Lactation Legislation and Its Implications in the United States: Systematic Literature Review

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Research Objective: The Surgeon General calls to action to support breastfeeding cite workplace barriers as a significant contributor to low breastfeeding rates. Although the Affordable Care Act (ACA) attempts to address this barrier, the federal legislation as well as many state laws applicable to breastfeeding are highly variable or do not apply to the workplace. Lactation legislation varies widely across the nation. Emerging research suggests lactation laws improve breastfeeding rates, especially among ethnic minorities; however, more research is needed to identify which laws have the greatest impact on breastfeeding behaviors. The purpose of our study was to (1) conduct a structured content analysis of national breastfeeding laws following the implementation of the Affordable Care act (ACA) and (2) provide a systematic review of their effects.

Study Design: A structured content analysis of national breastfeeding laws and systematic literature review of their effects was conducted. Using PubMed, Google scholar, and grey literature, we searched for studies on the relationship between lactation laws and breastfeeding behavior in the United States between 1996 and 2016. The main terms used in the literature search were breastfeeding practices and breastfeeding legislation, policy or law.

Population Studied: The reviewed lactation laws in the United States urged or required employers to provide break time and offer a secure location for breastfeeding employees, allowed breastfeeding in any public or privation location, and included other workplace-specific mechanisms to promote breastfeeding.

Principal Findings: Much research has been conducted examining the individual level factors that influence breastfeeding; however, only five studies have sought to examine the relationship between legislation and breastfeeding practices. Literature indicates that state lactation laws, particularly workplace specific policies have the greatest effect on increasing breastfeeding rates. Nation-wide there was a breastfeeding increase of 2.4% while there was a 5.6 and 5.8 percentage increase for Black and Hispanic women respectively in states with new workplace provisions.

Conclusions: Prior to the 2010 ACA enactment, thirty-six states and the U.S. Virgin Islands permit mothers to breastfeed in any public or private location where the mother is legally permitted to be, 23 states and the U.S. Virgin Islands exempt breastfeeding from public indecency laws, and 12 states and Puerto Rico have workplace specific breastfeeding laws. Meanwhile, only seven states and Washington, D.C. have implemented or encouraged the development of a breastfeeding awareness education campaign. The ACA requires employers to provide reasonable break time and a space other than a bathroom for an employee to express breast milk for her nursing child for one year after the child’s birth. Research illustrates that lactation laws have the largest impact on minority women, who typically have the lowest rates of breastfeeding, indicating such policies can also reduce the gap in breastfeeding disparity.

Implications for Policy or Practice: There is the dire need for the development of further comprehensive workplace legislation on breastfeeding in order to improve breastfeeding behavior and ultimately infant health outcomes. Laws encouraging breastfeeding are a means to raise awareness, education, and societal support to increase breastfeeding rates and close the gap in breastfeeding disparities across the nation.


Academy Health Annual Research Meeting (ARM)


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