In 1997, the American Academy of Pediatrics issued a policy statement on “Breastfeeding and the Use of Human Milk,” declaring human milk to be “species-specific” and recommending it as the exclusive food for the first six months of a baby’s life, to be followed by a mixed diet of solid foods and human milk until at least the end of the first year. In that statement, and in a subsequent revision, the A.A.P. cited research linking breast-feeding to the reduced incidence and severity of, among other things, bacterial meningitis, diarrhea, respiratory-tract infection, ear infection, urinary-tract infection, sudden-infant-death syndrome, diabetes mellitus, lymphoma, leukemia, Hodgkin’s disease, obesity, and asthma. The benefits of breast-feeding are unrivalled; breast-feeding rates in the United States are low; the combination makes for a public-health dilemma. In 2000, the Department of Health and Human Services announced its goal of increasing the proportion of mothers who breast-feed their babies “at initiation” (i.e., before they leave the hospital) from a 1998 baseline of sixty-four per cent to a 2010 target of seventy-five per cent; until the age of six months, from twenty-nine per cent to fifty per cent; at one year, from sixteen per cent to twenty-five per cent. (The same targets were announced in 1990; they were not reached.) Attempts to improve initiation rates have met with much, if spotty, success. The Rush University Medical Center, in Chicago, which runs a peer-counselling program called the Mother’s Milk Club, has achieved an astonishing initiation rate of ninety-five per cent; nationally, the rate is not quite seventy-five per cent. More difficult has been raising the rates at six and twelve months. The C.D.C., which issues an annual Breastfeeding Report Card, has announced that for babies born in 2005 the rate of exclusive breast-feeding at six months was only twelve per cent (although the rate of some breast-feeding at six months had risen to forty-three per cent).
One big reason so many women stop breast-feeding is that more than half of mothers of infants under six months old go to work. The 1993 Family and Medical Leave Act guarantees only twelve weeks of (unpaid) maternity leave and, in marked contrast to established practice in other industrial nations, neither the government nor the typical employer offers much more. To follow a doctor’s orders, a woman who returns to work twelve weeks after childbirth has to find a way to feed her baby her own milk for another nine months. The nation suffers, in short, from a Human Milk Gap.
There are three ways to bridge that gap: longer maternity leaves, on-site infant child care, and pumps. Much effort has been spent implementing option No. 3, the cheap way out. Medela distributes pumps in more than ninety countries, but its biggest market, by far, is the United States, where maternity leaves are so stinting that many women—blue-, pink-, and white-collar alike—return to work just weeks after giving birth. (Breasts supply milk in response to demand; if a woman is unable to put her baby to her breast regularly, she will stop producing milk regularly. Expressing not only provides milk to be stored for times when she is away; it also makes it possible for a working woman to keep nursing her baby at night and on weekends.) In 1998, Congress authorized states to use food-stamp funds granted to the U.S.D.A.’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to buy or rent breast pumps for eligible mothers. Breast-feeding rates rise with maternal age, education, and income. Medela offers a Corporate Lactation Program, free advice for employers seeking to reduce absenteeism and health-insurance costs by establishing “Mother’s Rooms,” equipped, ideally, with super-duper electric pumps, because “breastpumps with double-pumping options save time and can even help increase a mother’s milk supply.” The loss of productivity, Medela promises, is slight: “If each employee uses safe, effective, autocycling breastpumps, each visit to the Mother’s Room should last no longer than 10 to 15 minutes.”
Even more intensive has been the energy directed toward legislative reform. Many states have recently passed laws about breast-feeding, having to do with option No. 3. Must companies supply employees with refrigerators to store milk expressed during the workday? Twenty-one states, along with Puerto Rico and the District of Columbia, require employers to make a “reasonable effort” to accommodate nursing mothers and their bottled milk, although these laws are, generally, toothless. As a rule, the posher the employer, the plusher the pump station. Traders at Goldman Sachs can use an online booking service to reserve time in dedicated lactation rooms, equipped with pumps and chairs; baristas at Starbucks are left to line up to use the customers’ loo. In 2007, Oregon became the first state to pass a law requiring companies with more than twenty-five employees to provide “non-bathroom” lactation rooms. (A national media campaign asks, reasonably enough, if you wouldn’t make your kid a sandwich in a public rest room, why would you expect a woman to bottle her baby’s milk in one?) Virginia and Maryland recently joined twenty-three other states and the Virgin Islands in exempting women who expose their breasts while suckling infants from indecency laws. Whether pumping in public is obscene has not yet been tested—honestly, who would want to?—but, what with all these lactation rooms, maybe that won’t come up.
More rules are under consideration. Can a woman or her employer get a tax break for producing or storing milk? Maryland exempts breast pumps from its sales tax, but a congressional sub-committee is still mulling over the Breastfeeding Promotion Act. The goals of the bill are to add the word “lactation”—defined as “the feeding of a child directly from the breast or the expressing of milk from the breast”—to the Civil Rights Act of 1964, and to allow a tax credit of up to ten thousand dollars per year to companies that provide their employees with pumps or pump rooms. A better title for the proposed legislation might be the Breast Pump Promotion Act.