American women breastfed their babies for two weeks longer when shelter-in-place directives were in effect for COVID-19 compared to before the pandemic, a new study led by UC San Francisco reported.
"Stay-at-home policies allowed parents to continue breastfeeding at home rather than returning to the workplace," said first author Rita Hamad, MD, PhD, UCSF associate professor of Family and Community Medicine and chief policy officer. UCSF Social Sciences for Health. Equity Research Program. “This suggests pent-up demand for breastfeeding that may be hampered by the lack of a national paid family leave policy in the US.”
The Academy of Pediatrics recommends six months of exclusive breastfeeding, as the practice is known to improve the health of both the baby and the parents.
The gains in breastfeeding duration during shelter-in-place were more dramatic for white women and those with higher incomes, likely because these groups had jobs that could be done more easily at home, the study noted. Hispanic fathers were more likely to have lower-wage "essential" jobs during the pandemic, according to the study, so breastfeeding gains in this group were more modest.
“Once again, the pandemic served to highlight an area of health inequity: differences in workplaces that facilitate breastfeeding,” Hamad said.
The study appeared May 18, 2023, in the American Journal of Public Health .
A natural experiment
The researchers used workplace closures during the initial period of the pandemic (March-April 2020) as a natural experiment to see if the ability to stay home changed new fathers’ breastfeeding patterns.
They used national survey data and birth certificates from 2017-2020 for 118,139 postpartum people to examine whether a baby was breastfed and, if so, for how long. They compared the initiation and duration of breastfeeding for babies born before and after shelter-in-place policies.
While breastfeeding initiation rates did not change during the pandemic, women increased the time they breastfed from 12.6 weeks to 14.8 weeks, or 18%. White women had the largest increase in duration at 19%, while Hispanic women had the smallest at 10.3%. High-income women had a larger increase than low-income women, 18.5% and 16.8% respectively. Longer durations persisted through at least August 2020 before falling to pre-pandemic levels.
The fact that breastfeeding initiation generally did not change in the early months of the pandemic may suggest that the barriers to starting breastfeeding differ from those to continuing. However, Black and low-income subgroups showed a drop in initiation during the pandemic, which may reflect lower access to breastfeeding support during shelter-in-place for these groups, according to the study.
The United States ranks worse than most peer countries in the initiation and duration of breastfeeding and is the only high-income country without a national paid leave policy for new parents. Only 25% of U.S. private industry workers have access to paid family leave through employers, and people of color and low-wage workers are less likely to be eligible.
“Our study suggests that the duration of breastfeeding in the US would be longer and more comparable to other countries if working parents were paid while they stayed home to care for their newborns, particularly parents of color and those with low-income jobs who cannot afford to care for their newborns. unpaid time off,” Hamad said.
In March, President Joe Biden announced plans to allocate $325 billion in his 2024 budget proposal for a permanent paid family leave program that would give workers up to 12 weeks of paid time off to bond with a child.
| Conclusions: The United States ranks worse than similar countries when it comes to breastfeeding initiation and duration. This study suggests that this is partly attributable to inadequate access to paid postpartum leave. This study also demonstrates the inequities introduced by remote work patterns during the pandemic. |
Authors : ( Am J Public Health . Published online ahead of print May 18, 2023:e1–e4. https://doi.org/10.2105/AJPH.2023.307313 ). In addition to Hamad, authors include Daniel Collin, MPH, and Kaitlyn Jackson, MPH, UCSF Phillip R. Lee Institute for Health Policy Studies; Deborah Karasek, PhD, UCSF Department of Obstetrics and Gynecology; and Alison Gemmill, PhD, MPH, Johns Hopkins Bloomberg School of Public Health.
