Lack of policy and infrastructure to support breastfeeding in the US means that breastfeeding is made unnecessarily difficult. Breastfeeding is an important public health issue, both for women and children. Growing evidence shows that longer durations of breastfeeding are linked with a lower risk of many costly chronic diseases, including obesity, a national epidemic. It therefore makes sense to incorporate the creation of an infrastructure around breastfeeding as part of health care reform. Such investment in breastfeeding is likely to have significant cost-containment benefits and may greatly help stem the spread of many costly chronic diseases.
All major medical organizations in the world recommend 6 months of exclusive breastfeeding, with continued breastfeeding for at least the first 1 to 2 years of life. Growing research shows that the earlier a woman stops breastfeeding, the higher her risk of breast cancer, ovarian cancer, diabetes, hypertension, and cardiovascular disease. A 2007 government report finds that early weaning is linked to higher rates of many diseases in children besides obesity, including acute infections, type 1 diabetes, and leukemia. The California Department of Health notes that 2 to 4 billion health care dollars could be saved annually in the United States if all women breastfed their infants for as little as 12 weeks, and this does not include costs of time missed from work, or cost of management of expensive chronic diseases in children and women. Research shows that formula feeding has been shown to increase time missed from work to care for sick children, and conversely, those companies who have invested in their lactating employees have enjoyed significant returns on their investments.
A 2001 study from the US Department of Agriculture (USDA) found that the US could save $3.6 billion a year if breastfeeding rates rose to the levels recommended by the federal government, based on an assessment of just a small fraction of disease in infants. If this analysis were adjusted using the more accurate breastfeeding data now available, adjusted for inflation and raised to the medically recommended rates, the true figure would be over $14 billion per year. If the costs of childhood obesity, maternal diabetes, cancer, and cardiovascular disease were factored in, the true cost would likely be several times that figure.
There is a staggering gap between the medical recommendations and actual breastfeeding rates. The CDC shows that only 12% of US children are exclusively breastfeed for 6 months, and only 21% are still breastfeeding at one year. In addition, the government notes there are alarming disparities in breastfeeding rates across racial and socioeconomic lines, and that 60% of women cannot even meet their own breastfeeding goals.
The countries that have managed to promote breastfeeding most successfully, such as Sweden, have strong central leadership and widespread implementation of the Baby-Friendly Hospital Initiative, a WHO/UNICEF certification shown to promote breastfeeding duration and exclusivity. Unlike the US, where fewer than 3% of all hospitals are Baby-Friendly, these countries have created a functional, well-funded infrastructure around breastfeeding. Often these countries have single payer health care, and recognize the intrinsic value of breastfeeding as a strategy to promote health and reduce health care expenses.
There is a chasm between what our breastfeeding goals are, and any appreciable funding and infrastructure to meet those goals. The United States Breastfeeding Committee, a coalition of representatives from national organizations and government agencies, has been given the federal mandate to write a national agenda on breastfeeding. Yet, it gets very little funding and contracts with only one individual to provide administrative and support services. The federal budget has only one line item pertaining specifically to breastfeeding, which is the $20 million for peer counselors of the federal Women, Infants, and Children nutrition program (WIC).
The ideal infrastructure around breastfeeding in the US would involve a central lead government agency for breastfeeding, with adequate line-item funding to sustain it, starting with at least $10-$20 million. In addition, paid maternity leave and/or worksite measures could possibly be rolled into health care reform legislation.
Areas for policy improvement in Health Care Reform
Maternity practice challenges: Few incentives currently exist to promote and implement the Baby-Friendly Hospital Initiative (BFHI) in the US. A national infrastructure led by a lead government agency can help with widespread implementation.
Access to lactation care and services: Health Care reform can mandate coverage of lactation care and services on a national level. Insurance companies vary widely as to what kinds of lactation services they will pay for, if any. Such problems with access further compounds the disparities already seen across racial and economic lines with respect to breastfeeding.
WIC has a significant breastfeeding component, including some peer counselors. However, breastfeeding rates among WIC recipients are even lower than in the general population, for a variety of reasons, including worksite issues and lack of social support. A federal infrastructure could evaluate expanding successful WIC strategies to the general population.
Worksite issues: Research from California, which has worksite protection legislation, shows that even the WIC mothers there have impressive records of breastfeeding duration. This demonstrates that worksite legislation is an effective way to improve breastfeeding duration. National legislation modeled on California's can be rolled into health care reform or passed separately. In addition, health insurance plans proposed around health care reform can consider discounts to those employers who have lactation programs, on-site daycare, and babies-at-work programs.
Paid maternity leave would help all families, regardless of how their babies are fed. The US joins only Papua New Guinea, Swaziland, and Lesotho as the world's only countries without any form of paid maternity leave. Paid family leave has been shown to reduce infant mortality by as much as 20%. As noted by MomsRising, having a baby is a leading cause of "poverty spells" in the U.S. -- when income dips below what's needed for basic living expenses. In countries with national health insurance, such as Costa Rica, such leave may be paid for out of a general disability fund paid into by the citizenry, along with employer contributions. Thus, the opportunity exists to roll in at least a limited form of paid leave with health care reform.
In conclusion, it is in the best interest of the United States to fund and build an infrastructure to support breastfeeding. Our nation faces epidemics of obesity, breast cancer, diabetes, and cardiovascular disease. Funding an infrastructure around breastfeeding should be a priority that likely will reap significant returns on investment in the form of reduced health expenditures and reduced health disparities.
A Peaceful Revolution is a blog about innovative ideas to strengthen America's families through public policies, business practices, and cultural change. Done in collaboration with MomsRising.org, read a new post here each week.
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