There’s no question among health experts that breastfeeding is best for babies. It’s common knowledge that breastfeeding not only provides optimal nourishment for infants, but also protects them against infectious diseases, dehydration due to diarrhea, chronic diseases, obesity, and Sudden Infant Death Syndrome; breastfeeding optimizes development and promotes bonding between the mother and her infant. The mother benefits, as well, in terms of decreased postpartum bleeding and decreased risk of breast cancer, ovarian cancer and osteoporosis.

Indeed, breastfeeding is one of the few examples of the gold standard being less expensive than all of its alternatives: it is absolutely free. So important is breastfeeding for the health of the infant and the mother that the American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of life, and continued breastfeeding with the addition of complimentary foods until at least one year of age (http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/2/496).

The good news is that American mothers are paying attention. According to the Centers for Disease control, 74% of mothers in 2005 initiated breastfeeding, compared to 68% in 1999 (www.cdc.gov/breastfeeding/data/NIS_data/index.htm). This approximates the United States Department of Health and Human Services national Healthy People 2010 goal of a 75% initiation rate (www.healthypeople.gov).

The bad news:

 Average breastfeeding duration in the United States remains dismal. Only 43% of infants are breastfeeding by 6 months, and only 21% by one year.
 Most mothers are not breastfeeding exclusively for any length of time. By two days of age, one out of every four breastfed infant is being given formula, which seriously cuts into the benefits of exclusive breastfeeding. By six months, only a little over 10 percent of infants are being exclusively breastfed.

So while breastfeeding initiation rates are encouraging, it is very clear that we are far from achieving what most health experts would consider optimal national goals. Why is that?

Well, there are a number of reasons: inadequate support from the health care community, aggressive promotion and advertisement of infant formula, commonly held misperceptions about breastfeeding, and the difficulty many women encounter when they have to breastfeed in public places, to name a few. One exceptionally big problem is the return to work.

It wasn’t such a big problem back in 1900, when only 19% of women worked outside of the home (www.bls.gov/cps/wlf-databook2007.htm). Most mothers could breastfeed for as long as they wanted, never having to concern themselves about how they would manage once they returned to work. But by 2006, the proportion of employed women had risen to 59%. That year, fully 60% of mothers of children less than three years of age were in the workforce. Any working mother will readily tell you that unless the employer has gone out of his way to make the necessary accommodations, it can be extremely difficult for mothers to continue to breastfeed once they return to work.

It’s not that employed mothers are less likely than non-employed mothers to start off breastfeeding their infants. In fact, the initiation rates are almost identical: in 1997, 54% of employed mothers started breastfeeding, compared to 53% of non-employed mothers1. But working mothers tend to stop breastfeeding shortly after returning to work, usually within the first eight weeks after delivery.

Things can be done to make the workplace a little more breastfeeding-friendly. For example, workplaces can establish lactation rooms, and they can provide employees with the break time they need to express their milk. They can provide on-site or near-site day care. They can provide flex-time programs. They might even offer breastfeeding support programs. But what mothers and infants need more than anything else during the first few months of life is time to be together.

A number of studies have shown that maternity leave has a positive impact on breastfeeding duration1, 2--5. But in the United States, paid time off for maternity leave consists of whatever a family can cobble together from short-term disability, sick days, and vacation time. We have no national paid maternity leave policy, which in this respect leaves us alone among nations – almost. There are others: Swaziland, Liberia, and Papua New Guinea, to be exact. This is not a distinction that should be a source of great pride for the most affluent nation in history. If we are serious about improving our breastfeeding rates, a national paid maternity leave policy will be absolutely necessary.

1. Visness CM, Kennedy KI. Maternal employment and breastfeeding: findings from the 1988 National Maternal and Infant Health Survey. Am J Public Health 1997;87:945-950.

2. Ryan AS, Wenjun Z, Acosta A. Breastfeeding continues to increase into the new millennium. Pediatrics 2002;110:1103-1109.

3. Gielen AC, Faden RR, O’Campo P, et al. Maternal employment during the early period:effects on initiation and duration of breast-feeding. Pediatrics 1991;87:298-305.

4. Auerbach KG, Guss E. Maternal employment and breastfeeding. American Journal of Diseases of Childhood 1984;138:958-960.

5. Guendelman S, Kosa JL, Pearl M et al. Juggling work and breastfeeding: effects of maternity leave and occupational characteristics. Pediatrics2009;123:e38-e46.