A Choice No Mother Should Have to Make

Update: Nursing moms are now eligible for accommodations! The ABIM has just posted its new policy on its website, making nursing mothers eligible for additional break time and a private place to pump during any of the tests it administers. Thanks to ABIM for doing the right thing, and to Meghan for standing up for herself and fighting for the rights of others!

In September, the ACLU wrote a letter on behalf of Meghan McInerney, a medical doctor doing her fellowship in Pulmonary and Critical Care Medicine, a sub-specialty of internal medicine. Dr. McInerney had been denied additional break time to pump breast milk during her pulmonary medicine licensing examination. She took the examination on Wednesday, November 12.

You wouldn't think that as a medical professional, I'd be asked to choose between the health of my child and the advancement of my medical career, but that's exactly the choice that was put before me.

I am a physician in my third and final year of sub-specialty fellowship training. I am also a first-time mother trying to make my way through the logistical and emotional challenges that come with working 50-70 hours per week and having an infant at home—while remaining committed to breastfeeding.

At the end of our training in Pulmonary and Critical Care Medicine we are required to take sub-specialty certifying exams, which are offered only once a year to all trainees in the country. This exam, which is administered by the American Board of Internal Medicine (ABIM), is a grueling all-day test. After paying the $2,200 exam fee, I wrote to the ABIM to inquire about accommodations for breastfeeding mothers to express milk during breaks on the exam day.

I never anticipated how ABIM—a medical organization—would respond: "we give no accommodations to nursing mothers".

I wrote again to clarify that I was not asking for extra time to take the exam, but extra break time. Again, the response from the ABIM was that the time allotted in the 10 hour exam day should suffice. Their explanation was that as a nursing mother I am not considered a person with a disability, so I don't qualify for protections under the Americans with Disabilities Act. They added that they couldn't even guarantee that there would be a private place for me to pump.

Without the ability to pump, I would face engorgement and extreme discomfort, possible infection, or a diminished milk supply—not to mention not having enough food for my baby. Without the additional break time, I would have to choose between pumping and doing the things the rest of the test takers were able to do with their breaks—for example, eating, using the restroom, getting fresh air, or studying.

I was astounded by ABIM's response. First, how could a medical society take a position so antithetical to the medical evidence (The American Academy of Pediatrics recommends breastfeeding at least one year)? Second, where did the ADA come into this? I don't consider myself disabled and am not requesting accommodations as such. I am simply trying to do what I believe is best for my baby.

Equally shocking was some of the feedback I got from fellow physicians. While some supported me in challenging the ABIM's policy, others suggested I postpone the exam for a year, or even that I stop breastfeeding altogether. Is this what it means to be a working mother? Why should I have to choose between continuing to breastfeed and remaining on track with my career?

I decided I would not make that choice. Instead, I contacted the ACLU, which, along with a private attorney, sent a letter to the ABIM on my behalf, highlighting the fact that the ABIM's policy is discriminatory against women.

I am happy to report that last month the ABIM reversed its decision: They stated that they would allow me the additional break time I requested, and agreed to provide me with a room in which I could pump in private. And, they added, the ABIM will review its policy for nursing mothers.

Thanks to this change, when I took the exam earlier this week I was able to pump twice during the nine-hour test day. My experience made it clear how necessary this extra time was, as there is no way I would have had enough time without the extra break time provided.

The ABIM has done the right thing by not forcing me to choose between the health of my child and staying on track with my chosen career. I hope that they will take this one step further and put into place a policy that applies to all nursing mothers who will sit for the board exams they administer.

Click here for more information on ACLU's past campaigns to eliminate barriers for new moms entering the legal profession.

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