May 15, 2012
The issue we should worry about is not women who breastfeed their 3-years-olds, it's that many women find it impossible to breastfeed their 3-month-olds.
Janet Walsh, Deputy Women's Rights Director

Disturbing. Fantastic. Creepy. Awesome. Sick.

These are some of the comments about the TIME magazine cover that went online this week, showing a woman breastfeeding her 3-year-old son as he stands on a chair.

Love it or hate it, people are entitled to their opinions about the photo. They're also entitled to make their own choices about whether they can and want to breastfeed, and for how long.

But what's truly disturbing are the US government policy failings ─ especially the lack of paid family leave ─ that drive many women who would like to continue breastfeeding to stop earlier than they wish, often after just a few weeks or months. The issue we should worry about is not women who breastfeed their 3-years-olds, it's that many women find it impossible to breastfeed their 3-month-olds.

Sarah O., for example, taught college courses and had a waitressing job when she had her first baby. Her baby was not yet nursing reliably when Sarah returned to work three weeks later. "It was very difficult," Sarah told me. "I was working two jobs, and had no office.... [Pumping] was time consuming, and I didn't produce much... I couldn't pump at my waitress job. There was no place to go there, and it wasn't a good atmosphere." She stopped nursing when the baby was a few months old. "Ideally I would have liked to [breastfeed] at least a year if not longer.... I really wanted it to work."

The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for six months and continued breastfeeding for at least the first year of life. But only 44 percent of US babies are breastfed at all at six months, and only 14.8 percent exclusively. Some mothers make the legitimate choice not to breastfeed, and indeed in some cases it is not advisable for health reasons (for example, the Centers for Disease Control advise against breastfeeding for HIV positive women in the US). But many other women would breastfeed longer if they could.

A key reason that some women stop breastfeeding earlier than they wish is that the US doesn't do what 178 other countries do: guarantee paid family leave for new mothers by law. The US Family and Medical Leave Act enables some workers to take three months of unpaid leave to care for a new baby. But close to half the workforce is not eligible, and many cannot afford unpaid leave. Only California and New Jersey guarantee paid family leave by law, financed by minimal worker payroll contributions.

When a mother's leave from work after childbirth is very short, breastfeeding often suffers. For some mothers and babies, it can take more than a month for breastfeeding to be firmly established, and even if it is, some workplaces are hostile to pumping. This in turn can impact children's and mothers' health and public health generally.

The AAP says breastfeeding decreases infectious diseases, infant mortality, sudden infant death syndrome, diabetes, lymphoma, leukemia, Hodgkin disease, obesity, asthma, and other diseases. Maternal health benefits include reduced postpartum bleeding and decreased risk of breast and ovarian cancer.

Breastfeeding can also save a whole lot of money. A 2010 study found that the US could prevent the deaths of nearly 900 infants and save $13 billion a year if 90 percent of mothers breastfed exclusively for their babies' first six months of life.

Over the past few years I've interviewed parents and health providers across the country about the impacts of the lack of paid family leave. Harm to breastfeeding is a prime concern. Many women told me they returned to work quickly because they could not afford or were not entitled to unpaid leave after childbirth. Almost all stopped or steeply reduced breastfeeding shortly after returning to work.

Policies that guarantee paid family leave substantially extend breastfeeding duration. California, where workers can take up to six weeks of partially paid leave, is a prime example. A 2011 study showed that the program doubled the median duration of breastfeeding for mothers who used it.

The debate triggered by the TIME magazine cover is showing that people have strong feelings about breastfeeding. If they channel those passions into promoting policies that will help women carry on breastfeeding if they so choose, rather than worrying about whether a few moms breastfeed too long, the debate will have paid off.

The question isn't who is "mom enough" as the TIME title suggests, but whether policymakers are smart enough to devise sound policies for breastfeeding, work, and paid family leave.