Commentary, NC Budget and Tax Center

Support breastfeeding with paid family and medical leave

Note: This post refers to breastfeeding as nursing and avoids the use of gender-specific language in order to remain inclusive. For more information about this, visit the links here and here.

Too many parents are faced with the difficult choice between earning an income and caring for their newborns. As National Breastfeeding Month 2018 comes to a close, it is important to consider barriers that new parents face to nursing their infant and what opportunities exist to better support new parents. The American Academy of Pediatrics recommends exclusive nursing for the first six months of an infant’s life, followed by nursing that is supplemented with complementary foods for an additional six months. However, data from the CDC show that only 25 percent of infants are nursed exclusively for the first six months and only 36 percent are nursed at 12 months of age.

Despite overwhelming evidence demonstrating the short- and long-term benefits of nursing for both parents and infants, families can face tremendous barriers to adhering to the recommendations. These include challenges with lactation, poor social supports, barriers to health services, limited knowledge of the benefits of nursing, embarrassment, and challenges relating to employment and child care. It is also important to recognize that many new parents are unable to nurse their infant for reasons that include medical conditions and contra-indications, situations of foster care or adoption, cases where caregivers are not the birthing parent, and more.

The trade-off families face between nursing their infant and earning an income reflects the lack of options that exist for many working families. The only federal protections for new parents is the Family and Medical Leave Act (FMLA), which provides 12 weeks of unpaid leave and job protection for eligible employees who need time off to recover from childbirth or personal medical crisis, or care for a seriously ill loved one. However, a staggering 41 percent of American workers did not have access to, or were ineligible for, FMLA in 2012. Census data show that from 2006 to 2008, nearly five percent of new parents were let go from their job after giving birth, while 10 percent took disability leave, 22 percent quit their job, 42 percent took unpaid leave, and 51 percent took paid leave. Those who took paid leave used a combination of paid parental leave, sick leave, vacation leave, or other types of paid leave.

However, many workers who are eligible and can access FMLA are unable to take leave because they cannot afford to take time off without pay. A study prepared for the U.S. Department of Labor found that 46 percent of respondents with jobs at which they were eligible and covered to use FMLA cited the unaffordability of unpaid leave as the reason for not taking leave.

Furthermore, educational attainment is directly tied to leave arrangement. Compared to their more educated counterparts, new parents with lower levels of educational attainment were more likely to be fired, quit their job, and take unpaid leave. These trends reveal that current paid leave policies exacerbate employment inequities and put low-income parents at a further disadvantage in the work force. Moreover, when new parents are unable to take leave from work due to their lack of access to paid leave, it often means that recommendations for nursing guidelines are not met.

Sub-optimal nursing can have lifelong repercussions, undermining quality of life and increasing health care costs for everyone. One study observed lower rates of nursing and vaccination when new parents return to work during the first 12 weeks of their infant’s life, while another demonstrated that even unpaid leave leads to modest improvements in birth weight and premature birth, as well as substantial reductions in infant mortality. Thus, when new parents are eligible and can afford to take unpaid leave, there is significant reduction in adverse health outcomes. An extensive study from 2016 found $18.5 billion in pediatric and maternal healthcare costs could have been avoided through optimal nursing. Even if you consider the cost of providing paid family leave, the economic benefits still outweigh the costs. A study examining the net cost associated with improved nursing compliance to 90 percent calculated a savings of $8.7 billion after taking into account the cost of providing 12 weeks of paid leave at 55 percent pay.

While studies to date do not capture the full health and economic burden of sub-optimal nursing, it is overwhelmingly clear that supporting new parents and families by offering paid leave makes economic sense and, more importantly, mitigates many adverse health outcomes. Rather than force new parents to choose between nursing their infant and earning an income to support their family, we should support families by giving new parents time to bond with and nurse their infant. Providing paid family and medical leave to all workers improves us as a society by ensuring that income does not come at the expense of health; no family should have to make that choice.

Suzy Khachaturyan is an MSW/MPH intern with the Budget & Tax Center, a project of the North Carolina Justice Center.

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