Maternity Leave and Breastfeeding
by Anne Eglash MD, IBCLC, FABM
According to the the WHO/UNICEF Global Breastfeeding Scorecard 2017, going back to work has been considered a key reason why women don’t breastfeed or wean early. The International Labour Organization (ILO) recommends that women should have the right to paid maternity leave as well as breaks during the work day to breastfeed or express breastmilk. In 2000, it recommended that countries should strive to extend paid maternity leave to 18 weeks. The 2017 Global Breastfeeding Scorecard reported that only ~10% of countries ensured 18 weeks of paid maternity leave.
What does research tell us about maternity leave and breastfeeding duration? A recently published literature review of 21 studies included a total of 57,804 women. Each study followed groups of women according to their duration of maternity leave, and measured breastfeeding duration.
- Among the 21 studies, 20 found that a longer maternity leave was associated with longer breastfeeding duration.
- Women with a maternity leave of 6 months led to a 30% increase in breastfeeding until 6 months postpartum.
- Studies from the USA and UK found that women with high-profile or managerial positions had a longer duration of breastfeeding as compared to women in other jobs such as manufacturing.
- Among women who return to work before 6 months postpartum, there is no difference in rate of weaning between women with or without a college degree.
See the Answer
Breastfeeding is known to be the best source of nutrition for infants. The World Health Organization recommends to exclusively breastfeed up to the sixth month of life and to breastfeed with complementary foods until the age of 2. It is reported that maternity leave (ML) is one of the most important interventions for an extended breastfeeding duration. The aim of this review is to synthesize the available data worldwide on the association of ML and breastfeeding duration. We also intend to provide an overview of whether this association is differential by socioeconomic status.
Materials & Methods:
Relevant primary studies relating ML and breastfeeding were included by searching several databases, including PubMed, SCielo, Health Systems Evidence, Health Evidence, Cochrane Reviews, and Epistemonikos. Articles were included up to May 2018.
A total of 239 relevant articles were identified, of them 21 were included in the review based on exposure, outcome, and study design. These studies reported that an extended ML might be related to breastfeeding duration. In addition, studies reporting data on work type, race, and education showed that black women, women in less privileged position, and women with less education have less breastfeeding duration.
This review showed a positive relationship between ML length and breastfeeding duration. These results have a homogeneous trend; however, this was different when studies reported results on ML and breastfeeding stratified by socioeconomic status. Public health policies should ensure that all women, especially the most vulnerable, have equal access to the benefits that ML provides.
This literature review provides evidence that our assumptions regarding the negative impact of early return to work on breastfeeding duration are true. Although maternity leave is considered quite important to protect breastfeeding, it is interesting that Canadians and Australians do not have markedly higher breastfeeding rates than Americans at around 6 months postpartum, even though Canadians have paid maternity leave for a year and Australians have paid maternity leave for 39 weeks but can take 52 weeks off. Six-month exclusive breastfeeding rates were 26% in Canada in 2012, 15% in Australia in 2010, and 24.9% in the USA in 2014.
Although maternity leave is important, women also need good prenatal education, safe and effective birthing practices, strong community, family, and partner support, and involvement of knowledgeable healthcare providers. Laws that protect breastfeeding in public, insurance coverage, and at the workplace play important roles, as do accurate and positive news and social media. So let’s keep pushing for paid maternity leave, but we need to continue our advocacy in so many other dimensions in our society to optimize every mother’s right to breastfeed without barriers.