A new report from the Healthy People Law and Health Policy project — The Role of Law and Policy in Assisting Families to Reach Healthy People’s Maternal, Infant, and Child Health Breastfeeding Goals in the United States — identifies progress and priority areas for meeting Healthy People 2020 objectives related to breastfeeding.
Dr. Alison Stuebe, an obstetrician and distinguished scholar in infant and young child feeding in the Department of Maternal and Child Health at the University of North Carolina Gillings School of Global Public Health, coauthored the report. In this blog post, she focuses on some of the challenges related to breastfeeding and opportunities for law and policy to improve breastfeeding rates.
Breastfeeding Rates in the United States
For most babies, breast milk is the best source of nutrition, providing the nutrients needed for healthy growth and development. It may also help protect both babies and mothers from health problems. For babies, being breastfed is linked to lower rates of ear infections, pneumonia, sudden infant death syndrome (SIDS), and leukemia. For mothers, breastfeeding is linked to lower rates of type 2 diabetes, high blood pressure, and certain types of cancer.
Because of the health benefits associated with breastfeeding, all major U.S. medical organizations recommend 6 months of exclusive breastfeeding and continued breastfeeding after 6 months while introducing new foods.
And yet, according to the new Healthy People Law and Health Policy project report, breastfeeding rates in the United States fall short of these recommendations. Among children born in 2015, 83.2% of mothers and babies initiated breastfeeding, but that percentage dropped to 57.6% at 6 months after birth — and only 35.9% at 1 year. In addition, 60% of women say they weren’t able to meet their breastfeeding goals.
So why the discrepancy?
Barriers to Breastfeeding
Stuebe says there are many reasons, noting families may face barriers to meeting their breastfeeding goals in a variety of settings — at the hospital, at home, and at work. Examples of common challenges include not having enough support from health care providers, lack of insurance coverage, and inadequate support in the workplace. And in the context of the COVID-19 pandemic, many families now have less access to in-person lactation consultations.
It’s also important to note that these barriers disproportionately affect racial/ethnic minorities and families with lower socioeconomic status. For example, Black and Hispanic employees are less likely to have paid parental leave than white employees. And low-income women are more likely to return to work earlier — and to have jobs that make it difficult to continue breastfeeding — compared to women with higher incomes.
Additionally, Stuebe says that bias among health care providers can further contribute to these disparities. “There is implicit bias in the practices of health care providers that might not provide the same support to Black women based on assumptions about whether or not they’re going to breastfeed,” she says.
The Baby-Friendly Hospital Initiative (BFHI) is a proven strategy for improving breastfeeding rates. One example is the Indian Health Service’s BFHI, which launched in 2011 with the goal of certifying its federally administered obstetric facilities as Baby-Friendly. This initiative targeted American Indian (AI) and Alaska Native (AN) populations, a group that has disproportionately high rates of conditions like diabetes and obesity.
Within 2 years of launch, all 13 facilities had achieved the Baby-Friendly designation. As a result, breastfeeding rates for AI/AN populations increased:
- The rate of breastfeeding at age 6 months increased from 37.3% for babies born in 2011 to 55.0% for babies born in 2015
- The rate of exclusive breastfeeding through age 6 months increased from 15.6% for babies born in 2011 to 19.6% for babies born in 2015
As an obstetrician, Stuebe says she especially appreciates that the BFHI promotes an hour of uninterrupted skin-to-skin contact between mothers and babies right after birth. This both helps babies breastfeed and increases the length of time that they breastfeed. “It really points to the power of keeping moms and babies together right after birth,” Stuebe says.
Legal and Policy Support for Breastfeeding
Federal, state, tribal, and local policies all play a role in accommodating families who want to breastfeed, says Stuebe. Looking back at successful policies, she notes that the investment in technical assistance for hospitals implementing the BFHI has been especially effective in helping health care providers better support families who want to breastfeed. “There really needs to be coaching that guides folks through doing something that they haven’t done before,” she says.
She also notes that the Affordable Care Act (ACA) and Medicaid expansion have helped mothers get support when dealing with specific breastfeeding challenges.
The Family and Medical Leave Act of 1993 has supported breastfeeding by providing unpaid time off work to care for a newborn — as well as a sick child, spouse, or parent. And in California, the first state to implement paid leave from work after the birth of a baby, evidence shows that breastfeeding rates increased. Workplace accommodations are also key to ensuring employees have the time and space to breastfeed. For example, the ACA included a break-time law that protects hourly employees’ right to express milk for a reasonable amount of unpaid break-time. Stuebe says this is critical for new mothers continuing to breastfeed.
“We need to construct systems that lift up and support everybody to enable women to be able to breastfeed,” she says.
Stuebe says supporting breastfeeding should be a fundamental part of society, and there’s more work ahead to achieve that goal. In particular, she says she’d like to see universal paid family leave implemented, which she believes would promote health and well-being for generations to come.
“With all the things going on in the world, hopefully people will realize that caring for children needs to be supported institutionally,” she says.