Paid family leave to promote breastfeeding: catching policy up to the science

Breastfeeding is increasingly recognized as a powerful biologic intervention associated with positive infant and maternal health outcomes. Emerging evidence continues to expand our understanding of the mechanisms through which human milk promotes health, including via immune system development and modulation of antimicrobial resistance. Yet despite the robust scientific evidence supporting breastfeeding as critical to public health, many families in the US face structural barriers to achieving their breastfeeding goals. In the US, paid family leave has been strongly associated with both the initiation of breastfeeding and its duration. Paid family leave has also been associated with improved maternal and infant health, including reduced infant mortality. These findings suggest that paid family leave should be viewed not solely as a labor policy, but as a maternal-child health policy. The US remains one of the few high-income nations without a federal paid family leave program, relying instead on a fragmented patchwork of state policies. State experiences demonstrate that paid family leave can be implemented without major labor market disruption, while public support for a national program remains high. As breastfeeding science continues to advance, federal paid family leave represents overdue public health infrastructure necessary to translate evidence into population-level health improvements. IMPACT: Paid family leave is one of the most effective and well-supported policy mechanisms for promoting breastfeeding success and improving maternal and infant health. This article synthesizes emerging breastfeeding science, including new evidence regarding human milk's influence on neonatal immunity and antimicrobial resistance. We then link breastfeeding research with research on the policy that most supports widespread breastfeeding at a population level: paid family leave. Translating the benefits of breastfeeding into improved public health will require national policies that enable families to achieve breastfeeding goals. Federal paid family leave is among the most evidence-based policy strategies to achieve such goals.