Protecting Infant Nutrition Security:
Shifting the Paradigm on Breastfeeding to Build a Healthier Future for all Americans
The health and wellbeing of American babies have been put at risk in recent years, and we can do better. Recent events have revealed deep vulnerabilities in our nation’s infant nutritional security. For example: Pandemic-induced disruptions in maternity care practices that support the establishment of breastfeeding; the infant formula recall and resulting shortage; and a spate of weather-related natural disasters have demonstrated infrastructure gaps and a lack of resilience to safety and supply chain challenges. All put babies in danger during times of crisis.
Breastfeeding is foundational to lifelong health and wellness, but systemic barriers prevent many families from meeting their breastfeeding goals. The policies and infrastructure surrounding postpartum families often limit their ability to succeed in breastfeeding. Despite important benefits, new data from the CDC shows that while 84.1% of infants start out breastfeeding, these numbers fall dramatically in the weeks after birth, with only 57.5% of infants breastfeeding exclusively at one month of age. Disparities persist across geographic location, and other sociodemographic factors, including race/ethnicity, maternal age, and education. Breastfeeding rates in North America are the lowest in the world. Longstanding evidence shows that it is not a lack of desire but rather a lack of support, access, and resources that creates these barriers.
This administration has an opportunity to take a systems approach to increasing support for breastfeeding and making parenting easier for new mothers. Key policy changes to address systemic barriers include providing guidance to states on expanding Medicaid coverage of donor milk, building breastfeeding support and protection into the existing emergency response framework at the Federal Emergency Management Agency, and expressing support for establishing a national paid leave program.
Policymakers on both sides of the aisle agree that no baby should ever go hungry, as evidenced by the bipartisan passage of recent breastfeeding legislation (detailed below) and widely supported regulations. However, significant barriers remain. This administration has the power to address long-standing inequities and set the stage for the next generation of parents and infants to thrive. Ensuring that every family has the support they need to make the best decisions for their child’s health and wellness benefits the individual, the family, the community, and the economy.
Challenge and Opportunity
Breastfeeding plays an essential role in establishing good nutrition and healthy weight, reducing the risk of chronic disease and infant mortality, and improving maternal and infant health outcomes. Breastfed children have a decreased risk of obesity, type 1 and 2 diabetes, asthma, and childhood leukemia. Women who breastfeed reduce their risk of specific chronic diseases, including type 2 diabetes, cardiovascular disease, and breast and ovarian cancers. On a relational level, the hormones produced while breastfeeding, like oxytocin, enhance the maternal-infant bond and emotional well-being. The American Academy of Pediatrics recommends infants be exclusively breastfed for approximately six months with continued breastfeeding while introducing complementary foods for two years or as long as mutually desired by the mother and child.
Despite the well-documented health benefits of breastfeeding, deep inequities in healthcare, community, and employment settings impede success. Systemic barriers disproportionately impact Black, Indigenous, and other communities of color, as well as families in rural and economically distressed areas. These populations already bear the weight of numerous health inequities, including limited access to nutritious foods and higher rates of chronic disease—issues that breastfeeding could help mitigate.
Breastfeeding Saves Dollars and Makes Sense
Low breastfeeding rates in the United States cost our nation millions of dollars through higher health system costs, lost productivity, and higher household expenditures. Not breastfeeding is associated with economic losses of about $302 billion annually or 0.49% of world gross national income. At the national level, improving breastfeeding practices through programs and policies is one of the best investments a country can make, as every dollar invested is estimated to result in a $35 economic return.
In the United States, chronic disease management results in trillions of dollars in annual healthcare costs, which increased breastfeeding rates could help reduce. In the workplace setting, employers see significant cost savings when their workers are able to maintain breastfeeding after returning to work. Increased breastfeeding rates are also associated with reduced environmental impact and associated expenses. Savings can be seen at home as well, as following optimal breastfeeding practices reduces household expenditures. Investments in infant nutrition last a lifetime, paying long-term dividends critical for economic and human development. Economists have completed cost-benefit analyses, finding that investments in nutrition are one of the best value-for-money development actions, laying the groundwork for the success of investments in other sectors.
Ongoing trends in breastfeeding outcomes indicate that there are entrenched policy-level challenges and barriers that need to be addressed to ensure that all infants have an opportunity to benefit from access to human milk. Currently, for too many families, the odds are stacked against them. It’s not a question of individual choice but one of systemic injustice. Families are often forced into feeding decisions that do not reflect their true desires due to a lack of accessible resources, support, and infrastructure.
While the current landscape is rife with challenges, the solutions are known and the potential benefits are tremendous. This administration has the opportunity to realize these benefits and implement a smart and strategic response to the urgent situation that our nation is facing just as the political will is at an all-time high.
The History of Breastfeeding Policy
In the late 1960s and early 1970s less than 30 percent of infants were breastfed. The concerted efforts of individuals and organizations and the emergence of the field of lactation have worked to counteract or remove many barriers, and policymakers have sent a clear and consistent message that breastfeeding is bipartisan. This is evident in the range of recent lactation-friendly legislation, including:
- Bottles and Breastfeeding Equipment Screening Act (BABES Act) in 2016
- Friendly Airports for Mothers (FAM) Act in 2018
- Fairness for Breastfeeding Mothers Act in 2019
- Providing Urgent Maternal Protections (PUMP) for Nursing Mothers Act in 2022
Administrative efforts ranging from the Business Case for Breastfeeding to The Surgeon General’s Call to Action to Support Breastfeeding and the armed services updates on uniform requirements for lactating soldiers demonstrate a clear commitment to breastfeeding support across the decades.
These policy changes have made a difference. But additional attention and investment, with a particular focus on the birth and early postpartum period, as well as during and after emergencies, is needed to secure the potential health and economic benefits of comprehensive societal support for breastfeeding. This administration can take considerable steps toward improving U.S. health and wellness and protecting infant nutrition security.
Plan of Action
A range of federal agencies coordinate programs, services, and initiatives impacting the breastfeeding journey for new parents. Expanding and building on existing efforts through the following steps can help address some of today’s most pressing barriers to breastfeeding.
Each of the recommended actions can be implemented independently and would create meaningful, incremental change for families. However, a comprehensive approach that implements all these recommendations would create the marked shift in the landscape needed to improve breastfeeding initiation and duration rates and establish this administration as a champion for breastfeeding families.
Recommendation 1. Increase access to pasteurized donor human milk by directing the Centers for Medicare & Medicaid Services (CMS) to provide guidance to states on expanding Medicaid coverage.
Pasteurized donor human milk is lifesaving for vulnerable infants, particularly those born preterm or with serious health complications. Across the United States, milk banks gently pasteurize donated human milk and distribute it to fragile infants in need. This lifesaving liquid gold reduces mortality rates, lowers healthcare costs, and shortens hospital stays. Specifically, the use of donor milk is associated with increased survival rates and lowered rates of infections, sepsis, serious lung disease, and gastrointestinal complications. In 2022, there were 380,548 preterm births in the United States, representing 10.4% of live births, so the potential for health and cost savings is substantial. Data from one study shows that the cost of a neonatal intensive care unit stay for infants at very low birth weight is nearly $220,000 for 56 days. The use of donor human milk can reduce hospital length of stay by 18-50 days by preventing the development of necrotizing enterocolitis in preterm infants. The benefits of human milk extend beyond the inpatient stay, with infants receiving all human milk diets in the NICU experiencing fewer hospital readmissions and better overall long-term outcomes.
Although donor milk has important health implications for vulnerable infants in all communities and can result in significant economic benefit, donor milk is not equitably accessible. While milk banks serve all states, not all communities have easy access to donated human milk. Moreover, many insurers are not required to cover the cost, creating significant barriers to access and contributing to racial and geographic disparities.
To ensure that more babies in need have access to lifesaving donor milk, the administration should work with CMS to expand donor milk coverage under state Medicaid programs. Medicaid covers approximately 40% of all US births and 50% of all early preterm births. Medicaid programs in at least 17 states and the District of Columbia already include coverage of donor milk. The administration can expand access to this precious milk, help reduce health care costs, and address racial and geographic disparities by releasing guidance for the remaining states regarding coverage options in Medicaid.
Recommendation 2. Include infant feeding in Federal Emergency Management Agency (FEMA) emergency planning and response.
Infants and children are among the most vulnerable in an emergency, so it is critical that their unique needs are considered and included in emergency planning and response guidance. Breastfeeding provides clean, optimal nutrition, requires no fuel, water, or electricity, and is available, even in the direst circumstances. Human milk contains antibodies that fight infection, including diarrhea and respiratory infections common among infants in emergency situations. Yet efforts to protect infant and young child feeding in emergencies are sorely lacking, particularly in the immediate aftermath of disasters and emergencies.
Ensuring access to lactation support and supplies as part of emergency response efforts is essential for protecting the health and safety of infants. Active support and coordination between federal, state, and local governments, the commercial milk formula industry, lactation support providers, and all other relevant actors involved in response to emergencies is needed to ensure safe infant and young child feeding practices and equitable access to support. There are two simple, cost-effective steps that FEMA can take to protect breastfeeding, preserve resources, and thus save additional lives during emergencies.
- Require FEMA to participate in the Federal Interagency Breastfeeding Workgroup, a collection of federal agencies that come together to connect and collaborate on breastfeeding issues, to ensure coordination across agencies.
- Update the FEMA Public Assistance Program and Policy Guide (PAPPG) to include breastfeeding and lactation as a functional need in the section on Congregate Shelter Services so that emergency response efforts can include services from lactation support providers and be reimbursed for the associated costs.
Recommendation 3. Expand access to paid family & medical leave by including paid leave as a priority in the President’s Budget and supporting the efforts of the bipartisan, bicameral congressional Paid Leave Working Group.
Employment policies in the United States make breastfeeding harder than it needs to be. The United States is one of the only countries in the world without a national paid family and medical leave program. Many parents return to work quickly after birth, before a strong breastfeeding relationship is established, because they cannot afford to take unpaid leave or because they do not qualify for paid leave programs with their employer or through state or local programs. Nearly 1 in 4 employed mothers return to work within two weeks of childbirth.
Paid family leave programs make it possible for employees to take time for childbirth recovery, bond with their baby, establish feeding routines, and adjust to life with a new child without threatening their family’s economic well-being. This precious time provides the foundation for success, contributing to improved rates of breastfeeding initiation and duration, yet only a small portion of workers are able to access it. There are significant disparities in access to paid leave among racial and ethnic groups, with Black and Hispanic employees less likely than their white non-Hispanic counterparts to have access to paid parental leave. There are similar disparities in breastfeeding outcomes among racial groups.
The momentum is building substantially to improve the paid family and medical leave landscape in the United States. Thirteen states and the District of Columbia have established mandatory state paid family leave systems. Supporting paid leave has become an important component of candidate campaign plans, and bipartisan support for establishing a national program remains strong among voters. The formation of Bipartisan Paid Family Leave Working Groups in both the House and Senate demonstrate commitment from policymakers on both sides of the aisle.
By directing the Office of Management and Budget to include funding for paid leave in the President’s Budget recommendation and working collaboratively with the Congressional Paid Leave Working Groups, the administration can advance federal efforts to increase access to paid family and medical leave, improving public health and helping American businesses.
Conclusion
These three strategies offer the opportunity for the White House to make an immediate and lasting impact by protecting infant nutrition security and addressing disparities in breastfeeding rates, on day one of the Presidential term. A systems approach that utilizes multiple strategies for integrating breastfeeding into existing programs and efforts would help shift the paradigm for new families by addressing long-standing barriers that disproportionately affect marginalized communities—particularly Black, Indigenous, and families of color. A clear and concerted effort from the Administration, as outlined, offers the opportunity to benefit all families and future generations of American babies.
The administration’s focused and strategic efforts will create a healthier, more supportive world for babies, families, and breastfeeding parents, improve maternal and child health outcomes, and strengthen the economy. This administration has the chance to positively shape the future for generations of American families, ensuring that every baby gets the best possible start in life and that every parent feels empowered and supported.
Now is the time to build on recent momentum and create a world where families have true autonomy in infant feeding decisions. A world where paid family leave allows parents the time to heal, bond, and establish feeding routines; communities provide equitable access to donor milk; and federal, state, and local agencies have formal plans to protect infant feeding during emergencies, ensuring no baby is left vulnerable. Every family deserves to feel empowered and supported in making the best choices for their children, with equitable access to resources and support systems.
This policy memo was written with support from Suzan Ajlouni, Public Health Writing Specialist at the U.S. Breastfeeding Committee. The policy recommendations have been identified through the collective learning, idea sharing, and expertise of USBC members and partners.
This action-ready policy memo is part of Day One 2025 — our effort to bring forward bold policy ideas, grounded in science and evidence, that can tackle the country’s biggest challenges and bring us closer to the prosperous, equitable and safe future that we all hope for whoever takes office in 2025 and beyond.
PLEASE NOTE (February 2025): Since publication several government websites have been taken offline. We apologize for any broken links to once accessible public data.
Rather than being a matter of personal choice, infant feeding practice is informed by circumstance and level (or lack) of support. When roadblocks exist at every turn, families are backed into a decision because the alternatives are not available, attainable, or viable. United States policies and infrastructure were not built with the realities of breastfeeding in mind. Change is needed to ensure that all who choose to breastfeed are able to meet their personal breastfeeding goals, and society at large reaps the beneficial social and economic outcomes.
The Fiscal Year 2024 President’s Budget proposed to establish a national, comprehensive paid family and medical leave program, providing up to 12 weeks of leave to allow eligible workers to take time off to care for and bond with a new child; care for a seriously ill loved one; heal from their own serious illness; address circumstances arising from a loved one’s military deployment; or find safety from domestic violence, sexual assault, or stalking. The budget recommendation included $325 billion for this program. It’s important to look at this with the return on investment in mind, including improved labor force attachment and increased earnings for women; better outcomes and reduced health care costs for ill, injured, or disabled loved ones; savings to other tax-funded programs, including Medicaid, SNAP, and other forms of public assistance; and national economic growth, jobs growth, and increased economic activity.
There are a variety of national monitoring and surveillance efforts tracking breastfeeding initiation, duration, and exclusivity rates that will inform how well these actions are working for the American people, including the National Immunization Survey (NIS), Pregnancy Risk Assessment and Monitoring System (PRAMS), Infant Feeding Practices Study, and National Vital Statistics System. The CDC Breastfeeding Report card is published biannually to bring these key data points together and place them into context. Significant improvements in the data have already been seen across recent decades, with breastfeeding initiation rates increasing from 73.1 percent in 2004 to 84.1 percent in 2021.
The U.S. Breastfeeding Committee is a coalition bringing together approximately 140 organizations from coast to coast representing the grassroots to the treetops – including federal agencies, national, state, tribal, and territorial organizations, and for-profit businesses – that support the USBC mission to create a landscape of breastfeeding support across the United States. Nationwide, a network of hundreds of thousands of grassroots advocates from across the political spectrum support efforts like these. Together, we are committed to ensuring that all families in the U.S. have the support, resources, and accommodations to achieve their breastfeeding goals in the communities where they live, learn, work, and play. The U.S. Breastfeeding Committee and our network stand ready to work with the administration to advance this plan of action.
Shifting the Paradigm on Breastfeeding to Build a Healthier Future for all Americans
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