2022 Impact Report: Breastfeeding Policy Priorities

Infant feeding practices have a profound impact on population health outcomes. This is why increasing breastfeeding rates and creating lactation-friendly environments have been identified as critical public health priorities both nationally and globally. Yet barriers to establishing and maintaining the human milk feeding relationship are persistent and pervasive in the United States. This year, in addition to the ongoing COVID-19 pandemic, many families also had to navigate the devastating infant formula recall and shortage, stripping away their confidence in keeping their babies safely fed. 

The U.S. Breastfeeding Committee and our network of members, partners, and supporters are diligently working to remove the policy, system, and environmental barriers that families face. We are proud to share that in 2022, we did many great things together, including achieving forward movement on all five of the policy priorities that were selected by our supporters and member organizations in 2020. We thank you for your continued support.

​Here is a detailed account reflecting ongoing USBC activities to advance these five policy priorities.

Since 2012, Congress has allocated funds to the CDC Hospitals Promoting Breastfeeding program. CDC uses these funds to improve maternity care practices, increase access to peer & professional support, ensure continuity of breastfeeding care, increase support for breastfeeding employees, and address disparities in breastfeeding rates. In Fiscal Year (FY) 2022 our collective efforts resulted in a $250,000 increase for this line item. 

While we are grateful for any increase, we know that a much larger investment is needed to meet the needs of today’s families. Over 120 organizations joined the USBC in calling for a funding increase for FY 2023. We bolstered our call for increased funding with hundreds of constituent messages sent with USBC action tools. The FY23 federal budget is still under negotiation. We are hopeful that the $180,000 increase included in the Senate appropriations bill will be maintained in the final budget.  

The USBC is also looking ahead to FY 2024, calling on the White House to increase the President’s Budget request for this line item to $20 million, an increase from the FY 2023 request of $9.5 million. Please take a moment to contact the President and Vice President with our easy action tool today!

The Hospitals Promoting Breastfeeding line item is an important priority for the USBC, but it certainly isn’t the only funding provision that impacts infant feeding. The Healthy Meals, Healthy Kids Act (H.R. 8450) would reauthorize critical child nutrition programs, including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The bill would authorize $180M in funding for the Breastfeeding Peer Counselor program, a $90M increase, to ensure that WIC agencies can support more full-time positions and increase placements outside of clinics. A detailed analysis of appropriations provisions that impact infant feeding can be found on the Federal Appropriations for Breastfeeding webpage, including funding for the Racial and Ethnic Approaches to Community Health program, WIC breastfeeding peer counselor program, and beyond. The USBC actively supports funding for these programs.

The infant formula recall and resulting shortage demonstrate the urgent need to build a robust infrastructure for infant nutrition security with federal policies and programs that ensure access to lactation support, supplies, and accommodations; expand access to pasteurized donor human milk; reduce predatory marketing practices by formula manufacturers; and ensure the safety of commercial milk formulas. No baby should ever go hungry.

The USBC mobilized stakeholders and curated and shared information, resources, and news with our network and the public throughout the crisis. These conversations led to the articulation of the four pillars of infant nutrition security in the United States, which were widely shared across the nation and are helping guide our collective efforts. The USBC-affiliated Infant & Young Child Feeding in Emergencies (IYCFE) Constellation updated the Joint Statement on Infant and Young Child Feeding in Emergencies in the U.S. to inform and support infant and young child feeding in emergencies as a component of emergency response, including in the event of an infant formula shortage. The USBC also convened stakeholders for incubation conversations exploring the formation of a Disrupting Formula Marketing Constellation. Participants reviewed the landscape and explored their interest and capacity to engage in collaborative work.

Access to lactation support and supplies remains a major challenge for young families during emergencies and natural disasters. The USBC worked with Congressional champions and partners from the field to create the DEMAND Act of 2022 (Delivering Essentials to Mothers Amid Natural Disasters Act) (S. 3601/H.R. 6555). This legislation would ensure that lactation support and supplies are eligible for reimbursement under the Federal Emergency Management Agency (FEMA) Critical Needs Assistance program. The IYCFE Constellation launched a joint letter signed by 98 organizations urging Senators and Representatives to cosponsor the bill and connected hundreds of constituents to their legislators to express their support for this legislation.

Too often, new parents are left without the basic lactation support and supplies they need to start and maintain human milk feeding. The USBC and our network continue to advocate for timely, comprehensive, and culturally appropriate care for all families.

Insurer coverage of lactation support and supplies is critical to building a landscape of support for babies
and families. Unfortunately, coverage gaps leave too many families unable to access these essential services. In 2022, the Women's Preventive Services Initiative released updated clinical recommendations on which breastfeeding services and supplies private insurance must cover without cost-sharing. The final recommendations featured important improvements from the previous version, and incorporated several recommendations from the USBC-affiliated Lactation Support Provider (LSP) constellation on how to create more equitable access. The LSP Constellation continues to work to close remaining policy gaps. In advance of the finalization of 2023 health plan coverage, the constellation is engaged in conversation about what improved coverage should look like.
 
Issues accessing lactation support are a major problem among military servicemembers and their families. The TRICARE Childbirth and Breastfeeding Support Demonstration Project is underway to evaluate the cost, quality of care, and impact on maternal and fetal outcomes of using extramedical maternal health providers for military families. The LSP Constellation continues to advocate for a more equitable approach that utilizes and reimburses the full spectrum of providers and their specific skills through a culturally-centered lens.
 
The infant formula shortage caused a flurry of attention on infant feeding, including the introduction of legislation which would have had a profound negative impact on the nation’s already under-resourced milk banking system. The USBC-affiliated Pasteurized Donor Human Milk (PDHM) and LSP Constellations mobilized in response and leaders have been working with congressional champions to develop new legislation to create a robust infrastructure for pasteurized donor human milk banking in the United States. The Access to Donor Milk Act was introduced in the House and Senate this month!  

The USBC also submitted comments and joined conversations throughout the development of the White House National Strategy on Hunger, Nutrition, and Health, urging the administration to include infant nutrition security as an important component of food security efforts. The final strategy featured commitments from the federal government to expand access to virtual lactation support, fund efforts to reduce disparities, address gaps in insurer coverage of breastfeeding support and supplies, and protect the rights of lactating workers.

Research shows that access to paid family and medical leave makes a world of difference for lactating
parents and their families. Still, only a small portion of workers in the United States have paid leave. The
USBC stands with a coalition of organizations working to establish a national paid family and medical insurance leave program. The lactation field brings an important perspective to the paid leave dialogue.
 
This year, efforts to create a national paid leave program got farther than ever before. In addition to a growing number of cosponsors on the Family And Medical Insurance Leave (FAMILY) Act (S. 248/H.R. 804), the Build Back Better Act, which was passed in the House, included a provision for a national paid leave program. Although this was ultimately cut from the legislative package that was signed into law, it signals the growing support for a national paid leave program.
 
After returning to work, lactating employees and students must have access to break time and a safe space to pump while they are separated from their baby. The USBC is incredibly proud to serve as part of the strategy team ushering the Providing Urgent Maternal Protections (PUMP) for Nursing Mothers Act (S. 1658/H.R. 3110) through the Congressional process. The PUMP Act is the first standalone breastfeeding bill to receive a recorded vote on the House floor, where it passed with strong bipartisan support. The Senate bill advanced out of committee with unanimous bipartisan support. When the bill was brought to the Senate floor with a request for unanimous consent, there was an objection so it did not pass that day. However, negotiations have continued in earnest and we are anticipating that the bill will go to the full Senate for consideration a second time in the weeks ahead. More than 230 organizations signed on to support the PUMP Act, bolstered by thousands of individual advocates who have called, emailed, or met with their Senators this year. Stay tuned for news and action opportunities in the weeks ahead!
 
In addition to the PUMP Act, the USBC is advocating for passage of the Pregnant Workers Fairness Act (PWFA) (S. 1486/H.R. 1065), The PWFA would ensure reasonable workplace accommodations for workers whose ability to perform the functions of a job are limited by pregnancy, childbirth, or related medical conditions, including lactation. The bill passed with bipartisan support in the House and has the votes needed to pass the Senate, however it needs to be prioritized by Senate leadership to be brought to the Senate floor. Tell your Senators to take action today!
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Finally, the USBC-affiliated Workplace Support Constellation worked with a range of stakeholders to develop a joint letter for organizations and community leaders in response to proposed regulations from the U.S. Department of Labor on Title IX of the Education Amendments Act of 1972, which recognizes lactation as a pregnancy-related condition and includes proposed requirements for lactation break time and space for students and school employees.

Maternity care practices play an essential role in setting families up for human milk feeding success. This summer, the Centers for Medicare & Medicaid Services (CMS) unveiled its Maternity Care Action Plan to support the implementation of the White House Blueprint for Addressing the Maternal Health Crisis, inviting the public to submit comments. In response, the USBC convened stakeholders for a series of Maternity Care Practices Constellation Incubation Conversations in which participants undertook a comprehensive assessment of the blueprint and action plan and developed talking points and key messages that member organizations could use/adapt in their comment submissions. The USBC continues to connect with federal agencies and stakeholders on this issue.
 
In addition, the USBC is part of a mighty coalition working to advance a legislative package known as the Black Maternal Health Momnibus. The Momnibus includes several bills endorsed and supported by the USBC to address barriers to lactation support and reduce disparities. Several key legislative provisions from the Momnibus package were included in the Build Back Better Act, passed by the House, but were not included in the final legislative package signed into law. We will continue to push for passage and keep the field informed on news and action opportunities.
 
Together, we rose to the invitation to make a big impact in 2022. We showed up when it was time to dig into the details of complicated policies because we knew what it could mean for babies and families. We elevated our concerns and solutions to policymakers. We showed up, even when it was difficult. We still are. And, it was all possible thanks to your support and engagement.

We are buoyed by every action you take! Signing on to letters, using our advocacy tools to contact legislators, and urging others to act by posting on social media and talking to people in your networks are all necessary steps to advance the policy agenda we've defined together. We also need financial support to fund our advocacy efforts. Please consider making a donation to the USBC. All contributions, from $5 to $5,000 or more, are valuable, worthy, and appreciated.

On January 3, 2023, a new Congressional session will begin. The USBC is working with our membership to identify our top five policy priorities for the new session. Stay tuned for news and updates!

We are so grateful to have you with us on this journey.
Warm wishes,

Amelia Psmythe Seger, USBC Deputy Director

PS. Want to learn more? Read the 2021 Impact Report.