How do policies surrounding breastfeeding affect women in the workforce? It is not hard to imagine the difficulties – or rather, impossibility – of breastfeeding without the proper facilities, privacy, or policies in the workplace. According to the Centers for Disease Control and Prevention (CDC), 79% of women breastfeed after giving birth, however only 49% exclusively breastfeed 6 months later (2014).
The Affordable Care Act (ACA) and Family Medical Leave Act include policies that address breastfeeding access in the workplace. The World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months of life. Breastfeeding has a strong correlation with the lifetime trajectory of individuals and populations, lowering the risk of childhood-related diseases and chronic diseases later in life. The Family Medical Leave Act indirectly supports breastfeeding by mandating unpaid time off for a short period of time postpartum. Yet, low-wage workers and unmarried women are less likely to be eligible for unpaid leave and more likely to be unable to survive on little to no income. The ACA includes a “Reasonable Break Time for Nursing Mothers” which states that workplaces are required to provide a private space (not a restroom) for women to take unpaid breaks to pump breast milk. While this amendment was created to assist women working for hourly wages, studies have shown that these women are least likely to have access to ACA accommodations.
Why is policy not translating into practice in both of these cases? Dr. Elizabeth Dalianis explored this issue for her doctorate in Public Health at Drexel University. She analyzed the relationship between state laws and enforcement of the above federal laws with breastfeeding practices among working women, with a particular focus on racial disparities in breastfeeding practices. She utilized the CDC survey on infant feeding, the first of its kind, and she stratified the data into three separate categories for analysis: states with regional law on breastfeeding in the workplace that include enforcement mechanisms (California, Minnesota, and Connecticut), states with regional law on breastfeeding with no enforcement mechanisms (n=28), and states which only have the ACA federal requirement (n=19). Across the board, longer duration of breastfeeding was associated with regional law on breastfeeding and active enforcement of these laws. In California, for example, the Labor Commissioner investigates complaints from workplaces that do not uphold the standards of the ACA and the state law. If the claims are proven true, there is a $100 fine assessed per infraction. This is not a perfect solution, however, because it places the burden and responsibility on women to self-report on their employers. For those states without any enforcement specified in the law, it was as if there was no law protecting the basic rights of breastfeeding women at all.
The lack of breastfeeding policy enforcement across the United States (in 47 out of the 50 states), according to Dr. Dalianis’s work, leads to a disparity in breastfeeding practices among working women, particularly for low-income and hourly wage-working women. Without the conditions necessary to breastfeed in the workplace, women are denied the choice to breastfeed their children. Body autonomy is an important aspect of any discourse on Women’s Health. Institutions continually under-prioritize women’s rights to body autonomy– by writing laws that are never enforced, or by creating laws that make it near impossible for women to access the health resources that they need. Many women across the United States are forced to choose between breastfeeding and their career, or between breastfeeding and their livelihood. Women with low-incomes do not even have the luxury of that difficult choice due to the institutional devaluation of women’s body autonomy.
While establishing women’s body autonomy is argument enough to support better enforcement of breastfeeding accessibility laws and policies in the workplace, in terms of public health, breastfeeding a baby provides numerous health benefits that last into adulthood. Thus, low-income women’s inability to choose to breastfeed their children can become a powerful form of structural violence that perpetuates social and health inequalities on the population level.