The government wants more people to breastfeed. Experts say paid parental leave could help.

A new health report by the Trump administration claims it wants more people in the United States to breastfeed their babies. Experts on the topic and caregiving advocates have a few suggestions — including a federal paid parental leave policy that the nation currently lacks.

The recommendation on breastfeeding is one of dozens in the “Make Our Children Healthy Again Strategy” released this week that aims to address childhood chronic disease. The details are scarce for now, but it commits that two federal agencies — the Departments of Agriculture and Health and Human Services — will work to increase breastfeeding rates through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and “other policies” that support breastfeeding parents. The agencies will also work with federal partners to develop policies to promote and ensure a safe supply of donor human milk.

The MAHA report does not reference support for a federal paid parental leave program.

Experts agree that more breastfeeding is possible in the United States, but it will require the government to enact structural reform and to make financial investments — at a time when the president and his cabinet have proposed slashing critical safety net programs around food and health that could help.

“If we really want to tackle this issue, we know the solutions. We know the structural policies and investments it requires,” said Dawn Huckelbridge, founding director of the organization Paid Leave for All. “But instead of investing in working families they are slashing these investments and coming up with everything but the real fixes.”

About 84 percent of the 3.5 million parents who give birth each year in the United States initiate breastfeeding. But there is a major drop-off during the first months after birth, and fewer than 40 percent of U.S. infants are still receiving human milk when they turn a year old. Sixty percent of parents who begin breastfeeding report that they stopped sooner than they planned.

Rafael Pérez-Escamilla, a professor at the Yale School of Public Health who has extensively researched breastfeeding, said the high initiation rate shows that new parents are highly motivated. Research shows breastfeeding or pumping has health benefits to the nursing parent — it can reduce cardiovascular disease and rates of cancer — and the baby, whose immune system can be strengthened. 

“So it’s not an issue that women don’t want to breastfeed. The issue is that the great majority, or half of the women who choose to breastfeed, cannot breastfeed for as long as they want. It’s not even as long as recommended, as long as they want. And it is because of these major structural barriers,” he said.

Pérez-Escamilla is one of several authors of a just released report through the National Academies of Sciences, Engineering, and Medicine on breastfeeding. That report, commissioned by Congress in 2023, offers evidence-based recommendations to improve and expand breastfeeding services and rates. Among its suggestions: 

• A federal paid parental leave program
• More maternity services at designated “baby-friendly” hospitals that encourage breastfeeding
• More coordinated postpartum breastfeeding services between the federal government and states, since WIC is a federal program but is often administered by state and local health agencies 
• Breastfeeding training in medical schools, nursing schools and other allied health professions
• Medicaid and private insurances need to cover more breastfeeding services and educate parents about the benefits available to them

The report was supported by a contract between the National Academy of Sciences and the health department that’s now led by Robert F. Kennedy Jr. A spokesperson for Kennedy did not immediately respond to a request for comment on the new MAHA report.

The United States is the only high-income country in the world that doesn’t have a federal mandate for paid maternity leave — yet birthing parents are told to breastfeed exclusively for the first six months and then to continue for at least two years. That’s the international World Health Organization recommendation, and it has been endorsed by the American Academy of Pediatrics.

Among parents of color, breastfeeding rates are lower for Black women, Native American and Alaska Native women. It also impacts women with lower socioeconomic status, unmarried women, women living in rural areas and younger mothers. Many are more likely to work in jobs that do not provide paid parental leave. The United States currently only allows some workers to take up to 12 weeks of unpaid time off after the birth or adoption of a child — but the protections of the Family and Medical Leave Act are not available to all employees, and even with that in place many are unable to afford it.

“We know that a very high proportion, especially of very low-income women, many of whom are women of color, end up having to go back to work very, very soon after birth,” added Pérez-Escamilla. “So they just don’t even have a chance to get their milk properly established. They don’t have that social support that they need.”

A federal paid parental leave policy in particular could be a game changer. Research shows that parents who received 12 or more weeks of paid leave were more likely to initiate breastfeeding when compared to parents with no paid leave. Those with paid leave are also more likely to be breastfeeding when their child is six months old.

In California, a paid family leave law enacted in 2004 that ensured mothers up to six weeks of some paid leave is estimated to have increased the overall duration of breastfeeding by nearly 18 days, and the likelihood of breastfeeding for at least six months by 5 percentage points.

“Establishing the breastfeeding relationship and establishing the breastfeeding supply is the most important thing when it comes to be able to being able to breastfeed, and that needs to happen right after birth,” said Inimai Chettiar, president of A Better Balance, a nonprofit organization that has advocated for worker protections for pregnant and postpartum people. 

Chettiar said that beyond support for paid family leave, enforcement of existing laws is also key. Her organization runs a free legal helpline where parents report workplace complaints that may be in violation of the Pregnant Workers Fairness Act and the PUMP Act, two federal laws that have protections for postpartum parents.

“There is a need for policies — and enforcement. Enforcement of those policies around giving women space and time, not just to pump but to establish breastfeeding,” she said.

Chettiar also pointed to a need for ongoing research into maternal health disparities. Complications from delivery — which can impact milk supply — happen more frequently to Black women and women of color.

“Not addressing the racial disparities around this seems like a huge gap, and I don’t see how any kind of program that tries to increase breastfeeding can be in any way successful without addressing the underlying health disparities,” she said.

Huckelbridge said her organization is advocating for a federal paid leave law, because the state-level system that has emerged in recent years to provide paid leave to new parents — 13 states and the District of Columbia have laws that guarantee paid family leave programs, while other states have partnered with insurance companies to offer optional policies — are not enough for the people who don’t live in those states.

“That is increasing the divide between the haves and have nots,” she said. “Until we have a federal program that is truly universal, it’s going to be really hard to reach people who need it most.”

The fact that breastfeeding even got a mention in the MAHA report was welcome news to Cecilia Tomori, an associate professor at Johns Hopkins University who has studied what it takes to increase breastfeeding. She was among the co-authors of the breastfeeding report from the National Academy of Sciences, and worked with Pérez-Escamilla on a series in The Lancet that examines the impact of how infant formula is marketed to parents and its impact on breastfeeding. Kennedy has vowed to “modernize” the nutrition requirements in formula, and the MAHA report includes a blurb on developing new infant formulas.

“We welcome any opportunity to enhance support for breastfeeding, because it is indeed obviously crucial to maternal and child health, and really longer term outcomes,” she said. “In terms of how to implement changes that we need, there are many different ways to do that.”

Pérez-Escamilla said the administration’s focus on WIC can be a positive avenue, since the USDA, through the program, serves nearly half of all infants born in the United States. It offers low-income families a range of services, including a tailored food package and a peer lactation support program.

“The WIC program is clearly one of the key settings through which strengthening policies or new policies could be implemented,” he said.

But Tomori worries about cuts to other programs that provide food and nutritional support to low-income parents. President Donald Trump’s tax and spending law that he signed over the summer would cut about $186 billion from the Supplemental Nutrition Assistance Program, a separate program that helps poor families pay for groceries. Cuts to Medicaid, the federal-state health insurance program, also raised questions about the future of some related coverage for pregnant and postpartum parents.

“Food assistance makes a difference prenatally and postnatally,” she said. “If you want to influence health in a nation and to actually improve health over time, investing in supporting mothers and infants is one of the most effective strategies and provides the greatest return on investment. So anything that threatens that is going to have impacts on health.”

The MAHA report also called for promoting and ensuring a safe supply of donor human milk, a detail that Lindsay Groff finds promising. She is executive director of the Human Milk Banking Association of North America, a nonprofit organization that helps screen the donation of breast milk that can then be pasteurized and used in hospitals and outpatient settings to feed medically fragile children who are often in neonatal care. While the federal government inspects milk banks as food manufacturing facilities, the system is run by outside groups.

The issue intersects with breastfeeding. When a baby is born premature, a parent who intends to breastfeed may not be producing milk yet. Donor milk, which Groff called a “bridge,” helps fill that gap and increases the likelihood that a parent will be able to breastfeed later because the child may not be introduced to formula. The access can be lifesaving: Scientific evidence shows that using donor human milk can reduce cases of necrotizing enterocolitis, an intestinal disease that primarily impacts premature or very low birth weight infants.

Groff’s organization has advocated for legislation that would increase federal funding for nonprofit donor milk. The bill includes setting up a mechanism for letting more people know about the role of human milk in saving lives and increasing breastfeeding.

“Having funding from the federal government could make a huge difference in our reach, in our ability to raise awareness — so that more people can donate milk, and more milk means helping more babies,” she said.

Pérez-Escamilla said it’s important to note that the solutions to increasing breastfeeding rates are multifaceted, and they require the federal government to work with states to ensure implementation of existing maternal health programs and new ones. 

“It’s very complex. It involves, can you imagine: health care systems, social protection systems. It involves the education sector. It involves the employment and labor sector as well,” he said. “And it requires systems thinking and really understanding how to coordinate better.”