Effect of legislation on breastfeeding initiation and duration in the US

Background: Legislation to promote breastfeeding exists in most US states, but no studies have measured its effect on breastfeeding rates. This is in contrast to other public health legislation such as tobacco control.

Objective: To evaluate the effect of breastfeeding-related legislation on breastfeeding initiation and duration in the US.

Methods: Breastfeeding legislation from all 50 states, enacted by January 2003, was analyzed, ranked, and scored by a panel of 4 experts. State breastfeeding initiation rates, and duration at 6 months, were obtained from the 2006 Ross Mother's Survey, and related to legislative scores. The states were categorized into 3 groups: those with “good” legislation (13); “fair” legislation (20); and no legislation (17).

Results: Average breastfeeding initiation was 67% in states with “good” legislation; 69% in states with “fair” legislation, and 59% in states with no legislation. Lack of legislation was significantly correlated with low breastfeeding initiation (Pearson correlation, r = 0.60, P = 0.05). In states with fair and good legislation, initiation rates were not correlated with legislative scores (Pearson correlation, r = 0.21, P = 0.48; r = -0.50, P = 0.25, respectively). No correlations existed between legislation and breastfeeding duration at 6 months.

Conclusions: States with no breastfeeding legislation had the lowest initiation rates. However, no correlation existed between strength of legislation and breastfeeding initiation in states where initiation rates were highest, and strength of legislation was not correlated with duration. This may be due to lack of enforcement, regardless of strength of the legislation.