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FY25 Appropriations: Current Status and Implications for Breastfeeding

7/22/2024

Cheryl Lebedevitch
National Policy Director

The fiscal year 2025 appropriations process is underway. Follow the status of each of the spending bills in the Congressional Research Service Appropriations Status Table: FY2025.

Funded provisions in these bills can be found on the Federal Appropriations for Breastfeeding webpage. The webpage traces program funding levels at each step in the federal budget process.

The appropriations bills and associated reports also include a variety of unfunded or one-time directives, pasted below:

Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations

House Report
The Committee remains interested in how to improve breastfeeding rates through consistent, collaborative, and high-quality breastfeeding services and supplies. Reports that some WIC agencies only make breast pumps and related supplies available to WIC participants who meet certain criteria are concerning and seem to be in opposition to the goals of encouraging breastfeeding. The Food and Nutrition Service is directed to provide a report to the Committee within 120 days of enactment of this Act detailing any conditions WIC agencies consider, or requirements they impose, when determining whether a WIC participant who intends to fully breastfeed her infant may access breastfeeding supplies and services. The report should also identify any waivers active or granted in the last five years allowing any state agency to spend less than required by WIC program regulations on breastfeeding promotion and support activities.

The Committee recognizes the Food and Drug Administration (FDA) efforts to develop consensus standards for pregnancy and lactation registries, including common data elements, so that registry data can be interoperable within and between such registries. The Committee directs the FDA to continue to develop these consensus standards by convening a forum including participants from federal agencies with experience in patient registries, including the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the National Institutes of Health, and others. The Forum should also include representatives of health care professionals who serve pregnant and lactating people, the pharmaceutical industry, electronic medical record companies, and other organizations with registry experience.

The Committee remains concerned about FDA’s failure to issue final regulations relating to the protection of human subjects, including parts 50 and 56 of title 21, Code of Federal Regulations, with the latest regulations of the Department of Health and Human Services relating to the inclusion of pregnant women as subjects in clinical research, as required by 21st Century Cures Act (P.L. 114–255). Despite the fact that 90 percent of pregnant women take prescription medication during their pregnancy, 70 percent of medications approved by the FDA have no human pregnancy data, and 98 percent have insufficient data to determine the risk to the infant, leaving both the mother and infant at risk to adverse health events. Following recommendations of the Task Force on Research Specific to Pregnant Women and Lactating Women, the Committee urges the agency to issue final regulations.

Senate Report
Following recommendations by the Task Force on Research Specific to Pregnant Women and Lactating Women, the Committee urges the agency to issue final regulations relating to the protection of human subjects, including parts 50 and 56 of title 21, Code of Federal Regulations, with the latest regulations of the Department of Health and Human Services relating to the inclusion of pregnant women as subjects in clinical research. The agency should consider further guidance about ethical issues to be considered and strategies for designing ethical studies, to inform the inclusion of pregnant women and lactating women in a clinical trial and facilitate their participation.

The Committee is concerned that lead, arsenic, cadmium and mercury are often present in dangerous quantities in foods intended for consumption by infants and toddlers and encourages the FDA to coordinate with the U.S. Department of Agriculture to ensure that a wide variety of healthy nutritious foods remain available to participants of Federal nutrition programs.

The Committee remains concerned about the domestic production of infant formula after the 2022 infant formula crisis and that since the 2022 crisis, there have been several instances of cronobacter being found in infant formula and illness and death among babies who consumed it. The Committee directs the FDA to use all authorities to prevent contaminated infant formula from making it to market. The Committee also directs the FDA to streamline approval processes for small domestic manufacturers to increase and expand the domestic supply of infant formula and bring jobs to the Unites States.

The Committee supports the FDA’s efforts to bring together data from several agencies to identify and predict vulnerabilities in the Nation’s food supply chain and enable the FDA to take a proactive approach to ensure food safety and supply chain continuity to prevent and respond to crises, such as the recent infant formula shortage. The Committee provides no less than the fiscal year 2024 level to continue this initiative.

The Committee is concerned by the findings of the HHS Office of Inspector General’s report on the FDA’s response to the infant formula crisis (A–01–22–01502). The Committee directs FDA to provide the Committee with quarterly briefings on changes FDA has made as a result of the findings to improve inspections, recalls, and administrative responses within FDA. The Committee also directs the FDA to provide a report, within 90 days of enactment of this act, outlining any statutory changes needed to fully implement the findings from the report.

The Committee directs the Secretary to ensure that small infant formula manufacturing facilities located in rural areas are aware of their eligibility for the Business and Industry Guaranteed Loan Program.

Commerce, Justice, Science, and Related Agencies

House Bill
None of the funds appropriated or otherwise made available by this Act may be made available for the implementation, administration, or enforcement of the Equal Employment Opportunity Commission's final rule published on April 19, 2024, 89 Fed. Reg. 29096, so as to include elective abortion in the definition of “pregnancy, childbirth, or related medical conditions” requiring reasonable accommodation.

Financial Services and General Government

House Bill
Notwithstanding any other provision of law, a woman may breastfeed her child at any location in a Federal building or on Federal property, if the woman and her child are otherwise authorized to be present at the location.

Department of Homeland Security

House Bill
Except as provided in subsection (b), none of the funds made available in this Act may be used to place restraints on a woman in the custody of the Department of Homeland Security (including during transport, in a detention facility, or at an outside medical facility) who is pregnant or in post-delivery recuperation.

House Report
U.S. Immigration and Customs Enforcement (ICE) is directed to continue providing semiannual reports on the total number of pregnant, postpartum, and lactating women in ICE custody.

The recommendation provides $2,500,000 for OHS for strategic hiring needs and to build-out its mission support capabilities, to include acquisition, IT, finance, human resources, and communications to support the office’s growing responsibilities and oversight. The Committee reminds the Department that OHS shall review all contracts that broadly impact how the Department delivers healthcare, including maternal and postpartum care, to individuals in its custody and to departmental personnel. This includes any contracts related to electronic health or medical records.

Not later than 90 days after the date of enactment of this Act, Customs and Border Protection (CBP) shall provide a briefing to the Committee outlining medical treatment and attention provided to detained women in CBP facilities who are pregnant, nursing, or postpartum.

Labor, Health and Human Services, and Education, and Related Agencies

House Report
The Committee continues to support the Maternal Mental Health Hotline. Maternal mental health conditions impact 1 in 5 pregnant and postpartum women and 1 in 3 female servicemembers and military spouses. The hotline provides 24-hour voice and text maternal mental health support services for pregnant and postpartum mothers and their families in English and Spanish. The Committee directs the Health Resources and Services Administration to coordinate with the Department of Veterans Affairs and the Department of Defense to increase awareness and utilization of the hotline by servicemembers, veterans, and military spouses, including promotion at military treatment facilities, hospitals, lactation spaces, and locations frequented by servicemembers and veterans. The Committee requests a report within 180 days after the enactment of this Act detailing current data on hotline usage, caller demographics to include active duty or veteran status, and the most common reasons for calling the hotline; such report shall be made available on the agency’s website.

The Committee remains concerned about the lack of pregnant and lactating women in clinical research. Women with chronic health conditions lack access to appropriate treatments during pregnancy, putting both them and their infants at risk. Despite 90 percent of pregnant women taking prescription medication, only 5 percent of medications have data on the impact of the medications during pregnancy. The Committee urges the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) to conduct priority research projects on existing medications and therapeutics prescribed to pregnant and lactating women. NICHD is urged to prioritize research applications in the following areas as it relates to pregnant and lactating women: an unmet medical need or gap in treatment, severity and prevalence of a specific disease or condition, and cost and availability of treatment or alternate treatments. The Committee requests an update in the fiscal year 2026 congressional justification on this effort.

The Committee continues funding for the advisory committee to continue activities within the 2020 Task Force on Research Specific to Pregnant and Lactating Women (PRGLAC) Implementation Plan. The Committee requests an update in the fiscal year 2026 congressional justification on progress and Federal activities undertaken to implement the PRGLAC recommendations and recommendations for further implementation of PRGLAC recommendations.

The Committee directs CDC to use the Safe Motherhood and Infant Health funding increase to support Maternal Mortality Review Committees (MMRCs), Perinatal Quality Collaboratives, and other programs, including the Sudden Unexpected Infant Death and Sudden Death in the Young Case Registry. The Committee encourages CDC to prioritize funding to help MMRCs build stronger data systems and improve data collection at the State level to ensure accuracy and completeness in data collection, analysis, and reporting across State MMRCs. This investment is necessary to provide accurate statistics on U.S. maternal mortality rates and inform data-driven actions to prevent these deaths.

Legislative Branch

Senate Bill
Extension of pump act protections to congressional staff
Sec. 212. Section 203(a)(1) of the Congressional Accountability Act of 1995 (2 U.S.C. 1313(a)(1)) is amended--
(1) by striking “and section 12(c)” and inserting “section 12(c), and section 18D”; and
(2) by inserting “, 218d” after “212(c)”.

[USBC note: this provision integrates the PUMP Technical Correction Act into the Legislative Branch Appropriations Act]

Senate Report
The Committee continues to encourage legislative branch entities to enhance the locations and access to spaces dedicated for the use of nursing mothers. The Committee notes that the Further Consolidated Appropriations Act, 2024 (P.L. 118–47) provided the Architect of the Capitol (AOC) with $1,000,000 to retrofit certain nursing mothers’ locations across the Capitol complex. The Committee directs the AOC to brief the Committee on Appropriations of the Senate not later than 60 days after enactment of this act on which lactation rooms were retrofitted and the improvements made to such rooms. Further, the Committee directs the AOC to conduct a survey within 120 days of enactment of this act of users and potential users of lactation rooms across the Capitol complex to better understand the use of such rooms, the need for additional locations and the potential for additional retrofits that may be necessary to better meet the needs of nursing mothers. The AOC is directed to provide the results of the survey and brief the Committee not later than 30 days after the completion of such survey.

Military Construction, Veterans Affairs, and Related Agencies

House Report
The Committee is pleased that to coordinate prenatal and postpartum care provided in the community, the Department has established maternity healthcare and coordination programs, which have been successful in ensuring that veterans can receive high-quality, appropriate care and robust support during and after pregnancy. The Committee supports these programs and encourages Veterans Affairs (VA) to continue to ensure veterans have access to high-quality, well-coordinated care, and robust services and directs VA to continue to implement the Protecting Moms Who Served Act (P.L. 117–69).

State, Foreign Operations, and Related Programs

House Report
The Committee supports effective nutrition interventions, including to reduce stunting and wasting, increase breastfeeding and nutrition supplementation for pregnant women, treat severe malnutrition, and ensure integration with early childhood development, deworming, and water and sanitation efforts. The Committee includes further language under Reports under this heading.

The Committee notes the increase in cases of child wasting globally and the shortage of therapeutic food treatments. Therefore, the Committee directs not less than $300,000,000 under title III of this Act be made available for American-made Ready-to-Use Therapeutic Foods (RUTF). In addition, the Committee expects not less than 50 percent of nutrition funding be devoted to the most cost-effective and evidence-based nutrition interventions, including American-made RUTF, breastfeeding support, prenatal vitamins, and vitamin A supplementation.

What's next for the federal budget process?

In the coming months, the Senate will work to introduce the remaining appropriations bills and the House and Senate will work to advance each of the twelve appropriations bills. Once the full House and Senate have each passed their appropriations bills, they must be "conferenced" to work out any differences between the two versions. House-Senate conference committees make final determinations and prepare a Conference Report. The Conference Report is then passed by the House and the Senate and sent to the President to be signed. All appropriations bills must be completed by the end of the fiscal year on September 30, or Congress will have to pass a continuing resolution to keep the government funded at the start of FY 2025 on October 1.

Learn more on the Federal Appropriations for Breastfeeding webpage.
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