Elsevier

Health Policy

Volume 97, Issue 1, September 2010, Pages 79-86
Health Policy

The differential effects of full-time and part-time work status on breastfeeding

https://doi.org/10.1016/j.healthpol.2010.03.006Get rights and content

Abstract

Objectives

Return to work is associated with diminished breastfeeding. Although more mothers breastfeed after returning to work compared to a decade ago, research has not documented the variations in breastfeeding initiation and duration based on full-time and part-time (less than 35 h/week) work status. In this study, we clarify these differences.

Methods

Longitudinal data from the Infant Feeding Practices Study II, collected between 2005 and 2007, for over 1400 mothers are used. In analyzing initiation, mother's work status was categorized by the expected number of hours she planned to work postpartum. In the duration model, work status was categorized based on the actual number of hours worked upon mother's return to employment after controlling for baby's age when she returned to work. Covariates in logistic and censored regressions included demographics, maternity leave, parity, past breastfeeding experience, hospital experience, and social support.

Results

Compared with expecting not to work, expecting to work <35 h/week was not associated with breastfeeding initiation while expecting to work full-time decreased breastfeeding initiation. Compared with breastfeeding mothers who did not work, returning to work within 12 weeks regardless of work status and returning to work after 12 weeks while working more than 34 h/week were associated with significantly shorter breastfeeding duration.

Conclusion

Part-time work and increased amount of leave taken promote breastfeeding initiation and duration.

Introduction

In the United States, lower rates of initiation and shorter duration of breastfeeding are generally observed among mothers who return to work after a child's birth than among mothers who do not return to market work [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]. However, one large study of U.S. mothers finds statistically similar initiation rates among mothers who were not working after the birth of their child compared with mothers who were working for pay part-time [12]. More U.S. mothers of infants are participating in the workforce [13]; the 2001–2003 estimate was that 67% of mothers of first children worked during the pregnancy, and most of this work was full-time employment [14]. Even as maternal workforce participation grows, the importance of breastfeeding in developed countries is increasingly emphasized. In 1997, the American Academy of Pediatrics increased their recommendation for the minimum duration of breastfeeding from 6 to 12 months based on diverse research showing health benefits in developed countries, and the policy was reaffirmed in 2005 [15], [16]. National U.S. health objectives call for exclusive breastfeeding for 6 months and breastfeeding duration for at least 12 months [17], [18]. A series of meta-analyses concluded that breastfeeding is associated with a reduced risk of many undesirable health outcomes in both mothers and infants in developed countries [19]. Although the Centers for Disease Control and Prevention estimates that breastfeeding initiation has increased in recent years, and that 73.9% of new mothers initiated breastfeeding in 2006 [20], this is slightly below the Healthy People 2010 target of 75% [17].

Previous work has investigated the relation between employment and breastfeeding, but the focus has primarily been on full-time vs. non-working groups [2], [4], [5], [6], [7], [8], [10], [11], [12]. A notable exception is the analysis from the first Infant Feeding Practices Study (IFPS I) [3], which is replicated with new data in this paper. Variables from several domains have been found to affect breastfeeding initiation or duration and may confound the relation between breastfeeding and work status. These include demographic and economic [21], [22], [23], medical [22], [23], [24], and social context variables [22], [23], [24]; parity [23], [24]; positive feelings toward the act of breastfeeding [23], [24]; and ability to follow health recommendations [22], [23], [24].

Rates of maternal labor force participation, maternity leave policies, breastfeeding initiation and duration, and the availability of portable breast pumps, which enable a mother to pump milk for her infant during the work day, have changed considerably since the period of the cited literature. We use variables from the above domains as control variables to clarify the effect of full-time and part-time employment on breastfeeding initiation and duration.

Section snippets

Sample

The Infant Feeding Practices Study II (IFPS II), conducted by the Food and Drug Administration in collaboration with the Centers for Disease Control and Prevention (CDC) from May 2005 to June 2007, is a longitudinal study of women from late pregnancy through their infant's first year of life. Following IFPS I (1992–1993), the new study collected data on infant feeding practices used by women in the U.S. to better understand the effect of significant changes in products, policies, and education

Results

Mean values of model variables are shown in Table 1. The percentages of mothers who had any amount of leave of each type are not shown; these are 27.2% for fully paid leave, 17.9% for partially paid leave, and 54.9% for unpaid leave. We also present the descriptive statistics and regression results from IFPS I for comparison purposes [3]. In addition to using the interaction categories between leave taken and work status, we crossed the collinear variables of parity and previous breastfeeding

Discussion

In this sample, 86.5% of mothers initiated breastfeeding, which is higher than the 2006 estimate of 73.9% from the CDC for U.S. mothers based on a nationally representative sample. The increase of 10.5% points in breastfeeding initiation from the IFPS I, conducted in 1992–1993, is consistent with an increase in initiation rates of 5.6% points reported by CDC since they began collecting breastfeeding statistics in 1999 and an increase in initiation rates of 10.1% points reported by Ross Labs

Conclusions

The overwhelming health benefits of breastfeeding, including long-term effects, are well-known [37]. While it is a national goal of the U.S. Department of Health and Human Services to increase the proportion of mothers who breastfeed their babies in the early postpartum period to 75% by the year 2010, more U.S. mothers of infants are participating in the workforce and facing difficulties in combining paid work with breastfeeding [18]. Not surprisingly, the U.S. still remains below the Healthy

References (39)

  • K.B. Flower et al.

    Understanding breastfeeding initiation and continuation in rural communities: a combined qualitative/quantitative approach

    Maternal and Child Health Journal

    (2008)
  • L.M. Berger et al.

    Maternity leave, early maternal employment and child health and development in the US

    The Economic Journal

    (2005)
  • S. Arora et al.

    Major factors influencing breastfeeding rates: mother's perception of father's attitude and milk supply

    Pediatrics

    (2000)
  • Dye J. Fertility of American women: June 2004. In: Current population reports. Washington, DC: US Census Bureau;...
  • T. Johnson

    Maternity leave and employment patterns of first time mothers: 1961–2003

    Current Population Reports

    (2008)
  • L.M. Gartner et al.

    Breastfeeding and the use of human milk

    Pediatrics

    (1997)
  • L.M. Gartner et al.

    Breastfeeding and the use of human milk

    Pediatrics

    (2005)
  • Services UDoHaH. Healthy people 2010: conference ed., vols. I and II. Washington, DC: U.S. Department of Health and...
  • Services UDoHaH. HHS blueprint for action on breastfeeding. Washington, DC: U.S. Department of Health and Human...
  • Cited by (99)

    • Work schedule arrangements in two-adult households with children

      2023, Transportation Research Part B: Methodological
    • Promoting Lactation Support: Challenges and Solutions to Supporting Breastfeeding Radiologists

      2022, Academic Radiology
      Citation Excerpt :

      Previous studies have shown that longer maternity leave has led to increased breastfeeding duration in other professions (17). Additionally, returning to work full-time before 3 months has been shown to reduce the likelihood of meeting breastfeeding goals (18,19). Medical trainees have also reported more lactation barriers than attending physicians (20).

    • Breastfeeding knowledge and practices of working mothers in the informal economy in New Delhi: A formative study to explore new intervention pathways towards improved maternal and child health outcomes

      2021, Social Science and Medicine
      Citation Excerpt :

      This intersectionality exacerbates vulnerability, putting pressure on the length of maternity break a woman can opt for. The choice and ability for women to take a 6-month break after delivery has a strong impact on their ability to breastfeed exclusively for six months, as observed in this study and supported by other research (Mandal, 2010; Mirkovic, 2016). The most common mode for enabling maternity break is paid maternity leave.

    View all citing articles on Scopus
    View full text