Most national and international health organizations recommend at least three to six months of exclusive breastfeeding for newborns, with good reason: Ample studies have demonstrated that breastfeeding lowers infant mortality—and the transmission of HIV from mothers to infants—reduces the chance of developing chronic conditions later in life, and significantly improves maternal health after birth.
For millions of mothers around the world, however, these suggested guidelines are not always realistic or achievable. For some new moms, social, political, and economic barriers prevent them from accessing the support and resources—such as lactation counseling and breastfeeding supplies—and the paid leave from work that they need to breastfeed. Today, on International Women’s Day, it is important to reflect on what progress we have made in supporting breastfeeding, as well as on what policies we can promote to help improve the lives of women and children everywhere by making breastfeeding a more viable option for all new mothers.
Rates of breastfeeding vary greatly across developed and developing nations, as well as within countries, by class, race, and level of education. Less than 40 percent of children younger than 6 months old are exclusively breastfed in developing nations. Within developed countries, lower-income and minority groups are less likely to breastfeed than better-educated, older, or professional women.
This is in part because of the lingering effect of the development and intense marketing of formula that began in the middle of the 20th century. The marketing campaigns were geared toward all women, but those with the money to spend on formula were the earliest converts and trendsetters. While the 1950s’ move toward formula was led by wealthy and better-educated women—with formula subsequently becoming a symbol of status while breastfeeding was stigmatized—the move back toward breastfeeding that began in the late 1970s left behind many minority groups. Lower-income and less-educated women are less likely to be informed of the benefits of breastfeeding and are more vulnerable to the aggressive and targeted commercial promotion of formula permitted in many hospitals, especially in the United States.
This discrepancy within and between populations is one reason why it’s particularly important for health organizations and governments to take a multifaceted approach to supporting new mothers’ breastfeeding. For instance, policymakers cannot focus solely on waging informational campaigns or providing new mothers with breastfeeding equipment, although both of these are important goals. Instead, they need to support policies that begin at pregnancy and continue over the months—if not years—after childbirth. It is universally important to help mothers initiate breastfeeding immediately after birth, but hospitals often lack clinicians with sufficient experience in lactation medicine.
The international Baby-Friendly Hospital Initiative—which aims to champion and support hospitals that educate and assist new moms to start breastfeeding—is a good example of a program that ensures that hospital staff have adequate training in breastfeeding counseling and support. The Nurse-Family Partnership is another remarkable U.S. program that works to support new low-income mothers in all aspects of parenting—including breastfeeding—up to two years after the birth of a child. Despite the successes of programs such as these, they are not universal, and they do not change all the realities of what happens once a woman leaves the hospital with her newborn.
Once women have returned home or to their jobs, rates of breastfeeding drop precipitously around the world. This is especially true in countries that do not provide paid maternity or family leave, including the United States. Among developed nations, the United States ranks last in Save the Children’s 2012 Breastfeeding Policy Scorecard—which ranks countries based on whether they have policies that promote and support breastfeeding—in large part because it doesn’t guarantee any paid maternity leave after the birth of a new child. The lack of such a policy is especially regressive, given that women and mothers in the United States are increasingly likely to be their families’ breadwinners or co-breadwinners.
While some critics argue that paid family leave would be too costly for businesses and for Americans, not guaranteeing families this right is also costly. If women are allowed to take paid leave after the birth of a child, it is more likely that they will breastfeed for a longer period of time, which has health benefits for both children and mothers. The United States would save an estimated $13 billion annually in health care costs if 90 percent of mothers breastfed exclusively for six months. It would also save the lives of an estimated 1,000 babies.
American lawmakers have also failed to adopt any laws that might regulate the marketing and promotion of breast-milk substitutes such as formula, leaving the United States even further behind other developed nations that have such policies in place to discourage mothers from using substitutes too soon after the birth of a child. The Affordable Care Act helped make breastfeeding counseling and supplies available at no extra cost by covering them in health care plans, and it mandated that businesses with 50 employees or more allow women to have breaks and private spaces for pumping.
At the other end of the spectrum are countries such as Germany, Poland, and Portugal. These three countries support women who are back in the workforce but still breastfeeding by guaranteeing an hour or more of paid time daily for nursing breaks. Other nations guarantee the time to pump but do not protect the worker’s pay, meaning that the time taken to pump is unpaid. In the United Kingdom, national programs and initiatives educating expectant moms on the benefits of breastfeeding and supporting them postbirth have increased the relatively low rates of breastfeeding that the nation has had historically. France’s lack of data on breastfeeding has been a more difficult problem to navigate, although smaller studies have highlighted the importance of providing prenatal breastfeeding information to prospective mothers.
While there is a role for public-health advisories and suggested guidelines on breastfeeding in the United States, policymakers must do more to make sure that all women have equal access and economic support to act upon their inclinations. If a woman risks exacerbating her pay gap—or worse, her paycheck and employment completely—the myriad and long-term health benefits of breastfeeding for both mother and child will be negligible.
To make breastfeeding a choice that each woman is able to make, we must also make it an economically viable option for all of them. Developed nations such as the United States should be leading the way in setting an example for modern, equitable policies that support women and families. Unfortunately, we still have a long way to go.
Jane Farrell is a Research Assistant at the Center for American Progress.
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