Breastfeeding: The Illusion of Choice

Background Breastfeeding is frequently described as a woman\u27s decision, yet this choice is often illusionary owing to suboptimal social and structural supports. Despite the passage of the Patient Protection and Affordable Care Act (2010) that requires all qualifying employers to provide mothers “reasonable” break time and a private, non-bathroom space to express breast milk, the majority of women in the United States still do not have access to both accommodations. The Problem At least three issues may be influencing this suboptimal implementation at workplaces: 1) federal law does not address lactation space functionality and accessibility, 2) federal law only protects a subset of employees, and 3) enforcement of the federal law requires women to file a complaint with the United States Department of Labor. Recommendations To address each of these issues, we recommend the following modifications to current law: 1) additional requirements surrounding lactation space and functionality, 2) mandated coverage of exempt employees, and 3) requirement that employers develop company-specific lactation policies. Conclusions If the goal is to give women a real choice of whether to continue breastfeeding after returning to work, we must provide the proper social and structural supports that will allow for a truly personal decision. No mother should have to choose between breastfeeding her child and earning a paycheck

Speaking out on “breastfeeding” terminology: Recommendations for gender-inclusive language in research and reporting

The term “breastfeeding” has recently been critiqued for its ambiguity, as it has come to mean both (1) feeding an infant at the breast and (2) feeding expressed human milk to an infant. In addition, “breastfeeding” is nearly always associated with mothers and women, yet there are individuals who feed their infants human milk and do not identify as such. By using gendered language when conducting and publishing lactation-related research, we risk both alienating an already marginalized population and inhibiting our ability to gather valid, high-quality surveillance data. For example, of 15 U.S. surveys measuring breastfeeding rates, practices, and public opinions, 33% only sampled mothers, and another 33% made assumptions regarding the gender or sex identity of the person giving birth or breastfeeding. In addition, a review of 20 scholarly journals that publish lactation-related research found that only one requires specific language for breastfeeding in their instructions for authors. In response, I recommend several additions to recently proposed terms that describe human milk feeding and associated behaviors. Acceptance and consistent usage of these linguistically inclusive or nongendered terms by researchers will further enhance the quality of future data collection and research dissemination through the representation of all individuals choosing to provide human milk to their infants

Infant Feeding Tracker Applications: Cross-Sectional Analysis of Use

Objective Examine the extent to which postpartum patients use infant feeding tracker applications (apps), characteristics of app users, and app features most used and desired. Design Cross-sectional survey. Setting An obstetrics/gynecology practice in Northern New Jersey in 2019. Participants One hundred twenty-six patients aged ≥ 18 years recruited during their 6-week postpartum visit. Main Outcome Measures Self-reported sociodemographics, infant feeding behaviors, and health app use. Respondents were grouped by self-reported use of an infant feeding tracker app. Analysis Frequencies were calculated for descriptive analysis, and comparisons were made between user groups. Fisher\u27s exact tests of independence were used to analyze categorical data. Mann-Whitney U tests were employed for continuous variables (significance at P \u3c 0.002). Results Fifty-seven percent of respondents reported using an app to track infant feeding. Compared with nonusers, users were more likely to have an infant who was ever breastfed (P = 0.001; Cramer\u27s V = 0.30) and exclusively breastfed (P \u3c 0.001; Cramer\u27s V = 0.44). Users also used significantly more health apps than nonusers (P \u3c 0.001). Most respondents used the app to track infant feeding, diapering, and sleep. Conclusions and Implications Given their frequency of use—particularly among those who breastfeed—infant feeding tracker apps have the potential to support parents in meeting their infant feeding goals

Conflict and Compromise in Public Health Policy: Analysis of Changes Made to Five Competitive Food Legislative Proposals Prior to Adoption

Competitive foods in schools have historically been scrutinized for their ubiquity and poor nutritional quality, leading many states to enact legislation limiting the availability and accessibility of these items. Evaluations of these policy approaches show their promise in improving the healthfulness of school food environments, considered an important strategy for reducing childhood obesity. Yet little is known about the decision-making processes by which such legislation is formed and adopted. Using a comparative case study design, this study describes and analyzes the policy formation processes surrounding five state-level competitive food bills introduced in 2009-2010. Data for each case were drawn from multiple key informant interviews and document reviews. Case studies were conducted, analyzed, and written independently using a standard protocol and were subsequently compared for recurring and unique themes. Abbreviated case studies and summary tables are provided. Results indicate that bill cost is a major barrier to achieving strong, health-promoting policy change. Additionally, findings reveal that supporters of stronger competitive food policies often concede to changes that weaken a bill in order to neutralize opposition and achieve stakeholder buy-in. These challenges suggest that continued research on the development, implementation, and evaluation of public health policies can contribute to the advancement of new strategies for effective health promotion

Validation of A Theory of Planned Behavior-Based Questionnaire to Examine Factors Associated With Milk Expression

Background: A proper assessment of multidimensional needs for breastfeeding mothers in various settings is crucial to facilitate and support breastfeeding and its exclusivity. The theory of planned behavior (TPB) has been used frequently to measure factors associated with breastfeeding. Full utility of the TPB requires accurate measurement of theory constructs. Research aim: This study aimed to develop and confirm the psychometric properties of an instrument, Milk Expression on Campus, based on the TPB and to establish the reliability and validity of the instrument. Methods: In spring 2015, 218 breastfeeding (current or in the recent past) employees and students at one university campus in northern New Jersey completed the online questionnaire containing demography and theory-based items. Internal consistency (α) and split-half reliability (r) tests and factor analyses established and confirmed the reliability and construct validity of this instrument. Results: Milk Expression on Campus showed strong and significant reliabilities as a full scale (α =.78, r =.74, p \u3c.001) and theory construct subscales. Validity was confirmed as psychometric properties corresponded to the factors extracted from the scale. Four factors extracted from the direct construct subscales accounted for 79.49% of the total variability. Four distinct factors from the indirect construct subscales accounted for 73.68% of the total variability. Conclusion: Milk Expression on Campus can serve as a model TPB-based instrument to examine factors associated with women\u27s milk expression behavior. The utility of this instrument extends to designing effective promotion programs to foster breastfeeding and milk expression behaviors in diverse settings

Potato Chips, Cookies, and Candy Oh My! Public Commentary on Proposed Rules Regulating Competitive Foods

Background. The Healthy, Hunger-Free Kids Act of 2010 authorizes the U.S. Department of Agriculture (USDA) to establish nutritional standards for all foods sold in schools participating in federally funded meal programs. These foods, known as competitive foods, are commonly found in school cafeterias, vending machines, fundraisers, and snack bars and are associated with unhealthy dietary patterns. However, little is known about the regulatory process and opportunities for public participation to improve school food. Aims. This study investigates public commentary on the USDA’s proposed rules governing competitive foods in schools. Methods. On February 8, 2013, the USDA’s Food and Nutrition Service solicited public comments via Regulations.gov. A corpus of 247,871 public comments was obtained. Duplicate and near-duplicate comments were removed resulting in 3,032 unique comments. Two researchers content analyzed 10% of the sample, removing nonrelevant comments (n = 249). Results. A majority of commenters are women, and mention their affiliation. Comments tend to be short, and exhibit low levels of complexity. An overwhelming majority of comments expressed concerns about the public health of youth vis-à-vis the new rule, whereas a small but vocal minority opposed the rule for financial and labor reasons and/or opposition to further government regulation. Discussion. Commentary on proposed rules should be specific, avoiding off-topic remarks. Commenters should be strategic, include their credentials, and provide a rationale for their position. Conclusion. The rules governing competitive foods are poised to reverse the childhood obesity epidemic, and public commentary may shape these rules

Charity-and project-based service learning models increase public service motivation outcomes among dietetic students in a community nutrition course

Objective: To determine whether dietetic students would report a change in their public service motivation (PSM) following a community nutrition service learning (SL) course, and whether the SL model (charity v. project) influences this change differently. Design: Using a pretest–posttest, nonequivalent groups quasi-experimental design, this study compared students’ PSM at the beginning and end of a 15-week college-level course. PSM and four component dimensions (attraction to public policy, commitment to public interest, compassion and self-sacrifice) were measured via electronic survey using the PSM scale. Average PSM scores were compared between and within the charity and project groups using independent samples and paired sample t tests, respectively. ANCOVA assessed the effect of SL model on post-survey scores, controlling for pre-survey scores. Setting: Public university in northeastern United States. Participants: Dietetic students enrolled in six sections of the same undergraduate community nutrition SL course. Students were placed by section in either charity (n 59) or project (n 52) SL experiences and required to complete 14 h in this role. Results: Mean PSM total scores increased between pre-survey and post-survey (3·50 v. 3·58; P = 0·001). Students reported small increases in three PSM dimensions: commitment to public interest, compassion and self-sacrifice (all P ≤ 0·01). Holding pre-scores constant, the charity group reported a higher attraction to public policy post-score, while the project group reported a higher self-sacrifice post-score (both P \u3c 0·05). Conclusions: Educators should consider adopting SL methods into curricular offerings to enhance students’ motivation for public service

Lessons Learned from A Student-Led Breastfeeding Support Initiative At A US Urban Public University

Despite US laws requiring most workplaces to provide reasonable unpaid break time and a private space for female employees to express breast milk, much of the statutory language is vague and open to interpretation, potentially leading to suboptimal implementation. College and university campuses in the US represent a particular concern, as students are typically not employed by their school and thus not protected by state and federal labor laws. This article describes the work of 2 graduate students to successfully establish a dedicated space at their US urban public university for the purpose of expressing breast milk. A 3-pronged strategy was implemented to create a dedicated lactation space: (1) collecting data to support the establishment of the room, (2) raising awareness of legislation related to protection of breastfeeding, and (3) community organizing and advocacy. After nearly 18 months of advocacy and planning, the campus\u27 dedicated lactation room was opened for use in March 2012. Two years later, the room remains a valuable resource and is used, on average, 8.4 times per weekday during a typical school week. Several lessons learned are described, and the strategies employed can be tested and applied in other US academic settings to assist in advocating for more supports for breastfeeding mothers. However, it is also imperative that US legislation be amended to include language that explicitly protects students so that women do not need to make the choice between continuing their education and continuing to breastfeed

Valuing Diversity in Dietetics: Considerations for Service Dogs at School, Internships, and the Workplace

Diversity has become an increasingly important topic within the field of dietetics to create a profession representative of the population it serves, capable of providing culturally appropriate patient care. Yet people with disabilities (PwDs) are often overlooked. The Americans with Disabilities Act (ADA) defines disability as “a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or being regarded as having such an impairment.”1 In the United States, approximately 12.6% of the noninstitutionalized population lives with a disability.2 One strategy employed by PwDs to mitigate their disabilities is the use of a highly trained service dog (SD). PwDs in general and individuals assisted by SDs specifically face significant challenges entering the health care field and accessing medical care. However, data are lacking on disability prevalence among dietetics students, interns, and registered dietitian nutritionists (RDNs).3 PwDs often exhibit many valuable proficiencies, including creativity, flexibility, and peak performance under pressure,4 yet also experience unique challenges. For the field of dietetics to become a diverse, equitable, and inclusive profession, it is important for food and nutrition practitioners to understand both the unique challenges and valuable contributions of students, interns, employees, and patients with disabilities assisted by an SD (herein referred to as SD handlers). The purpose of this article is to share best practices for accommodating SD handlers involved in all areas of the field of dietetics