Latina Mom and Baby Health Research: Breastfeeding Promotion

Share On Social!

This is part of our Latina Mom and Baby Health: A Research Review »

Limited time available for breastfeeding

Short periods of maternity leave remain a major barrier to breastfeeding, as a woman’s employment plans commonly impact her plan to breastfeed.72–77

Women who return to work before 6 weeks are over 3 times as likely to stop breastfeeding than those who return to work later than 6 weeks postpartum.78,79

In addition, the timing of breastfeeding discontinuation is closely linked with the return to work in low-income mothers.72 A mother is more than twice as likely to quit breastfeeding during the month she returns to work compared with a mother who remains on leave.72 A longer duration of exclusive breastfeeding correlates with a longer period of maternity leave.72–77 Each additional week of maternity leave has the potential to increase breastfeeding duration by nearly half a week.80

In California, where a paid family leave program is currently in place, breastfeeding duration was twice as long among mothers who took paid family leave, increasing from 5 to 9 weeks in women with lower-paying jobs.81

According to global social policies, the United States is 1 of only 5 countries—and the only developed country—not to mandate paid leave for new mothers.82

In the U.S., the Family Medical Leave Act (FMLA) offers women up to 12 weeks of unpaid, job-protected maternity leave; however, not all female employees are eligible and many low-income households cannot afford to take unpaid leave, relying on a combination of short-term disability, sick leave, vacation, and personal days.83

Between 2006 and 2008, one-third of employed women (29.4%) did not report the use of maternity leave during their last pregnancy.83 For those who did report taking maternity leave, the average duration was 10.3 weeks, and was completely unpaid for 33.1 percent of women.

A more recent study demonstrated that 59 percent of women did not receive paid maternity leave, and those who did averaged only 3.3 weeks paid with 31 percent wage replacement.84 Policies surrounding maternity leave are particularly important for Latino families, as data from the CDC National Survey of Family Growth show that Latina women are less likely to utilize maternity leave compared with non-Latino white and black women.83

Mothers who planned to return to work before 12 weeks were less likely to express a plan for exclusive breastfeeding, according to a study of 2,348 prenatally employed women.85 In another published analysis from this cohort, only 28.8 percent of women who intended to breastfeed for ≥3 months were able to meet this objective.86

Policies supporting flexible work scheduling and paid maternity leave may allow more women to achieve their breastfeeding goals, which may also reduce the rates of childhood obesity. There is a need for further studies investigating the impact of paid maternity leave on breastfeeding and childhood obesity directly within Latino populations.

Intent to breastfeed and achieving goal

A mother’s prenatal intention regarding infant feeding is one of the strongest predictors of how she will feed her infant.87–90

In a study of 2,348 prenatally employed women from the Infant Feeding Practices Study II, the majority of mothers (59.5%) planned to exclusively breastfeed during the first few weeks postpartum.85

Pre-delivery strategies have been shown to be effective not only in increasing the likelihood of breastfeeding, but also in achieving numerous other desired outcomes for both mother and child.

Following this concept, the Nurse Family Partnership Program (NFP) is dedicated to pairing a nurse with a first-time, low-income mother in an attempt to help educate new mothers in areas that may improve the health and well being of her and her child.91 Several randomized controlled trials from the NFP were conducted in Elmira, New York, Memphis, and Denver.

Follow-up studies continue to show long-term benefits in several areas: improved prenatal health, fewer childhood injuries, increased intervals between births, increased maternal employment, and improved school readiness among children.91 In a prenatal setting, the NFP has been shown to decrease prenatal cigarette smoking and improve diets over the course of pregnancy significantly more than women in control groups.92–94 In addition, women enrolled in the NFP in Colorado (47% Latino) achieved several positive outcomes, including 90 percent of babies being born at a healthy weight, 91 percent of mothers initiating breastfeeding, and 36 percent continuing breastfeeding by 6 months.95

The benefits of such pre-delivery interventions are also evident in the Latino population. A study in Orange County, California in 2003 demonstrated that the NFP home visitation program and a less intensive Public Health Field Nursing (PHFN) home visitation schedule could both positively affect birth outcomes in a population of 225 Latino adolescent mothers and their infants.96

More recently, a 2014 study of 1,000 Latina women enrolled in the Pennsylvania NFP demonstrated that home visitation was associated with reducing the risk of short interpregnancy intervals, effectively improving birth spacing in Latina mothers.97

Promoting breastfeeding via federal food assistance

WIC program policies are being revised to promote increased breastfeeding rates and healthier eating habits among low-income populations.

Federal food assistance programs, such as the WIC program, are important for ensuring that low-income families have access to healthy foods. The WIC program is funded by the U.S. Department of Agriculture and aims to offer nutritious food as well as education on nutrition and breastfeeding to low-income, prenatal and postpartum women, and to their children up to age 5.98

There have been conflicting reports on the affect of WIC programs on breastfeeding because women are allowed to purchase formula under the program.99–106

Due to the role of breastfeeding and healthy eating habits in childhood obesity, policies to improve breastfeeding rates among low-income, WIC participants is an important area of focus.107

Based on recommendations from the IOM, the WIC program was revised in 2009 to increase breastfeeding support and improve the types of foods contained within its packages.107,108 Food packages for women and children older than 2 were revised to include fruits and vegetables, whole grains, and lower-fat milk options. For postpartum women and infants, food packages were updated in an attempt to incentivize breastfeeding. This included an increase in the amount and variety of food benefits for fully breastfeeding mothers as well as infants not receiving formula.

Additionally, for infants receiving formula, formula amounts are now calibrated according to infant age and complementary infant foods are postponed. In the state of California, a policy was adopted preventing routine issuance of formula to breastfeeding mothers within the first 30 days after delivery.107,108

A study in 2012 aimed to assess the affects of these policy changes in a population of over 180,000 infants enrolled in WIC in Southern California.109 The study demonstrated an 86 percent increase in the issuance rate of the “fully breastfeeding” package at the time of infant enrollment following the policy change. There were also significant increases in the issuance of packages without formula at 2 and 6 months of age, while formula-containing packages were issued at a significantly decreased rate.

Importantly, a total of 18 months following food package revisions, a study by Kong and colleagues demonstrated significant improvements in total fat, saturated fat, dietary fiber, and overall diet quality specifically among Latino children participating in WIC in Chicago, Illinois.110

A more recent study in 2015 demonstrated conflicting findings in a population of majority-Latino infants and toddlers enrolled in WIC in south central Texas.111 Compared with feeding practices prior to 2009 package changes, this population showed no significant post-change improvements in either breastfeeding initiation, duration, age of introduction of complementary foods, or exposure to baby food fruits and vegetables. A significant improvement was noted in the amount of infants receiving cereal in their bottles.111

Although findings relating to the impact of WIC policy updates on breastfeeding rates remain unclear, some recent evidence in the literature has illustrated that WIC policy changes can result in a moderate decrease in the prices of fruits and vegetables.112

Studies have shown that reducing fruit and vegetable prices can increase the consumption of these healthy foods and improve weight outcomes, especially among low-income families.113,114 As a result, WIC policy changes may have the potential to affect childhood obesity not only via altered breastfeeding rates, but also through healthier diets upon introduction of solid foods.

The potential benefits of WIC programs are especially important for Latino communities, as Latinos comprise 41.5 percent of all WIC participants.115

More from our Latina Mom and Baby Health: A Research Review »

• Introduction & Methods
  
• Key Research Finding: Maternal obesity
• Key Research Finding: Breastfeeding
• Key Research Finding: Breastfeeding promotion (this section)
• Key Research Finding: Marketing of infant formula
• Key Research Finding: Latino infant habits
• Key Research Finding: Early childcare settings
• Policy Implications
• Future Research Needs

References for this section »

72. Kimbro RT. On-the-job moms: work and breastfeeding initiation and duration for a sample of low-income women. Matern Child Health J. 2006;10(1):19-26. doi:10.1007/s10995-005-0058-7.
73. Ogbuanu C, Glover S, Probst J, Liu J, Hussey J. The effect of maternity leave length and time of return to work on breastfeeding. Pediatrics. 2011;127(6):e1414-e1427. doi:10.1542/peds.2010-0459.

74. Thulier D, Mercer J. Variables associated with breastfeeding duration. J Obstet Gynecol neonatal Nurs JOGNN / NAACOG. 2009;38(3):259-268. doi:10.1111/j.1552-6909.2009.01021.x.

75. Ryan AS, Zhou W, Arensberg MB. The effect of employment status on breastfeeding in the United States. Women’s Heal Issues Off Publ Jacobs Inst Women’s Heal. 2006;16(5):243-251. doi:10.1016/j.whi.2006.08.001.

76. Cooklin AR, Rowe HJ, Fisher JRW. Paid parental leave supports breastfeeding and mother-infant relationship: a prospective investigation of maternal postpartum employment. Aust N Z J Public Health. 2012;36(3):249-256. doi:10.1111/j.1753-6405.2012.00846.x.

77. Baker M, Milligan K. Maternal employment, breastfeeding, and health: evidence from maternity leave mandates. J Health Econ. 2008;27(4):871-887. doi:10.1016/j.jhealeco.2008.02.006.

78. Guendelman S, Kosa JL, Pearl M, Graham S, Goodman J, Kharrazi M. Juggling work and breastfeeding: effects of maternity leave and occupational characteristics. Pediatrics. 2009;123(1):e38-e46. doi:10.1542/peds.2008-2244.

79. CLASP and Breastfeeding Taskforce of Los Angeles. Paid Family Leave: A Crucial Support for Breastfeeding. CLASP and Breastfeeding Taskforce of Los Angeles; 2013.

80. Roe B, Whittington LA, Fein SB, Teisl MF. Is there competition between breast-feeding and maternal employment? Demography. 1999;36(2):157-171.

81. Appelbaum E, Milkman R. Leaves That Pay: Employer and Worker Experiences with Paid Family Leave in California. Washingt Cent Econ Policy Res. http://www.cepr.net/documents/publications/paid-family-leave-1- 2011.pdf.

82. Maternity, Paternity, and Adoption Leave in the United States — IWPR. http://www.iwpr.org/publications/pubs/maternity-paternity-and-adoption-leave-in-the-united-states. Accessed June 8, 2015.

83. Maternal and Child Health Bureau. Women’s Health USA 2011. 2011. http://www.mchb.hrsa.gov/whusa11/more/downloads/pdf/w11.pdf.
84. Shepherd-Banigan M, Bell JF. Paid leave benefits among a national sample of working mothers with infants in the United States. Matern Child Health J. 2014;18(1):286-295. doi:10.1007/s10995-013-1264-3.

85. Mirkovic KR, Perrine CG, Scanlon KS, Grummer-Strawn LM. In the United States, a Mother’s Plans for Infant Feeding Are Associated with Her Plans for Employment. J Hum Lact Off J Int Lact Consult Assoc. 2014;30(3):292-297. doi:10.1177/0890334414535665.

86. Mirkovic KR, Perrine CG, Scanlon KS, Grummer-Strawn LM. Maternity leave duration and full-time/part-time work status are associated with US mothers’ ability to meet breastfeeding intentions. J Hum Lact Off J Int Lact Consult Assoc. 2014;30(4):416-419. doi:10.1177/0890334414543522.

87. Donnan PT, Dalzell J, Symon A, et al. Prediction of initiation and cessation of breastfeeding from late pregnancy to 16 weeks: the Feeding Your Baby (FYB) cohort study. BMJ Open. 2013;3(8). doi:10.1136/bmjopen-2013-003274.

88. Colaizy TT, Saftlas AF, Morriss FH. Maternal intention to breast-feed and breast-feeding outcomes in term and preterm infants: Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2003. Public Health Nutr. 2012;15(4):702-710. doi:10.1017/S1368980011002229.

89. Bai Y, Middlestadt SE, Peng C-YJ, Fly AD. Predictors of continuation of exclusive breastfeeding for the first six months of life. J Hum Lact Off J Int Lact Consult Assoc. 2010;26(1):26-34. doi:10.1177/0890334409350168.

90. Bai Y, Wunderlich SM, Fly AD. Predicting intentions to continue exclusive breastfeeding for 6 months: a comparison among racial/ethnic groups. Matern Child Health J. 2011;15(8):1257-1264. doi:10.1007/s10995-010-0703-7.

91. Nurse Family Partnership – NFP. Healthy Babies Program With Proven Results. http://www.nursefamilypartnership.org/proven-results. Accessed June 9, 2015.

92. Nurse Family Partnership – NFP. Better pregnancy outcomes. http://www.nursefamilypartnership.org/proven-results/Better-pregnancy-outcomes. Accessed June 9, 2015.

93. Olds DL, Henderson CR, Tatelbaum R, Chamberlin R. Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home visitation. Pediatrics. 1986;77(1):16-28.

94. Olds DL, Robinson J, O’Brien R, et al. Home visiting by paraprofessionals and by nurses: a randomized, controlled trial. Pediatrics. 2002;110(3):486-496.

95. Nurse Family Partnership in Colorado: State Profile 2014. http://www.nursefamilypartnership.org/assets/PDF/Communities/State-profiles/CO_State_Profile.aspx. Accessed June 9, 2015.

96. Nguyen JD, Carson ML, Parris KM, Place P. A comparison pilot study of public health field nursing home visitation program interventions for pregnant Hispanic adolescents. Public Health Nurs. 2003;20(5):412-418.

97. Yun K, Chesnokova A, Matone M, Luan X, Localio AR, Rubin DM. Effect of maternal-child home visitation on pregnancy spacing for first-time Latina mothers. Am J Public Health. 2014;104 Suppl :S152-S158. doi:10.2105/AJPH.2013.301505.

98. United States Department of Agriculture. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program). http://www.fns.usda.gov/sites/default/files/wic/wic-fact-sheet.pdf. Accessed June 9, 2015.

99. Bunik M, Krebs NF, Beaty B, McClatchey M, Olds DL. Breastfeeding and WIC enrollment in the Nurse Family Partnership Program. Breastfeed Med Off J Acad Breastfeed Med. 2009;4(3):145-149. doi:10.1089/bfm.2008.0140.

100. Metallinos-Katsaras E, Brown L, Colchamiro R. Maternal WIC participation improves breastfeeding rates: a statewide analysis of WIC participants. Matern Child Health J. 2015;19(1):136-143. doi:10.1007/s10995-014-1504-1.

101. Ziol-Guest KM, Hernandez DC. First- and second-trimester WIC participation is associated with lower rates of breastfeeding and early introduction of cow’s milk during infancy. J Am Diet Assoc. 2010;110(5):702-709. doi:10.1016/j.jada.2010.02.013.

102. Ryan AS, Zhou W. Lower breastfeeding rates persist among the Special Supplemental Nutrition Program for Women, Infants, and Children participants, 1978-2003. Pediatrics. 2006;117(4):1136-1146. doi:10.1542/peds.2005-1555.

103. Jacknowitz A, Novillo D, Tiehen L. Special Supplemental Nutrition Program for Women, Infants, and Children and infant feeding practices. Pediatrics. 2007;119(2):281-289. doi:10.1542/peds.2006-1486.

104. Chatterji P, Brooks-Gunn J. WIC participation, breastfeeding practices, and well-child care among unmarried, low-income mothers. Am J Public Health. 2004;94(8):1324-1327.

105. Bitler MP, Currie J. Does WIC work? The effects of WIC on pregnancy and birth outcomes. J Policy Anal Manag [the J Assoc Public Policy Anal Manag. 2005;24(1):73-91. doi:10.1002/pam.20070.

106. Li R, Darling N, Maurice E, Barker L, Grummer-Strawn LM. Breastfeeding rates in the United States by characteristics of the child, mother, or family: the 2002 National Immunization Survey. Pediatrics. 2005;115(1):e31-e37. doi:10.1542/peds.2004-0481.

107. Oliveira V, Frazao E. The WIC Program: Background, Trends, and Economic Issues: 2009 Edition. United States Dep Agric. 2009. http://www.ers.usda.gov/media/159295/err73.pdf. Accessed June 9, 2015.

108. Institute of Medicine, Committee to Review the WIC Food Packages and Food and Nutrition Board. WIC Food Packages: Time for a Change. Washington, DC: The National Academies Press; 2005.

109. Whaley SE, Koleilat M, Whaley M, Gomez J, Meehan K, Saluja K. Impact of policy changes on infant feeding decisions among low-income women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children. Am J Public Health. 2012;102(12):2269-2273. doi:10.2105/AJPH.2012.300770.

110. Kong A, Odoms-Young AM, Schiffer LA, et al. The 18-month impact of special supplemental nutrition program for women, infants, and children food package revisions on diets of recipient families. Am J Prev Med. 2014;46(6):543-551. doi:10.1016/j.amepre.2014.01.021.

111. Reat AM, Crixell SH, Friedman BJ, Von Bank JA. Comparison of Food Intake Among Infants and Toddlers Participating in a South Central Texas WIC Program Reveals Some Improvements After WIC Package Changes. Matern Child Health J. 2015. doi:10.1007/s10995-015-1697-y.

112. Zenk SN, Powell LM, Odoms-Young AM, et al. Impact of the revised Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package policy on fruit and vegetable prices. J Acad Nutr Diet. 2014;114(2):288-296. doi:10.1016/j.jand.2013.08.003.

113. Andreyeva T, Long MW, Brownell KD. The impact of food prices on consumption: a systematic review of research on the price elasticity of demand for food. Am J Public Health. 2010;100(2):216-222. doi:10.2105/AJPH.2008.151415.

114. Powell LM, Chriqui JF, Khan T, Wada R, Chaloupka FJ. Assessing the potential effectiveness of food and beverage taxes and subsidies for improving public health: a systematic review of prices, demand and body weight outcomes. Obes Rev An Off J Int Assoc Study Obes. 2013;14(2):110-128. doi:10.1111/obr.12002.

115. WIC Participant and Program Characteristics 2012 Final Report. United States Dep Agric. 2013. http://www.fns.usda.gov/sites/default/files/WICPC2012.pdf. Accessed June 9, 2015.