P3A086: Association of Maternity Leave with Breastfeeding Duration in the United States: A Scoping Review

Background: Breastfeeding provides numerous health benefits to both infants and mothers and benefits the economy in health cost savings. Despite these benefits, only 24.9% of infants are exclusively breastfed at 6 months in the United States due to multiple factors, including shortened maternity leave and early workforce re-entry. The United States is the only high-income country that does not guarantee paid maternity leave. A review on the association of maternity leave and breastfeeding duration is missing in the literature and this scoping review aims to characterize existing literature on the relationship between length of maternity leave and duration of breastfeeding in the United States.

Methods: This review was conducted using a five-stage model for scoping reviews. Inclusion criteria included: publications from the year 2000 to 2023, US-based studies written in English, and only primary research and peer-reviewed articles were included. In March 2023, a medical librarian conducted a search across seven databases, yielding 1,540 results. After duplicates were removed, 835 abstracts were screened for additional review. A full text article review was then conducted of the remaining 32 articles by two authors. Conflicts were resolved by a third author. Variables collected included methods, setting, type and length of maternity leave, breastfeeding outcomes, differences between groups, health disparities, and socioeconomic status.

Results: A total of 21 articles met inclusion criteria. Thirteen (61.9%) articles utilized national survey data to examine the relationship of breastfeeding duration and length of maternity leave. Six (28.6%) articles utilized local survey data, of which two (9.5%) articles studied active-duty military mothers , two (9.5%) utilized state-wide data, and two (9.5%) were cohort studies at local hospitals. The remaining two (9.5%) articles provided narrative information based on previous literature. Of the non-narrative articles, all nineteen articles found an overwhelmingly positive relationship between increased maternity leave and duration of breastfeeding. Most studies utilizing national data showed that regardless of the type of leave (paid, unpaid, combination), an earlier return to work decreased the odds of a breastfeeding dyad to meet AAP breastfeeding guidelines. Many studies adjusted for confounders like race, socioeconomic status, and marital status; however, health disparities still exist for Black and Latina women.

Conclusion: Current data shows a strong positive relationship between length of maternity leave and duration of breastfeeding. Data also demonstrate that social determinants of health can impact breastfeeding duration. Black or Latina mothers experience shorter breastfeeding durations and/or lower breastfeeding exclusivity, even when given equal leave. Most articles included in our review utilized national survey data in a cross-sectional research method. There is a need for more robust data, such as large sample sizes rooted in prospective, intervention research methods, or a meta-analysis, which may help inform policy changes and result in beneficial health and economic outcomes.