1. Section Editor(s): Newland, Jamesetta A. PhD, FNP-BC, FAANP, DPNAP, FAAN

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August is National Breastfeeding Month, and August 1 to 7 is World Breastfeeding Week. Breastfeeding is the most natural source of nutrition for infants and a practical method of promoting normal growth and development through early childhood. The benefits of breast milk for infants and mothers have been well established. Infants receive protective antibodies, vital nutrients to prevent malnutrition, and mothers have a reduced risk for postpartum bleeding and breast and ovarian cancers.

Jamesetta A. Newland... - Click to enlarge in new windowJamesetta A. Newland. Jamesetta A. Newland

The World Health Organization encourages breastfeeding for all infants worldwide to improve infant health and decrease mortality. The Infant nutrition and child feeding resolution was reaffirmed in 2018 by the World Health Assembly despite initial objection from the US.1 This was a puzzling position because the nation's Healthy People 2020 initiative includes two objectives specific to breastfeeding: Increasing the proportion of infants who are breastfed and increasing the proportion of employers that have worksite lactation support programs.2


Breastfeeding in the workplace

In 2006, only 74% of all infants were ever breastfed; the target for 2020 is 81.9%. In 2009, only 25% of employers provided lactation support programs; the 2020 target is 38%.2 Subobjectives related to length and intensity of breastfeeding are also listed. One provision of the Patient Protection and Affordable Care Act was an amendment to the Fair Labor Standards Act of 1938 requiring employers with more than 50 employees to "provide reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child's birth each time such employee has need to express milk."3 The employer, however, does not have to compensate the employee for any work time spent for this purpose.


Breastfeeding in the US

Controversy over breastfeeding in public continues across the US. The National Conference of State Legislatures, under the auspices of the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services offer several informative facts:3


* All 50 states, the District of Columbia (DC), Puerto Rico (PR), and the Virgin Islands (VI) have laws that protect women and permit breastfeeding in any public or private location.


* Twenty-nine states, DC, and PR have laws related to breastfeeding in the workplace.


* Six states and PR have implemented the development of a breastfeeding awareness education campaign.3



A state can pass legislation that provides even greater protections, as was done in Texas recently. Governor Greg Abbott signed into law additional protections for women to pump breast milk in public.4 Individual state laws can be found online.


Promoting breastfeeding

Many organizations dedicated to mother, infant, and child health recommend that women start breastfeeding at birth and continue through 6 months.


As NPs, we commonly encourage mothers to breastfeed their infants when possible. Additionally, we must continue to advocate for continued and expanded protections under the law to remove barriers to breastfeeding.


Jamesetta A. Newland, PhD, FNP-BC, FAANP, DPNAP, FAAN

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.





1. World Health Organization. World Health Assembly resolutions and documents: WHA71.9 Infant nutrition and child feeding. 2018. [Context Link]


2. Office of Disease Prevention and Health Promotion. Maternal, infant, and child health. 2019. [Context Link]


3. National Conference of State Legislatures. Breastfeeding state laws. 2019. [Context Link]


4. Byrne E. Texas governor signs bill clarifying that women are allowed to pump breast milk in public. The Texas Tribune. 2019. [Context Link]