Determinants of breastfeeding initiation and duration among employed women in the first year after childbirth

Background: Maternal employment following childbirth is associated with non-initiation and early cessation of breastfeeding. We investigated the personal and employment factors associated with both breastfeeding initiation and duration in the first postpartum year.

Methods: A prospective cohort study design was utilized to recruit women while hospitalized for childbirth. The population included Minnesota women ages 18 and older and admitted to the hospital for childbirth in 2001; the sample criteria included English-speaking, employed mothers with a singleton birth.

Results: On average, women were 30 years old; 86% were Caucasian, and 73% were married. Breastfeeding rates were 81% (N=580) at childbirth; 67% (N=480) at 6 weeks, 49% (N=340) at 12 weeks, 33% (N=230) at 6 months, and 11% (N=75) at 12 months postpartum. Logistic regression revealed the odds of initiation of breastfeeding were higher for women who: were primiparas, earned graduate (versus high school) degrees, held professional jobs (versus blue collar or clerical), did not smoke, and lacked physical problems precluding breastfeeding.

Cox proportional hazards regression showed the hazard for breastfeeding cessation was: 1) higher among single (HR= 2.3) and partnered (HR= 1.6) than married women, and 2) higher for clerical (versus professional) workers (HR=1.3), and for women who returned to work (versus those who did not) (HR=1.8), at any time 12 months postpartum.

Conclusions: These mothers exceeded Healthy People goals 2010 (75%) of ever breastfeeding, but fell below goals for any breastfeeding at 6 and 12 months (HP 2010 goals: 50% and 25%). Workplace interventions that support breastfeeding are warranted.