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 Breastfeeding and the Affordable Care Act

By Carolyn Mullen
Associate Director, Government Affairs, AMCHP

Breastfeeding is recognized as the best source of nutrition for most infants1 and strategies to support breastfeeding mothers and babies are some of the most effective measures to protect and promote the health of all infants. According to a report published by the Agency for Health Research and Quality, the evidence is clear that breastfeeding reduces Sudden Infant Death Syndrome, gastrointestinal infections, upper and lower respiratory diseases, childhood leukemia, asthma, ear infections, childhood obesity, and diabetes mellitus type 2 risk for children, as well as rates of hospitalization.2 Mothers also benefit from breastfeeding. Research shows that women who breastfeed have a decreased risk of breast and ovarian cancers.3

Breastfeeding promotion is currently a significant focus of national health policy. In January 2011, the U.S. Surgeon General released a Call to Action to Support Breastfeeding. The call to action summarizes research on the health benefits of breastfeeding and outlines steps many entities can take to support healthy breastfeeding practices. Simultaneously, the U.S. Baby Friendly Hospital Initiative encourages and recognizes hospitals and birthing centers that offer an optimal level of care for infant feeding practices and have implemented the Ten Steps for Successful Breastfeeding for Hospitals outlined by the World Health Organization. Moreover, the Patient Protection and Affordable Care Act (ACA) provides states and communities additional opportunities to strengthen breastfeeding support.

A soon to be released AMCHP issue brief entitled Breastfeeding and the Affordable Care Act explores how states and communities can capitalize on the opportunities presented by the ACA to advance breastfeeding. In particular, it examines state partnerships; financing of breastfeeding support and counseling services; promoting worksite accommodations; utilizing the Maternal, Infant and Early Childhood Home Visiting Program (MIECHV) to improve referral and tracking; and leveraging other funding opportunities. This issue brief also highlights some of the best practices of state Title V MCH programs and their partners and offers strategies for states interested in developing similar efforts. The states featured in this issue brief include the following:

  • New York Division of Chronic Disease Prevention, as part of the state initiative to redesign Medicaid, created a state plan amendment to require Medicaid reimbursement for evidence-based breastfeeding education and lactation counseling consistent with the U.S. Preventive Services Task Force recommendation.
  • North Carolina Perinatal Committee of the North Carolina Child Fatality Task Force, which included the breastfeeding coordinator for the state, designed a benchmark definition of lactation support and counseling for International Board Certified Lactation Consultant coverage under the ACA provision.
  • California Department of Public Health is implementing an obesity prevention program to increase breastfeeding duration rates in California communities of color. The information gathered from this program will be used to inform California state efforts in promoting and developing guidelines for the breastfeeding provision of the women’s preventive services regulation. California also is featured for developing a benchmark indicator for breastfeeding which is tied to the MIECHV program.
  • Nebraska Division of Public Health and Department of Labor embarked on a joint project to inform businesses throughout the state about the changes in the Fair Labor Standards Act.
  • Oregon Public Health Division initiative to ensure workplace accommodation for breastfeeding women.

Finally, this issue brief provides a range of strategies that state Title V MCH programs, Medicaid agencies, chronic disease directors, state departments of labor and other groups, such as The Nurse Family Partnership program, can use to promote and improve breastfeeding through the ACA. It is part of a national project, Optimizing Health Reform to Improve Birth Outcomes, funded by the W.K. Kellogg Foundation to strengthen the capacity of state Title V MCH programs and their partners to improve birth outcomes and infant health through health reform.


1 The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies
2 IOM (Institute of Medicine). 2011. Clinical Preventive Services for Women: Closing the Gaps. Washington, DC: The National Academies Press: 110
3 United States. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011: 1