By Rebecca Beitsch

The Trump administration this spring tried to remove pro-breastfeeding language from a World Health Organization resolution. But here at home, breastfeeding has steadily become more accepted and accessible — culminating this year in the 49th and 50th states enacting laws to allow it in public.

The World Health Organization resolution stated that breast milk is the healthiest choice for babies and encouraged countries to crack down on misleading claims from purveyors of formula. Attempts by the United States to remove language that called on governments to “protect, promote and support breastfeeding” were unsuccessful, but the move shocked researchers and health advocates who have long contended “breast is best.”

The measure succeeded even after the United States reportedly threatened to withdraw military aid or introduce new trade measures against Ecuador, which had planned to introduce it. In the end, Russia introduced the measure. President Donald Trump criticized coverage of the controversy and said the United States wants to promote access to formula.

Meanwhile, this year in the United States, Idaho became the last to protect mothers who are nursing in public against fines for public indecency. Utah enacted a similar law a few days before, so all 50 states now allow public breastfeeding. New Jersey expanded its civil rights law to protect nursing mothers from discrimination at work, joining 28 states that offer workplace protections. New York will begin requiring breastfeeding rooms in all state buildings open to the public by next year.

The choices made by mothers in the United States and those abroad may seem unrelated, but in fact are closely intertwined. As cultural norms and laws in the United States shift, more women are breastfeeding, and a plateau in the market for substitutes has left manufacturers turning to developing nations, where formula is sometimes viewed as a healthier alternative and thus a status symbol by a growing middle class.

Eighty-one percent of newborn infants were breastfed in the United States in 2016, according to the Centers for Disease Control, up from a low of 24 percent in 1971. While laws can often lag decades or more behind social norms, legislation related to breastfeeding has passed more swiftly by comparison. A number of states passed bills in the late 1990s and then again in the late 2000s, as the U.S. Department of Health and Human Services ramped up ads encouraging breastfeeding from 2004 to 2006. And nursing mothers have put serious pressure on state legislators after stories circulated of nursing women being asked to leave restaurants and other businesses.

“I was a new mom asked to leave an establishment or go into the bathroom within two weeks of giving birth, and that fundamentally changed me,” said Adrean Cavener, the mother of a two-year-old son and the owner of a lobbying firm that helped push for the law in Idaho. “ ‘Cause I was looking into the face of the most miraculous thing that ever happened, and I’m feeding him in a place that someone just defecated. I was sitting in this bathroom stall with tears streaming down my face.”

In Idaho, the holdout state, the bill passed without a single “no” vote and was received very differently than a similar bill considered in 2003 that never made it out of committee. One legislator made headlines for saying he feared women would “whip it out and do it anywhere.”

Linda J. Smith, a lactation consultant and board member at La Leche League, a breastfeeding advocacy group, said that when she was working on a bill to allow public breastfeeding in Ohio, she and other mothers used a stunt to help legislators understand why women preferred to nurse wherever they may be with their child.

“We brought them individually wrapped cookies, but we said, ‘You can’t eat it now. You have to wait ‘til you’re in the bathroom and eat it there.’ ”

States that initially passed breastfeeding protection laws more than a decade ago have had to make updates as more women enter the workforce. Laws requiring workplaces to accommodate nursing mothers were in part spurred by Affordable Care Act regulations, stating that businesses with at least 50 employees must provide time for women to express breastmilk for at least a year after they have given birth. But many states have added specific requirements to their own statutes.

New Jersey Assemblywoman Valerie Vainieri Huttle sponsored a law this year that expands civil rights protections to include breastfeeding and requires workplaces to accommodate mothers while they’re breastfeeding. It passed unanimously.

“My male counterparts tend to trust the judgment of women legislators. Look, they’re fathers and they’re husbands, so it sort of crosses partisan lines,” said Huttle, a Democrat. “These are the issues that tug to the appeal of wider consensus… They’d be hard pressed to vote no.”

When legislators have voiced opposition to breastfeeding bills, their comments have gained notoriety.

As Utah considered a law enacted earlier this year to clarify that breastfeeding is allowed in public, one legislator questioned what the bill did to address modesty.

“This seems to say you don’t have to cover up at all,” Rep. Curt Webb, a Republican, said during a hearing. “I’m not comfortable with that, I’m just not. It’s really in your face.”

Salt Lake Tribune columnist Marina Gomberg later retorted, “Some might say that it’s not in your face, Rep. Webb, it’s in the baby’s face.”

Webb voted for the bill after a portion was removed that said women did not need to cover themselves to comply with the law.

“Let’s just stay silent on it, and let women do what they want to do,” he told Stateline. “We just don’t need the bill saying women don’t need to cover up one way or another.”

Other legislation passed this year suggests there are still new frontiers for those who wish to make breastfeeding easier and more accessible. New Jersey became the third state to remove taxes on items related to breastfeeding, in this case enacting a law that exempts breast pumps, which can run around $100, and other supplies from sales taxes.

“When you got back to work, you have to buy a pump. You have to buy pads in case you are leaking. You have to buy bottles. So, breast milk isn’t free; it’s actually quite expensive,” said Assemblywoman Pamela Lampitt, a Democrat who sponsored the law. “We don’t want to put up barriers for women that maybe can’t afford to do it.”