IRS Finally Agrees that Breastfeeding Is a Health Issue; Provides Breaks for Breast Pumps

Amie Newman

The IRS announced today that, contrary to it's original decision, the cost of breastfeeding supplies will now be covered under a family's flexible spending account, as pre-tax funds.

The IRS today announced that an employee’s flexible spending account money, which is pre-tax money, can be used to purchase breastfeeding supplies: breast pumps and related lacation equipment. It’s good news, indeed. In October of last year we reported on breastfeeding supplies being shut out of the health reform’s list of health care “needs” covered by this type of tax shelter:

According to an article in the New York Times yesterday, “Denture wearers will get a tax break on the cost of adhesives to keep their false teeth in place. So will acne sufferers who buy pimple creams.”

And:

People whose children have severe allergies might even be allowed the break for replacing grass with artificial turf since it could be considered a medical expense.

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But, notes the Times,nursing mothers will not be allowed to use their tax-sheltered health care accounts to pay for breast pumps and other supplies.”

The American Academy of Pediatrics even requested the IRS to change its policy on covering breast pumps last year. They were denied the request.

Initially the IRS determined that breastfeeding did not qualify because it did not have enough health benefits. From Forbes Magazine,

The IRS position was that breast pumps were feeding devices, not medical devices that would be covered as medical expenses.

That didn’t sit well with individuals, advocacy groups and legislators across the country, who wrote letters and campaigned against the decision. The message?

Breastfeeding is, without a doubt, an issue of medical care. The World Health Organization and our own Department of Health and Human Services, notes Momsrising.org, promote breastfeeding for its numerous health benefits. And the Food and Drug Adminisration (FDA) considers breastpumps to be medical devices. Therefore the tools needed to pump in order to ensure one’s baby receives breastmilk should fall under medical expenses.

Health reform did include a provision to ensure that mothers who work out of the home are provided with adequate time and space in which to pump. It makes sense, therefore, to cover the tools with which a working mother needs to do this in flexible spending account plans. Breast pumps typically cost over $200; with related supplies costs can go as high ast $1000, according to the Wall Street Journal. These costs can now be deducted from family’s taxable income. More information will ultimately be found in the Medical and Dental Expenses form.

News Family

Breast May Be Best, But Buying Breast Milk on the Internet Is Risky, Says Study

Martha Kempner

Some women who are unable to breastfeed turn to the Internet to buy breast milk from others who produce more than they need. While this may seem like a good use of modern technology to share a scarce and important resource, new research suggests it could be dangerous.

Some women who are unable to breastfeed their infants because of adoption, lack of production, medical issues, or other reasons turn to the Internet to buy breast milk from others who produce more than they need. While this may seem like a good use of modern technology to share a scarce and important resource, new research suggests it could be dangerous. A study published this week in the Journal of Pediatrics found that much of the breast milk purchased or exchanged online contained potentially harmful bacteria.

Researchers from Nationwide Children’s Hospital in Columbus, Ohio, found over 13,000 websites offering to sell or exchange breast milk when they began their study in 2011. They bought samples from 100 of these sites and compared them to samples from a nonprofit breast milk bank, USA Today reported. There are 12 of these banks in the United States, and they follow strict guidelines set by the Human Milk Banking Association of North America. Not only do these banks carefully screen donors, they pasteurize the milk before shipping it out to infants, which kills harmful bacteria. Milk purchased or exchanged on the Internet is not pasteurized. (For the purposes of the study, however, the milk from the milk bank was provided to the researchers without being pasteurized so that it could be more fairly compared to the unpasteurized milk purchased via the Internet.)

The study found big differences in the two sets of milk. Specifically, it found that 72 percent of the milk purchased online had detectable levels of gram-negative bacteria (which are associated with bloodstream infections, wound infections, meningitis, and fecal contamination), compared to 35 percent of milk bank samples; 63 percent of the Internet samples tested positive for staph infections, compared to 25 percent of milk bank samples; 36 percent of the Internet samples tested positive for strep infections, compared to 20 percent of the milk bank samples; and 3 percent of the Internet samples were contaminated with salmonella, compared to none of the milk bank samples. Though HIV can be transmitted through breast milk, that virus was not found in any of the samples.

Dr. Sarah Keim, the study’s lead author, told the New York Times, “Most staph and strep are harmless at normal levels. But some of the levels we found were very high.” She added that salmonella “doesn’t belong in milk at all.” Keim believes that the high level of bacteria is most likely caused by poor hygiene in the collection process (women who don’t wash their hands and/or don’t adequately wash the breast pump) as well as improper shipping techniques. For example, 19 percent of Internet sellers did not include dry ice or another cooling mechanism when they shipped the milk.

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Keim and her team also questioned the authenticity of some of the samples they got. She told the New York Times, “Buyers have no way of knowing even what they’re getting—it could be cow’s milk or formula.”

Though milk banks are safer, pasteurization can also destroy some of the substances that make breast milk beneficial to babies. Moreover, milk banks tend to reserve their supply for premature infants with medical issues and will only provide it with a prescription. If there is extra supply, they may give it to a healthy infant with a prescription, but there is rarely such a surplus, and the milk is expensive at about $6 per ounce. (Remember that a one-month-old drinks about 25 ounces per day.)

Kim Updegrove, president of the milk bank association, says she understands why some women turn to the Internet given these prohibitions. She told the New York Times, “I hate to say this to an informal sharer, because they are trying to do good. But they are playing a game of Russian roulette.” Her comments to the Philadelphia Inquirer were even stronger. “Human milk is a body fluid, so it contains all the bacteria and viruses that are in the mom’s body at the time the milk is expressed,” she said. “It’s no different than blood. Would you go to your neighbor and ask for a pint of blood?”

Some people, however, believe that the practice of sharing breast milk through informal networks of neighbors and friends or even online is an important way to spread the benefits of breastfeeding to more infants. They say that the study focused on most risky method of sharing breast milk—having it shipped from anonymous people who are selling it online. Shell Walker, a midwife in Phoenix, started a site called Eats on Feets, through which women share milk in person. (Her site does not allow women to sell the milk, because that opens up ethical and safety questions.) She called the study “sensational and flawed.”

Still, most experts agree that sharing breast milk is too risky. The Food and Drug Administration discourages both online and person-to-person sharing, and the American Academy of Pediatrics discourages feeding preterm infants breast milk from unscreened donors.

Updegrove believes that women are better off turning to the supermarket shelf than the Internet: “My advice would be to use formula. These children are just too precious.”

Commentary Maternity and Birthing

In All the Debate About Breastfeeding, Where Is the Support For Mothers?

Jessica González-Rojas

In all the debate about breastfeeding and parenting, I know some choices will work for some mothers and not for others. But it is critical that as a society, we have the policies and infrastructure in place to support those decisions.

A few weeks ago, I found myself in the back of a rental car on the Rio Grande Valley in Texas, heading towards a gap in the border fence near a sanctuary that a local organizer insisted we MUST see. My colleagues and I were on a field visit to do campaign planning and technical support on reproductive justice, organizing with our local activists that are part of the National Latina Institute for Reproductive Health (NLIRH). As we approached the visually painful 18-foot steel fence in the Sabal Palm Sanctuary section of the border, I pulled up a jacket over my chest as the border patrol agent was peeking into our vehicle.  I was pumping in the backseat, with my battery-powered Medela pump making that familiar ‘whish-whish’ sound. My nerves calmed once the border patrol agent let us pass without questioning what the heck I was doing attached to that machine.

As a new mom to a 9-month-old and a new Executive Director for a national reproductive justice organization, I find myself in precarious situations when on work travel. Do I bring my son? Can I find childcare? If not, who will care for my child while I am away? Where will I pump? Where do I store the milk? The quandary leaves me scrambling for resources that range from the kindness of friends, strangers and colleagues, to extra cash to cover overtime childcare costs. Both my partner and I have careers that require a high percentage of travel, leading to a decision to either pump or breastfeed on the road. Since I started my new role in mid-October, fresh off the return from parental leave, I have traveled 21 times to seven cities ranging from Washington, DC to Oakland, California. My son has joined me on a dozen of those trips; some have been quite exciting (White House Holiday Party where, at 4 months old, he was held by the President and First Lady) and others a unique experience (staying at a day-care in the Bay Area with a friend’s son for two days where only Chinese was spoken). At one meeting that provided on-site childcare, my child rotated to almost every lap of each of my colleagues, often chiming in the dialogue with a gurgle or a defiant ‘bah bah bah.’ I’ve nursed on trains, planes and automobiles… one time, performing acrobatic-like maneuvers to wiggle out of a back zippered dress on a shuttle flight in order to position my son to my breast, all while attempting to be “discreet.” I felt the stares of men in suits on that typically infant-free business flight from New York to Washington, DC. Despite the endless stories and struggles of traveling with my infant, I have felt very empowered that, as a new mom, I could ‘juggle it all’—a career I love and am passionate about, a positive and fulfilling personal life, and attempt at being the best parent I could to my precious little baby. But this is not without the anxiety and difficult decision-making that put me at odds with my independent style; I’ve had to plead for help and support in ways I have never done before.

In all the recent debate about attachment parenting, feminism and ‘extended’ nursing, including a New York Times ‘Room for Debate’ feature and a provocative Time magazine cover article, no one talks about the flip side of being a nursing working mama… pumping.  During the daily grind, I have to figure out ways to squeeze in three pump sessions a day (or more if traveling without my son), often excusing myself from meetings to seek a private refuge and attach myself to that darn pump. In addition to pumping in the back seat of a car at the Texas-Mexico border, I’ve pumped at countless random locations, including the U.S. Capitol, bathrooms at bars, funder’s offices, empty conference rooms, cramped Amtrak and airplane restrooms, closets, hotel rooms, and the ladies room at a sports arena during a Miami Heat basketball game. With a horrific gasp, I’ve spilled milk on my office carpet, a hotel bed and a conference room table. While on the pump, I’ve practiced speeches, joined conference calls, responded to emails or looked at photos of my baby (I am told it is supposed to help the ‘let down’… it doesn’t for me).  And speaking of ‘let down,’ how about the race to work with your heavy breast pump bag in tow (and its serpent-like tubing parts), getting the pumps in throughout the day, and the rush home to see your baby and find out what you pumped is just not enough for the next day. My partner would be the bearer of good or bad news, as he applied his biomedical engineering degree to measure the liquid gold to the milligram. Yes, pumping is the very un-glamorous side of the decision to breastfeed.  

But while it comes with the territory and along with the decision to breastfeed (or not), it should be supported. In all the debate about breastfeeding, I feel that it is a personal choice that may or may not work for all mothers; however, it is critical that as a society, we have the policies and infrastructure in place to support those decisions. We should not be relegated to a bathroom or closet because society has not deemed it critical to create private nursing or pumping spaces in public locations. We should not have to feel the burning judgmental stares because we decide to breastfeed on a plane, or anywhere in public. We should not have to hear the banter of folks who are uncomfortable with the idea of mothers continuing to nurse when children are ‘too old.’ We should not have to hear the denigration of mothers who are unable or uninterested in nursing at all. On this mama’s day, we — as a society — need to respect and support the decisions that women and families make when raising their children. We also need to serve as advocates for change at the political and societal level so that the U.S. is no longer one of the lowest-scoring industrialized countries to be a mom, with a dismal breastfeeding policy score of ‘poor’ and the only developed country to not guarantee paid parental leave. Until then, I will continue to keep track of my random nursing and pumping adventures, hoping for one day to turn this randomness into acceptance.

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