Comments by "Paddle Duck" (@paddleduck5328) on "The New York Times"
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Study:
Background
Only 63% of U.S. infants are breastfeeding at 3 months of age, and only 27% at 12 months.1
Furthermore, approximately 60% of mothers do not breastfeed their infants as long as they want.2
Maternal employment is frequently cited as a barrier to breastfeeding.3–10
Indeed, mothers who anticipate earlier return to work and/or return to full-time work are less likely to prenatally intend to initiate exclusive breastfeeding.11 Additionally, earlier return to work and return to full-time work are associated with shorter durations of exclusive/predominant breastfeeding and shorter duration of overall breastfeeding.3–10
As such, national initiatives include recommendations for employer support for breastfeeding women. For example, Healthy People 2020, the 2011 Surgeon General’s Call to Action to Support Breastfeeding, and the National Prevention Strategy all include recommendations for employer support.12
While shorter durations of breastfeeding have been documented from mothers who return to work earlier and/or full-time,3–10 these studies do not consider the possibility of reverse causality – that women planning to breastfeed for a shorter duration are returning earlier to paid employment. We sought to address this issue by assessing the impact of maternity leave duration with part-time/full-time return status on the ability of a mother to breastfeed for at least 3 months, among a cohort of women who all reported prenatally that they intended to breastfeed for at least 3 months.
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Among women who intend to breastfeed at least 3 months, the odds of not breastfeeding at least 3 month, Infant Feeding Practices Study II, 2005–2007 (n=1172)
Overall, 28.8% of mothers in our study did not meet their intention to breastfeed for at least 3 months (Table 1). Mothers who returned to work before 6 weeks/FT had 2.25 times the odds and mothers who returned FT after 6 weeks but before 3 months had 1.82 times the odds of not meeting their intentions to breastfeed for at least 3 months, compared to mothers not working at 3 months. No association was observed between returning to work part-time and not meeting intentions to breastfeed for at least 3 months.
Discussion
Among mothers who intended to breastfeed for at least 3 months, those who returned to full-time work before 3 months were less likely to meet their intention to breastfeed at least 3 months. Fifty-seven percent of U.S. mothers with infants under one year of age participate in the work force, with 63% of these employed mothers working more than 35 hours per week.14 Support for employed mothers to meet their breastfeeding intentions may help improve U.S. breastfeeding rates.
Previous studies have documented shorter breastfeeding durations among mothers who return early to work or return to full-time work.3–10 Yet, these studies were cross-sectional and could not rule out whether mothers planning to breastfeed for shorter durations returned to work earlier or for more hours than mothers planning to breastfeed longer. Our study takes into account a mother’s prenatal intention regarding breastfeeding duration and demonstrates that early return to work, specifically full-time work, may result in a shorter than intended duration of breastfeeding.
Our study had several limitations. Mothers were categorized as full-time or part-time based on the number of hours they reported upon their initial return to paid employment, but mothers may have increased their working hours subsequently. Data are from 2005–2007 therefore are representative of working women during these years. While IFPSII included a national sample of women, it is not nationally representative; mothers were more likely to be older, white, and more highly educated, all factors associated with higher employment rates and better feeding practices.13, 15, 16 Moreover this study is limited to mothers who intended to breastfeed for at least 3 months, therefore the findings are not generalizable to all breastfeeding mothers. While our study focused on the ability of a mother to meet her goal to breastfeed for at least 3 months, the American Academy of Pediatrics recommend continued breastfeeding for the first 12 months or longer.17 Strengths of our study include the frequency of postpartum questionnaires to minimize recall bias regarding feeding and the inclusion of mother’s prenatal report of her breastfeeding intention.
A mother’s return to employment after giving birth is likely influenced by the amount of paid leave she is granted and the amount of unpaid leave she can afford to take.
Of the 167 countries reviewed by the International Labor Organization (ILO), the U.S. is one of only three that does not mandate paid leave for new mothers.18, 19 ILO recommends a minimum of 18 weeks paid maternity leave,20 however in the U.S. 83% of working mothers return to their job within 12 weeks.21
Action 13 of the 2011 Surgeon General’s Call to Action to Support Breastfeeding calls for “work toward establishing paid leave for all employed women”.12 Returning to work full-time within the first 3 months postpartum may interfere with a woman’s ability to breastfeed as long as she intends to, which may result in the loss of health benefits associated with breastfeeding and in more women falling short of AAP recommendations for breastfeeding durations.
Conclusion
We found that mothers who return to full-time work before 3 months postpartum were less likely to meet their intentions to breastfeed for at least 3 months. Support for a mother’s delayed return to paid employment, or return at part-time hours, may help more mothers achieve their breastfeeding intentions. This may increase breastfeeding rates and have important public health implications for U.S. mothers and infants.
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