Category: U.S.

Addressing breastfeeding disparities across the United States

By Valentina Giraldo Lozano, intern at 1,000 Days of FHI 360

Breastfeeding provides a fundamental contribution to early childhood nutrition and health. However, in the United States its benefits are not experienced by everyone equally, as breastfeeding rates vary significantly by race and ethnicity.

The national breastfeeding rate in the United States is relatively high: about 84% of infants are breastfed at birth. But when broken down by race and ethnicity, we see drastic disparities: the CDC reports that, at birth, 92.7% of Asian infants and 86.2% of white infants are breastfed, with rates dropping to 81.9% for Hispanic infants, 78.4% for Indigenous infants, and 77.3% for Black infants.  Black, Hispanic, and multiracial parents are also less likely to breastfeed for the recommended six months, compared to the U.S. national rate.

Multiple factors contribute to these disparities, including access to healthcare, socio-economic status, cultural norms, employment and childcare challenges and systemic racism.

The disparity in support often starts at the hospital, with maternity care facilities serving Black populations being much less likely to offer lactation support. A long history of medical racism and targeted marketing of formula to Black mothers also plays a role in Black mothers not being supported to breastfeed by medical professionals.

Low breastfeeding rates may also be a reflection of negative cultural perceptions of breastfeeding and a lack of support from breastfeeding role models in a mother’s family and community. Peer counseling and support groups can significantly increase breastfeeding rates and provide quality information in a culturally sensitive manner.

Socio-economic status and your job type can also play a role. Many lower-income jobs do not provide workplace supports that would support sustained breastfeeding, such as access to the Family and Medical Leave Act (FMLA) or employer provided- paid leave, flexible work schedules, or support for breastfeeding or expressing milk at work. This forces lower-income women to return to work sooner than other women, cutting short their opportunity to establish breastfeeding routines.

Racial and ethnic disparities in breastfeeding rates have significant implications for health and for future social and economic outcomes. Suboptimal breastfeeding rates are associated with a greater burden of disease among Hispanic and Black populations: the rates of the ear infection acute otitis media and necrotizing enterocolitis (the most common and serious intestinal disease among premature babies) are much higher in Black and Hispanic children than white children, as is the number of excess child deaths.

Policies have real impact

Breastfeeding doesn’t happen in a vacuum – to be successful, families need supportive policies. New hard-won policies, like the PUMP Act and the Pregnant Workers Fairness Act, are significant steps in the right direction. But stronger support is necessary, especially for Black, Hispanic, and Indigenous women who face significant barriers to breastfeeding.

Federal and state governments must take decisive action to ensure that all mothers have the support they need to breastfeed their children. This includes enforcing comprehensive policies like the PUMP Act, extending paid family leave, and ensuring workplace accommodations for breastfeeding mothers. Raising awareness about existing disparities and advocating for stronger, more inclusive breastfeeding support systems is essential for achieving equitable health outcomes among all parents and children. Employers, policymakers, and community leaders must collaborate to create environments that support breastfeeding mothers.

This year, the theme for National Breastfeeding Month is Nourish, Sustain, Thrive. Nourishing, sustaining, and thriving means ensuring that all mothers, regardless of race or socio-economic status, have the support they need to breastfeed during the critical first 1,000 days. By addressing disparities in breastfeeding rates and advocating for robust, inclusive policies, we can promote the health and well-being of infants and mothers across diverse communities. The journey toward equitable health outcomes begins with every drop of breast milk, and it’s a journey we must all support.

Breastfeeding in the United States: Empowering Mothers Through Paid Leave

Solianna Meaza, Interim Initiative Director at 1,000 Days of FHI 360, bonding with her firstborn during maternity leave.

 

By Solianna Meaza, Interim Initiative Director at 1,000 Days of FHI 360

In recent years, the United States has made progress in recognizing the critical role of breastfeeding in infant health and development. Central to this progress is the support provided by paid leave policies, which empower parents who choose to breastfeed the time and stability to breastfeed their children and promote a healthier start to life.

The benefits and challenges of breastfeeding

Breastfeeding is widely acknowledged as the optimal nutrition for children, providing essential nutrients, antibodies, and bonding opportunities crucial for their growth and development. The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of life, with continued breastfeeding alongside complementary foods for at least one year.

But breastfeeding is not a one-person job, and it doesn’t just happen. It requires encouragement and support from skilled counselors, family members, healthcare providers, employers, policymakers and others.

One of the most common reasons that breastfeeding is stopped early is the necessity to return to work and/or the lack of support received in the workplace. In the U.S., 79% of babies are breastfed at one month. However, this rate drops drastically in the first few months of life and by 6 months, only about half of infants receive any breast milk and just 25% receive breast milk exclusively.

This dramatic drop in breastfeeding rates can be directly linked to our lack of paid parental leave.

Research shows that maternity leave is critical to enabling early, exclusive and continued breastfeeding. The World Health Organization states that establishing and maintaining exclusive breastfeeding requires that all working mothers have access to at least 18 weeks, and preferably 6 months or more, of paid maternity leave. Today’s reality is vastly off target: on average, new mothers in the United States take 10 weeks of maternity leave, of which four weeks are covered through paid sick or personal time, with the rest unpaid. Paternity leave is also crucial as a support to mothers in recovery and breastfeeding and to allow for bonding and transition. There, the U.S. lags too: the average leave of non-birthing parents is just one week.

As the only wealthy country without universal paid family or medical leave coverage, the U.S. is a global outlier on paid leave. The majority of American families are forced to cut short their recovery, transition, and bonding time, all of which is crucial to establishing breastfeeding and supporting child and maternal health. In addition to early cessation of breastfeeding, having scarce or no paid leave contributes to serious health burdens, including delaying babies’ immunizations. Without the stability of paid family leave, mothers have higher financial pressures and increased stress, which leads to increased rates of postpartum depression symptoms.

As awareness grows about the benefits of breastfeeding and the importance of paid leave, policies are slowly improving. There’s a growing number of states that offer mandatory paid family leave systems: thirteen states and Washington, D.C. now offer partial wage replacement to workers in businesses of all sizes, with an additional nine states having voluntary systems that provide paid family leave through private insurance. But most families in the U.S. remain unsupported, especially those in lower-income brackets or working in industries with less generous policies.

Paid leave policies are instrumental in promoting breastfeeding in the United States and are crucial for infant and maternal health. I was able to take advantage of paid maternity leave with my first baby and soon with my second. We at 1,000 Days support advocacy efforts and continue to push for policy changes at both state and federal levels. As we continue to advocate for comprehensive paid leave policies, we move closer to ensuring every child has the best possible start in life.

Nourishing, surviving, and thriving with breastfeeding

Breastfeeding gives babies the very best start to life—and benefits that reach far into the future. Breastmilk is nature’s perfect first food, tailor-made for babies providing all the nutrition including vitamins, proteins and fats that they need for the first six months of life. It also acts as a baby’s first vaccine, protecting them from common childhood illnesses.

Despite all the great benefits, both globally and across the United States, breastfeeding rates are low, risking malnutrition and disease for both mothers and babies.

As World Breastfeeding Week and National Breastfeeding Month begin, 1,000 Days celebrates the progress made to support families in breastfeeding their babies, while also recognizing the additional steps that need to be taken to truly support all those who chose to initiate and sustain breastfeeding.

This year, the theme for World Breastfeeding Week (August 1-7) is Closing the Gap: Breastfeeding Support for All. Globally, breastfeeding rates have increased by 10 percentage points over the past decade to 48%, nearly reaching the World Health Assembly target of 50% by 2025. However, despite the increase, wide discrepancies remain between individual countries; in some places, rates remain as low as 20%. The consequences of not breastfeeding can be deadly and lead to mass financial loss. Nearly 500,000 children and nearly 100,000 women die each year due to inadequate breastfeeding. These preventable deaths, combined with cognitive losses, and health system costs of inadequate breastfeeding leads to over US$570 billion in economic losses annually.

Here in the United States, most babies start out being breastfed, but the rates drop quickly and suddenly a few months into life when mothers return to work. Only 1 in 4 American babies is exclusively breastfed at six months of age, due in no small part to workplace barriers and a lack of paid maternity leave. We join with National Breastfeeding Month organizers the U.S. Breastfeeding Committee to honor the incredible work that organizations across the country are doing to make the world a little more friendly for new parents and families, and celebrate the following observances across the month:

We welcome you to join us this month to shine a light on why protecting, promoting, and supporting breastfeeding is so important. You can find our 2024 Inspiration Guide, featuring social media messaging and graphics, here.

Follow along on our Twitter/X, LinkedIn, Facebook and Instagram all month long!

Why new dads should take parental leave – lessons from my father

In the early 1990’s, my dad joined the first cohort of men to take part in Canada’s newly minted paternity leave program, a step so novel that it inspired a full-page newspaper spread and the now cringe-inducing moniker, “Mr. Mom.” Mr. Mom, aka Gordon Kent, took 6 months off work to stay home with me, while my mom returned to work. Now, 3 decades later, I’m fighting to grant the same opportunity to dads across the United States.

Despite strong bipartisan support for parental leave, the United States remains the only high-income country that doesn’t mandate any paid parental leave. The Bureau of Labor Statistics shows that only about a quarter of employees in the private sector workforce have access to paid family leave and 1 in 4 women return to work within 2 weeks of giving birth. For fathers, the numbers are even bleaker: fewer than 5 percent of American fathers take 2 or more weeks of leave.

Programs and policies that allow men to spend more time caring for their young children have numerous benefits for nutrition, child development, and women’s empowerment. After taking parental leave, men tend to share more equally in household labor even after they return to work. The skills men gain during their time at home have important impacts on both their children and their partners. Paternity leave is correlated with improved breastfeeding rates, better psychological health for children, reductions to the “motherhood penalty”, and new mothers who are significantly less likely to face physical and mental health complications. At a societal level, the knock-on effects of paternity leave can facilitate economic growth, shift gender norms, and help level the playing field for working mothers.

When I asked my dad why he chose to take paternity leave, he said that not staying home with his first child (and a second daughter when she came along) never entered his mind. As he put it, “how could I miss such an opportunity when I was so lucky to have it offered?” My father recalls our time together being “exhilarating, exhausting, and sublime.” While holding his baby, he says the last thing on his mind was whether he was falling behind at work.

For individual dads, the experience can be life changing. Research has shown that spending time looking after a baby rewires fathers’ brains to make them better caregivers. The more time they spend, the more their brain adapts. Paternity leave is key to giving dads the time to bond more deeply with their children in ways that will impact their relationship both immediately and in the years to come.

Equally important are the ways in which men’s involvement in childcare and other household tasks can alleviate the care burden that is often placed disproportionally on women. As my dad wrote at the time, “even though I’m on parental leave, it should really be classified as educational leave. I’m seeing first-hand a world traditionally dominated by women.” For him, the experience gave him both an appreciation for the challenges of caring for a family and the skills he needed to contribute more to household work. 

When my dad wrote about his time staying home with me, he closed his article by noting that “Emma probably won’t remember our time together, but it’s something I’ll cherish forever.” In that he’s partially right – I don’t remember our time together per se. But I believe it laid the foundation for a life-long closeness between us and that it created the bond with my dad that I value so deeply today.

The author, Emma, smiles as her dad embraces her and her baby son

1,000 Days Statement on FY24 Minibus

Washington, D.C., March 25, 2024 –  Last Friday, Congress passed a fiscal year (FY) 2024 minibus spending bill, which includes funding for some key U.S. foreign assistance accounts that combat malnutrition. We applaud the passage of this bipartisan bill, while recognizing there is still work to be done to ensure all families have a happy and healthy first 1,000 days.

1,000 Days was grateful to see a modest increase to the Nutrition Account, but was dismayed that overall State, Foreign Operations, and Related Programs funding levels fell short of FY23 levels. For the first time in history, annual deaths of children under 5 have dropped below 5 million, a staggering decrease from 1990 when nearly 13 million children under 5 died each year. While we celebrate this incredible progress, now is not the time to take our foot off the gas. Globally, there is still 1 child death every 6 seconds and nearly 1 in 4 children worldwide has had their growth stunted by malnutrition. U.S. global leadership has reached families across the world with low-cost, quality, and effective health services and continued commitment is needed to end preventable maternal and child deaths.

“Malnutrition is still the greatest threat to child survival worldwide. U.S. investments support delivery of cost-effective, proven, life-saving services in countries around the world and maintaining that investment is crucial”

Solianna Meaza, Acting Initiative Director, 1,000 Days

We look forward to working with the Administration and colleagues in Congress to strengthen our FY25 appropriations with stronger global investments, including:

  • $300 million in the Global Nutrition Subaccount;
  • $1.15 billion for Maternal and Child Health, including $340 million for Gavi; and
  • New and additional funding to support the United States’ flagship food security program, Feed the Future.

Improving the Health of Ourselves and Our Nation

By Minerva Delgado, Director of Coalitions & Advocacy at the Alliance to End Hunger

March is National Nutrition Month. While the first impression we may get from hearing this is interpreting it as a challenge that seems simple and straightforward, the truth is that we as Americans are not great at nutritious eating.   

The U.S. Department of Agriculture (USDA), through its Healthy Eating Index reports,…“average diets in the U.S. do not conform to dietary recommendations.” The CDC reports that only small percentages of American adults consume the suggested amounts of fruits (12%) and vegetables (10%) daily. Poor nutrition can contribute to illness and death. Poor diets have been associated with nearly half of deaths from cardiometabolic diseases in the United States.

Developing healthier eating habits, while important, can be really challenging. These challenges are only further compounded for low-income families. Low-income households face additional challenges and tend to have fewer resources, less time for food preparation, and less access to healthy foods. Federal nutrition programs provide an opportunity to mitigate these challenges and support healthier diets.

The USDA defines nutrition security as consistent and equitable access to health, safe, affordable foods essential to optimal health and well-being. Nutrition security has become an important goal of federal nutrition programs alongside the long-standing goal of food security. We know that nutrition and food security are intertwined – a person cannot achieve nutrition security if they are food insecure. Unfortunately, food insecurity has been increasing.  Food insecurity increased sharply in 2022 across all populations. Across our country, an estimated 44 million people, including 13 million children, were living in food-insecure households.

Fortunately, most food-insecure households can turn to federal nutrition programs. These programs form a necessary food safety net, providing access to food and improving nutrition, health, household finances, academic outcomes for children and productivity for adults. They also have broad societal impacts such as supporting farmers and retailers, reducing healthcare costs and increasing gross domestic product.

Two key programs are the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

SNAP is the largest federal nutrition program, with over 42 million people receiving a monthly shopping credit to be used at approved retailers including grocery stores, farmers markets, and online shopping. The size of the benefit depends on a variety of criteria, such as income and household size, and was recently raised to an average of approximately $5.45 per person per day.  This bump in the SNAP benefit was the result of a reevaluation of the Thrifty Food Plan, the basis of the SNAP benefit amount.

While the benefit is modest, it has a huge impact on program participants. SNAP helps families stretch their food budgets, putting nutritious foods within reach.  As reported by Center on Budget and Policy Priorities, “SNAP improves food security, offers benefits that enable families to purchase healthier diets, and frees up resources that can be used for health-promoting activities and needed medical care.” 

According to USDA, SNAP reduces the rate of food insecurity among participants by at least 30%, particularly among young children and the most food insecure families.  Participation in SNAP lays the foundation for greater nutrition security among participants. 

WIC differs from SNAP in specifically focusing on “nutritionally at-risk” mothers and children. In addition to offering health screenings and breastfeeding support, WIC families receive vouchers for foods meant to maximize healthy birth outcomes and child development.

WIC has demonstrated multiple nutrition and health benefits, including: decreasing fetal deaths and infant mortality; improving the growth of nutritionally at-risk infants and children; and significantly improving children’s diets. Children enrolled in WIC are more likely to have a regular source of medical care and up-to-date immunizations. WIC also prepares children for school by improving intellectual development.

National Nutrition Month is an opportunity to highlight the tremendous importance of these programs as we strive to improve the nation’s nutrition and health. It was great to see Congress recently invest an additional $1 billion in WIC to address growing need for this vital program.  Now Congress has another opportunity to help struggling families through continued protection of and investment in SNAP. We have the opportunity to use this month of action to not only look inwardly at our own nutritional choices, but also more broadly at what will make our nation as a whole healthier.

Understanding Nutrition in the First 1,000 Days: Black Moms and Birthing People

To improve our advocacy and nutrition education efforts, 1,000 Days strove to understand sources of nutrition information during the first 1,000-day window and gaps in culturally relevant communications about healthy diets. Through a combination of qualitative research methods, including surveys and an environmental scan, we listened to over 225 Black pregnant and birthing people about their perceptions of their health, when and how they received nutrition information related to their pregnancy, and their preferred sources of information.

1,000 Days Statement on Increased U.S. Infant Mortality Rates

At 1,000 Days, we are deeply concerned by the recent CDC data revealing an increase in infant mortality in the United States for the first time in two decades. Our nation has one of the highest infant and maternal mortality rates of any wealthy country. This disheartening increase is a stark reminder of the urgent need for collective action to address the critical challenges facing maternal and child health in the United States.

The CDC found that the overall infant mortality rate increased by 3% with significant increases for mothers aged 25-29. Mortality rates also climbed for preterm babies, male infants, and for infants born in Georgia, Iowa, Missouri and Texas. The data also shows a deepening divide along racial and ethnic lines with infant mortality rates for American Indian or Alaska Native women increasing by over 20%, from 7.4 deaths to over 9 deaths per 1,000 births, while rates for White women increased by about 3% from 4.36 deaths to 4.52 deaths per 1,000 births. Infant mortality rates for infants of Black women did not drastically increase but they continue to experience the highest overall rates of mortality with nearly 11 deaths per 1,000 births, or over double the mortality rate of White infants. The significant disparities in infant mortality rates among different racial groups highlight the pervasive impact of systemic inequities on health outcomes.

1,000 Days remains dedicated to our mission of making the health and well-being of women and children in the first 1,000 days, from pregnancy to two years of age, a policy and funding priority. We call on Congress to continue investing in maternal and child health and services, recognizing that it is critical during the 1,000-day window to deliver nutrition and support for women and infants. Access to proper nutrition and comprehensive maternal health services is a right for all women and families, and it is imperative to ensure that no one is left behind. Strong policies and investments in this critical window are not only about saving lives today but also about nurturing healthier generations.

A strong start in life is every child’s right, and we are committed to working alongside partners, communities, and policymakers to create a world where all children can thrive. The CDC’s findings reinforce the urgency of our mission, and we stand ready to collaborate and advocate for the changes needed to ensure better outcomes for everyone.

Together, we can strive for a future where infant mortality is a rare and unacceptable tragedy. Join us in making a difference and securing a brighter future for the next generation.

For more insights and information, please visit the CDC report here.

1,000 Days Statement on Senate Finance Committee Paid Leave Hearing

Senate Finance Committee Holds Hearing on Paid Leave

This week, the Senate Finance Committee held a hearing on paid leave, highlighting the critical need for family and medical paid leave and how our current patchwork of paid leave policies falls short of supporting all infants and families. It also confirmed the importance of paid leave for workers, businesses, and the country.

While there have been some gains in paid family leave over the past five years, the Bureau of Labor Statistics shows that only about 1 in 4 employees (27 percent) in the private sector workforce have access to paid family leave. Access to paid family leave is lower among those receiving lower wages or working part-time. People of color also have less access to paid family leave than their white counterparts.

This lack of paid family leave means 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. It means that 1 in 4 women in America return to work just 2 weeks after giving birth, putting their health and that of their infant at risk. 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 birthweight or with illness—are critical to the healthy cognitive, social, and emotional development of children.

We applaud state, local and business-level efforts to increase access to paid family leave, but it is not enough to address this public health crisis. We need a national paid family and medical leave program that is comprehensive and covers all workers, including small business employees and the self-employed. Paid leave is the biggest obstacle to working women in the U.S. in the 1,000-day window and can reduce racial and ethnic health disparities. Our 2020 qualitative paid leave report highlights real stories from families without access to paid leave and the detrimental impacts it had on their family, including their health and the health of their baby.

We appreciate the Senate Finance Committee’s thoughtful attention to this issue. We call on Congress to take the next step, moving legislation to enact a comprehensive national paid leave policy that supports mothers and families and ensures children get the strongest start to life.

Bills We are Watching this Children’s Week

As we kick off the 2023 Children’s Week, we feel a mixture of excitement for the opportunities to improve children’s nutrition and concern about policy and funding proposals that undo progress to protect the health and wellbeing of children and their families in their 1,000-day window.

The nutrition that people receive leading up to and throughout their pregnancy, as well as the nutrition their babies receive in the earliest years of life, has a profound impact on a child’s ability to grow, learn, and thrive. In honor of Children’s Week, 1,000 Days is highlighting some legislation that we support focused on children, mothers, and birthing people. It is our hope that with these bills enacted, moms, babies, and their families will receive the support and resources they need to begin to build a healthier future.

The Wise Investment in Children Act of 2023 (WIC Act of 2023) (H.R.3364/S.1604) expands eligibility to receive benefits under the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). This would extend the certification period for infants to up to two years and increases the certification time under the program for postpartum women to a period of up to two years.

Modern WIC Act of 2023 (H.R.2424/S.984) would build on lessons learned during the pandemic and modernize WIC to allow remote access. The remote flexibility implemented during the public emergency contributed to a 12% increase in child participation since 2020.

WIC Healthy Beginnings Act (H.R.3151/S.974) requires USDA to make information on infant formula procurement under WIC publicly available. This increases transparency and promotes competition within the sole-supplier model.

Black Maternal Health Momnibus Act (H.R.3305/S.1606) will address the maternal mortality crisis in the U.S. through historic investments that comprehensively address every driver of maternal mortality, morbidity, and disparities in the United States. The Momnibus Act includes twelve individual bills that among other actions will make critical investments in social determinants of health that influence maternal health outcomes, like housing, transportation, and nutrition and extend WIC eligibility in the postpartum and breastfeeding periods.

The Family Act (H.R.3481) would provide employees a family and medical leave insurance monthly benefit payment of two-thirds of the employee’s regular pay, limited to a maximum of $4,000, for no more than 60 days of qualified caregiving. The bill also established the Office of Paid Family and Medical Leave within the Social Security Administration.

No Surprise Bills for New Moms Act (H.R.3387) would automatically cover newborns with health insurance for the first 30 days and create a standard for enrollment after that period. It eliminates confusion for new parents by establishing a uniform 60-day enrollment period after that first month. The bill would also have all health plans and insurers notify parents if they receive a bill for an uncovered newborn.

We also continue to remain focused and engaged in the appropriations process for FY2024. Non-defense discretionary programs, which disproportionately serve young children, families, and those most in need across the country, will face the brunt of spending caps and cuts. We must protect programs that support children and families and build off the recent successful increased investments in the first 1,000 days. In doing so, we are letting our children and our nation’s future the opportunity to thrive. How well or how poorly mothers and children are nourished and cared for during the 1,000-day window has a profound impact on a child’s ability to grow, learn and thrive.