Continued barriers for breast-feeding in public and the workplace.

n some parts of the United States, a woman waiting for a bus and breast-feeding her 6-week-old son could be arrested for violating “public indecency” laws; however, if she unzipped her bag, pulled out a bottle, and fed her son, she would be performing a perfectly decent act. Such a paradox should be matters of concern, especially because the scientific community, ederal agencies, and professional societies uniformly extol the virtues of breast milk and breast-feeding. Most countries are ignatories to the World Health Organization recommendation that infants should be exclusively breast-fed for 6 months. The S Healthy People 2010 target is to increase the proportion of mothers who breast-feed their babies for 6 months to 50%. Even uch a modest goal may be difficult to attain, however, because a large fraction of women in this country return to work after elivery. The US Department of Labor reported that in July 2005, 59.3% of women over age 16 were in the civilian workforce. eturning to work has been identified as an important cause of early termination of breast-feeding or of feeding expressed breast ilk. Some barriers to breast-feeding in the workplace include the perception that infants at work may impede mothers’ job erformance; lack of privacy for expressing breast milk or for breast-feeding; inability to find a day care facility at or near the orkplace; the high cost of day care and long waiting periods (up to 8 months in some localities); and insurance regulations, uilding codes, and other rules that limit infants and children in workplaces. Women in low-wage jobs may face substantially reater barriers for breast-feeding than those in higher-wage jobs. The 1996 Personal Responsibility and Work Opportunity econciliation Act (better known as the Welfare Reform Act) also may have had unintended negative consequences on reast-feeding rates, because mothers on welfare may have difficulty in finding jobs that support breast-feeding. There may be reluctance at the workplace to allow for adequate time for expressing breast milk, which may take up to 30 inutes a day. Employers may not appreciate the societal benefits accruing from high rates of breast-feeding, which may far utweigh the cumulative inconvenience of accommodating such efforts. Less well-appreciated issues that may affect breast-feeding rates are local and state laws related to breast-feeding. The able (available at www.jpeds.com) summarizes data from a study conducted by the La Leche League International, updated ay 2005. It is gratifying that 38 states (as of November 15, 2005) have enacted at least ome laws in support of breast-feeding. Some of these laws include exempting breasteeding from public indecency laws; considering breast-feeding a valid excuse for exempion from jury duty; requiring state Departments of Health to issue mercury alerts, xplaining the dangers of eating mercury-contaminated fish by women who are pregnant r breast-feeding; enacting antidiscrimination laws; and waiving sales and other taxes for roducts manufactured for initiating, supporting, and sustaining breast-feeding. The effect of these regulations on breast-feeding rates in the United States has yet o be studied. In a longitudinal survey currently underway, 2100 US women will be nrolled in the third trimester of pregnancy and followed through the first year of their nfants’ age. This study will evaluate the factors influencing women’s choices on feeding heir infant and also may shed light on the barriers to breast-feeding in the workplace. The LLLI data 16 also show that as of November 2005, no specific laws had been assed concerning breast-feeding in 12 states (Figure), but there are pending legislative roposals related to breast-feeding in several states. It is perhaps a sign of the times hat laws are required to “protect” women who plan on performing a perfectly normal iological act that is universally recognized as beneficial to the health and well-being of the ntire society. But regulatory actions do help. In Norway—arguably the breast-feeding capital of he West—high breast-feeding rates have been documented since the 1970s. More than 7% of women breast-feed their infants during the immediate postpartum period, 80% From the Pregnancy and Perinatology Branch, Center for Developmental Biology and Perinatal Medicine, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.