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Breastfeeding a Luxury? How Poor Babies Miss Out on Breast Milk

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By Diane R. Pagen, LMSW

Social "safety net" programs that run counter to breastfeeding our children form the basis of U.S. poverty policy in the 21st century.Specifically, the Temporary Assistance to Needy Families regulations (also known as TANF, Public Assistance or “welfare”), have requirements that make it nearly impossible for low income American mothers to breastfeed their children.

While the breastfeeding awareness events of last week certainly didn’t hurt, they don’t really help more babies to breastfeed, except maybe to convince a few mothers, or to encourage a few who had some trouble at the outset of their nursing. Awareness campaigns do nothing for area mothers and children who are so poor that they have to turn to TANF for some financial help to survive. These breastfeeding education events are sweet, with the proliferation of babies in strollers, but they don’t change that our existing social programs make it tough for mothers to be around their children enough to breastfeed them, period. In TANF in New York State, regulations require that all mothers report to a welfare to work job or “job training” once their baby turns three months old.

The American Medical Association recommends breastfeeding for every child, barring some conditions, for a full twelve months. Breastfeeding prevents ear infections, promotes healthy emotional attachment to the mother, reduces asthma and obesity later in life, and boosts immunity. Doctors agree that stopping an infant’s breastfeeding prematurely results in sicker babies, who in turn become sicker adults, who will need more money spent on their chronic and acute illnesses (think more Medicaid bills, more “early intervention” and so on.) Yet in the United States, only 60 percent of infants are still breastfed at six months old, much less twelve months old.

Well meaning groups are trying to correct our low breastfeeding numbers by “education and outreach,” doing awareness walks and occasionally trying to force legislation to get employers to set up lactation rooms for mothers. This strategy has not improved the lives of babies much as far as getting to breastfeed. The groups have overlooked, or don’t want to take on, the TANF “welfare to work” regulations that compel mothers nationwide to stop breastfeeding at three months after their infant’s birth. Some mothers I have worked with on welfare tell me in the hospital that they weren’t going to start breastfeeding because they knew they wouldn’t be allowed to continue. Regardless of whether they could have gotten some exemption (which is feasible though not common in NY), the fact that the regulation exists shows that our aid programs do not have a long term strategy for increasing the numbers of breastfed American children. If they did, TANF policy would allow for the AMA’s recommended 12 months of nursing.

Congress’s recent cuts to the Women, Infants and Children program—$504 million—will hurt children—but they are not as troublesome to the future of breastfeeding as the everyday policy contained in our main welfare program, TANF. Considering that many mothers have no choice but to apply for welfare in our stagnant economy (paid jobs are not exactly dropping from the sky in Delaware County), the threat of not being able to breastfeed falls disproportionately on the poor mothers, and of course, their children.

The U.S. Department of Health and Human Services routinely issues statements in support of breastfeedng. For some reason, the Department also lets each state fashion their TANF programs’ own regulations, including permission to set its own time frames for going “back to work” rather than use the time frame the federal regulation allows—twelve months from the time of baby’s birth. Nearly every state has chosen to shorten the work exemption to three months’ or fewer. This basically means that states are designing their welfare programs to run counter to every medical and nutritional recommendation that breastfeeding is best for the child and is critical to the public health. This defies all we know about health and distorts the true meaning of “welfare”—as in well-being—of children. The policy used to be known as “welfare” because its purpose was to help children to fare well. FDR never intended that one hundred years later, the policy would no longer prioritize the welfare of children. Yet this is exactly what has happened, with breastfeeding being one of the main things poor children need that poor mothers are thwarted from doing.

While politicians and pundits want you to believe that sending these mothers to work when their babies still need them saves you money, it actually costs you more:

More money up the road: in medical services to address the problems that breastfeeding could have prevented, like asthma, obesity, diabetes, and chronic ear infections. More money to counter the negative effects of not breastfeeding on the infant’s brain development.

More money immediately: as every mother who reports to a TANF work assignment will earn wages so low that she will need subsidized child care. The cost of the nine months of child care from age three months to age 12 months will be at minimum $6,000 per infant. Money will then have to be spent to purchase formula for the infant once it is no longer breastfeeding. Since most poor mothers cannot afford formula, taxes will have to pay.

We should have just let them stay home to breastfeed. It would be cheaper now, and cheaper later, and poorer children would have a better chance at growing up healthy and productive.



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