In recent posts I have asserted that a change in the law to explicitly permit public breastfeeding would help to support women in a choice to breastfeed, by removing or reducing an existing barrier to breastfeeding.
I asserted that nervousness about public breastfeeding was an existing barrier to breastfeeding in that it plays a role in women’s thinking about whether to breastfeed. I suggested that explicitly legalising public breastfeeding would give at least some of these women the extra confidence they might otherwise lack in order to support a choice for breastfeeding.
My assertions were based on my own experiences and impressions of talking to women about breastfeeding choices, and particularly from listening to women who chose not to do it. However, I did not have any objective evidence to back up my assertions.
Today I spent some time looking for any surveys, reports or other data online that might show whether my assertions had any real factual basis. I did not find any. (At least, not yet!) I have, however, done a very crude study of my own, and would like to share the results.
What I did
I used the United States Center for Disease Control’s Geographic-specific Breastfeeding Rates data for 2003 and 2004. This data is based on information gathered from the CDC’s National Immunization Survey. It breaks down breastfeeding rates by US state. Each state has from around 330 up to over 1,000 respondents included in the survey (for 2004, figures for 2003 were not given). Using this data, I took for each state in each of 2003 and 2004 the percentage of babies who had ever been breastfed. This seemed the most relevant statistic given that I was mainly interested in the choice to breastfeed in the first place rather than success, duration or exclusivity of breastfeeding.
I then assessed each state using information taken from La Leche League’s summary of US current breastfeeding law. I looked at (1) whether the state had law explicitly supporting the right to breastfeed in public and (2) whether the state had other law in place to support or encourage breastfeeding.
35 states had laws supporting public breastfeeding, usually either by explicilty stating that a woman was entitled to feed her child in public places or by exempting breastfeeding mothers from indecency or related legislation.
25 states had other laws, typically: exempting breastfeeding women from jury duty; relating to breastfeeding mothers in the workplace; providing for breastfeeding to be taken into account in family proceedings; prohibiting discrimination against breastfeeding women or breastfed babies; or promoting breastfeeding in other ways using hospital or other health-related regulations.
I then carried out a rudimentary analysis to see whether the states that had laws promoting or supporting breastfeeding in some way ended up with higher breastfeeding rates.
Obvious limitations / likely distortions
- A state that encourages breastfeeding through its laws may well be more likely to encourage it through other means. There is no evidence whether improvements in breastfeeding rates in states with breastfeeding laws were brought about by the laws or by the other means (or, more likely perhaps, a combination of the two).
- Conversely, poor rates may have been the reason for imposing legislation in the first place – if so, then a comparison between breastfeeding rates and the existence of legislation will not be fair or meaningful.
- I came at this expecting to see that laws can improve breastfeeding rates. I mention this because it is possible that such bias affected my objectivity, although I am not aware of any respect in which it did so.
- I have not taken account of any factors such as how long the laws had been in force (in at least one state – Ohio – the law was not brought in until 2005, after the date when the statistucs were gathered!)
- My figure work is rudimentary and was done swiftly. I may have committed errors or distorted the results by my approach. If so, the distortion / mistake could go either way. If anyone wants to check my analysis then I would be glad to hear from them!
So, bearing in mind all the limitations mentioned above, the results are as follows (the first figure given is for 2003, the second is for 2004):
Average across all states: 70.22% / 69.70%
With / without public breastfeeding law
States with a public breastfeeding law:
- whether or not there are other breastfeeding laws: 72.15% / 72.17%
- with other breastfeeding laws: 72.06% / 72.98%
- without other breastfeeding laws: 72.28% / 70.97%
States with no public breastfeeding law:
- whether or not there are other breastfeeding laws: 65.72% / 63.93%
- and there are no other breastfeeding laws either: 63.63% / 61.36%
With / without other breastfeeding laws
States with other breastfeeding laws:
- whether or not there are public breastfeeding laws: 71.97% / 72.66%
- with public breastfeeding laws: 72.06% / 72.98%
- without public breastfeeding laws: 71.48% /70.98%
States with no other breastfeeding laws:
- whether or not there are public breastfeeding laws: 68.47% / 66.74%
- and there are no public breastfeeding laws either: 63.63% / 61.36%
Other interesting points
In the 2003 “Top Ten” breastfeeding states, only Arizona in tenth place (80.4%) had no breastfeeding laws. Louisiana came last (46.4%) despite having strong breastfeeding laws – albeit relatively recent laws. Apart from Louisiana, every state in the bottom six lacked a breastfeeding law.
In 2004, Arizona had risen to 8th place (with 80.9%). Arizona aside, you need to go down to 14th place (Wyoming, 75.5%) and then 26th place (North Dakota, 69.1%) to find the next states without breastfeeding laws. At the other end of the table, Louisiana had risen to third from bottom (48.8%) but all other states in the bottom seven lacked breastfeeding laws.
In both 2003 and 2004, four of the top five states had both public breastfeeding laws and other laws supporting breastfeeding.
On average, breastfeeding rates are significantly higher in states that have breastfeeding laws than in states that do not. In states with only one kind of law, it does not seem to make any significant difference whether the law is about public breastfeeding or supports breastfeeding in some other way, however the best rates are found in states with both kinds of law.
From 2003 to 2004, breastfeeding rates generally improved or stayed about the same in states having laws (notably Louisiana, which enacted laws in 2001-03, improved rates by nearly 2.5% from a very poor starting point). States with both kinds of laws generally had the best improvements. Meanwhile, rates generally worsened in states without laws.
Despite the crudity and limitations of this analysis, it does tend to support the view that breastfeeding legislation is at least worth exploring as a means to improve breastfeeding rates.
Edited with additional analysis: Wednesday 22 February 2006