Editor’s Note: Leigh Anne O’Connor, a U.S. based IBCLC in private practice who often works with mothers planning to return to work, recently interviewed Kelsey R. Mirkovic, one of the authors of the recently published study on the impact of maternity leave on breastfeeding outcomes. Read on to learn more about the outcomes, study design, and more:
Recently the Journal of Human Lactation published the study Maternity leave duration and full-time/part-time work status are associated with US mothers’ ability to meet breastfeeding intentions by Kelsey R. Mirkovic, Cria G. Perrine, Kelley S. Scanlon, and Laurence M. Grummer-Strawn.
The study showed that employment can be a barrier to breastfeeding outcomes. This reiterates the importance of public health policy and its role in supporting employed breastfeeding parents.
I interviewed Kelsey R. Mirkovic, PhD to learn more about this study.
Here is what she had to say:
What were the key findings of your research?
We found that even among mothers who planned to breastfeed for more than three months, that those who returned to full-time work any time before three months were less likely to meet that intention.
Were there any big surprises for you and your team?
Early return to full-time work has been frequently cited as a barrier to breastfeeding and we were not surprised to find that even among mothers who planned to breastfeed for at least three months that those who did return to full time work did not continue breastfeeding.
What compelled you to do this study?
Others have published studies that show mothers who take shorter maternity leaves and return to work full-time stop breastfeeding earlier; however, some people think that mothers who plan to breastfeed for a shorter duration will return to work earlier. Because so many mothers participate in the work force, most with a full-time schedule, we wanted to determine if earlier return to full-time work was a barrier to breastfeeding even among women who planned to breastfeed for at least three months.
Was there any intervention for any of the parents with an IBCLC?
In this study we did not consider mothers experiences with an IBCLC.
What definition is used for breastfeeding? Partial or exclusive? Was the definition a consideration?
In this study we focused on any breastfeeding as an outcome. We considered looking at exclusive breastfeeding as an outcome; however, in another paper published using the same group of women, it was shown that even among mothers who planned to exclusively breastfeed, many infants were supplemented with formula within the first month. Because this happened so early, we thought that other barriers to breastfeeding were likely contributing to the early supplementation, such as hospital practices or lack of peer or professional support.
What are your hopes with this study? What outcomes on a national public health policy do you see occurring?
It is important for public health policy to support women who choose the healthiest option for feeding their infants and we hope this study will contribute to the growing evidence that returning to work earlier may reduce a mother’s ability to meet her own intentions for infant feeding.
Do you see this study as a tool to change policy?
At CDC, we are dedicated to conducting research that will inform public health policy and we believe this study will contribute to the growing evidence that longer maternity leaves and/or part-time return schedules may increase breastfeeding rates and have important health benefits for mothers and infants.
If you could do the same study again, what would you change about the methods used in this study?
The Infant Feeding Practices Study II (IFPS II) was a very valuable and comprehensive study that followed expectant mothers from the 3rd trimester of pregnancy through the first year of their child’s life. This study asked mothers a number of questions about infant feeding and infant care practices. Because this study was not primarily focused on maternal employment, only a few questions were asked about the new mothers’ work. It would be very interesting to know how much maternity leave each mother had available and why she returned to work when she did; and if she would have taken a longer maternity leave if she could have received pay during her leave. It would also be very interesting to know if the mothers who did not meet their three-month breastfeeding intention perceived work as a major barrier to breastfeeding as long as they had planned.
Did you find that the parents who planned to breastfeed for a shorter duration did, in fact, return to work sooner?
In this study, we only included mothers who planned to breastfeed for at least three months and most of the mothers in our study planned to breastfeed for at least nine months. In fact, more than 40% planned to breastfeed for at least twelve months. Despite the long breastfeeding duration many mothers planned, mothers who returned to work before three months were less likely to breastfeed for at least three months, especially mothers who returned to work full-time before six weeks.
What would you like to add that was not included in the final printed research?
This study focused on a breastfeeding duration of at least three months. However, the American Academy of Pediatrics recommends continued breastfeeding for the first twelve months or longer and it is important to support and encourage mothers to breastfeed as recommended.
Leigh Anne O’Connor, IBCLC, RLC
Leigh Anne O’Connor is a Private Practice Lactation Consultant, La Leche League Leader and mother of three. She lives and practices in New York City. She writes at www.mamamilkandme.com. You can learn more about her work at www.leighanneoconnor.com
Kelsey R. Mirkovic, PhD
Dr. Kelsey Mirkovic works as an epidemiologist for CDC in the Division of Nutrition, Physical Activity, and Obesity, where she focuses her work on infant feeding. Her current research activities have focused on how topics related to maternal employment influences breastfeeding behaviors and how we may support more working mothers successfully breastfeed.
Based on data gathered from the W.H.O. through 2003, of 11 1st-world countries:
53% of mothers are in the workforce (US 57%)
79.5% initiate breastfeeding (US 70.9% in 2003, 76.5% in 2013)
42.8% report breastfeeding between 4-6 months (US 36.2% in 2003, 49% in 2013)
9 of the 11 countries offer publicly funded leave.
5 report paid + unpaid leave = 1 year. Of these countries the average initiation rate is 91.65%.
As you can see, the U.S. with unpaid leave of 12 weeks available compares favorably to countries that offer paid leave < year, and with no change to this policy, the U.S. is improving. It is only when leave approaches 1 year that there are significant effects on breastfeeding. Paid leave is not a panacea. Enabling mothers to stay with their babies for about a year or more seems a better goal.