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Funded Projects

(SDAS) The Affordable Care Act, Lactation Support Services, and Breastfeeding

Grantee: RAND Corporation
Principal Investigator: Kandice Kapinos
Project Number: R40MC28305
Project Date: 04/01/2015

Age group(s)

  • Perinatal/Infancy (0-12 months)


Despite substantial evidence of the benefits of breastfeeding for both mothers and children, rates of sustained breastfeeding in the United States are quite low. In particular, women in certain vulnerable populations -including those with low incomes, less education, or belonging to some racial/ethnic groups- have below average rates of breastfeeding initiation, exclusivity, and duration. Studies have shown that lactation support services, including lactation consultants and breast pumps, can increase a woman's commitment to and success with breastfeeding. Availability and access to such services is limited for many women, particularly vulnerable populations for whom the benefits of breastfeeding may be greatest. Health insurance coverage of such services historically has not been universal, but the Affordable Care Act (ACA) mandated coverage of lactation support services in 2012. Little is known about the effectiveness of the mandate in increasing access to services and improving breastfeeding behaviors. This study endeavors to fill this knowledge gap by establishing causal evidence of the effect of the ACA's lactation support services mandate on breastfeeding behaviors. The study will use the National Vital Statistics System (NVSS) birth data and the National Immunization Survey (NIS) from 2009 to 2013/2014. We will also examine the extent to which the mandate influenced previously documented racial/ethnic and socioeconomic disparities in breastfeeding. The NVSS contains details about all live births in the U.S. each year, including socio-demographic information about the infant and mother, and whether the infant was being breastfed at discharge. The NIS is a nationally representative survey about immunizations and contains several questions on the extent of breastfeeding for each child. We propose to use two rigorous policy evaluation techniques: (1) a regression-adjusted difference-in-differences (DD) estimation and (2) a fuzzy regression discontinuity (RD) approach. Using both datasets and both econometric approaches will strengthen our ability to draw inferences from our findings. Aim 1 of this project is to ascertain whether the mandate improved sustained breastfeeding rates. Aim 2 is to delve deeper into the effects of the mandate on breastfeeding rates among women from groups that have been less likely to breastfeed, including low-income and less educated women and those from racial/ethnic minorities.


Listed is descending order by year published.

Gurley-Calvez T, Bullinger L, Kapinos KA. Effect of the Affordable Care Act on breastfeeding outcomes. Am J Public Health. 2018;108(2):277-283.

Kapinos KA, Bullinger L, Gurley-Calvez T. Lactation Support Services and Breastfeeding Initiation: Evidence from the Affordable Care Act. Health Serv Res. 2016 Nov 10.

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