Working and nursing: navigating job and breastfeeding demands at work

Breastfeeding is a sex-specific, work–family issue for women. Yet, there is relatively little sociological research on the breastfeeding-work interface. What challenges do breastfeeding women face during the workday? (How) Are some more successful than others at merging breastfeeding and work? We conducted interviews with 22 US women as part of a case study of workplace breastfeeding support. The Patient Protection and Affordable Care Act [PPACA] (2010) includes breastfeeding provisions, but primarily address hourly workers. Most women in our study were not covered by the PPACA but had access to a workplace Breastfeeding Support Initiative. Despite this, women faced several challenges: different degrees of schedule control, unequal access to space, and unexpected breastfeeding demands. Women also had differential access to workplace resources to cope with demands. Control over both time and space was a cross-cutting theme. Research needs to better address work conditions that are conducive to breastfeeding rather than simply asking if work and breastfeeding are incompatible. Furthermore, workplace support initiatives will succeed only to the extent that they can directly address work conditions, even if on a temporary basis.     

Parental leave benefits and breastfeeding in Germany: effects of the 2007 reform

While breastfeeding is associated with health benefits for both mothers and children, it may also make it difficult for mothers to return to the labor market early. Maternity and parental leave regulations have been developed to mitigate this conflict. In 2007, Germany passed a reform introducing a new parental leave benefit (Elterngeld). In this paper, we address the question of whether the new parental leave benefit impacts breastfeeding initiation and duration in Germany. We use the reform as an exogenous policy variation to obtain causal evidence on breastfeeding behavior, applying a difference-in-differences approach. Mothers in particular benefit from the reform especially if they were employed prior to childbirth or if they have a household income above the income threshold of the previous parental leave scheme (treatment group). The reform did not bring significant changes within the first year of a child’s life for all other mothers (control group). We draw on representative survey data from the Socio-Economic Panel (SOEP) study. Three breastfeeding measures are used for the 2004 to 2009 cohorts: (1) breastfeeding at birth; (2) breastfeeding for at least 4 months; and (3) breastfeeding for at least 6 months. We find no effect of the Elterngeld reform on breastfeeding initiation but do observe an effect on breastfeeding duration. Our results are robust over various sensitivity tests, including placebo regressions, the application of matching approaches, and controlling for regional indicators, among others. Thus, our empirical results provide evidence that the reform’s goal of allowing parents to spend more time with their children during the first year of life also impacted breastfeeding behavior.     

Infant feeding and asthma: is breast milk best?

Asthma is the most commonly occurring chronic childhood disease in the United States and is the leading cause of hospitalization and missed school days. In this article, I examine whether differences in asthma diagnosis can be attributed to differences in breastfeeding incidence and duration. Using data from the Fragile Families and Child Wellbeing Survey, I examine whether unobserved heterogeneity in the breastfeeding decision plays a role in childhood asthma propensity. I use the recursive bivariate probit framework to account for potential endogeneity by modeling the breastfeeding and asthma equations jointly. Results indicate that after accounting for the unobserved heterogeneity found in infant feeding practices, breastfeeding leads to lower rates of asthma diagnosis in children at age one. Breastfeeding for at least 3 months appears to have the strongest effects in children diagnosed at age one. However, there are no discernible effects of breastfeeding on the incidence of asthma by age three. These results indicate that breastfeeding can result in lower rates of wheezing and better respiratory health in small children.     

BREASTFEEDING AND INFANT MORTALITY: UNTANGLING THE COMPLEX WEB OF CAUSALITY

Much of the research which has been interpreted as showing the positive effect of breastfeeding on child survival is rendered inconclusive by errors in study design. Complexities of the breastfeeding/mortality relationship are discussed and a research strategy is outlined, based on secondary analysis of existing data, which would generate more reliable estimates of the benefits of breastfeeding.     

Work and breastfeeding decisions are jointly determined for higher socioeconomic status US mothers

We study postpartum decisions about paid work and breastfeeding using a simultaneous equations model. For our sample of higher socioeconomic status mothers, we find a joint decision process for three sets of decisions modeled: work leave duration and duration of any, as well as of exclusive, breastfeeding, and daily work hours and daily breastfeedings at infant age 3 months. We find that returning to paid work 1 week earlier reduces any breastfeeding duration by about two-thirds of a week while extending breastfeeding by a week delays work participation by about one-third of a week. We find larger elasticities for decisions involving daily work hours and number of breastfeedings at 3 months than for work leave duration and any breastfeeding duration and the smallest elasticities for duration of exclusive breastfeeding and work leave. This marks the first study to find a joint decision-making process for postpartum work and breastfeeding decisions and suggests that, in addition to increased leave impacting breastfeeding behaviors, successful breastfeeding promotion policies can have nontrivial impacts on the US labor market.     

Medicalized mothering: experiences with breastfeeding in Canada and Norway

This paper explores infant feeding practices and experiences of mothers in Canada and Norway, two countries where breastfeeding rates are relatively high. Based on interviews with 33 Canadian mothers and 27 Norwegian mothers, we also examine how mothers feel, think and talk about their infant feeding decisions and experiences, and examine similarities and divergences across their stories. Our findings reveal that infant feeding is very much organized according to the logic of the broader medical discourse, a finding which lends support to arguments that contemporary parenthood is characterized by a process of increasing medicalization. Our findings also reveal the existence of a broader culture of pressure, competition, judgement and surveillance regarding breastfeeding, suggesting that the high breastfeeding rates in these two countries are not merely a result of favourable structural conditions, but also of strong cultural expectations towards breastfeeding. We discuss our findings in connection with the broader argument that medical discourses and health professionals are becoming the primary authorities and moral gatekeepers of contemporary parenthood.     

Does Returning to Work After Childbirth Affect Breastfeeding Practices?

This study examines the effect of the timing and intensity of returning to work after childbirth on the probability of initiating breastfeeding and the number of weeks of breastfeeding. Data come from the National Longitudinal Survey of Youth (NLSY79). Baseline probit models and family-level fixed effects models indicate that returning to work within 3 months is associated with a reduction in the probability that the mother will initiate breastfeeding by 16–18%. Among those mothers who initiate breastfeeding, returning to work within 3 months is associated with a reduction in the length of breastfeeding of 4–5 weeks. We find less consistent evidence that working at least 35 h per week (among mothers who return to work within 3 months) detracts from breastfeeding. Future research is needed on understanding how employers can design policies and workplaces that support breastfeeding.     

Increasing breastfeeding rates among African-American women enrolled in the Special Supplemental Nutrition Program for Women,Infants, and Children: application of Social Cognitive Theory

Breastfeeding offers tremendous health benefits to both child and mother. In spite of these many benefits, current rates of breastfeeding initiation, duration, and exclusivity among African-American women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are lower than rates of other ethnic groups. The decision to breastfeed is complicated, and strategies are needed to increase breastfeeding rates among these women. Social Cognitive Theory (SCT) offers hope for understanding these complicated decisions and for developing strategies to overcome this problem. The purpose of this paper is to explore the literature and develop strategies based on SCT to increase breastfeeding among African-American women enrolled in WIC.     

Breastfeeding practices and parental employment in Japan

Much research shows that breastfeeding provides short- and long-term health benefits for both mothers and their children. However, few studies have yet investigated the factors which may promote or inhibit breastfeeding practices in Japan. To fill this research gap, this paper uses data newly gathered in 2012 on breastfeeding initiation and duration for each child of each mother, which enable us to estimate mother fixed-effects models that control for unobserved differences among mothers. Compared to mothers who leave their jobs after childbirth, mothers who return to work within a year after childbirth do not significantly differ in breastfeeding initiation but have a breastfeeding duration which is shorter by 1.654 months. On the other hand, when fathers work under a flextime system after childbirth, breastfeeding initiation is higher, and the duration is longer by 4.418 months. Therefore, letting fathers work under a flextime system would help promote breastfeeding practices in Japan.     

Breastfeeding and employment: A propensity score matching approach

ABSTRACT

It is well established within the scholarship on work and the family that many women experience difficulty juggling work and family responsibilities. Challenges to breastfeeding after giving birth are a specific manifestation of this work–family conflict. Many women report that they are unable to continue breastfeeding upon return to paid work. In this article, I analyze a subsample of 746 women from the United States Infant Feeding Practices Survey II to assess the effect of new mothers’ employment status and workplace characteristics on breastfeeding duration. This research reveals that new mothers who return to paid employment within three months of giving birth breastfeed an average of five fewer weeks than new mothers who do not return to paid work for three months or more. In addition, among mothers who return to paid work within three months, full-time workers breastfeed an average of more than 15 fewer weeks than part-time workers. These substantial differences in the duration of breastfeeding suggest that women face significant obstacles to combining paid work and mothering in the postpartum period.     

Resisting Guilt: Mothers’ Breastfeeding Intentions and Formula Use

Breastfeeding, the topic of numerous government-supported initiatives, is widely considered the optimal mode of infant feeding and is a central component of cultural ideals of good mothering. Prior research has indicated that one outcome of the emphasis placed on breastfeeding is the experience of guilt, regret, shame, or inadequacy that mothers may feel when they do not or cannot breastfeed. Using data from 96 interviews with 22 first-time mothers, the experiences of mothers who wanted to breastfeed but used formula are explored. Mothers engaged in three strategies that helped maintain a positive maternal identity: framing the use of formula as not a choice, recognizing the effort placed into breastfeeding, and focusing on overall health and happiness. Results indicate that the focus on individual choice in breastfeeding promotion highlights resulting guilt or failure, to the exclusion of recognizing women’s agency in using resistance strategies and the broader social context of breastfeeding.     

Making Milk and Money: Contemporary Mothers' Orientations to Breastfeeding and Work

In most Western industrial nations, gains have been made in women's educational and occupational opportunities as part of a larger gender revolution. At the same time, contemporary mothering expectations have expanded and intensified, especially the renewed focus on breastfeeding as the “optimal” choice for infant feeding. How do women perceive the simultaneous pursuit of these activities? Prior scholarship has identified tensions in cultural models of breastfeeding as well as in women's subjective experiences, emphasizing how breastfeeding is shaped and encountered through sociocultural context, especially ideologies that position work and mothering as incompatible. Building on this, I examine how the current generation of working mothers view working and breastfeeding. Through in‐depth interviews with 32 U.S. women, I show how women espouse distinctly different orientations to breastfeeding: instrumentalist, quasi‐maternalist, and pragmatist. I argue that these different orientations both reflect and reframe existing cultural models and discourses about contemporary women's relationships to work, mothering, and breastfeeding.     

Risky Business: Breastfeeding Promotion Policy and the Problem of Risk Language

Over the past decades, the rhetoric surrounding breastfeeding promotion policy has been increasingly focused on couching formula feeding in terms of “risk” rather than, as had been the norm, focusing on the “benefits” of breastfeeding. We examine this major policy shift in breastfeeding promotion and public health efforts. Analyzing qualitative data collected from 214 expectant mothers exposed to differently worded breastfeeding promotion materials, we identify several overwhelming trends in evaluations of the materials by those women exposed to “risk” language. These trends, we argue, point to strategic and normative reasons to reconsider this policy shift to the language of risk.     

A Land of Milk and Honey? Breastfeeding and Identity in Lesbian Families

ABSTRACT

This article explores the relationship between breastfeeding and identity in lesbian-identified families based on a pilot study of qualitative interviews and a short survey of six lesbian families in Canada and the United States. Although breastfeeding is assumed to be “natural” and a biological function, we problematize the practice as both gendered and heteronormative. In our research we found that breastfeeding has a complex role to play within the construction of one's identity as a mother, of one's gender, and of one's sexual orientation. These women's experiences offer interesting insights into the nebulous boundaries of biology and the ways in which assumptions about what is “natural” are actually social and cultural constructions.     

The Association of Couples’ Relationship Status and Quality With Breastfeeding Initiation

Using data from the Fragile Families and Child Wellbeing Survey (N= 3,567), we examine the links between relationship status, relationship quality, and race and ethnicity in breastfeeding initiation. We consider four relationship types: married, cohabiting, romantically involved but not cohabiting (termed visiting), and nonromantically involved mothers. We find that even after adjusting for a wide range of sociodemographic factors, married mothers were more likely to breastfeed than unmarried mothers and that racial and ethnic differences in breastfeeding do not result from differences in marriage rates. Among unwed mothers, paternal provision of money or other assistance during pregnancy decreases the likelihood of breastfeeding. We conclude that relationship status, above and beyond demographic characteristics, is an important correlate of breastfeeding.     

Breastfeeding interventions in Kansas: A qualitative process evaluation of program goals and objectives

Across the state of Kansas, eighteen public health departments received funding through the 2011 Breastfeeding Grant Initiative to start a breastfeeding intervention. The main objective of this study was to evaluate the progress toward program goals and objectives. This study was a process evaluation. Qualitative data were collected from recipient health departments at two time-points during the program year. Structured, open-ended questions were asked through telephone interviews. This study examined: (1) progress toward program goals and objectives, (2) problems encountered during implementation, and (3) evaluation measures employed to assess program impact. All health departments reported making significant progress toward program goals and objectives and reported successful collaboration with other healthcare providers. The use of breast pumps, educational classes, and professional training of staff were reported as providing the best outcome in the promotion of breastfeeding. The majority of respondents did not measure program impact. From a public health perspective, it is important that infants receive breast milk for the first six months of life. It appears that goals and objectives set a priori guided health departments with the administration of their breastfeeding program. Results may be used to enhance and sustain delivery of breastfeeding support programs in Kansas communities.     

Effects of prenatal care on maternal postpartum behaviors

Most research on the effectiveness of prenatal care has focused on birth outcomes and has found small or no effects. It is possible, however, that prenatal care is “too little too late” to improve pregnancy outcomes in the aggregate, but that it increases the use of pediatric health care or improves maternal health-related parenting practices and, ultimately, child health. We use data from the Fragile Families and Child Wellbeing birth cohort study that have been augmented with hospital medical record data to estimate effects of prenatal care timing on pediatric health care utilization and health-related parenting behaviors during the first year of the child’s life. We focus on maternal postpartum smoking, preventive health care visits for the child, and breastfeeding. We use a multi-pronged approach to address the potential endogeneity of the timing of prenatal care. We find that first trimester prenatal care appears to decrease maternal postpartum smoking by about 5 percentage points and increase the likelihood of 4 or more well-baby visits by about 1 percentage point, and that it may also have a positive effect on breastfeeding. These findings suggest that there are benefits to standard prenatal care that are generally not considered in evaluations of prenatal care programs and interventions.     

The impact of WIC on breastfeeding initiation and gestational weight gain: Case study of South Carolina Medicaid mothers

In this study, we estimate the effect of the Special Supplemental Nutrition Program for Women, Infant and Children (WIC) on breastfeeding initiation at hospital discharge and gestational weight gain, by relying on South Carolina birth certificates data for 2004–2013. The unique longitudinal feature of the data allows us to utilize maternal fixed effects to account for non-random selection into WIC. Contrary to the existing evidence, we find that WIC participation does not have a negative effect on breastfeeding initiation. We uncover an important heterogeneity in WIC's effect by race. More specifically, we find that WIC participation is associated with an increase in breastfeeding initiation among black mothers by nearly 7%, with no statistically significant effect among white mothers. We also document a reduction in the likelihood of an inadequate gestational weight gain of nearly 10% among white and black mothers.