In an article being early released this week in Pediatrics, Dr. Adi Noiman and colleagues from the Centers for Disease Prevention and Control (CDC) assess gains needed among differing racial, ethnic, and socioeconomic groups to reach the US Department of Health and Human Services Healthy People 2030 (HP2030) national health targets for exclusive breastfeeding through 6 months (target: 42.4%) and any breastfeeding at 12 months of age (target: 54.1%) (10.1542/peds.2024-066219).
HP2030 targets are intended to provide optimistic but achievable benchmarks toward improvement in many health areas.
To assess gains needed, the authors used data on breastfeeding from the CDC’s annual nationally representative survey, the National Immunization Survey-Child, and simply subtracted current breastfeeding rates among each demographic group from the HP2030 rates; the difference represents the gain needed.
Overall, a (whopping) mean gain of 17% is needed to meet HP2030 breastfeeding goals. But the differences by demographic subgroup are more worrisome, revealing not just health disparities (differences in health) but health inequities (disparities that are caused by avoidable and unjust barriers to opportunity or resources).
It will not surprise readers familiar with breastfeeding data that characteristics associated with the largest gains needed for both the 6- and 12-month HP2030 breastfeeding goals were:
- Non-Hispanic Black ethnicity and race,
- Participation in WIC (the Supplemental Nutrition Assistance Program for Women, Infants, and Children, a federal program for families with lower incomes),
- Household income <100% of poverty level, and
- Maternal age <20 years.
Each of these subgroups needed >28% gain to reach the 12 months breastfeeding target.
The authors point to national breastfeeding laws and programs, and federal funding opportunities, such as CDC’s Racial and Ethnic Approaches to Community Health Program (REACH), as critical paths forward.
I’d like to champion an evidence-based approach to equitably achieving HP2030 breastfeeding goals: it’s called paid maternity leave. Research consistently shows a positive relationship between longer maternity leave and breastfeeding duration, with paid maternity leaves of >12 weeks associated with increased initiation and 6-month breastfeeding.
Globally, half of countries meet the International Labour Organization (ILO) Convention No. 183 standards: at least 14 weeks of leave, at a pay rate of at least 2/3 of prior earnings, paid by social insurance or public funds. However, the US is not one of these countries and has no national maternity leave.
Additionally, data shows that Black women on average return to work 2 weeks earlier than other race peers, are more likely to have jobs with less maternity leave, less flexibility, and lower pay, and are more represented in stressful, minimum wage, non-managerial positions.
This perfect storm of inequities creates barriers to breastfeeding that align with the findings of Dr. Noiman and colleagues’ study: this is a gap that can be closed with national paid maternity leave.
While we celebrate the passage of the incredible PUMP act, which requires pumping breaks at work for almost all employed women, equity advocacy cannot stop. As this well written study highlights, we have much more to do to achieve breastfeeding parity for all women.
