Breastfeeding in Public: Overview

Introduction

Women have breastfed infants and young children from the earliest days of humankind. As poverty and poor diet negatively affected children's development during the late nineteenth century, doctors invented infant formula hoping to combat undernourishment and malnourishment. For years, parents and caregivers bottle-fed their infants in growing numbers, but a backlash against formula took hold around the 1950s. From the early 1980s, breastfeeding has been on the rise once again.

By the late twentieth century, women had created a drastically increased presence in the workforce and other public activities. Since many people cannot or prefer not to remove themselves from public places to feed their children, public breastfeeding is also on the rise. As a result, establishments struggle to keep both nursing mothers and uncomfortable patrons happy, as federal and state legislatures have worked to protect nursing mothers from discrimination or indecency charges while breastfeeding in public.

Understanding the Discussion

Infant formula: A manufactured food designed for infants under one year of age and regulated by government agencies. It is most often sold as a powder to be mixed with water and fed to the child using a bottle, although some ready-to-feed and concentrated liquid formulas are also available.

Malnourishment: Not receiving adequate nutrition to sustain good health, regardless of the quantity of food.

Pumping: The use of a manual or electric machine to extract breast milk from a nursing mother's breast for later use.

Undernourishment: Not consuming a sufficient quantity of food to sustain good health.

History

Biologically, breastfeeding is the way for a mother to feed her infant children. Before the development of alternate methods such as formulas, this was the only way. In the late nineteenth century, infant mortality rates were high even in developed countries, including the United States. Doctors identified undernourishment and malnourishment as significant contributors and introduced infant formula as a way to deliver a specified and easily measurable amount of food and nutrients to growing babies. Women across the world embraced bottle feeding for the potential health benefits and the freedom it provided to participate fully in public life and the workforce.

Some nutrition researchers, such as New York University professor Amy Bentley, believe that the divide between formula feeding and breastfeeding evolved to be about more than health and convenience. Bentley explains that by the post–World War II period, formula—which can be very expensive—became a symbol of wealth, privilege, and modernity; by contrast, breastfeeding became a primitive act reserved for poorer people and those in developing countries. The scientific community, advertisers, and the general public moved so far away from breastfeeding and all-milk diets for infants that it became the standard to start babies on solid food as soon as possible. Additionally, she says that public perception of female breasts transformed from food source to sexual object through the proliferation of war-era pin-up girls and magazines such as Playboy.

As a result of these societal changes, Bentley says that, by the 1950s, a significant part of the American public was uncomfortable seeing a woman breastfeed her child in public. Data showed a significant decline in breastfeeding among post–World War II mothers: the 1965 National Fertility Survey found that 68 percent of mothers born between 1911 and 1915 breastfed their first child, compared to only 35 percent of mothers born in the early 1940s. This percentage continued to decline into the 1970s.

At the same time, there was a growing backlash against formula feeding. As mothers' health and nutrition improved, many women felt that formula was no longer necessary and that bottle feeding interfered with vital mother-child bonding. By the end of the 1970s, the breastfeeding rates among American women had increased significantly, reaching 54 percent in 1980.

Various interest groups, including the newly formed La Leche League, fueled the debate between breastfeeding and bottle-feeding mothers. Each claimed to have medical science to support their position: proponents of breastfeeding cited studies claiming higher intelligence quotients (IQs), greater resistance to allergies and illness, and all-around better outcomes for their children. Those who continued to support bottle feeding cited other studies showing little, if any, difference in child outcomes not attributable to another factor, such as the mother's health or socioeconomic status. In 1997, the American Academy of Pediatrics (AAP) recommended that babies be breastfed exclusively for the first six months and then partially breastfed for supplementation as new foods are introduced over the next six months; in 2022, the AAP extended the recommended timeframe for children receiving breastmilk to two years or longer.

When women rarely worked outside the home and performed many of their daily chores there, breastfeeding in public was often not necessary, thus making it less of an issue. But as women increasingly participated in the workforce and other public activities, being physically tethered to an infant at inopportune times became a significant obstacle to that participation. As a result, more women embraced nursing in public so they would not have to choose whether to participate in life outside the home or feed their children.

Public breastfeeding led to its own backlash, however. News reports and social media outlets contain numerous accounts of women being harassed by those who are uncomfortable being in close proximity of a nursing mother. Anecdotal evidence also suggests larger-bodied women are subject to additional harassment when nursing in public than their thinner counterparts. Similarly, there are reports of mothers responding to requests to cover up or relocate by staging “nurse-ins” of dozens women in the offending establishment, or breastfeeding advocacy groups launching threatening campaigns against business owners. Sometimes, however, these incidents can lead to satisfactory results for both mother and establishment: in one example, a nursing mother at an Illinois restaurant was asked to cover up or relocate by a member of the wait staff who had received a complaint from another customer. Breastfeeding advocates online called for boycotts and nurse-ins, but the owner responded by educating his staff about the legal requirements and social protocols surrounding public breastfeeding. The restaurant made itself a welcoming place for nursing mothers while offering to relocate any uncomfortable patrons, and a potentially negative situation had a positive ending.

By the early twenty-first century, many US government agencies openly acknowledged the potential benefits of breastfeeding and recognized that women face numerous obstacles to nursing for the recommended six to twenty-four months. In 2011, the US surgeon general issued A Call to Action to Support Breastfeeding, which provided guidelines for families, communities, health care professionals, and employers to support breastfeeding women. It also addressed the impact of popular culture's sexualization of the female breast on women's willingness to breastfeed—especially in public—and sought ways to lessen this stigma. Similarly, the US Department of Agriculture (USDA) developed a series of materials in conjunction with its Women, Infants, Children (WIC) nutrition program to promote breastfeeding and provide support services to nursing mothers.

Additionally, the 2010 Affordable Care Act required large employers to provide “reasonable” break time and a private, non-bathroom location for nursing mothers to pump during working hours. This provision, however, covered only certain hourly-wage employees; many salaried workers are exempt and therefore had no recourse if these accommodations were not provided. Employers with fewer than fifty workers who demonstrate hardship also were not required to comply. It also required new insurers to cover professional lactation support and counseling and fund breastfeeding equipment.

Public breastfeeding has also presented legal issues. Prior to the passage of additional laws, a woman who exposed her breast in public for the purpose of feeding her child could be subject to indecent exposure charges. According to the National Conference of State Legislatures, by 2020 every state in the United States had a law in place to explicitly permit breastfeeding in any public or private location—while thirty-one states and the District of Columbia exempted nursing women from indecent exposure laws. Thirty-two states enacted laws providing additional protections relating to breastfeeding in the workplace, and nineteen exempted or delayed jury duty while nursing. Still other state laws addressed a host of related issues, such as tax exemptions for breastfeeding items, breast milk in childcare facilities, and public accommodations for breastfeeding.

Similarly, the federal government enacted the Fairness for Breastfeeding Mothers Act of 2019, which mandated the designation of lactation rooms in enclosed public facilities wherever feasible. A few years later, it also passed the PUMP Act of 2022, which extended protections for reasonable break times and clean areas for pumping to salaried workers but did not include funding for employers to set up the required spaces. As more employers and public accommodations carved out private spaces for breastfeeding in the 2020s, however, some lactation proponents feared increased backlash over visible breastfeeding in public.

According to the CDC's 2022 report, approximately 83 percent of women with infants born in 2019 began to breastfeed their babies; 55.8 percent were still receiving breastmilk at six months, and 35.9 percent at twelve months. This is an overall increase from the 2007 report total (73.8 percent), as well as an increase in the six- and twelve-month data (41.5 percent and 20.9 percent, respectively).

Breastfeeding in Public Today

Despite those changes, the issue of whether a woman must cover up while nursing in public remained legally murky. Most laws did not explicitly address the concern. Further, state laws tended to favor establishments over women who were shamed or forced to leave an establishment because of public breastfeeding. Advocacy groups and federal authorities sought to teach women their legal rights and provide tips on how, when, and where to breastfeed comfortably in public. Mothers launched social media discussions, public protests, and petitions in attempt to normalize the phenomenon, and dozens of female celebrities publicized the practices of nursing and pumping, including in public. A National Breastfeeding in Public Day was launched in February 2022 in the US to raise awareness and soon spread internationally. Societal change was perceived as one of the greatest barriers to breastfeeding initiation and continuation.

Perhaps surprisingly, an August 2019 poll by YouGov found that although seven in ten American adults accepted or tolerated public breastfeeding, slightly more women than men disapproved either somewhat or completely (35 to 33 percent). Notably, respondents aged fifty-five and older tended to be more opposed than those aged nineteen to fifty-four. Nevertheless, more than two-thirds of all respondents favored additional workplace breaks for nursing mothers to pump.

The COVID-19 pandemic blurred the lines between private and public spaces as people increasingly participated in education, employment, and other once-public activities remotely from their homes or other private spaces—complicating what constitutes “breastfeeding in public.” Instructors, for instance, were not necessarily aware of Title IX protections for breastfeeding students, including while attending remote classes. Likewise, employees had to decide whether to breastfeed onscreen during videoconferencing.

The linked issues of whether to breastfeed and where took on greater urgency amid the widespread infant formula shortage of the early 2020s. As a result of that shortage, many mothers felt increased pressure to breastfeed, even attempting to restart after weaning.

These essays and any opinions, information, or representations contained therein are the creation of the particular author and do not necessarily reflect the opinion of EBSCO Information Services.

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