Removing the Barriers to Breastfeeding

In June 2022, the American Academy of Pediatrics (AAP) issued new recommendations about breastfeeding to ensure optimal health benefits for babies and their lactating parents. For those who are able to breastfeed, the AAP continues to recommend exclusively breastfeeding1 babies for the first six months after they’re born — but now recommends continuing breastfeeding for at least two years, finally bringing it in line with the World Health Organization recommendation.

This recommendation is based on plentiful evidence that human milk continues to provide nutritional and immune support beyond one year — and that the longer you breastfeed, the more it helps reduce health risks, particularly for the lactating person2.

The Health Benefits of Breastfeeding

For the baby, human milk reduces the risk of sudden infant death syndrome (SIDS), ear infections, respiratory and gastrointestinal infections, allergies, celiac disease, obesity, diabetes, necrotizing enterocolitis (NEC), and some cancers.
Antibodies are transmitted to breastfed babies in milk, including COVID-19 antibodies from those who are vaccinated.
The lactating person recovers more quickly from pregnancy and has a reduced risk of breast, endometrial, and ovarian cancers, Type 2 diabetes, and heart disease.

In its recommendation, the AAP noted that people who want to continue breastfeeding their child until age two face many barriers, including social understanding, public policies, and workplace support. The AAP also notes that these challenges impact historically marginalized groups the most.

Barriers to Breastfeeding

The U.S. is the only industrialized country with no paid parental leave. One quarter of women return to work just two weeks after delivering, and only 13 percent of workers have access to any paid leave whatsoever.

The Affordable Care Act guaranteed reasonable space and time accommodations for lactating people at work, and coverage for breast pumps. But most who return to work are expected to advocate individually for these accommodations, as if they were the first employee who ever needed them! Lactating people are often only given the minimum support required by law, and reports of discrimination are common.

People who breastfeed also end up paying a price in lifetime earnings, and are especially vulnerable to other aspects of the motherhood penalty.

Outside of workplaces, there are even fewer lactation accommodations, and people have shared horror stories about nursing and pumping in unsanitary and dehumanizing conditions.

With all these barriers, is it any wonder that breastfeeding rates are lower among marginalized groups like Black and Indigenous women, young women, and poor women?

Racism’s Impact on Breastfeeding

Black women’s rate of participation in the labor market is the highest of all women, and return to work is the most common reason for weaning.
Increased vulnerability to job loss, retaliation, and discrimination in the labor market makes it that much harder for marginalized women to advocate for parental leave and lactation accommodations.
Lactation support groups have mostly centered on white women’s experiences and barriers.
Only 10% of lactation consultants, 11% of OB-GYNs, less than 7% of midwives, and 4% of pediatricians are Black.
Women at hospitals in Black neighborhoods are less likely to receive lactation support, and their babies are more likely to be given formula in the hospital.
Pregnant, birthing, and lactating people are quite literally policed, which can have devastating implications for some families, especially minoritized groups.
Instances of historical exploitation — such as enslaved or impoverished Black women being used as wet nurses for white babies, to the detriment of their own children — have made cultural attitudes toward breastfeeding complex.

Decisions about whether and how long to breastfeed are personal. But the reality is that for many parents, breastfeeding doesn’t even seem like an option because their circumstances make it too difficult.

I’ve used my academic position to do research and publish recommendations about optimal lactation space design and document the progress of colleges and universities in building lactation infrastructure. I’ve also collaborated with others to advocate for better lactation and workplace support for women in science. But that’s not enough. We all have a role to play in making it easier for every family to be able to meet these recommendations and every child to thrive.

What We All Can Do to Help Support Breastfeeding

Respect birthing people, and understand that their choices are made in contexts you may not fully understand.
Offer support, but withhold judgment, and push back on shaming anyone for their infant feeding plans or choices.
Advocate for policies and actions that dismantle institutional racism and sexism and promote health equity and justice.
Listen to, and amplify, groups that advocate for reproductive justice, including removing barriers for Black women to breastfeed — especially Black-led groups such as Oshun Family Center, Reaching Our Sisters Everywhere (ROSE), the Black Mothers’ Breastfeeding Association, and the Black Mommas Matter Alliance.
Be a friend. Offer whatever help you can to support families with a new infant. Bring a casserole, lend a sympathetic ear, take the baby for a walk so people can take a nap, or research and order a breast pump and accessories.

If You Are a Leader or Decision Maker at Work…

Send a strong, clear message that birthing people are supported — by taking a look at your leave and remote-work policies, and the clarity and accessibility of your lactation policy.
Consider providing on-site daycare or subsidies.
Communicate that harassment and discrimination are not tolerated, and then create easy processes for employees to alert you when it is happening.
Ensure that your workplace provides an appropriate, convenient, respectful lactation space, and that refrigeration is available for milk storage.
Make sure breastfeeding doesn’t require special accommodation requests, which can make people feel like they’re asking for something they’re not entitled to.
If employees must travel, pay to ship their milk home.
Work is an important social determinant of health; think about how different types of workers at your company may face different barriers. Measure how your supports and policies are being used, and adjust them if they aren’t working. Be bold and generous.
Initiate a conversation with your pregnant/nursing coworkers or direct reports about how you can support their infant feeding plans or choices. You could offer more flexible schedules, additional breaks, reduced travel responsibilities, adjusted meeting times, the option of remote work — anything that helps them with their more limited time.

If You Are Pregnant…

Learn what supports are in place for you, including through your health coverage. For example, Independence Blue Cross covers lactation counseling and breast pumps and has a maternity support program called Baby Blue Prints® to help you stay healthy during and after your pregnancy.
Seek out help and empathy; peer support can really help you feel like your experiences are normal.
Learn about what lactation support professionals do. While breastfeeding is a natural biological function, it doesn’t always come naturally. Sometimes it may take a few days for a new parent to produce sufficient milk — or any milk at all — and many struggle with pain or even finding the right positioning to nurse their newborns successfully. That’s on top of the sheer emotional and physical exhaustion that comes from giving birth, and the sleepless nights that are common in the first weeks afterward. Without some coaching, it can feel like you have no choice but to stop. But a lactation consultant can help you understand how to overcome both common and uncommon breastfeeding challenges.

Finally, if you are currently breastfeeding, however long you’ve been doing it, you are amazing! Some days might be hard, but you can do it with help. Trust yourself.

Do what is best for yourself and your family. Connect with others. Celebrate every success, no matter how small it feels.

Know your rights, and don’t apologize for your needs. If it feels safe, advocate for yourself and others. And remember: like everything else about parenting, whatever is happening now won’t last forever.

1 Although we use the term “breastfeeding” here, we recognize that it is not fully inclusive of feeding practices, and we acknowledge that the terms “chestfeeding” and “human milk feeding” may feel more appropriate for some.
2 Not all lactating individuals identify as women.