of disease for both mothers and their babies. Families can also save about 12% of their income when they do not have to buy infant formula milk and significantly reduce medical costs. Paying attention to improving working conditions and taking care of female employees’ health, especially establishing lactation rooms in the workplace, shall help female employees focus and enhance their work efficiency, thus creating a stable workforce for businesses.

In the Government’s Decree No. 145/2020/ND-CP dated December 14, 2020 detailing and guiding the implementation of a number of articles of the Labor Code regarding working conditions and industrial relations, Article 80, Clause 5 prescribes as follows: "Employers shall be encouraged to establish lactation rooms in line with the actual condition in the workplace, the needs of female employees and the capabilities of the employers. In cases where the employer hires 1,000 female employees or more, it is required to set up lactation rooms in the workplace"; Clause 6 prescribes as follows: "Employers shall be 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 employees and the employers".

Article 76 prescribes as follows "Lactation room shall be the private area that is not a bathroom or toilet cubicle; 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 be protected from the infringement and attention of the public and other colleagues so that female employees can breastfeed or express and store their breastmilk”.

On the basis of the regulations in Article 87, Clause 4, (c) of the Decree, the Ministry of Health shall issue the Guidelines for the implementation of lactation rooms in workplaces.

II. Guidelines for the establishment and operation of lactation rooms in workplaces

1. Identification of the location for lactation rooms

Lactation rooms must be ensured not to take more than a 10-minute walk from the workplace of the majority of female employees. It is necessary to consult female employees who are breastfeeding and trade union officers to select a suitable position. All female employees should be informed of the location of the lactation room.

It is possible to renovate one of the following areas to establish lactation rooms:

- A part of the health station

- An unoccupied space of the office

- A part of a warehouse that has been renovated to be well-ventilated

- 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. Number of lactation rooms

Table 1. Number of lactation rooms according to the number of female employees1

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

 (**) Lactation rooms are required.

3. Criteria for lactation rooms

Criteria for lactation rooms are divided into two types: basic and full.

Depending on the resources and actual conditions, establishments that employ female employees shall set up lactation rooms at appropriate levels.

Table 2. Criteria for lactation rooms

4. Communication and trainings on the establishment and operation of lactation rooms

Depending on the actual situation, employers who are assigned the task of establishing lactation rooms shall organize communication and training activities to raise awareness for female employees in the establishment and operation of lactation rooms.

a) Communication for female employees

- Objectives: To facilitate communications at workplaces to emphasize the importance of breastfeeding, provide instructions on how to express and store breastmilk, and provide information for female employees about their labor rights and benefits so that they know and use the lactation rooms effectively.

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

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

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

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

b) Trainings on the implementation of lactation rooms

- Objectives: To raise awareness of laborer’s rights and interests in breastfeeding, operation of the lactation rooms at the workplace.

- Persons in charge: Employers shall coordinate with the trade union, health units and relevant organizations.

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

- Subjects of trainings: Human resource officers, health officers, trade union and relevant officers of the establishment.

5. Management of the operation of lactation rooms

- Establishment establishing and operating lactation rooms shall assign officers in charge and assign responsibilities in managing the operation of lactation rooms.

- Management tasks shall include:

+ Arranging the use schedule and cleaning schedule of lactation rooms for users.

+ Providing instructions and managing the use, preservation, inspection and proposing replacement of equipment in lactation rooms.

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

+ Inspecting and monitoring the use and ensuring the general hygiene of lactation rooms (Appendix 3. Daily hygiene checklist).

+ Saving and replacing the hygiene checklist after each inspection time.

+ Making monthly report (Appendix 7).

6. Arranging the use schedule for lactation rooms and arranging replacement for female employees who take short break for expressing and storing breastmilk

- Establishments shall arrange time for female employees to take alternate breaks express milk.

- Depending on the actual situation, establishments shall arrange time so that it will not affect the production; suitable for the capacity of the lactation rooms, avoiding overload; suitable for the biological needs of female employees in expressing breastmilk. (Appendix 4. Registration form for using the lactation room).

7. Monitoring, assessments and collection of feedbacks of laborers

- Relevant departments of the establishment shall organize the periodical and irregular monitoring of the use and feedback of the users on the appropriateness of the frequency of use, availability and the conditions of the equipment (Appendix 6. Survey on the use of lactation rooms).

- Proposing leaders of the establishment management solutions to remove difficulties and unreasonable points in the process of using, if any.

________________________

1Based on the statistics of the Vietnam General Confederation of Labor dated May 2020 on the effectiveness of lactation rooms.

Appendix 1. List of communication materials

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

• The importance of breastmilk:

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

+ The importance of lactation rooms at workplace: https://tinyurl.com/Phongvattrusuame

+ Why the marketing of infant formula rampantly should be stopped: https://tinyurl.com/Ngungquangcaosuacongthuc

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

+ 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 milk

• 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

• Posters manifesting that breastmilk has full nutrition: https://o91.short.gy/Suamedayduduongchat

• Set of three posters about complementary food for 6-month-old babies:

Early nutrition plays the most important role: https://tinyurl.com/DDdaudoi

6-month-old babies are ready to eat solid food: https://tinyurl.com/6tandam

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

• The handbook on nutrition and health for babies, 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 milk: https://tinyurl.com/tachaiSCT

Appendix 2. Instructions on expressing, storing and preserving breastmilk

1. Instructions on 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 the workplace

- The way to express milk by hand:

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

+ Wash hands before expressing breastmilk 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 the 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 onto the clean container. Avoid rubbing the surface of the skin, which can scratch the skin, and avoid squeezing the nipple as it might block the flow of milk. Express milk from one breast for 3 to 5 minutes until the flow stops, turn to express on the other breast and then repeat. Each expression time shall take from 20 to 30 minutes.

- Expressing milk by breast pump:

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

+ Read instructions for use before expressing breastmilk. Practice hand washing, lactation stimulation, expressing and storing milk like expressing breastmilk by hand.

- How to maintain breastmilk flow:

+ 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 breastmilk before going to work so that the person taking care of the baby can give breastmilk to them. It is recommended to maintain an expressing schedule at work and when away from home, ensuring the gap of 3-4 hours between each time of expressing breastmilk to maintain milk flow and avoid engorgement.

2. Number of expression times in a day

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

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

- After expressing breastmilk, milk shall be stored in clean and covered containers or breastmilk storage bags. It is not recommended to store breastmilk in bottles as 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 contents: Full name of the female laborer who expresses breastmilk, date of expressing, and time of expressing.

- Expressed breastmilk should be stored in accordance with the following instructions.

Table 3. Instructions on storing the breastmilk

- Using expressed breastmilk:

+ The expressed breastmilk must be thawed and warmed up before feeding the baby.

+ Thawing milk: transfer 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, it must be used within 24 hours.

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

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

+ Feed the expressed milk to the baby using a cup and spoon.

Appendix 3. Daily hygiene inspection checklist

The staff in charge of cleaning shall clean the lactation room at the beginning of each day, record the date and sign the checklist to show that the tasks from 1-6 have been performed; when the task 6 is due for inspection, the managing officer must be notified one week in advance.

The managing officer shall check the hygiene irregularly, at least once a week, and then sign for confirmation.

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

Appendix 4. Registration form to use the lactation room

Appendix 5. Regulations on lactation rooms

Operation time:

- Based on shift time of staff

- The milk containing equipment shall operates 24/7 to ensure a stable temperature

For staff in charge of daily cleaning work:

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

- One week prior to the date of semi-annual inspection, the cleaning staff must notify the managing officer.

- In case of any problem, the cleaning staff must immediately report it to the managing officer and record it

For management staff:

- Conduct the irregular inspection, at least once a week to control the hygiene condition and equipment in the lactation room and number of female employees, time for registering to use the lactation room

- Do not inspect the room if no female laborer is expressing breastmilk, in order to respect their privacy.

- Immediately address any problem that arises

For female employees using lactation rooms:

- All female employees who are breastfeeding and wishing to express and store breastmilk shall have the right to register for using the lactation room

- Female employees using the lactation room need to fill in the registration form to use the lactation rooms to avoid crowding

- Female employees using the lactation room can use their personal breast pumps or use the breast pumps provided in the lactation room

- Female employees using the lactation room must keep general hygiene, self-clean and sterilize all personal equipment before and shortly after expressing breastmilk

- Female employees using the lactation room must quiet while using the room; avoid bothering other laborers who are expressing breastmilk

- Expressed milk must be marked with the full name, expressing time, and expressing amount on the bottle or bag before putting it into the shared cooler/refrigerator

- The freshly expressed milk stored in the shared cooler/refrigerator should be brought home when the female employees finish their shift.

- Any problem arising during the use of the lactation room should be recorded on the board of daily hygiene checklist or reported to the managing officer for timely handlings./.