Article

Juggling Work and Breastfeeding: Effects of Maternity Leave and Occupational Characteristics

University of California, Maternal and Child Health Program, School of Public Health, Berkeley, CA 94720-7360, USA.
PEDIATRICS (Impact Factor: 5.47). 02/2009; 123(1):e38-46. DOI: 10.1542/peds.2008-2244
Source: PubMed

ABSTRACT

Juggling breastfeeding and paid work can challenge breastfeeding success. We examined the relationship between breastfeeding and maternity leave before and after delivery among working mothers in Southern California. California is 1 of only 5 states in the United States providing paid pregnancy leave that can be extended for infant bonding.
Drawing from a case-control study of preterm birth and low birth weight, 770 full-time working mothers were compared on whether they established breastfeeding in the first month. For those who established breastfeeding, we examined duration. Eligible women participated in California's Prenatal Screening Program; delivered live births between July 2002 and December 2003; were > or =18 years old; had a singleton birth without congenital anomalies; and had a US mailing address. We assessed whether maternity leave and other occupational characteristics predicted breastfeeding cessation and used multivariate regression models weighted for probability of sampling to calculate odds ratios for breastfeeding establishment and hazards ratios for breastfeeding cessation.
A maternity leave of < or =6 weeks or 6 to 12 weeks after delivery was associated, respectively, with a fourfold and twofold higher odds of failure to establish breastfeeding and an increased probability of cessation after successful establishment, relative to women not returning to work, after adjusting for covariates. The impact of short postpartum leave on breastfeeding cessation was stronger among nonmanagers, women with inflexible jobs, and with high psychosocial distress. Antenatal leave in the last month of pregnancy was not associated with breastfeeding establishment or duration.
Postpartum maternity leave may have a positive effect on breastfeeding among full-time workers, particularly those who hold nonmanagerial positions, lack job flexibility, or experience psychosocial distress. Pediatricians should encourage patients to take maternity leave and advocate for extending paid postpartum leave and flexibility in working conditions for breastfeeding women.

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    • "Policies guaranteeing new mothers paid leave from work provide new mothers with the opportunity to rest and recover after childbirth, increase their job protection and labor force attachment [38], and may benefit their mental and physical health [7,8,39] . Moreover, a growing literature suggests that paid maternity leave policies have a beneficial effect on maternal health behaviors, including breastfeeding [12][13][14][15] , and infant health in higher-income coun- tries [3][4][5]. Given the lack of evidence, it has been unclear if these findings can be generalized to poorer countries, where rates of female labor force participation in the formal economy are generally lower. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Maternity leave reduces neonatal and infant mortality rates in high-income countries. However, the impact of maternity leave on infant health has not been rigorously evaluated in low- and middle-income countries (LMICs). In this study, we utilized a difference-in-differences approach to evaluate whether paid maternity leave policies affect infant mortality in LMICs. Methods and findings: We used birth history data collected via the Demographic and Health Surveys to assemble a panel of approximately 300,000 live births in 20 countries from 2000 to 2008; these observational data were merged with longitudinal information on the duration of paid maternity leave provided by each country. We estimated the effect of an increase in maternity leave in the prior year on the probability of infant (<1 y), neonatal (<28 d), and post-neonatal (between 28 d and 1 y after birth) mortality. Fixed effects for country and year were included to control for, respectively, unobserved time-invariant confounders that varied across countries and temporal trends in mortality that were shared across countries. Average rates of infant, neonatal, and post-neonatal mortality over the study period were 55.2, 30.7, and 23.0 per 1,000 live births, respectively. Each additional month of paid maternity was associated with 7.9 fewer infant deaths per 1,000 live births (95% CI 3.7, 12.0), reflecting a 13% relative reduction. Reductions in infant mortality associated with increases in the duration of paid maternity leave were concentrated in the post-neonatal period. Estimates were robust to adjustment for individual, household, and country-level characteristics, although there may be residual confounding by unmeasured time-varying confounders, such as coincident policy changes. Conclusions: More generous paid maternity leave policies represent a potential instrument for facilitating early-life interventions and reducing infant mortality in LMICs and warrant further discussion in the post-2015 sustainable development agenda. From a policy planning perspective, further work is needed to elucidate the mechanisms that explain the benefits of paid maternity leave for infant mortality.
    Full-text · Article · Mar 2016 · PLoS Medicine
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    • "It also examined factors associated with continuing EBF. While several of these factors are well established as associated with disparities in initiation and duration of breastfeeding, in general, this study demonstrated that the associations also hold with initiation and duration of EBF [12, 18, 21, 24]. Previous studies found that women who were college graduates, married, and multiparous were more likely to breastfeed for longer durations [4, 19]. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Exclusive breastfeeding (EBF) benefits the life course health development of infants, families, and society. Professional health associations recommend EBF for 4 months, and many now recommend EBF for 6 months. Yet only 18.8 % of US infants born in 2011 were exclusively breastfed. Numerous studies on breastfeeding are published, but few describe EBF. This study describes characteristics of women who initiated EBF and examines the associations of those factors with EBF lasting ≥4 months. The Life Course Health Development (LCHD) framework was used to structure the analysis and interpret results. Methods: Data collected through the Infant Feeding Practices Study II survey (2005-2007) were used to identify a cohort of women (n = 1226) practicing EBF at the time of hospital discharge and their sociodemographic, health, work, and childcare characteristics. Associations of these characteristics with EBF lasting ≥4 months were studied by bivariate and logistic regression analyses. Results: College education [odds ratio (OR) 2.14, 95 % confidence interval (CI) 1.58-2.89] and marriage (OR 2.19, 95 % CI 1.43-3.37) were associated with greater odds of EBF lasting ≥4 months, whereas the plan to return to work after birth (OR 0.57, 95 % CI 0.43-0.74), living in the south (OR 0.67, 95 % CI 0.47-0.95), and postpartum depression risk (OR 0.43, 95 % CI 0.28-0.66) were associated with lower odds of EBF lasting ≥4 months. Discussion: Several factors associated with disparities in continued EBF were identified. The application of the LCHD framework furthers understanding of the multiple and interacting risks associated with early discontinuation of EBF.
    Full-text · Article · Oct 2015 · Maternal and Child Health Journal
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    • "The multivariate analysis showed that mothers who resumed work when their baby was older than 3 months were 1.6 times more likely to provide exclusive breastfeeding compared with mothers who resumed work when their baby was 3 months or younger (AOR = 1.61; 95% CI 1.24, 2.35). Similar findings were obtained in other studies done in Nigeria [15,26] and Saudi Arabia [27]. In addition to inadequate maternity leave policy; lack of child care facilities at or near the work place and rigid time schedules that do not allow for nursing breaks, were other reasons mentioned by the respondents for early initiation of complementary feeding. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Health care workers have a duty to promote and support breastfeeding among their clients. Although their ability to do this may be influenced by their knowledge and personal experience; little is known about breastfeeding practices and the perceived barriers. The objective of this study was to assess the breastfeeding practices and the associated factors among female nurses and midwives in North Gondar Zone; Northwest Ethiopia. Methods An institution based cross-sectional study design was conducted in 2013 among 178 nurses and midwives. In this study exclusive breastfeeding refers to breastfeeding exclusively for the first six months of a child’s life. Bivariate and multivariate logistic regressions were performed to identify the presence and strength of association. Odds ratios with 95% confidence interval were computed to determine the level of significance. Results Exclusive breastfeeding rate among respondents was found to be 35.9%. Nearly half (49.4%) of the respondents exclusively breastfed for only 3 months or less. The mean duration exclusive breastfeeding was 4.1 ± 1.7 months. Older women (AOR = 2.8; 95% CI 2.16, 3.24), rural residence (AOR = 3.01; 95% CI 2.65, 3.84), being midwife (AOR = 2.01; 95% CI 1.83, 2.56), a women who gave birth through vaginal delivery (AOR = 2.0; 95% CI 1.68, 2.87), multiparous women (AOR = 2.20; 95% CI 1.74, 2.67) and resumption of work after 3 months (AOR = 1.61; 95% CI 1.24, 2.35) were independently associated with exclusive breastfeeding. Conclusion Though respondents had adequate knowledge on breastfeeding, the practice of exclusive breastfeeding was low. Maternal age, place of residence, profession, mode of delivery, parity and the time before resuming work were factors associated with exclusive breastfeeding. Appropriate education concerning breastfeeding, directed at nurses and midwives is required to enhance exclusive breastfeeding and duration of breastfeeding.
    Full-text · Article · Jul 2014 · International Breastfeeding Journal
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