Abstract
My support for breastfeeding is part and parcel of my broader advocacy of wellness and disease prevention. Back in 1991 and 1992, I ran for President of the United States. During that campaign, one of my signature issues was the need to transform America's sick care system into a genuine health care system—one focused on encouraging wellness and preventing disease, keeping people out of the hospital in the first place.
I have always been struck by the fact that, in the United States, we spend twice as much on health care compared with Europeans, but we have twice as much chronic disease. One big reason for this disparity is that we spend peanuts on prevention—only roughly 3% of our health care dollars. Instead of spending money up front to help people to take charge of their health, America spends colossal sums patching and fixing people after they get sick or disabled.
Looking back to the 1980s and 1990s, you might say that those were my wilderness years. Some of my political friends wondered, “Why does Harkin have this obsession with wellness and prevention?” but I persisted. As I rose in seniority in the Senate, I was able to make headway, if not headlines.
Sometimes, the changes were relatively modest, such as in 1992, when I passed a measure changing the name of the Centers for Disease Control to the Centers for Disease Control and Prevention, emphasizing the Centers' responsibility for addressing illness and disability before they occur.
Recently, I have been able to advance more ambitious legislation—for example, helping to pass new child nutrition legislation that will fight the childhood obesity epidemic by getting junk food and sugary sodas out of our public schools. 1
However, I take special pride in the new Affordable Care Act.2,3 Amidst the ridiculous hubbub about “death panels” and “government takeover,” the press largely failed to focus on a truly transformational section of this bill: Its array of provisions promoting wellness, disease prevention, and public health.
Two years ago, Senator Ted Kennedy, my predecessor as chair of the Health, Education, Labor and Pensions Committee, began the push for comprehensive health reform. Knowing my long-standing advocacy in this area, Ted asked me to draft the section of the bill focusing on wellness and prevention. That was like giving a kid the keys to a candy store. In the final health reform legislation, I was able to include a remarkable array of provisions that, I believe, will jumpstart America's transformation into a genuine wellness society.
One of those provisions was designed to encourage breastfeeding. I have always believed that breastfeeding should have the highest level of support throughout society. It must be permitted in all public places and accommodated in the workplace. Indeed, one big reason why mothers choose not to breastfeed is because of lack of support in the workplace. With that in mind, the Affordable Care Act requires employers to provide reasonable, unpaid break time for many nursing mothers. This provision is already in effect, benefitting many new mothers across the country.
As always, the devil is in the details. The Department of Labor is now working on administrative guidance for implementing this provision. I have weighed in strongly with a number of recommendations:
• Recently, a woman in Des Moines, returning to work after maternity leave, was told she couldn't have access to a workplace lactation room for at least 3 days. She ended up having to quit her job. I have urged the Department of Labor to make clear in its guidance that workers must be allowed immediate access to break time and lactation space upon returning to work. • Another issue is that some women have a medical need for a longer-than-average break time to pump. I have asked the Department to encourage employers to consider such factors and not set hard-and-fast limits on what constitutes reasonable break time. • I am also concerned that workers might be offered lactation space that isn't in the same building where they work. So, I have also asked the Department to require employers, wherever feasible, to provide rooms that do not require a significant amount of travel time—or travel outdoors.
Friends, this provision in the Affordable Care Act is an important step forward, and I will work to extend these protections to all nursing mothers.
Likewise, along with Senator Jeff Merkley of Oregon, I recently intervened with the Internal Revenue Service to reverse its longstanding policy that breast pumps and supplies are only tax deductible and reimbursable through flexible spending accounts if they are prescribed by a physician. That IRS policy is simply not consistent with support for breastfeeding. Thanks to the hard work of advocates like you, those expenses are finally tax deductible and reimbursable.
The fact is, we need a much more aggressive effort in the United States to raise awareness about the amazing benefits of breastfeeding. On that score, I applaud Surgeon General Regina Benjamin's Call to Action to Support Breastfeeding, issued in January 2011. 4 I salute the Academy of Breastfeeding Medicine for your own determined advocacy over the last decade and a half.
I also want to salute New York Times columnist Nick Kristof for his terrific op-ed published in June 2011. Here's how he began the column, “What if nutritionists came up with a miracle cure for childhood malnutrition? A protein-rich substance that doesn't require refrigeration? One that is free and is available even in remote towns . . . where babies routinely die of hunger-related diseases? Impossible, you say? Actually, this miracle cure already exists. It's breast milk.” 5
Kristof laments that fact that, in Africa, where he was visiting, appallingly low percentages of children are exclusively breastfed for the first 6 months—for instance, only 7% in Niger, only 3% in Mauritania. Who are we to talk? The rate here in the United States is just 13%! 6
On that score, I have never forgotten something that a prominent physician said at a hearing in my committee several years ago. He said, “The default status of the human body is to be healthy.” In other words, our bodies want to stay healthy, and our bodies have tremendous powers of healing.
As I thought about this observation, it dawned on me that, unfortunately, the default status of our society and culture is to sabotage our natural health.
For example, look at the multifront assault on our children's health. We are building subdivisions without sidewalks for walking . . . and many schools without adequate spaces to play. We have all but eliminated recess and health education. Meanwhile, our public schools have been inundated with vending machines selling sugary sodas, candy, and junk food. Our children are targeted by a relentless barrage of advertisements for fast food restaurants and junk food. Then, like clueless dodos, we are shocked that we have a childhood obesity epidemic!
Obviously, breastmilk and breastfeeding are supreme examples of the default status of the human body to be healthy. We know that children who are breastfed for the first 6 months are less likely to become obese, less likely to develop asthma, less likely to die from sudden infant death syndrome, less likely to contract infectious diseases such as ear infections and pneumonia. 4 But, too often, our society conspires to make breastfeeding undesirable, inconvenient, or, as a practical matter, not possible. There is widespread ignorance and prejudice about breastfeeding.
Of course, there is also foolish, short-sighted public policy. I must note that the Republican budget for 2012 would slash funding for the Women, Infants, and Children nutrition program by $733 million—a move that would turn away as many as 450,000 low-income women and children next year. This is shameful. The WIC program expressly encourages its clients to breastfeed their infants. It provides a whole range of incentives, including counseling and extended eligibility.
The deep cuts in the Republican budget are a dangerous step backward for children's health. Those cuts are the ultimate false economy because they will lead to higher rates of illness and obesity—and higher health care costs—in the future.
So, friends, as breastfeeding advocates, we have got our work cut out for us. We have this amazing nutritional source, along with a perfectly designed means of delivery—truly a gift of God and not enough of our citizens are taking full advantage of it. We can and must do better!
To that end, I am grateful for the leadership of our Surgeon General Regina Benjamin, Department of Health and Human Services Secretary Kathleen Sebelius, Department of Labor Secretary Hilda Solis, and the Academy of Breastfeeding Medicine for their leadership in removing barriers to breastfeeding.
I am grateful to each of you—as well as the organizations you represent—for your own determined advocacy in your communities and nationally. I want you to know that I am proud to be your partner, and I am committed to assisting you in your work in every way I can.
Thank you, friends, and keep up the great work!