National Consumers League

Breastfeeding denied coverage by IRS


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By Sally Greenberg, NCL Executive Director Since our founding in 1899, the National Consumers League has worked hard to advocate for the better health of women and children. Florence Kelley, the League’s first leader, grew up in a family in which five of her mother’s eight children died from infection or disease. Babies during that time – the period right after the Civil War - were relatively safe while breastfeeding. Once weaned, they were exposed to illness from unsanitary food, water, and milk. Today, though we pasteurize milk and have access to safe drinking water, breastfeeding remains the best option for babies and their mothers, at least for the first 6 months of a child’s life. That is why NCL was disturbed to read about an Internal Revenue Service decision that denies nursing mothers the ability to use their tax-sheltered health care accounts to pay for breast pumps and other breastfeeding supplies. NCL has written to the IRS to ask that the agency reverse its decision. According to IRS Publication 502, reimbursable items include those that aid in the “prevention of disease.” The IRS apparently has determined that breast-feeding does not help in the prevention of disease. NCL could not disagree more. Medical evidence that far more widespread breastfeeding would not only “prevent disease” in the United States, but would save our health care system billions of dollars is overwhelming. Consider the following evidence about the myriad health benefits to both breastfeeding mother and child:

  • According to a Harvard study published in April of this year, if 90 percent of American families would comply with medical recommendationsto breastfeed exclusively for 6 months, the United States wouldsave $13 billion per year and prevent an excess 911 deaths,nearly all of which would be among infants ($10.5 billion and 741deaths at 80 percent compliance).
  • The U.S. Department of Health and Human Services has found that breastfed infants have a lower risk of contracting ear infections, stomach viruses, atopic dermatitis, type 1 and 2 diabetes, childhood leukemia, and other health problems.
  • Mothers also benefit from breastfeeding because of lower risk of contracting type 2 diabetes, breast cancer, ovarian cancer, and postpartum depression (PPD).
  • Breastfed infants typically need fewer sick care visits; Congress recently acknowledged the importance of breastfeeding in landmark health care reform legislation by requiring that workplaces provide women with a private place to nurse or use a breast pump.
As Dr. Robert W. Block, president-elect of the American Academy of Pediatrics (AAP) noted in the New York Times this week, “The old adage that breast-feeding is a child’s first immunization really is true … So we need to do everything we can to remove the barriers that make it difficult.” We agree with Dr. Block. And NCL reached out to our friends at AAP to share our letter and join forces with those who work to protect and improve the health of babies. NCL strongly believes we need to encourage, not discourage, barriers to widespread breastfeeding. As in Florence Kelley’s day and ours, breast-fed babies get the best of all protections. Unfortunately, the IRS determination NOT to allow parents to use their tax-sheltered flex accounts to cover the cost of breast pumps has the impact of further discouraging women from breastfeeding and directly undermines what is by every measure a critical practice for improved public health. We believe the cost of breast pumps should and must be covered cost in these flex plans. We hope that NCL’s voice, along with the voices of AAP and so many others, will help to press the IRS Commissioner to reverse his decision.