Breastfeeding and the Affordable Care Act

CQ #28 - January 30, 2017

What has been the effect of the Affordable Care Act (ACA) on breastfeeding rates in the USA? Now that the ACA is in jeopardy because of the new administration, we need to ask ourselves whether it mattered anyway.

The ACA mandated that private health plans cover the cost of lactation support services, including a visit with a lactation specialist and breastfeeding durable medical equipment, with no cost sharing, such as copays or deductibles. The coverage began in August 2012 for all health plans except for those private plans that were grandfathered in. The goal in mandating such coverage was to increase breastfeeding rates and to decrease the risk of infant and maternal illness over the long run as an outcome of increased breastfeeding rates. In addition, breastfeeding success often depends on access to lactation specialists and pumps, both of which are less affordable for low income families. The mandate to cover lactation support services would address breastfeeding disparity due to lack of access to resources.

The authors of a study published in November 2016 measured the effect of the ACA’s mandate to cover lactation services on breastfeeding rates in the USA. What do you think the authors found? (Choose 1 or more)

The ACA increased breastfeeding initiation by as much as 2.5%.
African American mothers were approximately 2% more likely to initiate breastfeeding as compared to white mothers.
Mothers with a high school degree were about 2% more likely to initiate breastfeeding relative to college-educated mothers.
Unmarried mothers were about 1% more likely to initiate breastfeeding compared to married mothers.
All of the above.

Click here to view the answer to this question.

Correct Answers: The correct answer is E View the Abstract

Health Serv Res. 2016 Nov 10. doi: 10.1111/1475-6773.12598. [Epub ahead of print]

Lactation Support Services and Breastfeeding Initiation: Evidence from the Affordable Care Act.
Kapinos KA1, Bullinger L2, Gurley-Calvez T3.

Abstract

OBJECTIVE:
Despite substantial evidence of the benefits of breastfeeding for both mothers and children, rates of sustained breastfeeding in the United States are quite low. This study examined whether mandated coverage of lactation support services under the Affordable Care Act (ACA) affects breastfeeding behavior.

DATA SOURCE:
We studied the census of U.S. births included in the National Vital Statistics System from 2009 to 2014.

STUDY DESIGN:
We used regression-adjusted difference-in-differences (DD) to examine changes in breastfeeding rates for privately insured mothers relative to those covered by Medicaid. We adjusted for several health and sociodemographic measures. We also examined the extent to which the effect varied across vulnerable populations-by race/ethnicity, maternal education, WIC status, and mode of delivery.

PRINCIPAL FINDINGS:
Results suggest that the ACA mandate increased the probability of breastfeeding initiation by 2.5 percentage points, which translates into about 47,000 more infants for whom breastfeeding was initiated in 2014. We find larger effects for black, less educated, and unmarried mothers.

CONCLUSIONS:
The Affordable Care Act-mandated coverage of lactation services increased breastfeeding initiation among privately insured mothers relative to mothers covered by Medicaid. The magnitude of the effect size varied with some evidence of certain groups being more likely to increase breastfeeding rates.

IABLE Comment by Anne Eglash MD, IBCLC, FABM

The ACA’s coverage of lactation services and equipment increased breastfeeding rates among women who historically have lower breastfeeding rates, essentially improving one aspect of maternal child health disparity. One would hope that despite the elimination of the ACA, insurance companies would voluntarily continue to cover lactation services in order to improve the health of their populations. By increasing breastfeeding rates, insurance companies should see fewer health care costs for premature infants, childhood infections as well as for other illnesses including type 1 diabetes mellitus, childhood leukemia, and complications of obesity. Insurances would also save money in the long run on care for women because of decreased ovarian, breast, and endometrial cancer rates, as well as cost savings due to improved child spacing.

Breastfeeding and the Affordable Care Act

The authors of a study published in November 2016 measured the effect of the ACA’s mandate to cover lactation services on breastfeeding rates in the USA. What do you think the authors found? (Choose 1 or more)

Correct Answers: The correct answer is E View the Abstract

Abstract

IABLE Comment by Anne Eglash MD, IBCLC, FABM

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