By Michael Yudell

Almost two years ago my wife was visiting her native Boston with our second daughter, and was nursing her on a bench at a suburban mall. While sitting there, feeding our then 4-month-old child, a stranger aggressively approached her and said, "That is disgusting!" My wife, both shocked and appalled, asked the woman, "How could you say that? I am feeding my child."

"Well, I think you need to go into a restroom to do that," the woman angrily responded.

"As a matter of fact, I don't," my wife said. "The law here says I can breastfeed wherever I want." "Well then I am sorry," the woman huffed, and walked away, back to her life in a Victorian-era cave.

And my wife, who, of course, is always right, most especially on Mother’s Day, was in fact right. The Commonwealth of Massachusetts does indeed protect public breastfeeding, as do the state of Pennsylvania, the City of Philadelphia, and 43 other states around the country.

The 2007 “Pennsylvania’s Freedom to Breastfeed Act” permits a mother to “to breastfeed her child in any location, public or private, where the mother and child are otherwise authorized to be present, irrespective of whether or not the mother’s breast is covered during or incidental to the breastfeeding.”

Despite the attempts over the past decade to protect women who are breastfeeding, and despite the Affordable Care Act’s provisions “to provide reasonable break time and a private, non-bathroom place for nursing mothers to express breast milk during the workday, for one year after the child’s birth,” breastfeeding rates are still well below national goals.

Although 74 percent of women have breastfed at some point, only 43 percent were nursing at six months, and 23 percent at one year. Goals for the U.S. Department of Health and Human Services' Healthy People 2020 program for breastfeeding are 82 percent, 60 percent, and 34 percent for these respective goals. When looking at whether women breastfed exclusively, those numbers are worse. Only 33 percent did so through three months; that number dips to 14 percent through six months. Healthy People 2020 goals for these statistics are 46 percent and 25 percent.

The importance of these goals is reflected in the latest recommendations for breastfeeding by the American Academy of Pediatrics — an organization of 60,000 pediatricians committed to the optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults. Fundamental to the new policy, “Breastfeeding and the Use of Human Milk,” is the scientifically driven belief that breastfeeding and human milk are the “normative standards for infant feeding and nutrition.” In other words, when possible, babies should be breastfed. The AAP recommends exclusive breastfeeding “for about 6 months, followed by continued breastfeeding as complementary foods are introduced.” Ideally, the AAP calls for infants to be nursed until they are one.

In Philadelphia, overall, women lag behind national breastfeeding rates. The latest statistics show that only 57 percent of mothers have ever breastfeed. That’s nearly 20 percentage points below the national average. The numbers are worse at six months (29 percent) and 1 year (15 percent).

The Centers for Disease Control and Prevention has also identified significant disparities between between racial groups. African American women lag significantly behind women in all other groups in breastfeeding rates. Income is also a predictor: 85 percent of higher-income women had ever breastfed, while for low-income mothers the rate was 68 percent.

These disparities have a real impact on the health of babies, as breastfeeding is associated with a wide range of benefits. During the first year of life, any breastfeeding “is associated with a 64 percent reduction in the incidence of nonspecific gastrointestinal tract infections,” and significant decreases in colds, throat, and ear infections. Hospitalization for lower respiratory tract infections in infants are decreased by 72 percent for kids nursed more than four months.

Some of breastfeeding's advantages last a lifetime. Breastfed kids have lower lifelong risk of developing diseases like leukemia, for example. Reductions in both type 1 and type 2 diabetes have also been found, and breastfeeding has been linked to a 30 percent reduction in obesity – for adolescents and adults.

According to Bette Begleiter, deputy executive director of the Maternity Care Coalition, “while the disparities remain, there is a tremendous amount of interest and energy being devoted to the issue here in Philly. The momentum is towards a reduction in breastfeeding disparities.” (Full disclosure: Begleiter is my aunt). This momentum is good news for Philadelphia’s mothers and their children.

The coalition's MOMobiles, a ubiquitous sight around Philadelphia, run programs that help new mothers adapt to what can be the tough beginnings of nursing. The coalition has just launched a three-year project funded by the Kellogg Foundation to help increase breast feeding rates in North Philly.

So what else is being done to increase breastfeeding in all groups?

The Baby-Friendly hospital initiative, launched by the World Health Organization and UNICEF in 1991, seeks to improve breastfeeding rates around the world. Hospitals that “offer an optimal level of care for infant feeding” are deemed baby friendly, and help foster what the initiative calls the “Ten Steps to Successful Breastfeeding.” These include hospitals and birthing centers having “a written breastfeeding policy that is routinely communicated to all health care staff,” giving “no pacifiers or artificial nipples to breastfeeding infants,” and informing “all pregnant women about the benefits and management of breastfeeding.”

And a recent report from the Joint Center for Political and Economic Studies, a research advocacy organization working “to inform and illuminate the nation's major public policy debates,” identifies the need for cultural and structural changes to improve breastfeeding rates and to decrease disparities, particularly those affecting African American mothers. The report, “African American Women and Breastfeeding” identifies the need for health insurance to cover lactation needs; for health care professionals to have training in the basics of breastfeeding; and for hospital practices of giving out infant formula to new mothers upon discharge to be banned. It also says that “every licensed maternity site should be required to become Baby-Friendly.”

Let's hope that women in the near future are given all possible opportunities to understand the health benefits of breastfeeding and live in a nation that supports their choice to nurse their child.

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