CDC Public Health Law News | Profile in Public Health Law: Leila Barraza, JD, MPH
Title: Associate Professor, Mel and Enid Zuckerman College of Public Health at University of Arizona; Director, Arizona Area Health Education Centers
Education: JD, Sandra Day O’Connor College of Law, Arizona State University; MPH, Mel and Enid Zuckerman College of Public Health, University of Arizona; BA, Biological Sciences, University of Southern California
Public Health Law News (PHLN): What sparked your interest in public health law?
Barraza: During my undergraduate studies in biological sciences, I became interested in community health and public health. I was accepted into the MPH program at University of Arizona’s Mel and Enid Zuckerman College of Public Health. During my MPH coursework, I completed a policy course in which we tracked legislation and examined the implications of the legislative process on community health. I was fascinated with the widespread impacts that laws and policies have on the public’s health and safety.
PHLN: Please describe your career path.
Barraza: After completing my masters, I worked for the Arizona Rural Health Office (now Center for Rural Health), where I provided assistance to rural and tribal hospitals and clinics. During this time, I applied to law school because I felt a law degree was an important next step for my career based on my interests in public health law. Following law school, I did not have a defined path for my career but was open to various possibilities. I was grateful to be selected for a position as a judicial clerk, which provided me a chance to greatly improve my legal research and writing skills. I was then given an extraordinary opportunity to become a fellow in the Public Health Law and Policy Program (now Center for Public Health Law and Policy) at the Sandra Day O’Connor College of Law, Arizona State University, and a deputy director of the Western Region of the Network for Public Health Law, under the guidance and mentorship of national public health law expert James G. Hodge, Jr. Through my role there, I provided legal technical assistance on public health issues to individuals and organizations. Two years later, I was hired as an assistant professor at Zuckerman College of Public Health to teach public health law. I did not go to law school with a plan to work in academia, but I am so thankful for the way my career path has led me to my current position.
PHLN: What do you do in your current position?
Barraza: I serve as an associate professor at the Zuckerman College of Public Health at the University of Arizona. My research interests focus on the impact of laws and policies on public health, and I teach a public health law and ethics course to public health and law graduate students. I also serve as a senior consultant for the Network for Public Health Law—Western Region office. The Network for Public Health Law has recently provided numerous webinars, issue briefs, and requests related to legal responses to the COVID-19 pandemic. Additionally, I serve as the director of the Arizona Area Health Education Centers (AHEC) Program, where I focus efforts on overseeing programs to improve the supply and diversity of healthcare professionals serving in rural and underserved areas of the state.
PHLN: How did you come to work on the Healthy People 2020 Law and Policy breastfeeding initiative?
Barraza: Through my work with the Network for Public Health Law, I was connected with Angie McGowan, JD, MPH, who was leading the efforts to compile a team of authors for the Healthy People 2020 Law and Health Policy Project report focused on supporting breastfeeding. I was fortunate to be chosen alongside two amazing co-authors: Cheryl Lebedevitch, BA, Senior Workplace Program Manager and Policy Analyst, United States Breastfeeding Committee (USBC); and Alison Stuebe, MD, MSc, Professor of Obstetrics and Gynecology, University of North Carolina School of Medicine. We also had additional experts in the report working group and the federal Healthy People Maternal, Infant, and Child Health workgroup, which provided us with wonderful feedback.
PHLN: How is breastfeeding a public health issue?
Barraza: Breastmilk is uniquely suited to meet the nutritional needs of infants. Breastfeeding can confer numerous health benefits on both infants and mothers. For infants, not being breastfed has been associated with higher rates of ear and gastrointestinal infections, hospitalizations for lower respiratory tract infections, childhood obesity, and inflammatory bowel disease. For mothers, not breastfeeding has been associated with higher rates of ovarian and breast cancers, diabetes, myocardial infarction, and diabetes.
PHLN: How is law related to breastfeeding and public health outcomes?
Barraza: Approximately 4 in 5 women in the United States begin breastfeeding immediately after birth, but many face numerous barriers that prevent them from continuing breastfeeding. While the American Academy of Pediatrics and other major US medical organizations recommend that infants be exclusively breastfed for the first six months, only 29.5% of non-Hispanic White infants, 17.2% of non-Hispanic Black infants, and 19.6% of non-Hispanic American Indian or Alaska Native infants were exclusively breastfed in 2015. Legal and policy interventions focused on assisting more mothers to breastfeed are important to overcome some of the barriers women face in reaching their feeding goals.
PHLN: From your research, which laws or policies seem to best support breastfeeding practices?
Barraza: We examined numerous laws and policies that support breastfeeding practices in drafting the report. Examples in employment include laws providing paid family leave or break time for nursing mothers in the workplace, and laws that protect mothers breastfeeding in public places. All 50 states, DC, the Virgin Islands, and Puerto Rico have laws that permit women to breastfeed in public locations, and in private locations as well in many states. Thirty-one states, plus DC, the Virgin Islands, and Puerto Rico, exempt breastfeeding from public indecency laws. It is important for a breastfeeding mother to feel comfortable feeding her infant wherever she may be.
PHLN: Why are many breastfeeding laws and polices not effectively enforced?
Barraza: Initiation rates for breastfeeding have been shown to be higher in states with workplace breastfeeding laws that include an enforcement provision. In terms of laws protecting breastfeeding mothers in public places, many of these laws lack any enforcement provisions. As of 2016, only 10 states, plus DC and Puerto Rico, allowed breastfeeding mothers to bring legal actions against those who interfere with public breastfeeding rights. A few states allow women whose rights to breastfeed in public have been violated to file claims with the state’s human rights commission. Other enforcement mechanisms may include fines against a company or organization for violating the state’s protections for breastfeeding mothers in public places. However, these enforcement provisions are not universal, and comprehensive enforcement is needed to ensure adequate protections.
PHLN: How can these policies be expanded to create better outcomes for breastfeeding mothers and their children?
Barraza: The report details numerous approaches to help create better outcomes and accelerate the process to reaching national breastfeeding targets. To list a few: promoting coverage of lactation-support providers and timely access to the appropriate and necessary breastfeeding equipment and supplies for each person; considering whether laws or policies can be strengthened to help ensure that breastfeeding mothers are protected from being fired or discriminated against in the workplace via pregnancy accommodation/nondiscrimination legislation with explicit inclusion of lactation in the statutory language; and increasing access to paid, job-protected family and medical leave that is affordable and cost-effective for workers, employers, and the government.
In addition, the report includes a breastfeeding accommodations that details opportunities to accommodate breastfeeding in hospitals and healthcare settings, and in the home, workplace, child care, and community.
PHLN: What other projects are you working on?
Barraza: I am examining the impacts of COVID-19 on vaccination policies for the 2020–2021 school year. Evidence has shown that the pandemic is causing a decline in vaccination rates for recommended vaccines among US children. It is important that students maintain adequate vaccination status to reduce the risk of vaccine-preventable outbreaks in schools.
PHLN: What career advice do you have for young public health and public health law practitioners?
Barraza: At no other time in recent history have we seen the critical role of public health practitioners to protect the health of our communities. I would advise young public health and public health law practitioners to not become discouraged during these challenging times but to continue to follow their passion in public health and remember what they are doing is meaningful and impactful. I would also recommend finding a key mentor to help guide them on their career path and be open to new opportunities and experiences.