Lindsey Murtagh Public Health Law Program Centers for Disease Control and Prevention Summer 2008 JD/MPH Candidate

The content of this presentation was prepared by Lindsey Murtagh in her capacity as an intern with the CDC Public Health Law Program, summer It does not represent any policy of the Centers for Disease Control and Prevention. This presentation should not be considered to be legal advice; always consult your legal counsel for legal advice.

Outline Public health implications Overarching legal considerations Research objectives Early findings Additional research directions 2

Breastfeeding: a public health priority Benefits to Infant: Benefits to Mother: Nutritious Increases exposure to protective antibodies Decreases risk of ear infections, respiratory infections, urinary tract infections and decreased frequency of diarrhea Decreases risk of overweight Decreases risk of breast and ovarian cancers Facilitates post-pregnancy weight loss Reduces risk of osteoporosis Offers economic benefits Provides opportunities to bond with infant Decreases health care costs Increases work productivity Decreases waste Benefits to Society: 3

Breastfeeding: A Public Health Issue Ever BreastfedBreastfed at 6 months Breastfed at 12 months HP 2010 Target75%50%25% U.S. Average74.2%43.1%21.4% U.S. Range (by state) 47.9% %21.8% %7.5% % White76.8%43.2%21.9% Black/Afri-Am61.4%29.3%13.4% Hispanic/Latino80.6%45.1%24.1% Asian83.6%51.8%29.1% 2005 Data from: 4

Applicable (or not) Federal and International Laws Title VII, Civil Rights Act Does not protect women who are breastfeeding Pregnancy Discrimination Act (PDA) Extends Title VII protection to discrimination based on pregnancy, childbirth and related medical conditions BUT Derungs v. Wal-Mart Stores (6 th Cir. 2004) held PDA doesn’t apply to breastfeeding Americans with Disabilities Act Does not encompass breastfeeding 5

Applicable (or not) Federal and International Laws (cont’d) Family Medical Leave Act Mandates that certain employees be allowed 12-weeks unpaid leave to care for, among others, newborns Dike v. Orange County School Board (5 th Cir. 1981) Held that the decision to breastfeed is a fundamental right International Code of Marketing of Breastmilk Substitutes Contains recommendations for regulations to market breastmilk substitutes U.S. has endorsed Code but taken no action

Research Objectives: To identify express laws that promote or facilitate breastfeeding To examine whether a relationship exists between rates of breastfeeding and the presence of laws focused on breastfeeding Limits of Research Research will not focus on laws that appropriate funding for programs supportive of breastfeeding (e.g.-WIC). Research will focus on laws that expressly mention breastfeeding. 7

Express Laws by Setting Research will examine presence of relevant state and federal laws in five settings: Workplace Community Childcare Healthcare Industry 8

Early Findings Community Breastfeeding moms exempt from jury duty Breastfeeding permitted in any public or private location Breastfeeding exempt from public indecency laws Workplace Employers required to provide reasonable breaks for breastfeeding Maternity leave minimum requirements Childcare Childcare facilities prohibited from discriminating based on breastfeeding status 9

Early Findings (continued) 3 states have no laws directly related to breastfeeding. Ever BreastfedBreastfed at 6 months Breastfed at 12 months HP 2010 Target75%50%25% U.S. Average74.2%43.1%21.4% Massachusetts78.1%43.3%21.7% North Dakota68.2%36.8%18.4% West Virginia57.7%22.5%12.0% 2005 Data from: 10

Early Findings (continued) Oregon has the nation’s highest rates of breastfed at 6 months (62.1%) and breastfed at 12 months (39.8%) Oregon Laws: Or. Rev. Stat. § (1999) – allows a woman to breastfeed in a public place Or. Rev. Stat. § (1999) – excuses a woman from acting as a juror if the woman is breastfeeding Or. Rev. Stat. § , , (2007) – allows women to have unpaid 30 minute breaks during each four hour shift to breastfeed or pump. Includes exemptions for certain employers. Provides enforcement mechanisms. 11

Additional Directions Gaps in law Effectiveness of laws Recommendations for using law to increase breastfeeding Strategies for reducing disparities in rates using law Global comparison of laws (e.g. – Sweden) 12

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