United States Ranks Last on Breast-Feeding Support Does the United States - do we - really want women to breast-feed their infants? The American Academy of Pediatrics certainly does. As do the Surgeon General and the Centers for Disease Control and Prevention's Division of Nutrition, Physical Activity and Obesity, which clearly have the ring of officialdom about them. But as many mothers can attest, the awarding of a smiley-face sticker for diligent nursing does nothing to make up for inadequate support for women who want to breast-feed their babies while simultaneously remaining employed outside the home. It's possible to do both, and many women do - but very few would argue that the federal or state government offered much, if any, help. Last week, Save the Children released its State of the World's Mothers Report for 2012, and in it, amid the detailed discussion of successes and failures of all the world's nations with respect to taking care of mothers and infants, was this: The United States ranks last on the Breastfeeding Policy Scorecard. It is the only economically advanced country - and one of just a handful of countries worldwide - where employers are not required to provide any paid maternity leave after a woman gives birth. There is also no paid parental leave required by U.S. law. Mothers may take breaks from work to nurse, but employers are not required to pay them for this time. Only 2 percent of hospitals in the United States have been certified as "baby-friendly" and none of the provisions of the International Code of Marketing of Breast-Milk Substitutes has been enacted into law. While 75 percent of American babies are initially breast-fed, only 35 percent are being breast-fed exclusively at 3 months. Save the Children makes the point that women in developing countries don't need to breast-feed in the way that women in impoverished countries do. We have ready access to nutritious alternatives and clean water. But the science that's trumpeted by the Surgeon General, A.A.P. and the C.D.C. suggests that breast-feeding, when possible, has benefits that aren't matched by those alternatives - in its "Call to Action to Support Breastfeeding," the Surgeon General's office notes that breast-feeding reduces the risks of some infections and diseases, and of type 2 diabetes, asthma and childhood obesity. As others have said before me, increasing breast-feeding rates might only incrementally alter the health picture for any one child, but it holds the possibility of dramatic change nationwide with respect to the number of children affected by those problems, and the cost of their treatment. But if that's the case, then why not support policies that make breast-feeding as easy as possible? As the Surgeon General's report notes, rates of breast-feeding are lower among employed mothers, and women with longer maternity leaves, those who can work part time and those with breast-feeding support programs in the workplace nurse longer. But for many, if not most, women, those supports aren't available. I've written before that breast-feeding isn't free. Breast-feeding for six months or more is associated with a loss of earnings: women who nurse long-term spend more time out of the workforce, and work fewer hours, and the result seems to impact their earnings beyond even the time with an infant at the breast. That may be because women who nurse longer are also more likely to have made a conscious choice to stop working or cut back on their hours, but there's more to that story as well. Faced with a different work environment, women might make different choices. But if that different work environment is to include laws requiring more support of breast-feeding, many women have doubts about that as well. The costs may shift, but breast-feeding will never be "free" - there will always be a cost in terms of lost hours of productivity with respect to the financially remunerative work, and the return on that investment will never be in kind. We've collectively embraced the benefits of breast-feeding, but we still have no way to value those benefits within our economy. The result is that many women fear that laws that place the economic burden of breast-feeding on the employers will have a cost to all women (regardless of whether they ultimately breast-feed a child) in terms of hiring and promotion - one more way that a woman employee may be different from a man. So, do we as a country really want every woman (not just those who can bear the costs themselves) to breast-feed her infant? One reason we're ranked at the bottom of the worldwide "Breastfeeding Policy Scorecard" is that we don't have a good answer to that question.