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Working Parents Support Coalition
Overview and call-to-action
Plan for today
1. Why maternity leave is important for health, breastfeeding and child development – Sandra
2. Working Parents Support Coalition - Luciana
3. Call to action for new members to join
Sandra G Hassink, MD, MS, FAAP
Past President American Academy of Pediatrics
Luciana Nuñez WPSC Founder
CEO Danone Early Life Nutrition US
Parental Leave: Building the Foundations of Health for Children and Families from the Start
Sandra G Hassink, MD, MS, FAAP
Foundations of Health: Goal for Every
Child
Sound, appropriate nutrition
Health-promoting food intake, eating habits
beginning with mother’s pre-conception nutritional
status
Stable, responsive environment of
relationships
Consistent, nurturing, protective interactions
with adults that enhance learning, help develop
adaptive capacities that promote well-regulated
stress response systems
Safe, supportive physical, chemical
and built environments
Provide places for children that are free from
toxins, allow active, safe exploration without fear,
offer families opportunities to exercise, make social
connections
developingchild.harvard.edu/files/5012/8706/2947/inbrief-
health.gif
Threats to the Foundations of
Child Health: National
Diet quality
– Children ages 2-17 who meet federal diet quality
standards: 50%
Obesity
– Children ages 6-17 who have obesity:18%
Food insecurity
– Children living in food insecure homes: 21%
Activity limitation
– Children 5-17 with activity limitation resulting from one or
more chronic health conditions: 9%
Threats to the Foundations of
Child Health: National
Emotional behavioral
Children 4-17 (parent report) who have serious problems with emotions, concentration, behavior, getting along with others 5%
Youth 12-17 with past-year major depressive episode 8%
Early education Children 3-4 not enrolled in preschool 52%
Poverty
Children 0-6 live in low-income households 48% (11% <50% poverty)
How can providing parental leave help?
Promotes healthy nutrition and healthy early feeding
and activity patterns from the start
Opportunity to extend breast feeding, engage in
interactive feeding – hunger and satiety cues
Opportunity to optimize motor development
Provides opportunity for increase parent infant
interaction
Opportunities to promote bonding, literacy, social
emotional health
Breastfeeding is the best feeding for infants
AAP Policy
Breastfeeding
Photo CDC
Breastfeeding at Work
U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S.
Department of Health and Human Services, Office of the Surgeon General; 2011.
http://www.centrastate.com/maternity/breastfeeding-your-baby
Breastfeeding at Home Strengthens the relationship
between mother and infant in the critical first months of life Skin-to-skin promotes bonding
and attachment between mother and infant, increases the efficiency of breastfeeding, and enhances the neurological and psychosocial development of the infant
Smillie CM. Baby-led breastfeeding: a neurobehavioral model for understanding how infants learn to feed [presentation]. HealthConnectOne conference: Birth, Breastfeeding and Beyond, Chicago, IL, September 24, 2009.
Perez A, Petersen S. Meeting the needs of the youngest infants in child care. Zero to Three 2009;29:13–17
Infant Benefits: Respiratory Tract Infections and Otitis Media
Reduces risk of hospitalization for lower respiratory tract infections in the first year by 72% with exclusive breastfeeding for more than 4 months
Ip S, Chung M, Raman G,et al., Tufts-New England Medical Center Evidence-based Practice Center.Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (FullRep). 2007;153(153):1–186pmid:17764214
Ip S,Chung M,Raman G, Trikalinos TA,Lau J. A summary of the Agency for Healthcare Research and Quality’s evidence report on breastfeeding in developed countries. Breastfeed Med. 2009;4(suppl 1):S17–S30pmid:19827919
Exclusive breastfeeding for more than 6 mos reduced the risk of pneumonia 4X compared to Infants who exclusively breastfed for 4 to 6 months
Chantry CJ, Howard CR, Auinger P. Full breastfeeding duration and associated decrease in respiratory tract infection in US children. Pediatrics. 2006;117(2):425–432pmid:16452362
Infants who breastfed exclusively for 4 months had 74% reduction in severity of Respiratory syncytial bronchiolitis compared with infants who never or only partially breastfed
Nishimura T, Suzue J, Kaji H. Breastfeeding reduces the severity of respiratory syncytial virus infection among young infants: a multi-center prospective study. Pediatr Int.2009;51(6):812–816pmid:19419530
Any breastfeeding compared with exclusive commercial infant formula feeding will reduce the incidence of otitis media (OM) by 23%.
Ip S, Chung M, Raman G,et al., Tufts-New England Medical Center Evidence-based Practice Center.Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (FullRep). 2007;153(153):1–186pmid:17764214
Exclusive breastfeeding for more than 3 months reduces the risk of otitis media by 50%. Serious colds and ear and throat infections were reduced by 63% in infants who exclusively breastfed for 6 months
Duijts L, Jaddoe VW, Hofman A, Moll HA. Prolonged and exclusive breastfeeding reduces the risk of infectious diseases in infancy. Pediatrics. 2010;126(1). Available at:www.pediatrics.org/cgi/content/full/126/1/e18pmid:20566605
Infant Benefits - Gastrointestinal Any breastfeeding is associated with a 64% reduction in the incidence of nonspecific
gastrointestinal tract infections, and this effect lasts for 2 months after cessation of breastfeeding Ip S, Chung M, Raman G,et al., Tufts-New England Medical Center Evidence-based Practice
Center.Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (FullRep). 2007;153(153):1–186pmid:17764214
Ip S,Chung M,Raman G, Trikalinos TA,Lau J. A summary of the Agency for Healthcare Research and Quality’s evidence report on breastfeeding in developed countries. Breastfeed Med. 2009;4(suppl 1):S17–S30pmid:19827919
Duijts L, Jaddoe VW, Hofman A, Moll HA. Prolonged and exclusive breastfeeding reduces the risk of infectious diseases in infancy. Pediatrics. 2010;126(1). Available at:www.pediatrics.org/cgi/content/full/126/1/e18pmid:20566605
Quigley MA, Kelly YJ, Sacker A. Breastfeeding and hospitalization for diarrheal and respiratory infection in the United Kingdom Millennium Cohort Study. Pediatrics. 2007;119(4). Available at:www.pediatrics.org/cgi/content/full/119/4/e837pmid:1740382
Feeding preterm infants human milk is associated with a significant reduction (58%) in the incidence of necrotizing enterocolitis (NEC)
Ip S, Chung M, Raman G,et al., Tufts-New England Medical Center Evidence-based Practice Center.Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (FullRep). 2007;153(153):1–186pmid:17764214
There is a reduction of 52% in the risk of developing celiac disease in infants who were breastfed at the time of gluten exposure
Akobeng AK, Ramanan AV,Buchan I, Heller RF. Effect of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies. Arch Dis Child.2006;91(1):39–43pmid:16287899
Breastfeeding is associated with a 31% reduction in the risk of childhood inflammatory bowel disease.
Barclay AR, Russell RK, Wilson ML, Gilmour WH, Satsangi J, Wilson DC. Systematic review: the role of breastfeeding in the development of pediatric inflammatory bowel disease. J Pediatr.2009;155(3):421–426pmid:19464699
Reduction in Sudden Infant Death
Syndrome and Infant Mortality
Breastfeeding is associated with a 36% reduced risk of
SIDS Ip S, Chung M, Raman G,et al., Tufts-New England Medical Center Evidence-based
Practice Center.Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (FullRep). 2007;153(153):1–186pmid:17764214
A proportion (21%) of the US infant mortality has been attributed, in part, to the increased rate of SIDS in infants who were never breastfed
Chen A, Rogan WJ. Breastfeeding and the risk of postneonatal death in the United States. Pediatrics.2004;113(5). Available at: www.pediatrics.org/cgi/content/full/113/5/e435pmid:15121986
It has been calculated that more than 900 infant lives per year may be saved in the United States if 90% of mothers exclusively breastfed for 6 months
Bartick M, Reinhold A. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics. 2010;125(5). Available at:www.pediatrics.org/cgi/content/full/125/5/e1048pmid:20368314
Reduction in Cancer, Obesity, Diabetes 15% to 30% reduction in adolescent and adult obesity rates if any breastfeeding
occurred in infancy compared with no breastfeeding Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG. Effect of infant feeding on the risk of obesity across the
life course: a quantitative review of published evidence. Pediatrics.2005;115(5):1367–1377pmid:15867049
Each month of breastfeeding being associated with a 4% reduction in risk of obesity Ip S,Chung M,Raman G, Trikalinos TA,Lau J. A summary of the Agency for Healthcare Research and
Quality’s evidence report on breastfeeding in developed countries. Breastfeed Med. 2009;4(suppl 1):S17–S30pmid:19827919
Up to a 30% reduction in the incidence of type 1 diabetes mellitus is reported for infants who exclusively breastfed for at least 3 months
Rosenbauer J, Herzig P, Giani G. Early infant feeding and risk of type 1 diabetes mellitus—a nationwide population-based case-control study in pre-school children. Diabetes Metab Res Rev.2008;24(3):211–222pmid:17968982
A reduction of 40% in the incidence of type 2 diabetes mellitus is reported, possibly reflecting the long-term positive effect of breastfeeding on weight control and feeding self-regulation
Das UN. Breastfeeding prevents type 2 diabetes mellitus: but, how and why? Am J Clin Nutr.2007;85(5):1436–1437pmid:17490984
A reduction of 20% in the risk of childhood acute lymphocytic leukemia and 15% in the risk of acute myeloid leukemia for infants breastfed for 6 months or longer
Rudant J, Orsi L,Menegaux F, et al. Childhood acute leukemia, early common infections, and allergy: The ESCALE Study. Am J Epidemiol. 2010;172(9):1015–1027pmid:20807738
Kwan ML, Buffler PA, Abrams B, Kiley VA Breastfeeding and the risk of childhood leukemia: a meta-analysis. Public Health Rep. 2004;119(6):521–535pmid:15504444
Improvement in Neurodevelopmental
Outcomes Adjusted outcomes of intelligence scores and teacher’s ratings are
significantly greater in breastfed infants Kramer MS, Fombonne E, Igumnov S, et al., Promotion of Breastfeeding Intervention Trial (PROBIT)
Study Group Effects of prolonged and exclusive breastfeeding on child behavior and maternal adjustment: evidence from a large, randomized trial. Pediatrics. 2008;121(3). Available at:www.pediatrics.org/cgi/content/full/121/3/e435pmid:18310164
Kramer MS, Aboud F, Mironova E, et al., Promotion of Breastfeeding Intervention Trial (PROBIT) Study Group. Breastfeeding and child cognitive development: new evidence from a large randomized trial.Arch Gen Psychiatry. 2008;65(5):578–584pmid:18458209
Kramer MS, Chalmers B, Hodnett ED, et al., PROBIT Study Group (Promotion of Breastfeeding Intervention Trial). Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of elarus. JAMA. 2001;285(4):413–420pmid:11242425
Significantly positive effects of human milk feeding on long-term neurodevelopment are observed in preterm infants, the population more at risk for these adverse neurodevelopmental outcomes.
Vohr BR, Poindexter BB, Dusick AM, et al., NICHD Neonatal Research Network. Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics. 2006;118(1). Available at:www.pediatrics.org/cgi/content/full/118/1/e115pmid:16818526
Vohr BR, Poindexter BB, Dusick AM, et al.National Institute of Child Health and Human Development National Research Network. Persistent beneficial effects of breast milk ingested in the neonatal intensive care unit on outcomes of extremely low birth weight infants at 30 months of age.Pediatrics. 2007;120(4). Available at: www.pediatrics.org/cgi/content/full/120/4/e953pmid:17908750
Lucas A, Morley R, Cole TJ. Randomised trial of early diet in preterm babies and later intelligence quotient. BMJ. 1998;317(7171):1481–1487pmid:9831573
Cognitive and Behavioral Effects
Maternal work in the first year of life is associated with decreases in reading and math test scores at ages 3–11
Baum CL. Does early maternal employment harm child development? an analysis of the potentialbenefits of leave taking. Journal of labor Economics. 2003; 21(2):409–448.
Berger LM, Hill J, Waldfogel J. Maternity leave, early maternal employment and child health anddevelopment in the us*. The Economic Journal. 2005; 115(501):F29–F47.
Maternal return to work within the first 12 weeks of her child's life is associated with reduced breastfeeding and immunizations and increased behavior problems in early childhood
Negative effects of maternal work are partially offset by
the positive effects of increases in income Berger LM, Hill J, Waldfogel J. Maternity leave, early maternal employment
and child health anddevelopment in the us*. The Economic Journal. 2005; 115(501):F29–F47.
Improved Maternal Outcomes
Decreased postpartum blood loss and more rapid involution of the uterus
Continued breastfeeding leads to increased child spacing secondary to lactational amenorrhea
Increase in postpartum depression in mothers who do not breastfeed or who wean early Henderson JJ, Evans SF, Straton JA, Priest SR, Hagan R. Impact of postnatal depression on breastfeeding
duration. Birth. 2003;30(3):175–180pmid:12911800.
Rate of child abuse/neglect perpetrated by mothers was significantly increased for mothers who did not breastfeed as opposed to those who did (OR: 2.6; 95% CI: 1.7–3.9).
Strathearn L, Mamun AA, Najman JM, O’Callaghan MJ.Does breastfeeding protect against substantiated child abuse and neglect? A 15-year cohort study. Pediatrics.2009;123(2):483–493pmid:191716136
In mothers without a history of gestational diabetes, breastfeeding duration was associated with a decreased risk of type 2 diabetes mellitus; for each year of breastfeeding, there was a decreased risk of 4% to 12%
Stuebe AM, Rich-Edwards JW, Willett WC, Manson JE, Michels KB. Duration of lactation and incidence of type 2 diabetes. JAMA. 2005;294(20):2601–2610pmid:16304074
Schwarz EB, Brown JS, Creasman JM, et al. Lactation and maternal risk of type 2 diabetes: a population-based study. Am J Med. 2010;123(9):863.e1–.e6
Women with a cumulative lactation history of 12 to 23 months had a significant reduction in hypertension (OR: 0.89; 95% CI: 0.84–0.93), hyperlipidemia (OR: 0.81; 95% CI: 0.76–0.87), cardiovascular disease (OR: 0.90; 95% CI: 0.85–0.96), and diabetes (OR: 0.74; 95% CI: 0.65–0.84).
Schwarz EB, Ray RM, Stuebe AM, et al. Duration of lactation and risk factors for maternal cardiovascular disease. Obstet Gynecol. 2009;113(5):974–982pmid:19384111
Cumulative duration of breastfeeding of longer than 12 months is associated with a 28% decrease in breast cancer (OR: 0.72; 95% CI: 0.65–0.8) and ovarian cancer (OR: 0.72; 95% CI: 0.54–0.97) Each year of breastfeeding has been calculated to result in a 4.3% reduction in breast cancer.
Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet.2002;360(9328):187–195pmid:12133652
Economic Benefit
A detailed pediatric cost analysis based on the
AHRQ report concluded that if 90% of US mothers
breastfeed exclusively for 6 months, there would be
a savings of $13 billion per year
The savings do not include those related to a reduction in
parental absenteeism from work or adult deaths from
diseases acquired in childhood, such as asthma, type 1
diabetes mellitus, or obesity-related conditions. Bartick M, Reinhold A. The burden of suboptimal breastfeeding in the United
States: a pediatric cost analysis. Pediatrics. 2010;125(5). Available
at:www.pediatrics.org/cgi/content/full/125/5/e1048pmid:20368314
• U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding.
Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011.
Percent US Children Breastfed by 6 mo
Lack of parental leave can be a significant
barrier to breastfeeding
Women intending to return to work within a year after childbirth are less likely to initiate breastfeeding
Mothers who work full-time tend to breastfeed for shorter durations than do part-time or unemployed mothers
Johnston ML, Esposito N. Barriers and facilitators for breastfeeding among working women in the United States. J Obstet Gynecol Neonatal Nurs 2007;36:9–20.
Fein SB, Roe B. The effect of work status on initiation and duration of breast-feeding. Am J Public Health 1998;88: 1042–1046.
Women with longer maternity leaves are more likely to combine breastfeeding and employment.
Arthur CR, Saenz RB, Replogle WH. The employment-related breastfeeding decisions of physician mothers. J Miss State Med Assoc 2003;44:383–387.
In a survey of 712 mothers, each week of maternity leave increased the duration of breastfeeding by almost one-half week.
Roe B, Whittington LA, Fein SB, Teisl MF. Is there competition between breastfeeding and maternal employment? Demography 1999;36:157–171.
Jobs that have less flexibility and require long separations of mother and baby further complicate breastfeeding
Kimbro RT. On-the-job moms: work and breastfeeding initiation and duration for a sample of low-income women. Matern Child Health J 2006;10:19–26.
Hourly wage workers face different challenges than salaried workers They typically have less control over their schedules
Their pay may be reduced if they take breaks to express breast milk. Brown CA, Poag S, Kasprzycki C. Exploring large employers’ and small employers’ knowledge, attitudes, and practices on breastfeeding support in the workplace. J Hum Lact
2001;17:39–46.
U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011.
Mothers returning to work
2 out of 3 women in their third trimester of pregnancy said they planned to breastfeed exclusively in the first few weeks
But mothers planning to return to work within 6 weeks were 40% less likely to say they expected to breastfeed exclusively than those planning to return to work after 12 weeks.
MirkovicKR et al. J Hum Lact. 2014;30[3]:292-297
30% of pregnant women who intended to breastfeed for at least 3 months did not
Women who returned to work full time before 6 weeks were least likely to breast feed for 2 months.
Mirkovic KR et al. J Hum Lact. 2014;30[4]:416-419).
Employed mothers
Lower initiation rates
Shorter duration of breastfeeding
Rates of breastfeeding initiation and duration are
higher in women who have longer maternity leave
work part-time rather than fulltime and have
breastfeeding support programs in the workplace. • U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support
Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the
Surgeon General; 2011.
Parental leave
Most women need 4 to 6 weeks to physically recover
from giving birth before returning to work (longer for
a C section) 7th edition of Guidelines for Perinatal Care, published by the American
Congressof Obstetricians and Gynecologists(ACOG) and the American
Academy ofPediatrics (AAP) (http://bit.ly/1TOAjN6p 208)
The lack of paid maternity leave has been linked to
lower rates of breastfeeding and childhood
immunizations and higher rates of infant and child
mortality and depression in mothers Hajizadeh M et al. Soc Sci Med.2015;140:104-117; Heymann J et al.
PublicHealth Rep. 2011;126[suppl 3]:127-134
Maternal stress
Among mothers of 6-month-old infants maternal work hours were
positively associated with depressive symptoms and parenting stress
and negatively associated with mothers’ assessment of their overall
health
No difference in the quality of their parenting compared with the
mothers who were not working. Chatterji P et al. J Popul Econ. 2013;26[1] 285-301
Increases in symptoms of depression in mothers with less than 12
weeks of maternity leave and mothers with less than 8 weeks of paid
maternity leave were both associated with increases in depressive
symptoms Chatterji and Markowitz.J Ment Health Policy Econ. 2012;15[2]:61-76).
The United States the ONLY
developed country in the
world that does not require paid maternity leave.
At least 178 countries have
enacted laws to provide paid leave to new mothers, with more than
100 of those offering 14 or
more weeks of paid leave.
Maternity leave: the global landscape
The Family & Medical Leave Act was enacted in 1993 providing 12 weeks of protected, unpaid time off to full-time employees at companies with 50 people or more.
40% of workers are not covered by FMLA.
Resulting in: Financial stress to mom and family
Delaying essential medical appointments for newborns
Mothers ceasing breastfeeding early Mothers exiting the work force
Employee turnover Increased costs to recruit replacements
The reality in the US
Why does maternity leave matter to us
Our mission: Bring health through food
to as many people as possible
Health goals
Business goals
Employer goals
Reduce rates of maternal
anemia by 50%
No increase in childhood
obesity
Increase rate of exclusive
breastfeeding at 6 months to at
least 50%
• “War on talent” accelerating • Next generation are Millenials, for whom social company values and work/life
balance are key decision criteria.
Companies are proactively stepping up Strong momentum, driven by technology companies and starting to expand to “mainstream” industries
But we can do more if we work together…
Mission
Drive a collective commitment to a range of parental support practices that ultimately improve health, development, and economic outcomes for both families and companies
Vision/Purpose
By working together and partnering with leading experts, the coalition is a resource of best practices and data which is shared amongst members and with other companies looking to better support their working parents.
Q1
Initial discussions
with CGI
Shaping commitment
areas with partners
Q2 July
Summer meeting CGI
Barclays & KKR on board
August
E&Y, Nestle and new
partners on board
September
Finalizing individual
commitments and public
launch
Q4
Commitments ongoing and new partners
on board
Q1
Inaugural meeting:
4 workstreams
Milestones so far
2015
Q2
New members
to be announced
2016
Commitment to Action Improving parental support practices for positive impact
Three focus areas
Company culture In-office support Longer / paid leave
• Flexible return to work policies
• Create a culture of support
• Train managers / leaders
• Dedicated, appropriate lactation facilities
• Scheduling • Train managers,
educate parents
• Longer unpaid leave • Paid leave • Create awareness of
business case behind
1 2 3
Examples of individual commitments
6 months paid leave for primary caregivers
Breastfeeding support: 100% of employees with access to
upgraded breastfeeding rooms and CLC support
Flexible return-to-work parental policies
Double number of fathers taking
paternity leave Measure impact of
new policy in HR KPI’s
Breastfeeding support: child care companion during business trips,
shipment of breast milk, access to CLC
Metrics:
1. Defining common KPI’s
2. How can we measure it?
3. Plan to measure
Best practices:
1. Develop best practice toolkit (including breastfeeding chapter) by Q4
2. Build as open source to continuously update
Education:
1. Nutrition, breastfeeding and child development (pilot together with AAP)
2. Coaching for transitions: pilot scalable strategies building on existing experience from EY
Expansion:
1. Members: goal to get to 10 high-impact companies by year end
2. PR: create a 1st year update campaign around next CGI / UN General Assembly
Areas of common work for 2016
• Higher breastfeeding rates => lower risk of obesity (moms and babies), less NCD’s, lower incidence of allergies. Lower risk of breast and ovarian cancer => Healthcare savings of >$60Bio to the system
• Better early life brain development => higher IQ, intellectual abilities, closing the word gap => prosperity and equality for the next generation.
• Leave of ~9 weeks can lower infant mortality by 10%
Social
Economic
Health
Women advancement
Families
Companies
• Increasing women participation in the workforce = $4.3T by 2020.
• 15% above average financial returns; +53% return on equity +42% return on sales , 48% higher EBIT
• Higher return to work rates correlate with professional, economic and personal progress.
• Retaining two stable incomes
• Essential source for single mothers
• Better maternity leave makes women 50% more likely to increase lifelong wages
• Economic benefits of improvement (inclusion,
productivity and retention)
outweigh cost
• Increase # of women in workforce = more competitive economy and employers more (US
declining & below other developed nations)
• Macroeconomic benefits of a larger tax base, lower government health costs (-39%)
Multiplying the impact by working together
Leveraging media to help inspire others
Our ambition
New members by December 2016
What we expect from members
Commitments to action to support parents in the workplace that are: 1. New 2. Specific 3. Measurable
What members get out from the Coalition
1. Network 2. Best practice building 3. Best practice sharing 4. PR impact 5. Collective impact