Category: Breastfeeding

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!

The highlight of our year: #March4Nutrition

March is National Nutrition Month! Developed by our friends and colleagues at the Academy of Nutrition and Dietetics, every March we work to amplify the importance of nutrition for families in the first 1,000 days: the time between pregnancy and a baby’s second birthday.

Throughout pregnancy, infancy and beyond, families need good nutrition, breastfeeding support, and nurturing care in order to thrive. Decades of research has shown that nutrition plays a foundational role in a child’s development and her country’s ability to prosper.

We invite you to follow #March4Nutrition on Facebook, Instagram, LinkedIn, and Twitter all month long and join the conversation. Every week in March, we’ll dive deep into a new theme and explore how nutrition lays the foundation for brighter, healthier futures.

Week 1 March 4-10: Thriving families – What if … families had access to quality nutrition services before, during and after pregnancy?  

Week 2 March 11-17: Women’s nutrition and gender equity – What if … nutrition was seen as a key piece of achieving gender equity?  

Week 3 March 18-24: Nutrition & food (in)security – What if … families had access to safe, affordable and nutritious foods? 

Week 4 March 25-31: What we can do? – What if … our work could support moms, babies, and families in the United States and around the world to access nutritious food?

At 1,000 Days, we believe that every family, everywhere deserves the opportunity to have a healthy 1,000-day window and beyond – and that starts with access to good nutrition.

Join us this month as we #March4Nutrition for moms and babies!

Find the social media toolkit here.

Protecting, Promoting and Supporting Breastfeeding

We know that babies get the best start in life when they are exclusively breastfed for the first 6 months, and continue breastfeeding with complimentary feeding until they are 2 years old, following World Health Organization guidelines established in 2018.

As World Breastfeeding Week and National Breastfeeding Month begin, 1,000 Days celebrates the progress made to support mothers in breastfeeding their babies, while also recognizing the additional steps that need to be taken to truly support all those who wish to initiate and sustain breastfeeding. From policy changes to individual support, more action is needed to achieve breastfeeding goals globally. In the US, a recent win for breastfeeding mothers is the PUMP for Nursing Mothers Act, PUMP for Nursing Mothers Act, which extends the right to receive break time to pump and a private place to pump at work to more nursing employees. Another win for breastfeeding science globally is the 2023 Lancet Breastfeeding series which reinforces the power of breastfeeding, policy changes needed to protect breastfeeding, and calls out intrusive marketing strategies utilized by formula companies to diminish breastfeeding.

Even though breastfeeding is the best way to protect newborns from malnutrition, infections, and disease, only 48% of babies around the world are exclusively breastfed based on data from 2015-2021. Breastfeeding support is recognized as a “Power 4” nutrition intervention, showcasing how critical it is for mothers and babies in low- and middle-income countries to support health and nutrition. Not only is breastfeeding counseling impactful on health and nutrition outcomes, but it is also one of the most cost-effective nutrition interventions, yielding up to $35US in economic returns with a $1US investment.

Across the United States Agency for International Development’s 14 priority geographies, breastfeeding counseling rates remain low. On average, in these areas, only 45% of mothers are receiving breastfeeding counseling in the 2 days after delivery. Breastfeeding counseling, whether individually or in a group setting, can help ensure mothers have the support they need while also helping them gain confidence and overcome challenges in their breastfeeding journey.

Governments, development partners, UN agencies, and non-government organizations have pledged to improve nutrition globally, particularly through increased investments in breastfeeding, as outlined at the 2021 Nutrition for Growth Summit. Additionally, the Global Breastfeeding Collective identified policy priorities for countries to implement to support, protect and promote breastfeeding:

  • Increase funding to raise breastfeeding rates from birth through two years.
  • Fully implement the International Code of Marketing of Breastmilk Substitutes and relevant World Health Assembly resolutions through strong legal measures that are enforced and independently monitored by organizations free from conflicts of interest.
  • Enact paid family leave and workplace breastfeeding policies, building on the International Labour Organization’s maternity protection guidelines as a minimum requirement, including provisions for the informal sector.
  • Implement the Ten Steps to Successful Breastfeeding in maternity facilities, including providing breastmilk for sick and vulnerable newborns.
  • Improve access to skilled breastfeeding counseling as part of comprehensive breastfeeding policies and programs in health facilities.
  • Strengthen links between health facilities and communities, and encourage community networks that protect, promote, and support breastfeeding.
  • Strengthen monitoring systems that track the progress of policies, programs, and funding towards achieving both national and global breastfeeding targets.

As global leaders and governments continue to address the rising rates of malnutrition, which is impacting more than 1 billion adolescent girls and women worldwide, attention should be hyper-focused on breastfeeding support and counseling, through increased investments and policy changes, to support the health and nutrition of both current and future generations.

 

Lifting Up the Powerful Role of Nutrition for Policymakers and Advocates

Good nutrition before, during, and after pregnancy has a profound impact on the health of both a mother and child. This National Nutrition Month (NNM), and as part of our global #March4Nutrition campaign, 1,000 Days is highlighting some of the nutrition-related regulations and legislation that we support to ensure every child can grow, learn, and thrive. Much of this legislation also shapes the future for mothers, pregnant, birthing and postpartum people. This Spring, we are focused on advocating for regulatory updates, legislation that supports nutrition for families here in the U.S. and around the world, and additional funding to support all these programs. This year’s NNM theme of “Fuel for the Future” highlights the importance of ensuring families are well nourished to support healthy futures.

Updated Regulations for Maternal & Child Nutrition

WIC Food Package Updates

The United States Department of Agriculture (USDA) has proposed several regulatory changes to strengthen nutrition programs and improve maternal and child nutrition. The agency is currently updating the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages, that would impact over 6 million WIC participants which include moms, babies, and young children. The updates, which are science-based and align with the most recent Dietary Guidelines for Americans and the 2017 National Academies (NASEM) report, increase fruit and vegetable vouchers, promote greater flexibility to accommodate cultural food preferences and dietary needs, strengthen support for breastfeeding, and increase access to under-consumed, nutritious foods, like seafood with lower levels of methylmercury.

Child Nutrition Program Updates

USDA also proposed updated nutrition standards to school meals that would more closely align the standards recommended in the Dietary Guidelines for Americans to provide children with nutritious and delicious meals. The proposed updates do include some changes to the Child and Adult Care Food Program (CACFP), which serves young children, including those in their 1,000-day window, at childcare. Changes in the CACFP program would support more nutritious meals and snacks by reducing added sugar content and allowing more plant-based meat/meat alternate options.

Dietary Guidelines for Americans

While not specific legislation or regulations, the Dietary Guidelines for Americans (DGA) form the basis of nutrition policy in the U.S. and are a critical component of improving maternal and child nutrition. Co-developed every five years by USDA and the Department of Health & Human Services (HHS), the basis of the guidelines is a science-based report developed by the Dietary Guidelines for Americans Advisory Committee (DGAC) which includes nutrition researchers, physicians, and Registered Dietitians. The DGAs have a broad impact ranging from WIC food packages and child nutrition programs to food labeling and nutrition education programs. The guidelines include dietary recommendations for pregnant and lactating people and birth to age 2, which were included for the first time in the 2020-2025 DGA. The next iteration of the guidelines is currently underway as the DGAC is reviewing evidence and drafting conclusion statements which will ultimately lead to dietary recommendations and guidelines for Americans, including mothers, babies, and young children.

2023 Farm Bill

Every five years, Congress reauthorizes the Farm Bill which is a robust, multiyear law that authorizes food and agricultural programs. Although the name may imply that most of the bill is focused on farming and agriculture, nutrition spending makes up an overwhelming majority of the legislation. In 2018, the nutrition title (Title IV) made up about 76% of total Farm Bill spending, and for the 2023 Farm Bill, it is projected to be as much as 85%. The Supplemental Nutrition Assistance Program (SNAP), formerly known as “food stamps,” is authorized in the Farm Bill which is the reason for the large amount of spending for nutrition in the bill. When children have access to SNAP, from birth through early childhood, their risk of developing high blood pressure, heart disease, diabetes, and other poor health outcomes later in life greatly decreases. Children on SNAP can immediately experience a reduction in food insecurity. As Congress works to reauthorize the 2023 Farm Bill, it is imperative that they ensure families have access to the food and nutrition assistance they need through SNAP benefits as nearly half of all people who participate in SNAP are children.

In addition to domestic nutrition programs, the Farm Bill also reauthorizes international food aid programs in Title III. These programs include Food for Peace Title II, the McGovern-Dole Food for Education Program, Food for Progress, and the Bill Emerson Humanitarian Trust. These programs are primarily focused on improving food security. As Congress works to reauthorize the 2023 Farm Bill, we urge them to further consider how the programs can incorporate nutrition interventions to address both food and nutrition insecurity and prevent malnutrition. Robust funding will be needed to address the current malnutrition crisis and to build resilience in communities globally.

Implementation of the Global Malnutrition Prevention & Treatment Act

In October 2022, the Global Malnutrition Prevention & Treatment Act (GMPTA) was signed into law to bolster the federal government’s efforts to address global malnutrition and build resilience. It authorizes the United States Agency for International Development (USAID) to advance targeted interventions to prevent and treat malnutrition around the world while requiring a robust monitoring of interventions to ensure effective use of funding. As USAID works to draft the implementation plan and coordinate efforts, we look forward to working alongside them to ensure all activities address the nutritional needs of families in their first 1,000 days.

Fiscal Year 2024 Appropriations

Addressing nutrition security in the U.S. remains a critical need. 1,000 Days joins the National WIC Association and the broader maternal and child health community in urging funding of $6.35 billion for WIC in FY 2024. This amount will ensure adequate funding to support WIC’s growing caseload and address rising food costs in WIC food categories. We also support increased funding to strengthen FDA’s food safety and nutrition capacity, especially for infants and young children.

While reductions in global mortality rates for women and children are two of the biggest success stories in international development, progress has slowed over the past 12 years. There remain significant gaps that additional investments can help close. In 2021, 5 million children under age five died from mainly preventable and treatable diseases, with malnutrition as the underlying cause of roughly half of these deaths. Additionally, 300,000 women die annually of preventable causes related to pregnancy and childbirth. 

As Congress determines funding levels for FY2024, it is critical that funding meets the moment to address the malnutrition crisis. 1,000 Days as part of the 1,000 Days Advocacy Working Group (AWG) and the Maternal, Newborn, Child Health Roundtable (MNCH RT), is requesting $300 million for the nutrition account and $1.15 billion for the maternal and child health (MCH) account within USAID. Malnutrition costs the world $3.5 trillion in lost productivity and healthcare costs each year. The current global food crisis, fueled by conflict, climate shocks and the threat of a global recession, continues to threaten the lives of women and children globally. Full funding of the nutrition account is critical for saving lives and reaching USAID’s goal of ending preventable child and maternal deaths.

Our favorite time of year: #March4Nutrition

Our favorite time of year: #March4Nutrition

We’re thrilled to celebrate the 50th anniversary of National Nutrition Month in March 2023. Developed by our friends and colleagues at the Academy of Nutrition and Dietetics, every March we work especially to amplify the importance of nutrition for families in the first 1,000 days: the time between pregnancy and a baby’s second birthday.

Throughout pregnancy, infancy and beyond, families need good nutrition, breastfeeding support, and nurturing care in order to thrive. Backed by decades of research and most recently the American Journal of Public Health’s special nutrition series, we know nutrition plays a foundational role in a child’s development and her country’s ability to prosper.

We invite you to follow #March4Nutrition on Facebook, Instagram, and Twitter all month long and join the conversation. Every week in March, we’ll dive deep into a new theme and explore how nutrition lays the foundation for brighter, healthier futures.

Week 1 March 1-10: Women’s nutrition – Access to proper nutrition can help women grow their power.

Week 2 March 13-17: Benefits of breastfeeding – Breastfeeding has critical benefits for both moms and babies.

Week 3 March 20-24: Healthy foods and drinks for babies and toddlers – Growing babies need good nutrition to flourish.

Week 4 March 27-31: Raise your voices – Help us spark action to change the world for moms, babies and families, 1,000 days at a time.

At 1,000 Days, we believe that every family, everywhere deserves the opportunity to have a healthy 1,000-day window and beyond – and that starts with access to good nutrition.

Join us this month as we #March4Nutrition for moms and babies!

New Research Highlights Critical Need for Strong Policies to Leverage the Value of Breastfeeding

February 9, 2023

Dear Members of the 118th Congress,

As leaders advocating for healthy families and children, 1,000 Days and the U.S. Breastfeeding Committee invite you to join us in creating a landscape of breastfeeding support across the United States.

Breast milk is recognized as the optimal food for babies and plays a critical role in their growth and development.[i] Numerous studies have shown that breastfeeding promotes healthy cognitive and social-emotional development.[ii] It also saves lives by helping to protect babies from infections and conditions such as sudden infant death syndrome (SIDS).[iii] Breastfeeding even lowers a child’s risk of obesity and type 2 diabetes later in life. In addition, women who breastfed reduce their risk of specific chronic diseases, including type 2 diabetes, cardiovascular disease, and breast and ovarian cancers.[iv]

Unfortunately, the U.S. has many barriers to establishing and maintaining breastfeeding. While four out of five babies born in the United States start out being breastfed, about half are still doing so at six months.[v] This is not due to capacity or wishes of the parent, but rather because environments in the U.S. do not support breastfeeding.

Our country’s policies, systems, and environments must be improved to make breastfeeding a realistic option for all families. New research released this week highlights the critical need for strong policies to fully leverage the value of breastfeeding.

  • Breastfeeding rates can be rapidly improved by scaling up known interventions, policies, and programs in the workplace and health system.
  • Infant formula companies utilize intrusive marketing strategies to families, health care providers, and policy makers to portray these products as solutions to common infant health issues in ways that systematically undermine breastfeeding and prey on parental concerns.
  • Policy changes are needed to address the power imbalances and political and economic structures that influence feeding practices and health outcomes.

As we approach the one-year anniversary of the infant formula crisis, it is critical that you and your colleagues in the House and Senate take action to address infant nutrition security, including through support for breastfeeding.

As you know, changing environments and systems requires everyone do their part – parents, policymakers, health facilities, communities, and employers. As a Member of Congress, you have an incredible opportunity to create the policy changes families need. Together, we can build on the momentum from recent advancements like the Providing Urgent Maternal Protections (PUMP) for Nursing Mothers Act to build a robust infrastructure for infant nutrition security.

Breastfeeding has such a profound impact on population health outcomes that increasing breastfeeding rates and creating lactation-friendly environments have been identified as critical public health priorities in the U.S. as well as across the world. Breastfeeding is included in a variety of national initiatives, including the Dietary Guidelines for Americans, Healthy People 2030, The Surgeon General’s Call to Action to Support Breastfeeding, and more.

It is time to move from reports and vision statements, to taking action on the policy priorities that families deserve. We hope you will take the time to explore the new Lancet series on breastfeeding and join us as we work to build a country where infant nutrition security and breastfeeding is valued, protected, promoted, and supported.

Sincerely,

Amelia Psmythe Seger,
U.S. Breastfeeding Committee		 Blythe Thomas,
1,000 Days

 

About 1,000 Days

An Initiative of FHI Solutions, 1,000 Days is the leading non-profit organization working in the U.S. and around the world to ensure women and children have the healthiest first 1,000 days. Our mission is to make the well-being of women and children in the first 1,000 days a policy and funding priority. We are passionate about turning evidence into action and use our deep understanding of the science and the issues to help shape policies that improve the lives of moms and babies in the U.S. and throughout the world.

About the U.S. Breastfeeding Committee

The mission of the U.S. Breastfeeding Committee (USBC) is to drive collaborative efforts for policy and practices that create a landscape of breastfeeding support across the United States. USBC functions as a national coalition of 100+ organizational members representing nonprofits, breastfeeding coalitions, federal agencies, and businesses working at national, state/territorial, tribal, local, and community levels to protect, promote, and support human milk feeding. The USBC uses an equity-centered collective impact approach to facilitate multisectoral collaborations.

 

[i] Breastfeeding. World Health Organization. https://apps.who.int/nutrition/topics/exclusive_breastfeeding/en/index.html.  Published Aug. 2018. Accessed February 6, 2023.

[ii] Nutrition in the First 1,000 Days: A Foundation for Brain Development and Learning, 1,000 Days and Think Babies. https://thousanddays.org/wp-content/uploads/1000Days-Nutrition_Brief_Brain-Think_Babies_FINAL.pdf. Accessed February 4, 2023.

[iii] Breastfeeding Benefits Both Baby and Mom. Centers for Disease Control and Prevention, https://www.cdc.gov/nccdphp/dnpao/features/breastfeeding-benefits/index.html. Published July 27, 2021. Accessed February 6, 2023.

[iv] Making the decision to breastfeed | womenshealth.gov. womenshealth.gov. https://www.womenshealth.gov/breastfeeding/making-decision-breastfeed/#1. Published 2020. Accessed December 20, 2022.

[v] Breastfeeding Report Card, United States 2022. Centers for Disease Control and Prevention. https://www.cdc.gov/breastfeeding/data/reportcard.htm. Published August 31, 2022. Accessed February 8, 2023.

U.S. Breastfeeding Committee’s Statement on the Formula Shortage

The following guidance is also available from the Academy of Breastfeeding Medicine and HealthyChildren.Org.

Dear Members,

It’s been a long week/month/year (already, here in May). We see you. We are you. Much love.

As the United States faces a serious shortage of infant formula, we know that no baby should ever go hungry. Families are scared and stressed, and like every other crisis facing our nation, BIPOC and economically vulnerable communities are pressed even harder. This is a national crisis.

Long standing public health advocates know this was predictable and thus preventable. The USBC-Affiliated COVID-19 Infant & Young Child Feeding in Emergencies Constellation published a Statement at the start of the pandemic outlining actions needed to prevent the formula shortage and care gaps seen at that time from growing to a dangerous level. Being prescient is only valuable in the context of investment, action, and policy change to ensure every family has access to care. Yet here we are.

A robust infrastructure to support infant and young child feeding in emergencies includes both inventories of available commercial milk formula and lactation support and resources in every community. Public officials are currently calling for increased production of formula – which is desperately needed – yet without also investing in lactation support in every community. This exacerbates existing gaps, and as such feels short-sighted. Thank you to all the organizations lifting up resources and information on boosting milk supply, re-lactation, human milk donation, informed consent for safer milk sharing, all while calling out the systems failure that caused this to be necessary.

Long term, this is still a call to action to build systems and infrastructure to ensure that breastfeeding/human milk feeding is the easy and obvious feeding choice for most families. This includes routine skin to skin at birth; continuity of care from trained lactation support providers; family paid leave; workplace accommodations; a regulated commercial milk formula industry that invites formula-feeding parents to the table as valued stakeholders; a national network of milk banks; and IYCF-E infrastructure for disaster relief. Systems, in other words, that hold us all in care. Collectively we can build the resiliency to support a single community during a flood, a region during a power outage, or a nation during a pandemic or supply chain crisis. Dear choir – we know you know this sermon.

As the nation grapples with the immediate and present impact of this emergency, we need to do everything we can to support infant nutrition, including ensuring access to lactation support, supplies, and accommodations, donor milk, and infant formula. Organizations and agencies from across the nation are mobilizing in response to the shortage, offering support and messaging response according to the scope, stance, and capacity within their reach.

Throughout its history, the U.S. Breastfeeding Committee has worked to ensure food security for our nation’s infants by addressing gaps in the policy landscape with policy, systems, and environmental change solutions that include building an infrastructure for infant and young child feeding in emergencies. We remain committed to this cause and will continue to curate and amplify resources from the field, for the field, so that you are equipped to support the families you serve.

Thank you for all you are doing, including taking respite as you need.

Paid Family Medical Leave Remains Critical for Low-Income Pregnant and Postpartum Women

By: Daphna Dror, PHD, RD

The lack of national, comprehensive, and paid family medical leave in the United States has significant consequences for low-income women, especially those who are pregnant or have recently given birth. Many women risk their own or their child’s health to continue working throughout pregnancy and the early postpartum period in order to pay bills and provide for dependents. Only seven states and the District of Columbia have passed their own paid leave programs, meaning far too many new mothers must choose between caring for themselves and bonding with their newborn or making ends meet. 

Paid leave:

  • Supports healthier pregnancies. Financial concerns due to lost wages may prevent low-income women from seeking regular prenatal care, which itself is associated with better pregnancy and birth outcomes. Paid leave reduces the risk of preterm birth, low birthweight, and infant mortality (1). 
  • Increases breastfeeding initiation and duration. The American Academy of Pediatrics recommends exclusive breastfeeding for 6 months followed by a combination of complementary foods and breastmilk for at least 12 months (2), yet new mothers who plan to return to work before 12 weeks or to work full time are less likely to opt for exclusive breastfeeding (3). A recently published study of participants in the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) found that amongst women who had worked prenatally, returning to work within 3 months postpartum significantly decreased the odds of breastfeeding for the first year (4). Paid time off can alleviate the financial stress of combining work and breastfeeding (5,6).
  • Improves the physical and mental health of mother and baby postpartum. While postpartum depression (PPD) occurs in approximately 11% of all US mothers, a qualitative study in low-income women found that 35% experienced PPD or sadness (1). Nearly one third of low-income mothers who returned to work reported that employers were not understanding of postpartum needs, most commonly requiring more time off (1). Mothers who have access to paid leave and other work accommodations can minimize financial strain and career disruptions while improving their own health, their baby’s health and their bond with their baby.
  • Reduces maternal and infant racial and ethnic disparities. Women of color are disproportionately affected by lack of access to paid leave, exacerbating perinatal health disparities (7). Compared with Caucasians, African-American mothers in the United States are more than three times as likely to die of pregnancy-related causes (8); infants born to African-American mothers have more than twice the mortality rate of infants born to Caucasian mothers (9). Women of color are overrepresented in part-time, seasonal, and low-wage jobs, employment categories least likely to offer paid leave (7).

Of 41 high- and middle-income countries, the U.S. is unique in lacking nationwide paid maternity leave, paternity leave, or parental leave (10). Only 19% of U.S. workers have access to paid family medical leave, with even lower access amongst those who work part-time, in low-wage industries, at small firms, or who are not unionized (11). Universal access to paid family leave is imperative to ensure that all families in the United States have a healthy first 1,000 days and a strong foundation to thrive.

References

1.     McClanahan Associates, Inc., 1,000 Days. Qualitative Paid Leave Report: Furthering our Case for Paid Leave in the United States.

2.     Eidelman AI, Schanler RJ. Breastfeeding and the Use of Human Milk. Pediatrics. 2012 Mar;129(3):e827-41.

3.     Mirkovic KR, Perrine CG, Scanlon KS, Grummer-Strawn LM. In the United States, a Mother’s Plans for Infant Feeding Are Associated with Her Plans for Employment. J Hum Lact. 2014 Aug;30(3):292–7.

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