Breastfeeding: The Illusion of Choice



      Breastfeeding is frequently described as a woman's decision, yet this choice is often illusionary owing to suboptimal social and structural supports. Despite passage of the Patient Protection and Affordable Care Act (2010) that requires all qualifying employers to provide mothers “reasonable” break time and a private, non-bathroom space to express breast milk, the majority of women in the United States still do not have access to both accommodations.

      The Problem

      At least three issues may be influencing this suboptimal implementation at workplaces: 1) federal law does not address lactation space functionality and accessibility, 2) federal law only protects a subset of employees, and 3) enforcement of the federal law requires women to file a complaint with the United States Department of Labor.


      To address each of these issues, we recommend the following modifications to current law: 1) additional requirements surrounding lactation space and functionality, 2) mandated coverage of exempt employees, and 3) requirement that employers develop company-specific lactation policies.


      If the goal is to give women a real choice of whether to continue breastfeeding after returning to work, we must provide the proper social and structural supports that will allow for a truly personal decision. No mother should have to choose between breastfeeding her child and earning a paycheck.
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        • Abdulloeva S.
        • Eyler A.A.
        Policies on worksite lactation support within states and organizations.
        Journal of Women’s Health. 2013; 22: 769-774
        • Acker M.
        Breast is best… but not everywhere: Ambivalent sexism and attitudes toward private and public breastfeeding.
        Sex Roles. 2009; 61: 476-490
        • Andrews S.
        Practitioners’ note: Lactation breaks in the workplace: What employers need to know about the nursing mothers amendment to the FLSA.
        Hofstra Labor & Employment Law Journal. 2012; 30: 121-177
        • Bai Y.K.
        • Gaits S.
        • Wunderlich S.
        Workplace lactation support by New Jersey employers following US reasonable break time for nursing mothers law.
        Journal of Human Lactation. 2015; 31: 76-80
        • Bai Y.
        • Wunderlich S.
        • Weinstock M.
        Employers’ readiness for the mother-friendly workplace: An elicitation study.
        Maternal and Child Nutrition Journal. 2012; 8: 483-491
      1. Break Time for Nursing Mothers Provision of 2010, 29 U.S.C. § 207(r) 2010.

        • Chriqui J.
        • Resnick E.
        • Schneider L.
        • Schermbeck R.
        • Adcock T.
        • Carrion V.
        • Chaloupka F.
        School district wellness policies: Evaluating progress and potential for improving children's health five years after the federal mandate. Brief report. 3. Robert Wood Johnson Foundation, New York2013
      2. Child Nutrition and WIC Reauthorization Act of 2004, Pub.L. No. 108–265. (2004).

        • Dieterich C.M.
        • Felice J.P.
        • O′Sullivan E.
        • Rasmussen K.M.
        Breastfeeding and health outcomes for the mother-infant dyad.
        Pediatric Clinics of North America. 2013; 60: 31-48
        • Dinour L.M.
        • Pope G.A.
        • Bai Y.K.
        Breast milk pumping beliefs, supports, and barriers on a university campus.
        Journal of Human Lactation. 2015; 31: 156-165
        • Garvin C.C.
        • Sriraman N.K.
        • Paulson A.
        • Wallace E.
        • Martin C.E.
        • Marshall L.
        The business case for breastfeeding: A successful regional implementation, evaluation, and follow-up.
        Breastfeeding Medicine. 2013; 8: 413-417
        • Haight M.
        • Ortiz J.
        Airports in the United States: Are they really breastfeeding friendly?.
        Breastfeeding Medicine. 2014; 9: 515-519
        • Ip S.
        • Chung M.
        • Raman G.
        • Trikalinos T.A.
        • Lau J.
        A summary of the Agency for Healthcare Research and Quality’s evidence report on breastfeeding in developed countries.
        Breastfeeding Medicine. 2009; 4: S17-S30
        • Kozhimannil K.B.
        • Jou J.
        • Gjerdingen D.K.
        • McGovern P.M.
        Access to workplace accommodations to support breastfeeding after passage of the Affordable Care Act.
        Womens Health Issues. 2016; 26: 6-13
        • Office on Women’s Health, U.S. Department of Health and Human Services
        Breastfeeding support: time and space solutions.
        2014 (Available:) (Accessed: May 18, 2016)
        • Ortiz J.
        • McGilligan K.
        • Kelly P.
        Duration of breast milk expression among working mothers enrolled in an employer-sponsored lactation program.
        Pediatric Nursing. 2004; 30: 111-119
      3. Patient Protection and Affordable Care Act (PPACA) of 2010, Pub. L. No. 111-148, § 4207, 124 Stat. 119, 577(2010).

        • Payne D.
        • Nicholls D.A.
        Managing breastfeeding and work: A Foucauldian secondary analysis.
        Journal of Advanced Nursing. 2010; 66: 1810-1818
      4. Pendleton, D. (2015). Making millions from mother’s milk. Business Week, (4447), 29–30.

        • Raju T.N.K.
        Continued barriers for breast-feeding in public and the workplace.
        Journal of Pediatrics. 2006; 148: 677-679
      5. Supporting Working Moms Act of 2015, H.R. 4113/S. 2321, 114th Cong. (2015).

        • Taylor J.S.
        • MacNamara M.M.C.
        • Groskin A.
        • Petras L.I.
        Medical student-mothers.
        Rhode Island Medical Journal. 2013; 96: 42-45
        • U.S. Department of Health and Human Services
        The business case for breastfeeding, steps for creating a breastfeeding friendly worksite, easy steps to supporting breastfeeding employees.
        2008 (Available:) (Accessed: May 18, 2016)
        • U.S. Department of Health and Human Services
        Surgeon general’s call to action to support breastfeeding.
        U.S. Department of Health and Human Services, Office of the Surgeon General, Washington, DC2011
        • U.S. Department of Labor (DOL)
        Reasonable break time for nursing mothers.
        2010 (Available:) (Accessed: May 18, 2016)
      6. Wage and Hour Division, United States Department of Labor (DOL). (nd). Frequently asked questions. Available: Accessed: May 18, 2016.


      Lauren M. Dinour, DrPH, RD, is an Assistant Professor of Nutrition at Montclair State University. Her research centers on improving food environments that affect infants and children, with specific focus on breastfeeding policies in the workplace and school food policies in elementary schools.


      Yeon K. Bai, PhD, RD, is an Associate Professor in Nutrition and Food Science at Montclair State University. She is a deductive researcher extensively working with Reasoned Action Approach. Her research interests include breastfeeding behavior and eating behaviors of children and older adults.