Effect of the Affordable Care Act on Breastfeeding Outcomes

Published in: American Journal of Public Health, Volume 108, Number 2 (February 2018), pages 277-283. doi: 10.2105/AJPH.2017.304108

Posted on RAND.org on February 09, 2018

by Tami Gurley-Calvez, Lindsey Bullinger, Kandice A. Kapinos

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To assess how the 2012 Affordable Care Act (ACA) policy change, which required most private health insurance plans to cover lactation-support services and breastfeeding equipment (without cost-sharing), affected breastfeeding outcomes.


We used a regression-adjusted difference-in-differences approach with cross-sectional observational data from the US National Immunization Survey from 2008 to 2014 to estimate the effect of the ACA policy change on breastfeeding outcomes, including initiation, duration, and age at first formula feeding. The sample included children aged 19 to 23 months covered by private health insurance or Medicaid.


The ACA policy change was associated with an increase in breastfeeding duration by 10% (0.57 months; P=.007) and duration of exclusive breastfeeding by 21% (0.74 months; P=.001) among the eligible population. Results indicate no significant effects on breastfeeding initiation and age at first formula feeding.


Reducing barriers to receiving support services and breastfeeding equipment shows promise as part of a broader effort to encourage breastfeeding, particularly the duration of breastfeeding and the amount of time before formula supplementation.

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