Paid Family Leave Effects on Breastfeeding: A Quasi-Experimental Study of US Policies

Paid family leave policies increased exclusive breastfeeding at the 6-month benchmark. Breastfeeding duration for married, White, higher-income, and older mothers improved more from paid family leave policies compared to disadvantaged women.

Outcome Analysis

• There was a 1.3 percentage point increase in the number of children exclusively breastfed at 6 months due to paid family leave policies.
• The other six breastfeeding outcomes were whether parents had ever breastfed their child; whether the child remained exclusively breastfed at 3 months; whether the child was still breastfed at 6 and 12 months; days of exclusive breastfeeding; and days of any breastfeeding. These were not statistically significant in the overall sample.

Subgroup Analyses

• After the implementation of family leave policies:
  • Married women had higher rates of exclusive breastfeeding at 3 months, any breastfeeding at 6 months, and exclusive breastfeeding duration, compared to unmarried women.
  • Black women had reduced breastfeeding at 12 months compared to White women.
  • Hispanic women had improved exclusive breastfeeding at 6 months compared to White women.
  • Women of other races experienced reductions in ever breastfeeding compared to White women.
  • Middle- and high-income women had higher rates of ever breastfeeding, exclusive breastfeeding at 3 months, and breastfeeding duration compared to low-income women.  
  • Women younger than 30 years experienced reduced breastfeeding duration compared to older women.

The study suggests that existing paid family leave policies favored more advantaged women. California and New Jersey’s policies provided only modest salary coverage at the time this study was done (although both states’ policies have since been expanded). Given that low-income families may have lower take-up of unpaid and (partially) paid leave, the implementation and design of family leave policies must center disadvantaged women to avoid exacerbating health disparities.

The National Immunization Survey (NIS) is a nationally representative serial cross-sectional survey that includes questions on breastfeeding. This study analyzed NIS data of a large and diverse sample of 306,266 children born from 2001 to 2013 drawn from the 2003-2015 NIS waves.  

This study uses a linear regression model to estimate the impact of the paid family leave policy on length of breastfeeding. The primary independent variable was if a birth occurred in a year and state with (versus without) a paid family leave policy. Seven breastfeeding outcomes were considered: ever breastfed; whether the child remained exclusively breastfed at 3 and 6 months; whether the child was still breastfed at 6 and 12 months; days of exclusive breastfeeding; and days of any breastfeeding. A difference-in-differences approach was applied to test the differences in breastfeeding practices before and after policies were implemented in California and New Jersey compared to states without paid family leave policies. Analysis was also conducted to determine if the effects of paid family leave policies impacted breastfeeding length differently depending on variables like maternal marital status, race/ethnicity, income, and age.