Breastfeeding advocates are concerned that the Trump administration’s opposition to an international resolution promoting the practice will reverberate in policies at home.
It’s just the latest volley by the White House that undermines efforts to promote breastfeeding, some experts and advocates say. They point to changes in Obamacare regulations concerning breastfeeding education and supplies, the proposed elimination of a hospital breastfeeding program, and a lack of staffing in key government agencies as important indicators of where the Trump administration stands on the issue.
The White House received backlash last week when The New York Times revealed that U.S. officials had opposed a resolution at the World Health Assembly promoting breastfeeding and recommending restrictions on the marketing of alternatives. Democrats and advocates say the move goes against scientific research demonstrating the benefits of breastfeeding.
A lead dairy lobbying group, the International Dairy Foods Association, argued the resolution would have been too restrictive by discouraging the use of dairy products and infant formulas from ages 1 to 3. And President Trump tweeted that the "U.S. strongly supports breast feeding but we don’t believe women should be denied access to formula. Many women need this option because of malnutrition and poverty."
Revelations about what happened at that meeting in Geneva mark just the latest chapter in the U.S.’s debate over breastfeeding and infant formula. “I think it’s hard to see that this administration is putting their full support behind increasing support for women to breastfeed,” said Adrianna Logalbo, managing director of 1,000 Days, which advocates mother and infant nutrition.
“I would like to be wrong in that, but when you look at the efforts that are underway to undermine or change the elements of the Affordable Care Act, looking at what the president’s budget includes and where there are cuts for really important programs and initiatives ... we would like to see a lot more,” she said.
The president’s 2019 budget request proposes eliminating funding for a Centers for Disease Control and Prevention hospital breastfeeding program that promotes evidence-based strategies to help women start and continue breastfeeding. But House appropriators recently approved a draft bill that includes $10 million for the program.
Breastfeeding education and supplies have also been affected by Trump administration efforts to loosen regulations under Obamacare. The Health and Human Services Department has proposed to allow skimpier plans onto the market that don’t have to cover preventive services for women. This includes covering the costs of a breast pump and breastfeeding and lactation support and counseling.
“There have been studies that have shown that having access to breastfeeding support services and supplies has had an impact, and has increased the breastfeeding rate and the duration for women,” said Alina Salganicoff, director of women’s health policy at the Kaiser Family Foundation. “Women who don’t have access to that would have to shoulder those costs on their own. The reason that was recommended was because it was felt to be an extremely effective preventive service for women, in fact one of the most effective.”
Support and promotion of breastfeeding are key to the mission of the Special Supplemental Nutrition Program for Women, Infants, and Children, also known as WIC, according to the National WIC Association, a nonprofit group that advocates on issues related to the program and its members.
WIC provides low-income pregnant, breastfeeding, and non-breastfeeding women and infants supplement food, health care referrals, and nutrition education, according to the Agriculture Department, which oversees the program. WIC supports 53 percent of all infants born in the U.S., and over half of all infant formula is purchased by the program’s benefits, a 2015 USDA report stated.
“It is unprecedented for the administration to take a position on an international breastfeeding resolution that so clearly conflicts with its domestic policies,” said Douglas Greenaway, president and CEO of the National WIC Association. “We wonder whether the administration will be willing to defend programs like WIC that promote breastfeeding, or if they will put the voices of formula manufacturers first domestically, too, undermining programs like ours.”
Greenaway said the administration has not been clear on its opposition to the breastfeeding resolution and that a lack of staffing could hinder communication with relevant stakeholders.
“It is deeply concerning that the administration has not been transparent about how they came to their anti-breastfeeding stance on this resolution,” said Greenaway, who also expressed concern with the administration’s lack of movement in filling key positions at USDA, such as the undersecretary for the Food and Nutrition Service. “It is vital that USDA and HHS are fully staffed in order to fulfill their public health roles. Hiring freezes and delayed filling of political positions make it hard for the departments to do their work, and to be transparent and communicative with stakeholders.”
One of the biggest infant-formula makers, Abbott Laboratories, has been active on issues regarding infant-formula marketing this year. The company spent $790,000 so far in 2018, which includes lobbying the U.S. Trade Representative on “proposals regarding infant nutrition marketing,” according to a lobbying disclosure form provided by the Center for Responsive Politics. Abbott Laboratories also paid the Russell Group $50,000 to lobby the Senate, House, and USDA on “matters related to federal food and nutrition policy, including those impacting infant formula.”
Republican Rep. Phil Roe, a doctor, told National Journal that women should be provided alternative options to breastfeeding, citing concerns that the practice can be difficult for women. “I think in the United States of America if you can breastfeed you should, if you can, and if you can’t, there should be an alternative for you that’s safe, and there is,” said Roe, who fished his phone out to show a picture of his granddaughter and explained that she was both breastfed and bottle-fed.
“We shouldn’t be so prescriptive that we make our patients feel bad about if they can’t,” he added.
But some Democrats argue that the White House’s stance could limit pregnant women’s knowledge on what their best options are. “Women should have access to the most accurate information regarding the benefits and risks associated with infant nutrition methods, and countries should strive to limit inaccurate or misleading marketing campaigns,” Democratic senators wrote in a July 12 letter to U.S. Ambassador to the United Nations Nikki Haley.