摘要：Workplace barriers contribute to low rates of breastfeeding. Research shows that supportive state laws correlate with higher rates, yet by 2009, only 23 states had adopted any laws to encourage breastfeeding in the workplace. Federal law provided virtually no protection to working mothers until the 2010 enactment of the “reasonable break time” provision of the Patient Protection and Affordable Care Act. This provision nonetheless leaves many working mothers uncovered, requires break time only to pump for (not feed) children younger than 1 year, and exempts small employers that demonstrate hardship. Public health professionals should explore ways to improve legal support for all working mothers wishing to breastfeed. Researchers should identify the laws that are most effective and assist policymakers in translating them into policy. Breastfeeding yields important immediate and long-term health benefits for infants and their mothers, including positive impacts on children's cognitive development and their health as adults. 1 – 3 Breastfeeding is associated with higher productivity and lower absenteeism for breastfeeding mothers and has additional benefits for society ( Table 1 ). 4 – 6 The American Academy of Pediatrics recommends exclusive breastfeeding through 6 months postpartum and continued breastfeeding until the infant is aged at least 12 months. 1 Among other organizations, the World Health Organization, the US Surgeon General's Office, and the American Academy of Family Physicians recommend comparable or longer durations of breastfeeding. 7 – 9 TABLE 1 Selected Benefits of Breastfeeding Health Benefits to Child Health Benefits to Mother Economic Benefits Improved cognitive development Decreased postpartum bleeding Higher employee productivity and lower absenteeism Bolstered immune system Decreased menstrual blood loss Increased employment retention by working mothers who breastfeed Reduced incidence and severity of such conditions as bacterial meningitis, diarrhea, and urinary tract infections Increased child spacing Family cost savings by avoiding purchase of infant formula Reduced risk of diabetes, lymphoma, leukemia, hypercholesterolemia, and asthma Earlier return to prepregnancy weight Decreased health care costs of $3.6 billion if breastfeeding rates were raised to Healthy People 2010 goals, resulting in savings to public and private insurers Decreased risk of overweight Decreased risk of breast and ovarian cancers Open in a separate window Source. Gartner et al. 1 ; Harder et al. 2 ; Dietz and Hunter 3 ; US Department of Health and Human Services 4 ; Ball and Wright 5 ; Bartick and Reinhold 6 ; Healthy People 2010 Midcourse Review . 10 Healthy People 2010 established 5 US breastfeeding goals, none of which have been achieved ( Table 2 ). 10 Of the mothers of children born in 2006, 73.9% initiated breastfeeding, which is close to the Healthy People 2010 goal of 75%. However, only 43.4% continued breastfeeding for at least 6 months postpartum, only 33.1% continued exclusive breastfeeding at 3 months, and only 13.6% continued exclusive breastfeeding for at least 6 months postpartum. 11 Many states' breastfeeding rates for these mothers were small fractions of the Healthy People 2010 goals. Breastfeeding rates are low in certain minority groups (especially African Americans, American Indians, and Alaska Natives) and among low-income, less-educated, and younger women, directly implicating health equity issues. 12 TABLE 2 US Breastfeeding Goals and Rates Rate Category Ever Breastfed, % Breastfeeding at 6 Mo, % Breastfeeding at 12 Mo, % Exclusive Breastfeeding at 3 Mo, % Exclusive Breastfeeding at 6 Mo, % Healthy People 2010 goal 75 50 25 40 17 US ratesa 73.9 43.4 22.7 33.1 13.6 State ratesa 48.3–92.8 22.7–69.5 8.7–38.4 16.8–56.6 4.6–25.3 Open in a separate window Source . Healthy People 2010 10 ; Centers for Disease Control and Prevention. 11 aFor 2006 births. In 2003, the World Health Organization and UNICEF recommended “enacting imaginative legislation protecting the breastfeeding rights of working women and establishing means for its enforcement” by all governments. 7 (p14) An analysis of national, aggregate data in the United States found a general association between states' adoption of laws supporting breastfeeding (not limited to workplace laws) and initiation of breastfeeding and breastfeeding at 6 months. 13 Here we review federal and state laws relevant to breastfeeding in the workplace, identify gaps and limitations in those laws, and recommend actions to improve the use of law for achieving higher rates of breastfeeding.
