Tami Gurley-Calvez is with the University of Kansas Medical Center, Kansas City. Lindsey Bullinger is with the School of Public and Environmental Affairs, Indiana University, Bloomington. Kandice A. Kapinos is with the RAND Corporation, Arlington, VA.
Am J Public Health. 2018 Feb;108(2):277-283. doi: 10.2105/AJPH.2017.304108. Epub 2017 Dec 21.
To assess how the 2012 Affordable Care Act (ACA) policy change, which required most private health insurance plans to cover lactation-support services and breastfeeding equipment (without cost-sharing), affected breastfeeding outcomes.
We used a regression-adjusted difference-in-differences approach with cross-sectional observational data from the US National Immunization Survey from 2008 to 2014 to estimate the effect of the ACA policy change on breastfeeding outcomes, including initiation, duration, and age at first formula feeding. The sample included children aged 19 to 23 months covered by private health insurance or Medicaid.
The ACA policy change was associated with an increase in breastfeeding duration by 10% (0.57 months; P = .007) and duration of exclusive breastfeeding by 21% (0.74 months; P = .001) among the eligible population. Results indicate no significant effects on breastfeeding initiation and age at first formula feeding.
Reducing barriers to receiving support services and breastfeeding equipment shows promise as part of a broader effort to encourage breastfeeding, particularly the duration of breastfeeding and the amount of time before formula supplementation.
评估 2012 年平价医疗法案（ACA）政策的变化如何影响母乳喂养结果，该政策要求大多数私人医疗保险计划覆盖哺乳支持服务和母乳喂养设备（不收取费用分摊）。
我们使用了具有横截面观测数据的回归调整差异法，利用美国全国免疫调查 2008 年至 2014 年的数据，估计 ACA 政策变化对母乳喂养结果的影响，包括开始、持续时间和首次配方喂养的年龄。样本包括年龄在 19 至 23 个月之间、有私人医疗保险或医疗补助的儿童。
ACA 政策的变化与合格人群中母乳喂养持续时间增加 10%（0.57 个月；P = .007）和纯母乳喂养持续时间增加 21%（0.74 个月；P = .001）相关。结果表明，该政策对母乳喂养的开始和首次配方喂养的年龄没有显著影响。
减少获得支持服务和母乳喂养设备的障碍，有望成为鼓励母乳喂养的更广泛努力的一部分，特别是母乳喂养的持续时间和配方补充前的时间。
