U.S. women breastfed their infants for two weeks longer when shelter-in-place directives were in effect for COVID-19 compared to before the pandemic, reported a new study led by UC San Francisco.
“Stay-at-home policies enabled parents to continue breastfeeding at home instead of returning to the workplace,” said first author Rita Hamad, MD, PhD, UCSF associate professor in Family and Community Medicine, and the director of UCSF’s Social Policies for Health Equity Research Program. “This suggests a pent-up demand for breastfeeding which may be stymied by the lack of a national paid family leave policy in the U.S.”
... The pandemic served to highlight an area of health inequity – differences in workplaces that facilitate breastfeeding.
The Academy of Pediatrics recommends six months of exclusive breastfeeding, as the practice is well known to improve health for both infant and parent.
Gains in breastfeeding duration during shelter-in-place were most dramatic for white women and those of higher income, probably because these groups had jobs that could be done at home more easily, the study noted. Hispanic parents were more likely to have “essential,” lower-wage 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,” said Hamad.
The study appeared May 18, 2023 in the American Journal of Public Health.
A Natural Experiment
Researchers used workplace closures during the early pandemic timeframe (March-April 2020) as a natural experiment to see if the ability to stay home changed breastfeeding patterns for new parents.
They used 2017-2020 national survey and birth certificate data for 118,139 postpartum people to examine whether an infant was breastfed and, if so, for how long. They compared initiation and duration of breastfeeding for babies born prior to, and after, shelter-in-place policies.
While initiation rates of breastfeeding didn’t change during the pandemic, women increased the length of time they breastfed from 12.6 weeks to 14.8 weeks, or 18%. White women had the biggest increase in duration at 19%, while Hispanic women had the smallest at 10.3%. High-income women had a larger increase than lower-income women, 18.5% and 16.8% respectively. The longer durations persisted through at least August 2020 before dropping to pre-pandemic levels.
The fact that breastfeeding initiation overall didn’t change in the early pandemic months may suggest that barriers to starting breastfeeding differ from those for continuing. However, Black and low-income subgroups did show a dip in initiation during the pandemic, which may reflect less access to breastfeeding support during shelter-in-place for these groups, the study said.
The U.S ranks worse than most peer countries in breastfeeding initiation and duration 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 least likely to be eligible.
“Our study suggests that breastfeeding duration in the U.S. would be higher and more comparable to peer countries if working parents were paid while staying home to care for their newborns, particularly parents of color and those with lower income jobs who can’t afford to take unpaid time off work,” said Hamad.
In March, President Joe Biden announced plans to allocate $325 billion in his 2024 budget proposal toward a permanent paid family leave program that would provide workers up to 12 paid weeks off to bond with a child.
Authors: 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.
Funding and Disclosures: None.