Category: Paid Leave

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.

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

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.

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.

President’s FY2024 Budget Meets the Moment for U.S. Families, Misses the Mark for Foreign Investments in Nutrition

The Biden Administration’s FY 2024 budget proposal includes significant funding for several of 1,000 Days’ domestic key policy priorities. The proposal reflects priorities of the 2022 White House Conference on Hunger, Nutrition, and Health and opportunities identified in the American Journal of Public Health series to unlock the untapped potential of this critical time by closing data gaps, enhancing promising programs, strengthening policies and uniting around this powerful window of growth. It includes:

  • $6.3 billion to fully fund the 6.5 million individuals expected to participate in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
  • $325 million to establish a national, comprehensive paid family and medical leave program plus $10 million to help states expand access to paid leave benefits, including creation of a Technical Assistance Hub to share best practices among states.
  • $471 million to support implementation of the White House Blueprint for Addressing the Maternal Health Crisis to strengthen maternal health initiatives. Additionally, the budget requires all states to provide continuous Medicaid coverage for 12 months postpartum, eliminating gaps in health insurance at a critical time.
  • Increased funding for early care and education programs to increase childcare options for more than 16 million young children and lower costs so that parents can afford to send their children to high-quality child care.

While we celebrate increases across domestic nutrition programs, the proposals for global programs missed the mark. We welcome the topline increases for the State Department and USAID, but the Administration’s proposal to provide no increases to current investments in global nutrition and maternal & child health fall short in addressing growing the need. This past week, a report released from UNICEF shed light on how dire the malnutrition crisis is, particularly among adolescent girls and women. The number of pregnant and breastfeeding mothers suffering from acute malnutrition has soared from 5.5 million to 6.9 million – or 25 percent – since 2020 in 12 countries hardest hit by the global food and nutrition crisis. Ensuring children have access to good nutrition when it matters most is one of the most powerful and cost-effective ways to create brighter, healthier futures.

As rates of hunger and malnutrition continue to climb around the globe, it was disappointing to see that Global Health accounts within the United States Agency for International Development’s (USAID) budget for the Nutrition and Maternal & Child Health (MCH) did not receive funding increases in the President’s Fiscal Year 2024 budget. Within the proposal, the nutrition account is flat funded at $160 million and the MCH account is flat funded at $910 million. The NGO community has called for no less than $300 million for the nutrition account and $1.15 billion for the MCH account. The released budget is world’s apart from these needs-based community asks to address the ongoing health and nutrition crisis.

Ultimately, these funding levels will be decided by Congress and we urge Congress to fund State and Foreign Operations accounts at a level that meets the moment, including $300 million for the Global Health Nutrition account, $1.15 billion for the Maternal and Child Health account.

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.

Paid Leave Must Have a Place at the White House Conference on Hunger, Nutrition, and Health

The following is a statement from the Paid Leave for All coalition, of which 1,000 Days is part.


Dear members of WHCHNH Advisory Committee Members,

As parents, caregivers, early childhood and public health experts, race and gender equity advocates, social justice organizations, and on behalf of our tens of millions of members, we strongly urge you to include paid family and medical leave in the White House Conference on Hunger, Nutrition, and Health and its national strategy. We recommend the White House continue to promote its original proposal of at least 12 weeks of inclusive and comprehensive paid family and medical leave for all working people as a public health imperative. 

Paid leave is a proven tool in addressing the United States’ most pressing health issues, whether it be mitigating the ongoing COVID-19 pandemic, addressing breastfeeding needs in light of a national formula shortage, addressing our worsening maternal mortality rates, or improving our overall health outcomes and families’ well-being. It is also a tool for alleviating the systemic racism and sexism in health care, by allowing more people and those with more caregiving responsibilities access and time to care for themselves along with their loved ones. Yet only 23 percent of workers in this country have access to paid family leave through their jobs and we remain one of the only countries in the world without this protection. 

Paid leave is interconnected with a broad number of health indicators and outcomes. Workers without access to paid leave are more likely than workers with paid leave to experience financial and material hardships, including being more than twice as likely to be unable to pay for rent or utilities and twice as likely to experience food insecurity. Implementing paid leave in California, for example, reduced very low household food security by about two percentage points. Workers without access to paid leave are also more likely to be uninsured, have trouble paying for medical bills, and have less access to medical care because of the cost. A quarter are not confident they could come up with $400 for an unexpected emergency.

Paid leave is also a critical tool to support healthier pregnancies, better birth outcomes, more successful breastfeeding, and both physical and mental health in the postpartum period. This is particularly important while the United States faces a formula shortage—and has the worst maternal mortality rate among wealthy countries, disproportionately impacting Black women, and one that is worsening after COVID-19. Paid leave is critical to giving birthing people the opportunity to establish breastfeeding patterns as an option for their family, and we know that for those who are able and choose to breastfeed, it plays a powerful role in women’s health. Research has shown that breastfeeding is associated with a lower risk of heart disease—the leading cause of death among women in the U.S.—as well as breast cancer, ovarian cancer, type-2 diabetes, and hypertension later in life. It also has health benefits for the child, including improving the digestive and immune system. The American Academy of Pediatrics recently increased their recommended duration of breastfeeding to two years or beyond, a near impossibility for working families without access to paid leave. For low-income families in New Jersey, where a statewide paid family leave program has been in effect since 2009, researchers found that new mothers who use the state paid leave program breastfeed, on average, one month longer than new mothers who do not use the program. According to the Department of Health and Human Services, if 90 percent of women in the United States breastfed their babies for the first 6 months of life, it would save 900 babies’ lives and $13 billion in healthcare expenses annually.

We know that paid sick, family, and medical leave are critical to the overall health—including mental and emotional health—and well-being of working people, families, and whole communities. They are key to diagnosis, treatment and recovery, and the containment of disease. 

Every one of us is going to need to give and receive care in our lifetimes, and without a federal guarantee of paid leave, we will all suffer. We urge you to include paid family and medical leave in this conference and its related strategies, and to prioritize it across the administration. 

Additional Resources: 

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.

4.     Hamner HC, Chiang KV, Li R. Returning to Work and Breastfeeding Duration at 12 Months, WIC Infant and Toddler Feeding Practices Study-2. Breastfeed Med. 2021 Dec;16(12):956–64.

5.     Rojjanasrirat W, Sousa VD. Perceptions of breastfeeding and planned return to work or school among low-income pregnant women in the USA. J Clin Nurs. 2010 Jul;19(13–14):2014–22.

6.     Johnson AM, Kirk R, Muzik M. Overcoming Workplace Barriers: A Focus Group Study Exploring African American Mothers’ Needs for Workplace Breastfeeding Support. J Hum Lact. 2015 Aug;31(3):425–33.

7.     Goodman JM, Williams C, Dow WH. Racial/ethnic inequities in paid parental leave access. Health Equity. 2021 Oct 13;5(1):738–49.

8.     Howell EA. Reducing disparities in severe maternal morbidity and mortality. Clin Obstet Gynecol. 2018 Jun;61(2):387–99.

9.     Ely DM. Infant Mortality in the United States, 2018: DataFrom the Period Linked Birth/Infant Death File. National Center for Health Statistics; 2020 Jul.

10.     Chzhen Y, Gromada A, Rees G. Are the World’s Richest Countries Family Friendly? Policy in the OECD and EU. Florence, Italy: UNICEF Office of Research; 2019.

11.     National Compensation Survey: Employee Benefits in the United States. U.S. Department of Labor, U.S. Bureau of Labor Statistics; 2019 Mar.