Before the dizziness of the endorphins and drugs wear off, a lactation consultant marches into the maternity ward to give a woman who has just given birth the pep talk: that they too are capable of feeding their newborns breast milk, and that this is, without question, the best path forward for both mother and baby. While jostling the new moms’ breasts to demonstrate the best latch, the consultant will not fail to underscore the unique benefits of breast milk, and will, at some point, stipulate further that breast milk is not only better for baby’s health but better for mom’s wallet. Unlike formula, she’ll say, nursing is free.
If you, like me, spent thousands of hours nursing an infant, you may raise your sleepy eyebrows over the assumptions behind this last point. It’s only free if your time is worthless. And even then, it is only free if we all turn the blind eye to some obvious economic realities.
The relationship between money and nursing is nothing new. In 19th-century France, for example, thousands of newborn children were sent to remote parts of the country via train, often from Paris, to the care of wet nurses who breast-fed them for money and took basic care of them.* Many babies died en route, or in the care of the nurses who were overworked and unable to tend to all. Still, outsourcing breast-feeding was considered a financial necessity for many families, since it was cheaper than replacing the mother at the family store. Does it sound like a cynical, gruesome artifact of a time long past?
Consider this: Today in the U.S., one-quarter of mothers return to work less than 2 weeks after giving birth. Before the tears from deliveries and C-section scars have even healed, many women are leaving their newborns in the care of someone else, most typically as an economic necessity. As for feeding, they have two options: buying expensive formula for a caregiver to feed them; or if she is willing and able, take breaks to pump during work hours, spend (nonexistent!) spare time pumping in the evenings to build up supplies, store, freeze, transport this milk, and carve out the time to clean, sanitize, and maintain the pumping gear. No country in the world comes even close to the U.S. in breast-pump proliferation. Given these constraints, it’s no surprise then that living at or close to the poverty rate means you’re less likely to breast-feed exclusively for the first six months than those who are wealthier.
But the obstacles don’t end here. As someone who grew up in Europe, I noticed a striking paradox after having children here in the U.S.: Breast-feeding is heavily promoted, yet there is hardly any time for actual nursing if you’re a woman who needs to work (and that’s most mothers). High-fives all around if you are one of the lucky women who seamlessly pumps during conference calls, in your private office with full control over scheduling calls at a convenient pumping time–when you’re presumably also relaxed and well-hydrated! In general, however, while workspaces are supposed to provide some women with pumping breaks and facilities, the employer is not obligated to pay them for time spent pumping, and workplaces with less than 50 employees can claim that such breaks impose “undue hardship” and not provide a woman with any accommodations.*
And the reality is that even under the best of circumstances, pumping and nursing are not the same activities: many women who made the rhythmic sound of milk expression an integral part of their work day will tell you that their milk supply began to dwindle over time, and they ended up having to supplement with formula. In other words, they had a resource that they were not able to maintain.
So how do we ensure breast-feeding is actually valued and protected for women who want to do it? One way would be to make the actual financial value of breast milk to our economy more visible.
Human milk production—even milk that is expressed to be sold or donated—is still not measured in GDP in any country, although Norway calculates breast milk production in with its national food statistics. Treating breast milk as a “food commodity,” a 2013 study in Australia tried to quantify the potential loss of economic value caused by not protecting women’s lactation from competing market pressures. Using United Nations System of National Accounting guidelines and conventional economic valuation approaches to measuring production, it provided a year’s “milk worth” estimate for Australia ($3 billion), and Norway ($907 million). It notes that the United States has the potential to produce breast milk worth more than US$110 billion a year, although currently nearly two-thirds of this value is lost due to early weaning. But these costs are deceiving, as they focus on the output but do not include the time cost of breast-feeding to women.
The same study notes that the time spent breast-feeding (and by extension, pumping, with all the little chores that come along with it) should be quantified, but due to inadequate time use data we simply do not know the final figures that could guide economic policies. In turn, not having solid numbers to work with reduces the perceived importance of any programs and regulations that would protect and support women’s time allocation to feeding their babies.
Very little quantitative research has been done to examine how breast-feeding impacts women’s economic status, although it’s one of the most common manifestations of unpaid care work. A 2012 U.S.-based study by Mary C. Noonan and Phyllis L. F. Rippeyoung lifts the veil somewhat: Among women who were employed in the year before their first child, those who breast-feed for six months or longer experienced a steeper decline in their annual income, on average, than mothers who breast-fed for shorter durations or not at all. Why? Unlike in other developed countries, mothers of very young children in the U.S. usually work outside the home. The authors note that most mothers are not extended the right to take breaks to breast-feed their babies, and as a result, mothers who breast-feed for six months or longer are more likely to switch to part-time work or quit work entirely. This means the failure to recognize the value of breast milk is not only contributing to class inequality in breast-feeding outcomes, but is also linked to gender inequality in wages and the labor market.
While public health benefits and long-term public health cost savings due to breast-feeding are widely recognized, breast-feeding requires enormous maternal time investments that have other unrecognized costs. While infants are not being whisked off on trains around the country, our current breast-feeding order is nonetheless inhumane and costly.
Once we recognize these human and financial costs, the way forward is clear. Whenever possible, workplaces serious about retaining women should go beyond allowing and accommodating pumping breaks, and introduce affordable, onsite care so mothers can take breaks to nurse while working. When this isn’t possible, there’s another, simple way to offset the costs associated with infant feeding. Cue the notorious international best practice the U.S. has ignored for decades: paid parental leave for all working parents; leave that does not count in weeks, but in months, or even better, for as long as feeding is needed. Paid parental leave not only gives new moms the option to provide breast milk to their infants, but it begins to compensate them financially for a small fraction of the otherwise unpaid care work they will be contributing to our society for years to come.
Correction, Feb. 13, 2018: This post originally misstated that workplaces are supposed to give women the ability to pump at work. The Fair Labor Standards Act only requires this accommodation for hourly workers.
Correction, Feb. 14, 2018: This post originally misstated that children were transported by train in the 18th century.