I have two hours until I’m due to breastfeed my seventh-month-old baby again, so I’ll make this quick: Breastfeeding is really hard for many and our environment and current policy context makes it even harder.
The month of August has been declared “National Breastfeeding Month” by the United States Breastfeeding Committee — an organization committed to “creating a landscape of breastfeeding support” by advocating for policy changes to facilitate breastfeeding. Since the U.S. Surgeon General released a “Call to Action” to better support breastfeeding mothers and babies in 2011, many support efforts have been initiated, but we still have a long way to go. In fact, just a few weeks ago, the U.S. opposed a worldwide resolution to support breastfeeding at the World Health Assembly.
As a health researcher, I decided during my pregnancy that I would breastfeed my baby based on the American Academy of Pediatrics guidelines given the well-documented health benefits for both of us. At a prenatal breastfeeding class, we practiced the recommended breastfeeding positions using baby dolls, and I felt completely ready for what was sure to be a really easy and natural transition once the baby arrived.
It turns out it is a lot easier to latch a baby doll to your breast than an actual infant. It wasn’t easy for me in the beginning, and it isn’t easy now. And even though “it’s working” for me, it’s still extraordinarily restrictive and difficult for many women given the following environmental and policy challenges:
1. Breastfeeding support insurance reimbursement is inconsistent. I will spare you the details of the breastfeeding complications I had, but it took 12 weekly visits with an International Board Certified Lactation Consultant to breastfeed successfully on my own. Although the Affordable Care Act (ACA) requires full insurance reimbursement for lactation support services, in practice, many women still have difficulty receiving reimbursement for such services under certain circumstances (for example, if they have plans that existed before the ACA or they have out-of-network providers). For many women, this expert support is essential given that the lactation services provided at the hospital are often inadequate, and lack of such support has been linked to early breastfeeding cessation.
2. It is difficult to breastfeed and work full time. Breastfeeding or expressing milk to feed a baby feels like a part-time job, but many women have to work full time. I’m fortunate that I was able to take a medical leave to have time to care for my baby and adjust to breastfeeding. However, not all women are as fortunate. In fact, the US still has not passed any legislation that requires employers to offer paid maternity leave. Learning to breastfeed requires most mothers to be with their babies for weeks after birth to get into a rhythm and build up an adequate supply. Lack of paid leave policies makes breastfeeding impossible for women who would otherwise prefer to do so.
3. There are few clean and private-public places to breastfeed and/or pump. It is finally legal in all 50 states for women to nurse any place they choose in public, but not all women are comfortable doing this. I visited a museum a few months ago with a plan to nurse my baby in their “Caregiver Center.” I brought my hungry baby there to find it situated in the middle of an exhibit with the privacy curtain wide open, children running in and out of it to play with toys, and a row of dads sitting right outside. That doesn’t work for me, and it doesn’t work for a lot of nursing moms. Not every public place should be required to have adequate space for nursing moms, but large public spaces where people spend several hours at a time such as museums, parks, stadiums, and airports, certainly should. Thankfully, Senator Tammy Duckworth has been an amazing advocate for the Friendly Airports for Mothers (FAM) Act, which would require large and medium-sized airports to provide adequate spaces for nursing and pumping. More policies like this one are needed.
I’m only scratching the surface with policy issues that impede breastfeeding, but at the very least, we need reimbursable lactation consultant services to teach us how to breastfeed, paid time to initiate breastfeeding, and places to go where breastfeeding efforts are supported.
Joanna Buscemi is a psychologist.
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