Stronger regulations to support ACA

Opinion Editorial

Stronger regulations to support ACA

Stephanie Banks

The duration and exclusivity of breastfeeding across the U.S. has been severely stagnant for years. The Affordable Care Act (ACA) in 2010 included a provision for employers to “provide workplace accommodations that enable employees who are breastfeeding to express their milk”. In addition, the ACA amended the Fair Labor Standards Act of 1938 by having employers provide reasonable, unpaid break time for a mother to express milk and a private place besides a restroom that is clean to express it. I have worked alongside many women who struggle to continue breastfeeding children while they return to full-time employment. I had one co-worker in Texas who had her husband bring the newborn to her place of employment just so she could nurse on her break-time. Not all women have such dedicated husbands or family in close proximity to offer such help. She would breastfeed on a couch in the mall. She had tried to pump in the bathroom however, she constantly found herself being interrupted by other co-workers or customer needs. So, she fortunately solved her own problem by eliminating pumping by breastfeeding her baby directly. If regulations were in place to enforce these Acts, the jewelry store where we were employed would have had a private room. Sometimes, in the early stages when she was able to pump, she would use cups of ice from the mall eatery to keep the milk cold until she or her husband were able to get it home to store it for future use. This is where a refrigerator would come in handy for employees to utilize at work. Not only breastfeeding employee’s benefit from such an amenity but the whole workforce could utilize it for lunches, drinks, medicine, etc. The general public as well as employers in the health industry public should encourage employers to provide secure, private places where women can pump their milk and store it for later use.

Stronger regulations are needed to support ACA.  I am thankful the government has shown transparency of the benefits of breastfeeding by stating that mothers should breast-feed their babies. The American Academy of Pediatrics also tells us alongside many other organizations that breast milk reduces the prevalence, susceptibility, and severity of a wide range of illnesses such as diarrhea, respiratory & ear infections. The American Academy of Pediatrics also tells us that studies have proven that adults who were breast-fed are less apt to be diagnosed with type 2 diabetes, certain cancers, obesity, high cholesterol and asthma. Society as a whole is responsible for educating themselves and others about the benefits of breastfeeding. They are also responsible for reducing social stigmas that surround breastfeeding issues, especially when found in the workplace. The government and state legislation however, need to be more responsible for enforcing and adopting regulation which support Acts such as the Affordable Care Act, which in turn support the people starting at birth by supporting mothers who sacrifice so much to give the gift of breast milk.

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Infant formula companies attributing to the poor exclusivity and duration of breastfeeding?

Also attributing to the poor exclusivity and duration of breastfeeding are infant formula companies. Among women who had initiated breastfeeding, 66.8% reported having received commercial hospital discharge packs containing infant formula. We found that women who received these packs were more likely to exclusively breastfeed for fewer than 10 weeks than were women who had not received the packs (Marketing Infant Formula Through Hospitals: the Impact of Commercial Hospital Discharge Packs on Breastfeeding). To support this, studies also showed that receipt of a gift pack that contained formula (compared with receipt of no gift pack) was associated with a statistically significant decrease in exclusive breastfeeding at three weeks and in other areas a significant decrease in exclusive breastfeeding at four months.

These barriers are only getting worse. According to current trends, popularity of exclusivity and longer duration of breastfeeding (up to six months as suggested by the CDC) has not increased in recent decades. Though policy and other measures have been implemented in various areas, no significant increase in exclusivity and duration of breastfeeding has been recorded. If trends continue as they have in the past, this situation is only going to remain the same or worsen. What do you think?

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Breastfeeding barriers in the workplace

One of the main barriers to exclusivity and duration of breastfeeding lies within the workplace. According to the breastfeeding report card furnished by the CDC, only sixteen states in the union mandate employer lactation support. In 2009, only 23 states had adopted any laws to encourage breastfeeding in the workplace. In a publication produced by The American Journal of Public Health, researchers emphasized that public health professionals should explore ways to improve legal support for all working mothers wishing to breastfeed. Researchers should also identify the laws that are most effective and assist policymakers in translating them into policy.

The University of Kansas School Of Nursing (UKSN) published specific barriers in the workplace according to women’s perceptions and experiences. Responses were consistent in that many working women had experienced the following: perceived or experienced insufficient milk supply; lack of flexibility in work schedule for milk expression; lack of appropriate facilities for breastfeeding, pumping, or breast milk storage; lack of support from employers and colleagues. The UKSN also shared that most employers were not aware of benefits of breastfeeding such as decreased employee turnover, improved morale, decreased employee absenteeism, and increased recruitment ability.

As previously mentioned, another barrier included social stigmas, especially in the workplace. Research shows that some mother’s encountered pressure at work from co-workers and supervisors not to take work breaks to pump and that some co-workers, including those who had not breastfed their infants, were critical of those who did breastfeed.

Surprisingly, though this information has provided a step in the right direction, many companies fail to comply. While basic work-site accommodations such as a private,sanitary place for milk expression, time to express milk, access to professional support, and support from managers and coworkers can help women follow through on their breastfeeding goals, nearly 75% of companies in the United States do not provide these basic accommodations. Under current regulations, only twelve states support lactation in child care settings.

Section 4207 of the U.S Patient Protection and Affordable Care Act of 2010 (also known as ‘‘Health Care Reform’’) requires employers to provide reasonable break time and a place for breastfeeding employees to express milk during the work period. Though passed in 2010, enforcement of this act has been invisible.

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Hospital policies and practices

Current policies and hospital practices interfere with breastfeeding. Across the U.S. the average level of support that birth facilities provide to mothers and babies as they begin breastfeeding is inadequate, and hospital practices and policies that interfere with breastfeeding remain common. In the U.S., too few hospitals participate in the global program to recognize best practices in supporting breastfeeding mothers and babies, known as the Baby-Friendly Hospital Initiative.

As part of a nationwide survey, hospitals participated in identifying barriers to breastfeeding. Survey results (mPNIC) show that the lowest point regarding continued breastfeeding deals with support post hospital discharge. “The lowest score (40) was for breastfeeding support after discharge. For this sub-scale, 70% of facilities reported providing discharge packs containing infant formula samples to breastfeeding mothers, a practice not supportive of breastfeeding. Although 95% of facilities reported providing a telephone number for mothers to call for breastfeeding consultation after leaving the birth facility, 56% of facilities reported initiating follow-up calls to mothers. Facility-based postpartum follow-up visits were offered by 42% of facilities, and postpartum home visits were reported by 22% of facilities”.

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Just how old is too old?

I nursed my first baby for 16 months, my second for 12. We know research shows at least 12 months of breastfeeding is beneficial and The World Health Organization recommends a minimum of two years, so is there such a thing as too much breast milk? I had to use lime juice to wean my 16 month old. It was apparent she wasn’t ready to wean yet but I felt I had accomplished more than I had set out to do. Extensive feeding as some call it, is not as normal as you may think in the U.S. Other countries nurse for longer periods of time mainly out of necessity. How long is too long in the U.S. before it is culturally unacceptable? One of my Texas friends babysat her daughter until almost 5 years old. She weaned her just before her daughter’s first ballet recital. Thoughts?

The read about the woman pictured above visit

Breastfeeding Older Children by Ann Sinnott is a great book to read if you are interested in extensive breastfeeding.


Are mothers getting the breastfeeding support they need?

Breastfeeding has recently been recognized as a vital asset to the health of our nation’s infants. The Center’s for Disease Control and Prevention (CDC) along with the Surgeon General have emphasized the importance of breastfeeding. As part of this effort, the CDC has developed Six Winnable Battles, one of which focuses on nutrition. Within this Winnable Battle, breastfeeding is stressed in order to not only provide a healthy start for babies, but also to prevent future complications such as childhood obesity and other unfavorable conditions. Though this has been proven through various studies and many women initiate breastfeeding, problems of exclusivity and duration of breastfeeding persist among women in the United States.

The most recent data provided by the CDC show that three out of every four new mothers in the United States initiates breastfeeding. High breastfeeding initiation rates show that most mothers in the U.S. want to breastfeed and are trying to do so. However, even from the start, mothers may not be getting the breastfeeding support they need. Low breastfeeding rates a three, six, and twelve months illustrate that mothers continue to face multiple barriers to breastfeeding. The U. S. has now met the Healthy People 2010 national objective for breastfeeding initiation. However, rates of breastfeeding at six and twelve months as well as rates of exclusive breastfeeding at three and six months remain stagnant and low. More babies in the U.S. are now born at Baby Friendly facilities than ever before. However, these births still represent less than four percent of all U.S. births. Further, the CDC mPINC survey of all birth facilities in the U.S. shows that the average score for facilities nationwide is only sixty-five out of one hundred, and only two states’ facilities scored eighty or more points. Other data shows that southern U.S. states have lower levels of ever breastfed babies among those born in 2004. As alarming as these statistics are, the causation for lack of breastfeeding is of greater concern. These include lack of initial support post hospital discharge, contradicting policies and interfering hospital practices, social stigmas, and workplace barriers as the front runner.

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Funny comic about breastfeeding in public!!

This comic is so funny because it rings true. I started out breastfeeding my first infant in the privacy of my own home. As I got braver, I would breastfeed while  in the homes of family and friends. I remember a time when I was asked by my husband’s co-worker if I would feel more comfortable “doing that” in a private room of his home. Obviously he was uncomfortable and his reflection of this made me a little self-conscious so I left the room. After all, it was his house. Out of necessity I soon began to nurse in public. Even though I was always completely covered, I was still met with “disapproving glances”. Some of these glances came from the most unlikely of places. For instance, take church as a front runner. I would receive many of these glances while in Relief Society. What? If you can’t comfortably breastfeed a baby there, among all women (most of which initiated breastfeeding themselves) where can you? By the time my second baby came, I didn’t care what others thought, I just assumed they weren’t as informed as I was about the benefits of breastfeeding. I am thankful for the LDS church having mother’s rooms to accommodate breastfeeding women. There are times however when I chose to breastfeed according to the dictates of my own conscious which often led me outside of the mother’s room. So why does something so natural and discreet, especially when performed modestly, continue to create social awkwardness? Have we desecrated the sole purpose and function of the breast? Has pornography use in the LDS church and in the United States had an impact on breastfeeding in public?

For more discussion on this topic visit

For more information on Utah breastfeeding laws visit

Utah Code Ann. § 17-15-25 (1995) states that city and county governing bodies may not inhibit a woman’s right to breastfeed in public.

Utah Code Ann. § 76-10-1229.5 (1995) states that a breastfeeding woman is not in violation of any obscene or indecent exposure laws. (HB 262)