Month: August 2020

The Case for Paid Leave in the United States: Brittany’s Story

Our latest report, Qualitative Paid Leave Report 2020: Furthering Our Case for Paid Leave in the United States, is based on a study we commissioned to examine how lack of paid leave affects the well-being of new mothers and their babies, particularly women working in low-wage jobs, and to amplify the experiences of low-wage working mothers in their own words. By interviewing and surveying 20 women in five states that did not require workers to have access to paid leave, we learned about how mothers navigate the experiences, demands and joys of motherhood. Brittany was one of the study participants. She offered to share her story.

My name is Brittany Harvey, and this is my story about navigating pregnancy and having a baby as a low-wage worker. My baby, Damon, is almost a year old now, and his sisters – my nine-year-old daughter, Aubrey, and my 11-year-old stepdaughter, Kayleigh – are the absolute best big sisters any brother could ask for. Being a mother is the greatest accomplishment of my life and I wouldn’t trade it for anything in the world. But access to paid leave complicated our family’s situation and endangered my baby’s life. Things could have been so different if Dan and I could have cared for Damon without the pressures of work and finances those first few months of Damon’s life.

We were pretty excited when we first found out I was pregnant. I had a miscarriage the year before, so Damon was our rainbow baby. My husband, Dan, and I weren’t actually trying to have a baby at the time I got pregnant with Damon, so we were not prepared financially. We didn’t have any savings, and my husband’s income working flag hours as a technician is pretty spotty. My income was the money we could count on, but as I would soon find out, my job wasn’t as understanding about my pregnancy as I hoped. If I hadn’t found a job with paid leave, we could have been facing homelessness.

Four months into my pregnancy I was diagnosed with Symphysis Pubis Dysfunction and was in pain all the time. Damon was heavy – 10 pounds when he was born! – and he sat right on my pubic bone. Some days I felt so sick I couldn’t get up, and other days I was in so much pain I couldn’t walk. I worked as a banker for most of my pregnancy, but they did not offer paid leave, and I used up all my sick time and vacation time staying in bed and going to doctors’ appointments. I knew I would need at least six weeks after Damon was born to recover and care for him, so at seven months pregnant I found a new job in the Kansas State driver’s license office, and they offered me six weeks paid maternity leave. I still can’t believe they hired me that late in my pregnancy!

Damon ended up breached and I had a C-section. When I first came home from the hospital, I was so swollen from the anesthesia and other medications that I could not get off the couch without help, let alone take care of my brand new baby. I was already in so much pain because of my c-section, and on top of that I couldn’t walk because my legs were so swollen. Thankfully, my husband was able to get the first whole week off work. At the end of that week, still swollen and unable to care for Damon, I went to the hospital where they gave me medicine that reduced my swelling but made my breast milk dry up. If my husband could have stayed home a little longer, the swelling would probably have gone down on its own, and I could have breastfed my baby. Breastfeeding is healthier, cheaper and easier. I cried a lot after that, because I’m his mother and I’m supposed to provide that for him, and I couldn’t. But I didn’t have a choice.

When I went back to work, I found a daycare in my neighborhood run by the mom of my daughter’s friend. My daughter was four years old when she told me about the abuse that was happening at her daycare, so I was happy to find someone I could trust to care for Damon. Everything was fine, we thought. But then Damon’s doctor said he wasn’t gaining weight. Damon was spitting up a lot, so we changed formulas and put him on medicine, which helped tremendously. Three weeks after he started taking the medicine, COVID happened, so he stayed home with us. A month later, his doctor said he was back on track. When I went back to work Damon went back to daycare, and every time I’d hand him to the daycare provider he would cry and scream. When I would feed him dinner, he’d eat it savagely. My gut told me something was wrong, so I put in my two weeks at my job, and I took Damon out of daycare. When Dan picked up Damon’s stuff, he looked inside the can of formula that we had given the daycare provider at least a month before, and it was barely touched. We think she wasn’t feeding him because he was spitting up, and maybe because he wasn’t holding his own bottle and she didn’t have time to sit with him while he ate. Whatever the reason, Damon had been starving, and if it weren’t for a pandemic that forced us all home, we may never have known.

Today Damon and I are doing great. I still have pubic pain if I sit down for too long or exercise too much, but if I stretch and move around, it doesn’t hurt as bad anymore. During my final two weeks of work, I figured out a way to pay off our credit cards by getting a debt consolidation loan. Not paying for daycare also helps, and I’m working as a driver for Door Dash to generate some extra income. It’s less money than I was making, so our finances are very questionable. We are taking it one day at a time. I’m grateful for the paid leave I had, but I think, realistically, women need at least eight weeks, and that’s with a natural birth without complications. With Damon, I struggled to take care of him for two full months after my C-section. More paid time off work, for both my husband and me, would have made a world of difference in caring for Damon, especially being able to breastfeed him and ensure he was getting the food he needed.

I’m so thankful and blessed to have the ability to stay home with Damon now. Still, living paycheck to paycheck, not knowing if my husband’s income will be enough to cover the bills, is incredibly stressful. In an ideal world, paid leave would last at least three years, long enough for my child to have the ability to tell me about what’s going on in daycare. Without more paid leave, my options are to get a full-time job to relieve financial stress and put my baby in daycare where he could be harmed and can’t advocate for himself, or stay home and know he is well cared for but struggle to pay bills. Being a parent shouldn’t have to be like this.

For more about the report, our work with paid leave and how you can help, visit here.

Furthering Our Case for Paid Leave in the United States with Real Stories

Our latest report, Qualitative Paid Leave Report 2020: Furthering Our Case for Paid Leave in the United States, is based on a study we commissioned to examine how lack of paid leave affects the well-being of new mothers and their babies, particularly women working in low-wage jobs, and to amplify the experiences of low-wage working mothers in their own words. By interviewing and surveying 20 women in five states that did not require workers to have access to paid leave, we learned about how mothers navigate the experiences, demands and joys of motherhood.

 Overall, the participants in the study grappled with the following experiences:

  • Navigating work schedules, including leave and flex time policies.
  • How the women perceived that work was impacting both mothers’ and babies’ nutrition and feeding, health care and childcare.
  • Changes in the women’s original plans of working (both during their last trimester of pregnancy and postpartum), and why these changes occurred.
  • The impacts these changes had on the women and their families.

This report is complementary to our 2019 report, The First 1,000 Days: The Case for Paid Leave in America. It adds human voices and experiences to a vital policy issue. Examining 20 case studies, we unearthed moving stories that are representative of the trends discovered in our 2019 report.

For more about the report, our work with paid leave and how you can help, visit here.

Imbued With Nutritional Riches: A Black Woman’s Breastfeeding Journey

We know the statistics. We’re familiar with the trends. The organizational one-pagers, mission statements and excerpts already exist. Still, even with a wealth of information within reach, most discussions about breastfeeding rates among Black women tend to overlook evidence-based research, lack cultural competence and ignore our lived experiences altogether.

On the other side of the rainbow, there’s Black Breastfeeding Week, which culminates National Breastfeeding Month each year, where our firsthand narratives are highlighted and celebrated. We raise awareness to #ReviveRestoreReclaim Black women as nurturers who have nourished a nation forward, one latch at a time.

This is my story…

Hand in hand, my husband and I journeyed happily toward parenthood. We marveled as the two of us evolved into Mom and Dad. My husband had the grand idea that we should wait until the delivery to find out the sex of our baby and I was all in after confirming that he wasn’t just trying to save money by skipping out on a gender reveal party. For Baby Mitchell, as we affectionately called our growing child, there were four things that I looked forward to most:

  1. That s/he be a healthy, happy baby
  2. That I have the honor of being the one who teaches my baby to read
  3. That s/he gets to visit Walt Disney World during the early years
    I was born and raised in Orlando, Florida — This is a necessary rite of passage!
  4. That s/he breastfeeds for at least the first year!

Oh, I read just about every published article, Pinterest post, comment board and paperback book in preparation for this great journey. My husband and I signed up for classes, watched endless video tutorials and sifted through the web to find a lactation consultant who could provide postpartum support and assistance, if needed. I even chose a Baby-Friendly hospital to birth my child.

Well, the time had come and after 47-hours of labor, my darling son was delivered at 8:02 a.m. on Christmas Day. He latched shortly thereafter and I was delighted as my body produced a gratuitous supply of colostrum. My little baby seemed to love it and appeared to be receiving just the right amount despite his somewhat-shallow latch at the time. No worries, I thought! This base was covered because upon admission to the hospital, I requested a one-on-one with the lactation consultant though she hadn’t yet met with me. Also, I had already roped in the nurses who were said to be the best at early initiation of breastfeeding, too… Though, none of them ever got around to visiting with me either.

What I received was an electric breast pump and an instruction manual no more than 6-hours postpartum along with endless questions asking “Enfamil or Similac” with the implied notion that my newborn would need one of the two. This was followed by explicit statements indicating exactly what I perceived to be true: Reportedly, my son required infant formula.

I was perfectly capable and wanting to breastfeed but vulnerable and exhausted having just given birth and actively dissuaded by the medical team. Why was this happening? My baby appeared to be well-fed, plus I had already stated my desire and unwavering commitment to nursing. Still, I was being deterred and robbed of the early, critical support that was needed. Now if this were a lone narrative, I could live with that and walk away knowing it was nothing more than an unfortunate encounter with medical professionals who would’ve rather been home on Christmas Morning than at work dealing with a persnickety first-time mom. Shared narratives from a wide range of close mommy friends, though, proved this to be more than just an anomaly or “a few bad apples” scenario. This was a pattern!

To read the full story, visit: https://bit.ly/3ljP672


Denys Symonette Mitchell is the Policy & Advocacy Advisor at 1,000 Days and the Founder & Principal of Symonette Strategies & Solutions, LLC, a health policy and strategic advocacy consultancy.  She is also the co-owner and second shooter of M3 | Mitchell Media & Marketing, LLC where she captures life’s candids and memorializes moments with still images.  Denys resides in Prince George’s County, Maryland with her husband and their infant son.

Breastfeeding-Related Bills We Support in the 116th Congress

Here at 1,000 Days, we understand that success in breastfeeding is everyone’s responsibility. In celebration of National Breastfeeding Month and this year’s theme, Many Voices United, we’ve pulled together a short list highlighting the breastfeeding-related bills we support because we know increased breastfeeding support is multifaceted and multisectoral. It envelops a wide range of environments from birthing spaces to places of work and even the halls of Congress. We believe these bills will improve policies and increase investments to enable more women to reach their breastfeeding goals.

Federal Nutrition Programs

H.R. 6811 / S. 2358, the Wise Investment in Children (WIC) Act

  • This bill would increase the age of eligibility for children to receive benefits under the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program to two-years postpartum when the infant is still breastfeeding.

Access to Quality, Comprehensive Health Care

S. 3443, the Improving Coverage and Care for Mothers Act

  • This bill would authorize Medicaid to extend coverage of services provided to include lactation consultants. As the bill highlights, a lactation consultant is a health professional trained to focus on the needs and concerns of a breastfeeding mother and baby; and prevent, recognize and solve breastfeeding difficulties.

Pregnant and Postpartum Women in the Workforce

H.R. 5592 / S. 3170, the Providing Urgent Maternal Protections (PUMP) for Nursing Mothers Act

  • This bill would expand access to breastfeeding accommodations in the workplace. Amending the Fair Labor Standards Act of 1938, in the case of an employee who is compensated on an hourly basis (wage workers), the employer will be made to compensate the employee for a reasonable break time, if the employee is not entirely relieved from duty during the break.

Health Equity

H.R. 6142 / S. 3424, the Black Maternal Health Momnibus Act

  • This bill would fill gaps in existing legislation to comprehensively address every dimension of the Black maternal health crisis in America by making critical investments in social determinants that influence health outcomes. It would also establish grant programs to increase the number of perinatal health workers – including lactation consultants and nutritionists – who offer culturally congruent support.

Paid Family and Medical Leave

H.R. 1185 / S. 463, the Family and Medical Insurance Leave (FAMILY) Act

  • This bill would provide comprehensive paid family and medical leave to all workers in the United States. Categorically recognizing paid leave as a public health imperative, this bill has the potential to transform the lives of moms and babies. As research shows, paid leave supports breastfeeding initiation and duration in a number of ways. For example,  a mother is more than twice as likely to stop breastfeeding in the month she returns to work compared to a mother who has not yet returned to work.

Of Special Note

S.Res. 683: A resolution recognizing World Breastfeeding Week and National Breastfeeding Month to support policies and funding to ensure that all mothers can access a full range of appropriate support from child care and health care institutions, health care insurers, employers, researchers and government entities, in order to reach her breastfeeding goals.

Reflections on the United Nations Draft Global Action Plan on Wasting

Today, an estimated 7.3% (50 million) of all children under five suffer from wasting at any given time and less than 1 in five of them are receiving treatment. In an effort to realize the Sustainable Development Goal (SDG) target of reducing the proportion of children suffering from wasting to <3% by 2030, five UN agencies[1] are developing an updated plan to more effectively prevent and treat child wasting. On March 9, 2020, these agencies released a Global Action Plan (GAP) on Child Wasting. Here, Dr. Steve Collins provides his initial reflections on the GAP. The UN agencies are expected to release a more action-oriented ‘Roadmap for Action’ in late 2020.

Key Points:

  • We have failed to address wasting at a global scale and the coverage of interventions remains extremely low.
  • The GAP attempts to address this failure by moving away from a central focus on treating wasting, to a larger emphasis on prevention.
  • Though he agrees that measures to address wasting should be more holistic and include both prevention and treatment, Dr. Collins argues that the failure to address wasting doesn’t mean that our strategy so far is wrong, just that our system failed to adequately implement it:
    • Global nutrition stakeholders have consistently under-prioritized wasting.
    • The way we deliver treatment to wasted children is not fit for purpose and has evolved little in decades.
  • The GAP is unfocused and provides no vision of how the wide variety of different actors and sectors, in particular the private sector, can be included and harnessed in practical action. Without a clear vision of how this can happen, he fears that little will change and the GAP will be little more than “business as normal”.
  • By ignoring the massive implementation failures at the heart of the system and instead focusing on strategy, the draft GAP fails to grasp a critical opportunity for reform.

Key recommendations for the Roadmap for Action:

  1. Narrow the geographic scope: preventative interventions should be tightly targeted to communities and individuals at the highest risk of wasting, rather than spread homogeneously across the developing world, as this plan appears to suggest.
  2. Implement targeted reform: Instead of fundamentally changing the strategy and massively broadening the range of interventions, focus on fixing what is manifestly wrong with the way we intervene, the coalitions of stakeholders with whom we engage, and the products we use.
  3. Focus on fundamental research: Direct limited research dollars to addressing the most foundational issues first: expanding coverage, increasing impact and improving cost-effectiveness.
  • The research agenda must acknowledge that extremely low coverage is the main factor limiting impact and answer the question: “How do we deliver support to the greatest numbers of children in the most cost-effective manner possible?”
  1. Fully engage both the public and private sector:
  • Private sector: leverage the private sector’s scale, capability and capacity along the entire chain of service delivery, up to and including last-mile delivery to those suffering from wasting.
  • Public sector: focus on ensuring that the services delivered meet the needs of those affected by wasting by improving targeting, transferring entitlements to ensure equitable coverage, and imposing ethical standards to prevent exploitation.

Key Quotes:

  • “The fact that our interventions have failed to attain an acceptable level of coverage is not, per se, evidence of a flawed strategy. It is merely an observation that we have failed. In my opinion, our collective failure to address wasting at scale is not primarily a strategic issue, but rather a failure to execute the existing strategy effectively, and it is a severe indictment of the system charged with doing this.”
  • “We still engage too little (if at all) with affected communities to ensure that interventions are understandable, acceptable and appropriate for them. The market for nutritional products targeting wasting remains non-transparent and dysfunctional, dominated by a single supplier and single customer that is also the de facto market regulator.”
  • “Is ‘focusing’ resources on several billion people who require clean water, better sanitation, universal healthcare, improved food systems and more appropriate nutritional behaviours a cost-effective way to help more than 50 million children affected by wasting each year? I do not think it is and I believe that, by casting the net so widely while ignoring key structural issues that undermine implementation, the plan inevitably turns into an unrealistic wish list.”

[1] The five agencies are United Nations Children’s Fund (UNICEF), World Food Programme (WFP), the World Health Organization (WHO), the Food and Agriculture Organization (FAO) and the United Nations High Commission for Refugees (UNHCR)

As WIC Adapts, Pregnant Women and New Parents Need Congress to Act

As nutrition and public health professionals, we see the direct impact of the COVID-19 pandemic on families in the 1,000-day window. In this time of incredible uncertainty, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides crucial nutrition and breastfeeding support for pregnant and postpartum women, babies, and young children to age five. Since March 2020, WIC providers around the country have adapted in record time to shift the way they serve families by transitioning from in-person to remote and safe services.

Families are not only dealing with the stress of the pandemic while caring for children but also struggling with job losses and lost income. Every day, new families turn to WIC for support, and today clinics have the option to onboard these families by phone or other remote means.

With the everyday concern families feel about risk of COVID-19 exposure, Congress granted the U.S. Department of Agriculture (USDA) new authority to waive in-person requirements for WIC providers through the end of September 2020. This flexibility has allowed clinics to continue providing vital nutrition, health, and social services to pregnant women and new parents, while keeping WIC families healthy and safe.

Despite the success of these measures, they are currently set to expire at the end of next month. As infection rates continue to climb and states adjust or modify their reopening plans, WIC providers need these flexibilities extended well into 2021. We should not rush to open in-person services until it is safe to do so for both WIC families and clinic staff.  

1,000 Days urges Congress to extend WIC waiver authority until at least September 30, 2021. This will ensure that WIC continues to provide safe and critical support to help families have the healthiest first 1,000 days.

1,000 Days Submits Comments to USDA and HHS on the 2020-2025 Dietary Guidelines for Americans

For the first time ever, the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS) issued guidelines addressing the specific nutrition needs of babies aged 0 to 24 months. In response, 1,000 Days submitted comments emphasizing the importance of exclusive breastfeeding for the first six-months of a child’s life as well as recommendations for complementary foods and healthy drinks for toddlers. Our comments are based on specific, evidence-based research in the fields of neuroscience, biology, and early childhood development to provide powerful insights into how nutrition can shape future outcomes.

For the full comment letter, click here.

Nutrition’s Power 4 and Pandemic Response

By Emma Feutl Kent, Global Policy and Advocacy Manager, 1,000 Days & Karin Lapping, Nutrition Technical Director, FHI Solutions

Last week, a new article in the Lancet medical journal painted a stark picture for us: in the coming months, disruptions to food and health systems caused by the COVID-19 pandemic are projected to cause 6.7 million additional cases of child wasting. Kids who are severely wasted are 12 times more likely to die before their fifth birthday compared to healthy children.

Unfortunately, this projection represents only a fraction of the overall malnutrition-related death toll COVID-19 is likely to cause. Add these additional deaths to the 3.1 million children who already die of severe malnutrition each year – a number larger than the entire population of Chicago – and you have the makings of a global health disaster that may be more deadly than the pandemic itself.

Worse still, the destruction of this malnutrition epidemic will go far beyond the astronomical death toll. For young children, even a short bout of malnutrition can change the fundamental architecture of their brains and have devastating lifelong consequences including susceptibility to illness, disease, and stunted cognitive development. The indirect effects of this pandemic risk the lives and potential of an entire generation.

Now, more than ever, it is critical that we act quickly to implement a targeted package of preventative and curative essential nutrition interventions:

  1. Supplying all pregnant women with prenatal vitamins;
  2. Supporting breastfeeding mothers;
  3. Continuing large-scale Vitamin A Supplementation; and
  4. Providing lifesaving therapeutic foods to wasted children

These four interventions are especially critical today because they are cost effective, backed by research, and implementable at scale. COVID-19 has disrupted the health systems that often deliver these interventions, and it has become much more challenging to access the populations they serve. Fortunately, every day practitioners are finding new and innovative ways to deliver these services in the complex context of this global emergency.

Here is why they are each so critical:

Prenatal Vitamins: supplying pregnant women with a full dosage of multiple-micronutrient supplements (MMS) protects mothers from pregnancy complications and significantly increases the chances a baby will be born at a healthy weight and survive to his or her second birthday.

Supporting Breastfeeding: Babies get the best start at life when they consume nothing but breastmilk until they are 6 months old, and continue breastfeeding until they are 2 years old. On top of improving a child’s lifelong health and cognitive ability, breastfeeding also protects infants from illness and disease, which is especially critical in the midst of a pandemic. This is why the United Nations recommends mothers continue to breastfeed, even if they are sick with COVID-19. In the midst of the global emergency, breast milk is also, importantly, both a sanitary and low-cost way to feed infants.

Vitamin A Supplementation: Supplying a child with two high doses of Vitamin A every year is one of the most cost-effective ways to protect children from blindness, diarrhea, and other fatal illnesses. Traditionally, Vitamin A supplementation is delivered along with routine vaccination efforts. In many areas, experts have recommended that Vitamin A supplementation be temporarily suspended during the pandemic due to the nature of how it is administered. It is critical that supplementation efforts resume as soon as it is safe to do so.

Therapeutic Foods: Some children who lose a dangerous amount of weight become wasted and require treatment through an energy-dense product called Ready-to-Use Therapeutic Food (RUTF) to stay alive. Though the first priority of any nutrition program should be to prevent children from ever becoming malnourished, the pandemic has dramatically increased the number of children who are wasted. Even before COVID-19, the coverage for this essential service was much too low, with less than a quarter of children with even the most severe cases receiving treatment. By pre-positioning stocks of RUTF in places that are projected to suffer the most severe impacts, countries can avoid stock-outs during critical times.

Not only have the interventions on this list been highlighted by USAID and the four largest United Nations hunger-fighting organizations as essential to our global response to malnutrition in the COVID-19 context, but investing in these interventions will also pay dividends for years to come. Around the world, leading scientists and economists have consistently demonstrated that global nutrition interventions are some of the most successful, cost-effective, and scalable development investments, yielding up to $35 in economic returns for every $1 spent.

The United Nations has announced that a minimum of $2.4 billion dollars is needed immediately to roll out an initial package focused largely on these four lifesaving interventions. If we do not act now to roll out this largely prevention-focused emergency package, the cost will be significantly higher down the line.

As the development community responds to the global impact of COVID-19, we cannot allow the emerging and concurrent malnutrition pandemic to be overlooked. The stakes are too high. For the sake of the children whose lives are at risk today, and the entire generation that risks losing out on tomorrow, these interventions are of the utmost importance.

1,000 Days, Bread for the World and CARE Statement to the Candidates for Federal Office

Now more than ever, the political parties and candidates for office must focus on highly effective, science-based solutions to heal a sick country, and must make the difficult decisions to lift up the strategies with the highest return on investment. We have demonstrated that the best bet for investments that will show immediate impact, as well as future growth and prosperity, is one game-changing moment: the 1,000-day window. 

The first 1,000 days between a woman’s pregnancy and a child’s 2nd birthday are a time of tremendous potential and enormous vulnerability. Research in the fields of neuroscience, biology and early childhood development provide powerful insights into how nutrition, relationships, and environments in this window shapes future outcomes. It is why several of the world’s leading economists have called for greater investments in the nutrition and well-being of mothers. With millions more people facing economic crisis as a result of the coronavirus pandemic, now is the time to ensure moms and babies have what they need to thrive – so that we all may thrive, too. 

Specifically, we call on the candidates to include the following policies that:

  • Strengthen and improve federal nutrition programs for all moms and babies who need them;
  • Secure federal paid family and medical leave, enhancing millions of lives;
  • Provide all moms and their young children access to quality, comprehensive health care;
  • Create the environments for all moms to meet their breastfeeding goals; and
  • Invest in the nutrition and well-being of mothers, infants and young children around the world, to curb severe malnutrition and avoid preventable child deaths.

The right investments, the right returns.

From India to Indiana, Kenya to Kentucky, mothers and children everywhere need good nutrition and nurturing care in the first 1,000 days in order to thrive.

Yet too many women and children in the U.S. and throughout the world do not get the food, health care or support they need during this pivotal moment that sets the foundation for all the days that follow. The consequences are often devastating. Globally, hundreds of millions of young children fail to reach their developmental potential, while millions more die every year as a result of malnutrition.

In the U.S., as in many other parts of the world, there are profound health disparities that contribute to unacceptably high maternal and infant mortality rates. And when we fail to nourish strong beginnings, we all feel the consequences—from persistent poverty and worsening inequality, to higher health care costs and weaker economies.

While the roots of malnutrition, disease, stunted development and inequality are often found in the first 1,000 days, so is the opportunity to build healthier and more equitable futures for children, women, their families and societies.

The time is now.

1,000 Days, Bread for the World and CARE, call on the candidates to include in the Party Platform the following policies and programs:

Invest in Federal Nutrition Programs

Too many moms and babies in the U.S. cannot access good nutrition. One out of six households with children under age 6 is food insecure, and one in five infants and toddlers under age 2 lives in poverty. Sadly, these numbers are on the rise as families struggle to cope with the economic fallout of the coronavirus pandemic, and families of color, low-income families, and single-parent households are particularly at risk. Federal nutrition programs play a critical role in helping all families get the nutrition and support they need to thrive, especially during times of hardship.

The Supplemental Nutrition Assistance Program (SNAP) provides nutrition assistance to help protect families against food insecurity. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides nutritious foods, nutrition education, breastfeeding support and health care referrals to low-income women who are pregnant or postpartum, infants and children under age 5. Investments in these programs must be protected and expanded to help ensure that all families in America can thrive. 

Research shows that SNAP is effective in reducing food insecurity and leads to more regular access to food. It leads to improved birthweights, lower risks of developmental delays and better health, and it significantly reduces child poverty. Furthermore, the benefits of SNAP are long-lasting: when young children have access to SNAP, they have better health and improved economic self-sufficiency as adults.

WIC is one of the nation’s most successful and cost-effective nutrition intervention programs.

Research has shown that WIC reduces preterm and low birthweight births; reduces fetal and infant deaths; improves diet quality and nutrient status; increases access to prenatal care in early pregnancy; and saves health care costs.

The Party Platform must affirm its commitment to supporting and strengthening federal nutrition programs, including SNAP and WIC.

Support Paid Leave

The Policy Platform must include a comprehensive paid family and medical leave policy to support optimal child development, improve maternal health, reduce disparities, and enable future generations to live healthier lives.

Unlike in most other countries, in the U.S., parents are often unable to take time off from work to care for a new child, critically ill loved one, or tend to their own medical needs without sacrificing the income they need to support their families. This has profound and lasting impacts on maternal and child health in the United States. Because pregnancy, childbirth and the transition to motherhood can be physically and psychologically demanding, women need time to care for themselves and their health. Paid leave is a critical tool to support healthier pregnancies, better birth outcomes, more successful breastfeeding as well as both physical and mental health in the postpartum period. Additionally, inclusive and comprehensive policies can reduce the inequities in access to paid leave, helping to bridge the racial and ethnic disparities in overall maternal and child health outcomes.

Beyond allowing for physical recovery after childbirth, paid time off from work is essential to providing a strong foundation for mom, baby and their family to thrive. Science tells us that babies’ brains are nourished by time spent with parents and caregivers. Policies that enable parents to spend time nurturing and caring for their babies—particularly in the early weeks after birth and for babies that are born pre-term, low birth weight or with illness—are critical to the healthy cognitive, social, and emotional development of children.

For paid leave to have the kind of impact that will drive improvements to maternal and child health and child development, the policy must: 

  • Provide sufficient time off: Workers need access to a minimum of 12 weeks, but ideally 6 months (24 weeks), of paid leave annually to support the health and wellbeing of moms, children and their families.
  • Cover all employers and all workers: Policies must be inclusive of all workers to ensure they can care for themselves or a loved one. Paid leave must be available to all workers regardless of the size of their employer, the sector they work in, the length of their employment or whether they work full-time, part-time or are self-employed.
  • Ensure equitable economic security now and in the future: Workers should not have to decide between their health or caregiving responsibilities and their job. In addition, workers must retain the right to resume full paid employment after taking leave without fear of discrimination or retaliation. Policies must ensure that taking leave now does not threaten workers’ current or future economic security. 
  • Cover medical and family caregiving needs comprehensively: Any plan should be available for the full range of personal medical and family caregiving needs, such as those already established by the Family and Medical Leave Act (FMLA).

Support Pregnant and Postpartum Women in the Workforce

The Party Platform should include protections for pregnant workers and ensure that they cannot be discriminated or retaliated against for seeking appropriate accommodations.

The care and support a woman receives during her pregnancy has a profound impact on her health and on her child’s health. However, too many women—particularly low-income women and those who work in physically demanding occupations—are put in the impossible position of having to risk their health and their pregnancy in order to continue working so they can pay their bills and put food on the table. When workers are unable to receive necessary accommodations at work or are obligated to forgo their salary during pregnancy, the risk of pregnancy complications increases. Similarly, when pregnant women are pushed out of the workforce, their financial well-being and access to employer-provided health insurance and other benefits are compromised. This can have a long-term impact on a mother’s health and that of her child. 

There is bipartisan support for protections for pregnant workers and we strongly encourage the Party Platform to include a national standard ensuring these protections.

Support Access to Quality, Comprehensive Health Care

The Party Platform should include the mandatory extension of Medicaid from 60-days to 1 year following the birth of a child and authorize coverage of services provided by lactation consultants to focus on the needs and concerns related to breastfeeding. Additionally, coverage must be comprehensive and not limited to pregnancy-related care. This will ensure that women can maintain their insurance and choice of health care providers in order to access their postpartum services.

The protections and support for women must extend beyond pregnancy as significant research has shown the lifelong impacts of co-morbidities during childbirth. Postpartum health care is an opportunity to assess a woman’s physical recovery from pregnancy and childbirth and to address: chronic health conditions, such as diabetes and hypertension; mental health status, including postpartum depression; and family planning. It is a time to provide support and services that she needs, including lactation support. In order for a child to thrive during their first 1,000 days, they need their mother to be supported in her recovery during this period, too. 

Invest in Telehealth & Implicit Bias Training to Improve Maternal Health Crisis

The Party Platform must comprehensively address the maternal health crisis in America to reduce the number of pregnancy-related deaths among Black women.  Too many Black women do not make it to the postpartum period and many more will never see the 1,000-day window as they are two to three times more likely to die from pregnancy-related causes than White women.  

Unlike many other health disparities, Black maternal mortality cuts across zip codes impacting all socio-economic statuses.  Studies have found that implicit bias is one of the main drivers of the unintentional deaths of which 60 percent are preventable, according to the CDC.  Research shows that Black women receive a lower quality of care than White women and that they are treated differently even when they present with the same symptoms, receiving fewer diagnostic and therapeutic interventions and less pain medication, too, even following cesarean deliveries.  In congruence with their peers, Black women should receive health care that is culturally competent and of the highest quality.  Investments in implicit bias training for medical practitioners would help to identify and address this pervasive issue in health care, which would improve patient-provider interactions, health communication and, ultimately, health outcomes.  

Additionally, investment in telehealth would reduce maternal mortality by expanding access to care in underserved areas with high rates of maternal mortality and severe maternal morbidity.  Almost 65,000 Black women die from pregnancy- and childbirth-related causes each year.  These near-misses have lifelong consequences for women’s health, resulting in higher utilization of health services, higher direct medical costs and the need for long-term rehabilitation, including mental health services.  Telehealth could have a particular impact by expanding remote patient monitoring throughout a woman’s pregnancy and during the critical postpartum period.  

Invest in Global Nutrition

The party platform should prioritize global nutrition as a key component of its global health strategy and increase funding for the nutrition sub-account within the global health account at USAID. Severe malnutrition is the number one killer of kids under age 5, killing more children every year than AIDS, Malaria, and Tuberculosis combined and afflicting many of those children who survive with lifelong illness and impaired cognitive development. Around the world, leading scientists and economists have consistently demonstrated that global nutrition interventions are some of the most successful, cost-effective, and scalable development investments, yielding up to $35 in economic returns for every $1 the U.S. spends. 

Yet, despite these strong incentives, nutrition remains drastically underfunded, receiving less than 1% of official development assistance funding. Severe malnutrition stunts potential and wastes lives, but it does not have to. Scaling up proven nutrition interventions will allow children around the world to escape these preventable deaths.

Malnutrition has many root causes, including poverty, lack of education, erratic seasonal crop cycles, climate change, women’s inequality, and poor access to water, sanitation, and hygiene. As the world works to tackle these major challenges, which will help end child malnutrition in the long-term, there are four essential actions the U.S. can take now to prevent children from dying of severe malnutrition:

  • Supply all pregnant women with prenatal vitamins, especially multiple-micronutrient supplements (MMS);
  • Support breastfeeding mothers through one-to-one and group breastfeeding counseling;
  • Continue bi-annual Vitamin A Supplementation, especially in conjunction with large-scale vaccination campaigns;  
  • Expand coverage of specialized foods for treatment including by prepositioning Ready-to-Use Therapeutic Food (RUTF) in vulnerable communities in anticipation of a dramatic rise in cases of wasting as a result of COVID-19. 

The need is greater as we face a global pandemic.

Today, we are learning how COVID-19 disproportionately impacts women, girls and marginalized populations in the U.S. and around the world. Along with staggering mortality rates, the pandemic has led to soaring unemployment, giving rise to a new population at risk. Meanwhile, low-wage workers continue to serve their communities at the “new frontlines” of food service, home health aides, for example – putting themselves at risk without the guarantee of paid leave or health benefits.

In countries that offer more comprehensive support for families — like Germany, France, Canada and Sweden — a significantly larger proportion of women are in the labor force. Yet, in the United States, parents are often forced to choose between taking time off from work to care for their young children and earning the income they need to support their families. In fact, only a small minority of private sector workers in the U.S. — typically those who work in higher paid jobs — have access to paid leave. This means that many women return to work too soon after giving birth, putting their health and that of their infant at risk. Without a mandate for U.S. employers to offer paid leave, 81% of mothers receive no paid time off to care for their newborn child

As the world focuses on the containment of COVID-19, urgent action is needed to avoid the long-term and large-scale impacts on malnutrition and preventable deaths from the secondary effects of this crisis. We have long understood that increased undernutrition compromises immune systems, making bodies vulnerable to virus attacks and impeding recovery. People living with pre-existing medical conditions, and suffering from non-communicable diseases (NCDs, such as obesity, heart disease, type 2 diabetes, and some cancers), appear to be more at risk of developing severe COVID-19 symptoms and have higher mortality rate than other populations.

The COVID-19 pandemic has yet to be reported at scale in some of the most impoverished parts of the world. Government leaders are beginning to sound the alarm on the fragility of health systems, food systems, and economies in many low- and middle-income countries, which already face high rates of severe malnutrition.  COVID-19 will put vulnerable children and families at even greater risk of falling into the vicious intergenerational cycle of malnutrition, ill health, and poverty. For children in the first 1,000 days, even a short bout of malnutrition can have devastating lifelong consequences. The secondary consequences of this pandemic risk the lives and potential of an entire generation. 

In the short term, employment uncertainty, closing of schools, closing of borders, periods of isolation, and widespread sickness has implications for millions of people vulnerable to food poverty. As governments are responding to this health crisis, multi-sectoral nutrition and food security programs must be safeguarded to protect children and families vulnerable to malnutrition. Not only do we want to prevent a protracted nutrition crisis, but nutrition itself will play a role in recovery to help increase immunity and resiliency.