Maternal Health| Volume 29, ISSUE 6, P506-512, November 2019

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Time Off Work After Childbirth and Breastfeeding Supportive Workplaces: Associations with Near-Exclusive Breastfeeding Trajectory Membership

  • Mackenzie D.M. Whipps
    New York University Steinhardt School of Culture, Education, and Human Development, New York, New York
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  • Julia Honoroff
    Correspondence to: Julia Honoroff, BA, New York University Steinhardt School of Culture, Institute of Human Development and Social Change, 627 Broadway, Room 711, New York, NY 10012. Phone: 201-655-1963.
    Institute of Human Development and Social Change, New York University Steinhardt School of Culture, Education, and Human Development, New York, New York
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Published:October 15, 2019DOI:



      We aimed to determine whether the association between time off work and a near-exclusive breastfeeding trajectory is moderated by perceived employer support for breastfeeding.


      We conducted a secondary analysis of working mothers (n = 1,468) from the Infant Feeding Practices Study II, a longitudinal observational (2005–2007) study of U.S. infant feeding behaviors. Previous studies have found four latent infant feeding subgroups in the Infant Feeding Practices Study II sample, each following a distinct breastfeeding intensity trajectory. Multivariate least-squares regression was conducted to estimate whether time off work after delivery predicted increased membership in the subgroup characterized by near-exclusive breastfeeding, and whether this association was moderated by perceived employer support for workplace breastfeeding.


      Both time off work and perception of more breastfeeding support were independently, positively related to probability of membership in the near-exclusive breastfeeding trajectory (β = 0.16, p = .019, and β = 0.14, p = .004, respectively). The interaction of these two factors suggests an attenuation effect. The addition of paid leave to the model did not change the estimates.


      The positive relationship between time off and trajectory membership was significant only for mothers who perceived their workplaces to be unsupportive of breastfeeding.
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        • Abdulwadud O.A.
        • Snow M.E.
        Interventions in the workplace to support breastfeeding for women in employment.
        Cochrane Database Systematic Reviews. 2012; 10: CD006177
        • American Academy of Pediatrics
        Policy statement: Breastfeeding and the use of human milk.
        Pediatrics. 2012; 129: e827-e841
        • Anderson J.
        • Kuehl R.A.
        • Drury S.A.M.
        • Tschetter L.
        • Schwaegerl M.
        • Hildreth M.
        • Lamp J.
        Policies aren’t enough: The importance of interpersonal communication about workplace breastfeeding support.
        Journal of Human Lactation. 2015; 31: 260-266
        • Balkam J.A.J.
        • Cadwell K.
        • Fein S.B.
        Effect of components of a workplace lactation program on breastfeeding duration among employees of a public-sector employer.
        Maternal and Child Health Journal. 2011; 15: 677-683
        • Bartick M.
        • Schwarz E.
        • Green B.D.
        • Jegier B.J.
        • Colaizy T.T.
        • Bogen D.L.
        • Stuebe A.M.
        Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs.
        Maternal and Child Nutrition. 2017; 13: e12366
        • Baumgartel K.L.
        • Spatz D.L.
        • American Academy of Nursing Expert Breastfeeding Panel
        WIC (the special supplemental nutrition program for women, infants, and children): Policy versus practice regarding breastfeeding.
        Nursing Outlook. 2013; 61: 466-470
        • Berger L.M.
        • Hill J.
        • Waldfogel J.
        Maternity leave, early maternal employment and child health and development in the US.
        Economic Journal. 2005; 115: F29-F47
        • Cardenas R.A.
        • Major D.A.
        Combining employment and breastfeeding: Utilizing a work-family conflict framework to understand obstacles and solutions.
        Journal of Business and Psychology. 2005; 20: 31-51
        • Centers for Disease Control and Prevention
        Breastfeeding Report Card: Progressing toward national breastfeeding goals.
        Date: 2016
        Date accessed: October 15, 2018
        • Chowdhury R.
        • Sinha B.
        • Sankar M.J.
        • Taneja S.
        • Bhandari N.
        • Rollins N.
        • Martines J.
        Breastfeeding and maternal health outcomes: A systematic review and meta-analysis.
        Acta Paediatrica. 2015; 104: 96-113
        • CIGNA Corporation
        UCLA study of CIGNA corporate lactation program proves that helping working moms breastfeed is good business [Press Release].
        P. R. Newswire Association, Inc., Bloomfield, CT2000
        • Croker A.
        • Eldridge S.
        Breastfeeding friendly workplace accreditation: Creating supportive workplaces for breastfeeding women.
        Breastfeeding Review. 2005; 13: 17-22
        • Dettwyler K.A.
        Chapter 2: A time to wean: The hominid blueprint for the natural age of weaning in modern human populations.
        in: Stuart-Macadam P. Breastfeeding. Routledge, New York2017: 39-74
        • Dinour L.M.
        • Szaro J.
        Employer-based programs to support breastfeeding among working mothers: A systematic review.
        Breastfeeding Medicine. 2017; 12: 121-141
        • Eidelman A.I.
        Breastfeeding and the use of human milk: An analysis of the American Academy of Pediatrics 2012 Breastfeeding Policy Statement.
        Breastfeeding Medicine. 2012; 7: 323-324
        • Fein S.B.
        • Labiner-Wolfe J.
        • Shealy K.R.
        • Li R.
        • Chen J.
        • Grummer-Strawn L.M.
        Infant feeding practice study II: Study methods.
        Pediatrics. 2008; 122: S28-S35
        • Griswold M.K.
        • Crawford S.L.
        • Perry D.J.
        • Person S.D.
        • Rosenberg L.
        • Cozier Y.C.
        • Palmer J.R.
        Experiences of racism and breastfeeding initiation and duration among first-time mothers of the Black Women’s Health Study.
        Journal of Racial and Ethnic Health Disparities. 2018; 5: 1180-1191
        • Guendelman S.
        • Kosa J.L.
        • Pearl M.
        • Graham S.
        • Goodman J.
        • Kharrazi M.
        Juggling work and breastfeeding: Effects of maternity leave and occupational characteristics.
        Pediatrics. 2009; 123: 38-48
        • Hawkins S.S.
        • Noble A.
        • Baum C.F.
        Policy evaluation with incomplete data: Assessing the affordable care act breastfeeding provision.
        American Journal of Public Health. 2018; 108: 164-166
        • Johnston M.L.
        • Esposito N.
        Barriers and facilitators for breastfeeding among working women in the United States.
        Journal of Obstetric, Gynecologic & Neonatal Nursing. 2007; 36: 9-20
        • Kimbro R.T.
        On-the-job moms: Work and breastfeeding initiation and duration for a sample of low-income women.
        Maternal and Child Health Journal. 2006; 10: 19-26
        • Lennon T.
        • Willis E.
        Workplace lactation support in Milwaukee County five years after the Affordable Care Act.
        Journal of Human Lactation. 2017; 33: 214-219
        • Ma P.
        • Magnus J.
        Exploring the concept of positive deviance related to breastfeeding initiation in black and white WIC enrolled first time mothers.
        Maternal & Child Health Journal. 2012; 16: 1583-1593
        • Morris L.
        • Lee J.
        • Williams J.
        Exposed: Discrimination against breastfeeding workers.
        UC Hastings Research Paper No.328. 2019 (Available at SSRN 3341649)
        • Ogbuanu C.
        • Glover S.
        • Probst J.
        • Liu J.
        • Hussey J.
        The effect of maternity leave length and time of return to work on breastfeeding.
        Pediatrics. 2011; 127: e1414
        • Parsons W.L.
        • Duke P.S.
        • Snow P.
        • Edwards A.
        Physicians as parents: Parenting experiences of physicians in Newfoundland and Labrador.
        Canadian Family Physician. 2009; 55: 808-809
        • Radtke J.V.
        The paradox of breastfeeding-associated morbidity among late preterm infants.
        Journal of Obstetric, Gynecologic & Neonatal Nursing. 2011; 40: 9-24
        • Rossin-Slater M.
        Maternity and family leave policy (NBER Working Paper No.w23069).
        National Bureau of Economic Research, Cambridge, MA2017 (Available:)
        Date accessed: May 22, 2018
        • Sankar M.J.
        • Sinha B.
        • Chowdhury R.
        • Bhandari N.
        • Taneja S.
        • Martines J.
        • Bahl R.
        Optimal breastfeeding practices and infant and child mortality: A systematic review and meta-analysis.
        Acta Paediatrica. 2015; 104: 3-13
        • Schisterman E.F.
        • Cole S.R.
        • Platt R.W.
        Overadjustment bias and unnecessary adjustment in epidemiologic studies.
        Epidemiology. 2009; 20: 488-495
        • Thorley V.
        Is breastfeeding ‘normal’? Using the right language for breastfeeding.
        Midwifery. 2018; 69: 39-44
        • U.S. Department of Labor: Women’s Bureau
        Working mothers issue brief.
        • U.S. Department of Labor
        Section 7(r) of the Fair Labor Standards Act—Break Time for Nursing Mothers provision.
        Date: 2010
        Date accessed: October 7, 2018
        • Ventura A.K.
        Developmental trajectories of bottle-feeding during infancy and their association with weight gain.
        Journal of Developmental & Behavioral Pediatrics. 2017; 38: 109-119
        • Weber D.
        • Janson A.
        • Nolan M.
        • Wen L.M.
        • Rissel C.
        Female employees' perceptions of organisational support for breastfeeding at work: findings from an Australian health service workplace.
        International Breastfeeding Journal. 2011; 6: 19-25
        • Whaley S.
        • Meehan K.
        • Lange L.
        • Slusser W.
        • Jenks E.
        Predictors of breastfeeding duration for employees of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
        Journal of American Dietetic Association. 2002; 102: 1290-1293
        • Whipps M.D.M.
        Education attainment and parity explain the relationship between maternal age and breastfeeding duration in U.S. mothers.
        Journal of Human Lactation. 2017; 33: 220-224
        • Whipps M.D.M.
        • Yoshikawa H.
        • Demirci J.
        Latent trajectories of infant breastmilk consumption in the United States.
        Maternal Child Nutrition. 2018; 15: e12655
        • Whipps M.D.M.
        • Yoshikawa H.
        • Godfrey E.
        The maternal ecology of breastfeeding: A life course developmental perspective.
        Human Development. 2018; 61: 71-95
        • Zhuang J.
        • Bresnahan M.J.
        • Yan X.
        • Zhu Y.
        • Goldbort J.
        • Bogdan-Lovis E.
        Keep doing the good work: Impact of coworker and community support on continuation of breastfeeding.
        Health Communication. Taylor & Francis, United Kingdom2018: 1-9


      Mackenzie D.M. Whipps, BSc, CLC, is a doctoral candidate in Psychology and Social Intervention at NYU Steinhardt School of Culture, Education, and Human Development. She has spent more than 10 years as a birth and postpartum doula, childbirth educator, and lactation counselor.


      Julia Honoroff, BA, is a Junior Research Scientist at New York University. Her research interests overlap psychology and social policy, specifically related to prevention and intervention research that improves access to services and care for low-income and underserved children and families.