Breastfeeding Promotion & Support within the WIC Program
The Special Supplemental Nutrition Program for Women, Infants, and Children—better known as the WIC Program—serves to safeguard the health of low-income pregnant, postpartum, and breastfeeding women, infants, and children up to age 5 who are at nutritional risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care. The Food and Nutrition Service (FNS), a Federal agency of the U.S. Department of Agriculture, is responsible for administering the WIC Program at the national and regional levels.
Breastfeeding promotion and support components have been included in the WIC program since the 1970s (read the detailed legislative history). Every WIC State agency has a designated breastfeeding coordinator that provides training on breastfeeding promotion and support to local agency staff responsible for breastfeeding. In 2004, FNS launched a national peer counseling initiative developed specifically for WIC: Using Loving Support to Implement Best Practices in Peer Counseling, allocating funding to States and ITOTs via non-competitive, two-year grants to implement a peer counseling program based on the Loving Support model. To date, the Loving Support Peer Counseling model has been adopted by 51 States and the District of Columbia and 34 ITOTs.
Patient Protection and Affordable Care Act (ACA)
The Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010, by President Obama. There are three provisions of the ACA that have a direct impact on breastfeeding supports:
- Preventive Services
- Workplace Support
- Funding for CDC's Breastfeeding Programs via the Prevention Fund
Additionally, section 2951 of the ACA created and authorized funding for the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program, which gives pregnant women and families, particularly those considered at-risk, necessary resources and skills to raise children who are physically, socially, and emotionally healthy and ready to learn. By electing to participate in local home visiting programs, families receive help from health, social service, and child development professionals, which may include supporting preventive health and prenatal practices and breastfeeding assistance.
TRICARE Moms Improvement Act
As a result of the Affordable Care Act (ACA), the vast majority of private health insurance plans began to cover breastfeeding support, supplies, and counseling as preventive services for women. Yet coverage for military families under TRICARE—the Department of Defense health care program—does not fall under the ACA requirements. To remedy this gap, in 2014 Senator Claire McCaskill (D-MO) and Representative Lois Capps (D-CA-24) introduced the TRICARE Moms Improvement Act in both the Senate and the House of Representatives. The provision was then incorporated into the National Defense Authorization Act (NDAA) for Fiscal Year 2015 and subsequently passed into law. TRICARE serves approximately 9.7 million Active Duty Service members, National Guard and Reserve members, retirees, their families, survivors, and certain former spouses.
Safe Medications for Moms and Babies Act
Although nearly 4 million women give birth and more than 3 million breastfeed their infants annually in the U.S., there is little research to show the potentially unique effects of medication during pregnancy and lactation. Women who take medication for chronic conditions or isolated events have to make decisions with unknown impacts on their health or the health of their babies—or they forgo medication and suffer other health risks as a result. To address these gaps, in 2016 Representatives Jaime Herrera Beutler (R-WA-3) and Kathy Castor (D-FL-14) introduced the Safe Medications for Moms & Babies Act. The provision was then incorporated into the 21st Century Cures Act and subsequently passed into law. The measure will establish a taskforce of federal and medical experts to advance research and information sharing on medication use during pregnancy and breastfeeding.
Bottles and Breastfeeding Equipment Screening Act (BABES Act)
Although air travelers are explicitly permitted by the Transportation Security Administration (TSA) to bring formula, breast milk, and juice that exceed the 3-1-1 Liquids Rule for carry-on baggage, many report experiencing inconsistent implementation of these procedures during airport security screening. To address these recurring issues, in 2016 Representative Jaime Herrera Beutler (R-WA-3) and Senator Kelly Ayotte (R-NH) introduced the Bottles and Breastfeeding Equipment Screening Act (BABES Act) in both the House of Representatives and the Senate. The House version of the bill passed both houses of the 114th Congress unanimously and was signed into law by President Obama on December 16, 2016. It requires the TSA to provide ongoing training to ensure its officers consistently enforce TSA Special Procedures related to breast milk, formula, and infant feeding equipment across all airport security checkpoints.
There are several sources of information on state laws:
- The National Conference of State Legislatures provides compiled listings of breastfeeding-related state laws;
- ChangeLab Solutions has published a database on Law Atlas of state laws and regulations regarding recommendations or requirements for hospitals related to any of the 10 Steps to Successful Breastfeeding;
- The U.S. Breastfeeding Committee's Online Guide, What You Need to Know About the "Break Time for Nursing Mothers" Law, includes a state-by-state analysis of the intersection of federal and state workplace breastfeeding accommodation laws.
- The U.S. Department of Labor Women's Bureau publishes a map with details of employment protections for workers who are pregnant or nursing; and
- The National Partnership for Women & Families maintains a work and family policy database with an overview of bills proposed and laws passed in various states.