The Rights of Physicians and Future Physicians Who Are Lactating,Breastfeeding,or Chestfeeding: An American Medical Women’s Association Position Article

The American Medical Women’s Association

The American Medical Women’s Association (AMWA) is the oldest multispecialty organization dedicated to advancing women in medicine and improving women’s health. Founded in 1915, AMWA provides a supportive network and resources for more than 12,000 members consisting of physicians, residents, medical students, premedical students, health care professionals, and supporters from a diverse array of backgrounds. The association aims to advance women in medicine, advocate for equity, and ensure excellence in health care. Through education, mentorship programs, and advocacy efforts, AMWA empowers women in the medical field to achieve their full potential and work toward a healthier, more equitable future for all.

Development of This Position Article

This position statement was developed as an initiative of the AMWA Gender Equity Task Force (GETF), which is committed to fostering equity for women in medicine across all sectors and emphasizing the significance of gender equity as a crucial aspect of workforce and health care reform. AMWA GETF strives to raise awareness, advocate, and drive policy change with this overarching objective in mind. The authors were chosen by the physician leadership of the Gender Equity Task Force to include a few qualified GETF executive board members who are experienced in women’s advocacy and a selection of specialists in the field of lactation. All of the authors in this position statement have advanced training in gender equity, women’s advocacy, or breastfeeding and lactation medicine; two of the authors are physician IBCLCs (International Board of Lactation Consultant Examiners). All of the authors have independent academic publications in at least one of these fields. After the final draft of this position article was developed by the chosen authors, it was submitted to the AMWA Board of Directors for review and approval. The AMWA Board of Directors is composed of a diverse group of dedicated professionals who provide strategic guidance and leadership to advance the organization’s mission of supporting women in medicine. After their initial review, the board of directors provided the authors of this lactation position article with a few minor revisions. After the revisions were completed and resubmitted to the AMWA Board of Directors, the lactation position article was approved.

Position Statement

The AMWA advocates for comprehensive lactation support policies in educational institutions and workplaces to promote the health and well-being of parents within the medical field and their infants. This position article calls for comprehensive and inclusive approaches that recognize shared responsibilities, facilitate breastfeeding through provisions such as daycares and breastfeeding-friendly spaces, and address challenges that lactating physicians and future physicians face. By initiating conversations, implementing supportive policies, and striving for meaningful change, we can create a medical community that embodies gender equity and supports the diverse needs of all its members.

Inclusivity

In our dedicated community of physicians, doctors-in-training, researchers, students, and health practitioners who identify as women or gender-diverse, our overarching mission is to create an inclusive space that fosters leadership and participation among all. We respect the rights of all individuals who are deeply committed to advocating for underrepresented groups, including Black, Indigenous, and People of Color (BIPoC), LGBTQIA+ individuals, those who identify as transgender or nonbinary, women physicians serving in the military, international medical graduates, and people with disabilities. We recognize the significance of embracing diversity in our organization and within the broader medical community. It is important to acknowledge that not every individual who identifies as a woman may see themselves as a mother, and not every lactating parent identifies as a woman. Moreover, the distinction between lactating, breastfeeding, and chestfeeding is paramount, recognizing that these terms encompass a range of experiences and choices. Some lactating parents may choose to breastfeed their own children, while others may lactate for other purposes, such as providing milk for children in need. As we explore the rights of physicians and future physicians who are lactating, breastfeeding, or chestfeeding to nourish and care for their children in this article, we aim to approach this subject with a deep commitment to inclusivity and a recognition of the multifaceted identities and purposes within our community. We are dedicated to ensuring that every voice is heard, and every perspective is valued.

Background

Breastfeeding is a biological normal function. Human milk provides a unique blend of nutrients, antibodies, and bioactive compounds that support infant and child growth and development. Human milk is not only a source of essential nutrition but also plays a crucial role in building the child’s immune system, protecting against infections, and promoting cognitive and neurological development. ¹ Numerous studies have demonstrated the benefits of breastfeeding for both the lactating parent and child. ¹ Breastfed children experience overall reductions in morbidity and mortality, including from sudden infant death syndrome (SIDS), a reduced risk of infections, such as respiratory and gastrointestinal illnesses, and a lower likelihood of developing chronic conditions such as obesity, asthma, and diabetes later in life. ¹ Parental benefits include faster postpartum recovery, reduced risk of breast and ovarian cancers, improved cardiovascular and metabolic profiles, and improved bonding with the child. ¹ Moreover, breastfeeding contributes to environmental sustainability by reducing the need for formula production and associated packaging. ² Studies have shown that if 90% of breastfeeding parents met the present recommendations around breastfeeding, our economy could save $3.7 billion in pediatric health costs, with $10.1 billion being in premature deaths from pediatric disease. ² Even including paid leave, the net cost of suboptimal breastfeeding rates is still at least $8.7 billion. ²

Physicians often exhibit a deep commitment to their patients and a strong desire to prioritize patient care above all else, but this dedication can sometimes lead to institutional pressure, with medical institutions relying on these values to encroach upon physicians’ personal commitments to their children.

The AMWA’s mission has always strongly supported policies and programs to improve women’s health. ³ The World Health Organization and the American Academy of Pediatrics recommendations include exclusive breastfeeding for 6 months and continued breastfeeding combined with complementary foods for at least 2 years. ⁴ Given the undisputed benefits of breastfeeding, it is not surprising that many physicians desire to breastfeed, often to meet recommendations for optimal health. And yet, physicians often fall short of their goals. Studies have shown that physicians who become parents during training face significant obstacles to meeting their breastfeeding and pumping needs and goals. ⁵ In fact, a study of residents found that only 21% of residents reported access to usable lactation rooms, 60% reported not having a place to store breast milk, 73% reported residency limiting their ability to lactate, and 37% stopped before their desired goal. ⁵ In this same study, 40% reported that their faculty and coresidents made them feel guilty for breastfeeding. ⁵ Knowledge and attitudes toward breastfeeding, chestfeeding, and lactation in the medical workplace need to change, and a first step includes policy development and implementation.

In addition, many studies have found disparities in breastfeeding on the basis of race and ethnicity. ⁶ Racial and ethnic minority women continue to have lower breastfeeding rates than non-Hispanic white women and are far from meeting the standards set by the World Health Organization. ⁶ Black mothers are 2.5 times less likely to breastfeed than white mothers, and this gap has persisted since slavery. ⁶ In addition, black mothers have the lowest rates of breastfeeding initiation, as well as continuation at 6 months and 12 months. ⁶ These disparities exist even after adjusting for education and income. In addition to racial and ethnic disparities in breastfeeding rates, it is crucial to recognize that transgender and nonbinary individuals often encounter barriers to breastfeeding due to limited access to gender-affirming care, health care discrimination, mental health stressors, data gaps, and economic disparities. To promote equitable access to breastfeeding resources and support, inclusive policies are needed, such as ensuring that transgender individuals have access to lactation support and culturally competent care. These persistent disparities in breastfeeding rates highlight the urgent need for comprehensive policies and support systems to ensure equitable access to breastfeeding resources and promote the health and well-being of all parents and children.

Challenges Faced by Lactating Parents in Learning and Workplace Environments

Despite the well-documented advantages of breastfeeding, lactating parents often encounter barriers in learning and workplace environments that hinder their ability to breastfeed or express milk adequately. These challenges include the following:

Poor access to paid parental leave: In the context of medical education and training, there is often a glaring lack of adequate paid leave and supportive policies for those who are starting or advancing their careers in health care.

In light of these challenges, it becomes evident that comprehensive lactation support policies and initiatives are crucial to enabling parents to breastfeed successfully while pursuing their educational and professional aspirations.

Present State of Lactation Support

The present landscape of lactation support in educational institutions and workplaces varies widely across regions and sectors. While some regions have established comprehensive regulations that ensure lactating individuals’ rights to accommodation and support, others lack clear guidance or enforceable policies. In the United States, for example, the federal “Break Time for Nursing Mothers” law mandates that employers with more than 50 employees provide reasonable break times and a private, nonbathroom space for lactating employees to express milk. ⁷ However, compliance with and awareness of these regulations remain inconsistent.

Legislative initiatives such as the “PUMP (Providing Urgent Maternal Protections) for Nursing Mothers Act,” signed into law in December 2022, play a crucial role in strengthening lactation support in educational institutions and workplaces by extending protections and resources to lactating individuals, reinforcing the importance of creating breastfeeding-friendly environments, and ensuring consistent compliance with lactation accommodation regulations. ⁷ However, many of the protections offered by the PUMP Act may not be honored by educational institutions and workplaces due to various challenges, such as inadequate knowledge about the law’s requirements, insufficient resources allocated for lactation accommodations (including clinical coverage), and a lack of enforcement mechanisms. This implementation gap results in unequal access to lactation support, leaving many lactating individuals without the necessary facilities and time to express human milk during the work or school day.

Institutions and companies that have implemented lactation support programs often report positive outcomes, including improved service member morale, reduced absenteeism, improved retention, and enhanced job satisfaction. ⁸ Of note, the U.S. military has created model policies for service members allowing for significant paid paternal leave, categorized as maternity leave, mandatory convalescence leave (MCL), primary caregiver leave (PCL), and secondary caregiver leave (SCL) allowing the birthing and nonbirthing parent time to care for a newborn infant. ⁹ Policies across the different branches of the U.S. military direct that service members are allowed frequent pump breaks, and designated pumping areas. ⁹ The shortfall of the U.S. military policies is that they vary across branches of services due to the lack of federal guidelines and standards supporting lactating parents. ⁹ The effectiveness of these programs is contingent on their comprehensiveness, accessibility, and integration into the overall workplace culture. Lactation support is not solely about providing physical spaces and time/coverage for expressing milk; it also involves creating a supportive environment that recognizes the value of breastfeeding for both parental and child well-being.

Recommended Strategies and Policies

Conclusion

In the pursuit of fostering an inclusive and supportive environment for lactating parents in medical learning environments and workplaces, it is evident that comprehensive lactation support is essential and an ethical imperative. The integration of effective strategies and policies aimed at accommodating the unique needs of these parents is paramount in ensuring their ability to excel in both their medical careers and their roles as parents.

As medical institutions and workplaces recognize the significance of breastfeeding and lactation support for parental and child health, it becomes imperative to collaborate, innovate, and advocate for change. The success of these efforts hinges upon a shared commitment to creating a landscape where the physiological and psychological well-being of lactating parents is upheld without compromise.

Empowering lactating individuals in medicine involves more than just providing physical spaces and time for expressing milk; it requires cultural shifts, educational initiatives, and policy reforms. By embracing these recommendations and working collectively, medical learning environments and workplaces have the opportunity to become models of support and equity, setting a precedent for other industries to follow.

The AMWA stands at the forefront of this cause, advocating for the rights of lactating parents and championing their holistic well-being. The journey toward comprehensive lactation support in medicine is ongoing, but with the commitment of institutions, professionals, and advocates, a future where parents can thrive in both their medical careers and parenthood is well within reach.