Working conditions for new mothers are a public health issue

Who gets to breastfeed?
Who gets to breastfeed?
Image: Reuters/Lindsey Wasson
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At birth, 84% of American children are breastfed. That goes down to half at three months and to only about a quarter at six months, the period the World Health Organization recommends for babies to be exclusively breastfed.

Though much progress has been made in the past few decades, the US continues to lag behind most other countries: globally, an average 40% of babies under six months are exclusively breastfed vs. 35% in the US. This means the current formula shortage affects about two-thirds of American babies who rely on formula for at least part of their nutrition in their first half year.

Promoting breastfeeding as a solution to the shortage—or future ones—would be misguided, not least because it places all responsibility on the individual and none on the system. “The conversations, especially on social media, are often about individual blame, and that is a real problem…because the entire issue is around structural failures,” says Cecília Tomori, who heads global public and community health at Johns Hopkins School of Nursing.

Still, the emergency highlights the shortcomings of a society that frames breastfeeding as a moral choice but does not support it. Beginning with the workplace.

The US doesn’t support breastfeeding

The US is pretty much the only country without a federally guaranteed minimum of maternity leave. For working American women, parental leave policies vary dramatically depending on their employers, unless they live in one of five states that mandate paid parental leave.

“The majority of people in the US, as around the globe, do want to breastfeed. And they actually start out breastfeeding,” says Tomori. “We don’t have paid family leave, and that makes it very difficult for people to sustain lactation over time. So many people start out and then end up with mixed feeding.”

Pumping is cumbersome and time-consuming. Mothers who get back to work shortly after giving birth can continue breastfeeding only if they have flexible schedules, breaks, and privacy. These conditions are especially elusive for low-wage workers, who often don’t have health insurance that covers lactation consulting either.

“All of that has hugely inequitable impact because people with better employment often have access to better leave than people who are low-wage workers,” says Tomori.

Black people and other minorities are more likely to work in low-wage jobs, and have lower rates of breastfeeding: At three months, 73% of white children receive breast milk, compared to 58% of Black children; at six months, 62% of white children and less than 45% of Black children are breastfed. So they are more vulnerable to formula shortages.

“You need an entire system of structural and social support. And so you need to address the policies first,” says Tomori. The most pressing intervention is granting paid leave, but other workplace measures such as flexible work hours, breaks, or on-site child care can provide important support to mothers, so that they can continue breastfeeding for longer if they so choose.

“We know what to do. We just aren’t doing it,” she says.