title: The impact of prenatal employment on breastfeeding intentions and breastfeeding status at 1 week postpartum.
abstract: BACKGROUND
  Postpartum employment is associated with non-initiation and early cessation of breastfeeding, but less is known about the relationship between prenatal employment and breastfeeding intentions and behaviors.
  
  
  OBJECTIVE
  This study aimed to estimate the relationship between prenatal employment status, a strong predictor of postpartum return to work, and breastfeeding intentions and behaviors.
  
  
  METHODS
  Using data from the Listening to Mothers II national survey (N = 1573), we used propensity score matching methods to account for non-random selection into employment patterns and to measure the impact of prenatal employment status on breastfeeding intentions and behaviors. We also examined whether hospital practices consistent with the Baby-Friendly Hospital Initiative (BFHI), assessed based on maternal perception, were differentially associated with breastfeeding by employment status.
  
  
  RESULTS
  Women who were employed (vs unemployed) during pregnancy were older, were more educated, were less likely to have had a previous cesarean delivery, and had fewer children. After matching, these differences were eliminated. Although breastfeeding intention did not differ by employment, full-time employment (vs no employment) during pregnancy was associated with decreased odds of exclusive breastfeeding 1 week postpartum (adjusted odds ratio = 0.48; 95% confidence interval, 0.25-0.92; P = .028). Higher BFHI scores were associated with higher odds of breastfeeding at 1 week but did not differentially impact women by employment status.
  
  
  CONCLUSIONS
  Women employed full-time during pregnancy were less likely to fulfill their intention to exclusively breastfeed, compared to women who were not employed during pregnancy. Clinicians should be aware that employment circumstances may impact women's breastfeeding decisions; this may help guide discussions during clinical encounters.
authors.affiliation: 1Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Attanasio
authors.forename: Katy B
authors.initials: KB
authors.lastname: Kozhimannil
authors.forename: Patricia
authors.initials: P
authors.lastname: McGovern
authors.forename: Dwenda
authors.initials: D
authors.lastname: Gjerdingen
authors.forename: Pamela Jo
authors.initials: PJ
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000523:psychology*; D036861:Delivery, Obstetric; D004651:Employment; D005260:Female; D006266:Health Education / Q000458:organization & administration; D006739:Hospital Administration; D006801:Humans; D007231:Infant, Newborn; D033182:Intention; D009035:Mothers / Q000523:psychology*; D016134:Organizational Policy; D041361:Pacifiers; D011247:Pregnancy; D012959:Socioeconomic Factors; D014479:United Arab Emirates; D055815:Young Adult
keywords: breastfeeding; breastfeeding behaviors; exclusive breastfeeding; prenatal employment; propensity score matching
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