Breastfeeding Duration in U.S. Closely Linked With Length of Maternity Leave

Breastfeeding duration has a “clear, positive” relationship with length of maternity leave, according to a new systematic review by Cleveland Clinic. The study is the first to examine the association specifically in the U.S.

In addition, racial disparities were reported in the extent of maternity leave both offered and taken. The findings suggest the need for improvements in U.S. maternity leave policies, the researchers say.

“Given that the U.S. is the only high-income nation that does not provide federal paid maternity leave, it was important from a policy standpoint that we look at the available U.S. data,” says the study’s senior author, Suet Kam Lam, MD, MPH, Assistant Medical Director of Cleveland Clinic’s Breastfeeding Medicine Clinic. “I want to make sure that we all advocate at different levels to help our mothers succeed in breastfeeding. It takes more than just the parents and the baby.”

Health and economic benefits of breastfeeding

The American Academy of Pediatrics, the World Health Organization, and the Centers for Disease Control and Prevention all recommend that breastfeeding start within the first hour of birth and continue without the introduction of other foods for the first six months of life. Those organizations also call for societal and workplace policies that support breastfeeding parents, such as mandated and adequately paid parental leave.

Breastfeeding is associated with numerous health benefits for both infants and lactating parents. Infants have lower risks of infections and later chronic illness. Lactating parents have lower rates of cardiovascular disease, certain cancers and postpartum depression.

“We’re finding more and more data showing that it is dose dependent, meaning the more you’re able to provide human milk and the longer you’re able to provide it, the more these risks are decreased,” says Dr. Lam, who serves on the American Academy of Pediatrics’ Section on Breastfeeding, as does study co-author Heidi Szugye, DO.

Breastfeeding also has potential economic benefits, including fewer sick days for breastfeeding parents and fewer missed workdays due to sick infants, adds Dr. Lam. On a larger scale, if all U.S. infants were exclusively breastfed for the first six months of life, the U.S. would see a $2.2 billion reduction in annual direct medical costs and employers would see a 3:1 return on investment in lactation accommodations, according to the U.S. Breastfeeding Committee.

The U.S. Family and Medical Leave Act mandates unpaid parental leave of up to 12 weeks for certain employees. However, in a 2022 survey, more than 70% of U.S. respondents said it would be difficult or very difficult for them financially to forego even one week’s paycheck.

Target: 6 months of breastfeeding

The review, recently published in Obstetrics & Gynecology, included 23 articles. All found a positive relationship between increased maternity leave and duration of breastfeeding. The data showed that returning to work within six weeks postpartum was associated with a 3.4-fold increased risk of breastfeeding cessation prior to the recommended six months.

One study showed that 12 weeks or more of paid leave was associated with a nearly tripled likelihood of breastfeeding initiation and a doubled chance of continuing for the full six months compared to no paid leave. In another study, seven weeks of paid leave was associated with greater odds of initiating breastfeeding compared to zero weeks (75% vs. 67%, P = .01).

The rest of the studies reported that whether leave was paid or unpaid didn’t make a significant difference to breastfeeding duration. Instead, the strongest association was with the total amount of maternity leave provided.

Black and Hispanic mothers may have difficulty taking leave

Even after adjustment for socioeconomic status and provision of the same amount of leave, Black and Hispanic mothers still had shorter breastfeeding durations than white mothers. A narrative review revealed that single and Black mothers were less likely to take any leave offered than were married white mothers.

“I’ve seen that clinically, too,” says Dr. Lam. “There could be any number of economic reasons or social factors. It’s multifactorial. It’s not one thing that’s going to move the needle on disparities, but rather advocacy at both the micro and macro levels.”

She is now working to promote these findings so they can be used for advocacy purposes, to write policies or testify for changes.

Clinician support needed

In 2022, Dr. Lam helped open the Breastfeeding Medicine Clinic at Cleveland Clinic, one of just a handful of such clinics in the nation.

“As breastfeeding medicine physicians, we work closely with lactation consultant nurses to provide the best care to our patients,” she says.

Dr. Lam advises clinicians to support new parents whenever possible, both clinically and within the community, with culturally sensitive advocacy.

“Mothers may be struggling at home with their infants while their partners may not have parental leave at all,” she says. “At the individual level, we could all help make this time a little easier. And then at the macro level, we need systemic change if we’re going to improve health outcomes for mothers and children.”