How the AHCA Could Impact Breastfeeding Rights

Obamacare guarantees a woman's right to pump at work. But will Trumpcare offer the same protections?

Breastfeeding and the AHCA KPG Ivary/Shutterstock
You've probably already seen the headlines about the biggest potential impacts of the new GOP plan, the American Health Care Act (AHCA) to replace the Affordable Care Act (ACA): According to a report released by the Congressional Budget Office (CBO), an estimated 24 million people will lose their insurance under the GOP plan. What's tucked behind that headline is that millions of American women may also lose their right to pump or breastfeed at work.

Since it was passed in 2010, the ACA has mandated that employers with 50 or more employees must provide "reasonable break time" (as defined by the Department of Labor) and a private place (other than a bathroom, and shielded from public view) for women to express breast milk during the workday for at least one year postpartum.

The Republican replacement plan has been short on details thus far, and it has not specifically ended the protection. However, the bill making its way through Congress is only the first of three parts, and there is no guarantee that the final health care legislation will include protection for working mothers who breastfeed.

What we do know is that the first phase of the plan roles back insurance protections for essential health benefits, and there is concern among advocates that insurance plans may not include coverage for things such as breast pumps or lactation support.

"The protections for nursing mothers are a critical part of the ACA's overall re-focus on wellness and preventative care," said Congresswoman Carolyn B. Maloney (D-NY), who co-sponsored the Breastfeeding Promotion Act, which was written into the ACA. "Breastfed children are healthier, and we should support moms' choice to breastfeed by making it easier to pump milk at work. The ACA provided crucial time and space protection to make that a reality—but we should be working to expand that right to more women."

The importance of the protection cannot be understated. The American Academy of Pediatrics recommends exclusive breastfeeding for six months and continued breastfeeding for the first year of life, but because the vast majority of working women don't have paid maternity leave—the United States is the only industrialized nation without this benefit—many new mothers are forced to return to work shortly after giving birth. In fact, according to a 2015 report in the nonprofit magazine In These Times, a quarter of employed mothers return to work within two weeks of childbirth.

Breastfeeding has long been associated with improved health for baby and mother. Breastfed babies are 36 percent less likely to die from sudden infant death syndrome and are 55 percent less likely to become obese later in life, compared with babies who were not breastfed. Women who breastfeed have a lower risk of premenopausal breast cancer, ovarian cancer and osteoporosis, and may return to pre-pregnancy weight more quickly. Many studies also show an association between breastfeeding and lower health care costs.

Katy Kozhimannil, an associate professor of health policy and management at the University of Minnesota School of Public Health, is an author of a 2016 study on the effects of the ACA breastfeeding provision. The study measured whether women had access to both break time and private space, and then looked at breastfeeding duration. It found that those with both were more than twice as likely to be exclusively breastfeeding at six months; and more likely with each passing month to continue to breastfeed.

"The breastfeeding accommodations written into the ACA were evidence based, and our research showed improvement in breastfeeding outcomes to those who had access to the accommodations that the law requires," said Dr. Kozhimannil. "Removing that requirement would negatively impact women's abilities to meet their breastfeeding goals. That is to say, they would be less likely to exclusively breastfeed for six months and more likely to stop with each passing moth, which isn't good for moms or babies."

If the federal standard is removed from the GOP healthcare law, the power to protect working nursing mothers will revert back to the states—and it will be up to your state whether to continue to require these protections, or simply let your workplace decide if and where you can pump at work.

If you don't like the sound of these changes, contact your representatives to let them know that breastfeeding support needs to be a part of any healthcare legislation.

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