title: Determinants of breastfeeding initiation and cessation among employed mothers: a prospective cohort study.
abstract: The U.S. continues to have one of the lowest breastfeeding rates in the industrialized world. Studies have shown that full-time employment and early return to work decreased breastfeeding duration, but little is known about the relationship between leave policies and breastfeeding initiation and cessation. This study aimed to identify workplace-related barriers and facilitators associated with breastfeeding initiation and cessation in the first 6 months postpartum.
  
  
  
  A prospective cohort study design was utilized to recruit 817 Minnesota women aged 18 and older while hospitalized for childbirth. Selection criteria included English-speaking, employed mothers with a healthy, singleton birth. These women were followed up using telephone interviews at 6 weeks, 12 weeks, and 6 months after childbirth. The main study outcomes were breastfeeding initiation, measured during hospital enrollment, and breastfeeding cessation by 6 months postpartum.
  
  
  
  Women were 30 years old; 86 % were White, and 73 % were married. Breastfeeding rates were 81 % at childbirth, 67 % at 6 weeks, 49 % at 12 weeks, and 33 % at 6 months postpartum. Logistic regression revealed the odds of breastfeeding initiation were higher for women who: held professional jobs, were primiparae, had graduate degree, did not smoke prenatally, had no breastfeeding problems, and had family or friends who breastfeed. Survival analyses showed the hazard for breastfeeding cessation by 6 months was: higher for women who returned to work at any time during the 6 months postpartum versus those who did not return, lower for professional workers, higher among single than married women, higher for every educational category compared to graduate school, and higher for those with no family or friends who breastfeed.
  
  
  
  While employer paid leave policy did not affect breastfeeding initiation or cessation, women who took shorter leaves were more likely to stop breastfeeding in the first 6 months postpartum. Future research should examine women's awareness of employer policies regarding paid and unpaid leave.
authors.affiliation: Department of Health Services Administration, School of Public Health, University of Maryland, College Park, MD, USA. radadagher@gmail.com.
authors.forename: Rada K
authors.initials: RK
authors.lastname: Dagher
authors.affiliation: Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: McGovern
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Schold
authors.affiliation: US Department of Housing and Urban Development, Washington, DC, USA.
authors.forename: Xian J
authors.initials: XJ
authors.lastname: Randall
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D004651:Employment / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D008910:Minnesota; D009035:Mothers / Q000523:psychology*; D016524:Parental Leave / Q000706:statistics & numerical data*; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D011446:Prospective Studies; D055815:Young Adult
keywords: Breastfeeding; Family leave policy; Postpartum; Workplace barriers