Background. Non-initiation and early cessation of breastfeeding have been attributed to work-related issues. Our objective was to determine the effect of employment benefits and characteristics on breastfeeding initiation and duration.

Methods. Data were from the 9-month and 2-year waves of the Early Childhood Longitudinal Study-Birth Cohort. Restricting our sample to singletons whose biological mothers were the respondents at the 9-month interview (unweighted n∼8,750), we classified postpartum employment status as full-time, part-time, and unemployed. Among those working in the 12 months before delivery (unweighted n∼6,150), we classified time of return to work after delivery (weeks) as 1-6, 7-12, ≥13, and not yet returned to work (by the 9-month interview). Analyses included chi-square tests, multiple logistic regressions and Cox proportional hazards models (SUDAAN 10). The mean observation period for any and exclusive breastfeeding was 24.5 and 10.5 months respectively.

Results. Of all mothers of singletons born in the US in 2001, 69.5% initiated breastfeeding with no differences by postpartum employment status. The rate of initiation was highest among women who had not yet returned to work (72.1%) and lowest among women returning within 1-6 weeks (referent group; 63.4%; p=0.0520). In adjusted analysis, full-time workers were 28% (95% CI=0.57-0.92) less likely to initiate breastfeeding compared to unemployed women. Women who had not yet returned to work had a 46% (95% CI=1.08-1.97) greater odds of initiation than the referent group. Full-time workers had a 19% (95%CI=1.01-1.40) greater risk of cessation of any breastfeeding compared to unemployed women. Women returning at ≥13 weeks had a 19% (95% CI=0.68-0.97) lower risk of cessation of any breastfeeding and a 22% (95% CI=0.63-0.96) lower risk of cessation of exclusive breastfeeding compared to the referent group. Women who had not yet returned to work had a 24% (95% CI=0.59-0.98) lower risk of cessation of exclusive breastfeeding compared to the referent group.

Conclusions. Full-time work shortly after delivery may negatively impact breastfeeding. Women returning later to work are more likely to initiate breastfeeding and breastfeed longer. Part-time options should be offered to women working postpartum. Policies enabling postpartum women to take sufficient time from work are sorely needed.