Article Text
Abstract
Introduction Among all barriers to breastfeeding, the need to work has been cited as one of the top reasons for not breastfeeding overall and for early weaning among mothers who seek to breastfeed. We aimed to examine whether extending the duration of paid maternity leave available to new mothers affected early initiation of breastfeeding, exclusive breastfeeding under 6 months and breastfeeding duration in low-income and middle-income countries (LMICs).
Methods We merged longitudinal data measuring national maternity leave policies with information on breastfeeding related to 992 419 live births occurring between 1996 and 2014 in 38 LMICs that participated in the Demographic and Health Surveys. We used a difference-in-differences approach to compare changes in the prevalence of early initiation and exclusive breastfeeding, as well as the duration of breastfeeding, among treated countries that lengthened their paid maternity leave policy between 1995 and 2013 versus control countries that did not. Regression models included country and year fixed effects, as well as measured individual-level, household-level and country-level covariates. All models incorporated robust SEs and respondent-level sampling weights.
Results A 1-month increase in the legislated duration of paid maternity leave was associated with a 7.4 percentage point increase (95% CI 3.2 to 11.7) in the prevalence of early initiation of breastfeeding, a 5.9 percentage point increase (95% CI 2.0 to 9.8) in the prevalence of exclusive breastfeeding and a 2.2- month increase (95% CI 1.1 to 3.4) in breastfeeding duration.
Conclusion Extending the duration of legislated paid maternity leave appears to promote breastfeeding practices in LMICs. Our findings suggest a potential mechanism to reduce barriers to breastfeeding for working mothers.
- paid maternity leave policy
- early initiation of breastfeeding
- exclusive breastfeeding
- breastfeeding duration
- difference-in-differences
- longitudinal data
- low- and middle-income countries
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Footnotes
Handling editor Seye Abimbola
Contributors AN and JH led the development of the policy databases on which this analysis is based. All authors contributed to the conception and design of the study. YC performed the statistical analysis and drafted the manuscript. All authors reviewed the results, edited and approved the final version of the manuscript.
Funding Authors acknowledge funding from the Canadian Institutes of Health Research (CIHR) Foundation grant ‘Development epidemiology: identifying evidence-based interventions for improving population health and promoting health equity’ (FRN 148467). YC is supported by the Conrad N Hilton Foundation. AN is supported by the Canada Research Chairs program.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Analyses utilised two sources of data, specifically: (1) breastfeeding information collected from respondents surveyed as part ofthe Demographic and Health Surveys (DHS) (Table 1) and (2) measures of maternity leave policies. The DHS data are publicly available, but users must first registerwith the DHS program. Registration, which requires a summary of the proposed study and selection of country datasets, can be completed at: http://www.dhsprogram.com/data/. Data on current maternity leave policies for each sampled country were made available by the University of California Los Angeles’ WORLD Policy Analysis Center and then collected retrospectively to 1995 by McGill University’s PROSPERED project. The policy data are freely available through the website, https://www.prosperedproject.com/, without any restriction.