title: Lactation Support Services and Breastfeeding Initiation: Evidence from the Affordable Care Act.
abstract: Despite substantial evidence of the benefits of breastfeeding for both mothers and children, rates of sustained breastfeeding in the United States are quite low. This study examined whether mandated coverage of lactation support services under the Affordable Care Act (ACA) affects breastfeeding behavior.
  
  
  
  We studied the census of U.S. births included in the National Vital Statistics System from 2009 to 2014.
  
  
  
  We used regression-adjusted difference-in-differences (DD) to examine changes in breastfeeding rates for privately insured mothers relative to those covered by Medicaid. We adjusted for several health and sociodemographic measures. We also examined the extent to which the effect varied across vulnerable populations-by race/ethnicity, maternal education, WIC status, and mode of delivery.
  
  
  
  Results suggest that the ACA mandate increased the probability of breastfeeding initiation by 2.5 percentage points, which translates into about 47,000 more infants for whom breastfeeding was initiated in 2014. We find larger effects for black, less educated, and unmarried mothers.
  
  
  
  The Affordable Care Act-mandated coverage of lactation services increased breastfeeding initiation among privately insured mothers relative to mothers covered by Medicaid. The magnitude of the effect size varied with some evidence of certain groups being more likely to increase breastfeeding rates.
authors.affiliation: RAND Corporation, 1200 South Hayes, Arlington, VA, 22202.
authors.forename: Kandice A
authors.initials: KA
authors.lastname: Kapinos
authors.affiliation: School of Public and Environmental Affairs, Indiana University, Bloomington, IN.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Bullinger
authors.affiliation: Department of Health Policy and Management, University of Kansa Medical Center, Kansas City, KS.
authors.forename: Tami
authors.initials: T
authors.lastname: Gurley-Calvez
mesh_terms: D001942:Breast Feeding / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data*; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence*; D012959:Socioeconomic Factors; D014481:United States
keywords: Affordable Care Act; Breastfeeding