Maternity leave and breastfeeding during COVID: a cross-sectional study

TL;DR

The study found that during the pandemic, longer maternity leave in the US was not linked to better breastfeeding outcomes, unlike before the pandemic.

Contribution

The study reveals how pandemic-related changes in employment and home environments altered the relationship between maternity leave and breastfeeding.

Findings

During the pandemic, longer maternity leave was not associated with higher breastfeeding initiation or continuation.

Women with lower socioeconomic status were more affected by shorter maternity leave during the pandemic.

Pre-pandemic data showed a positive link between longer leave and breastfeeding, which disappeared during the pandemic.

Abstract

Maternity leave is an important driver of a woman’s ability to breastfeed, but this association may have changed during the COVID pandemic, which introduced new employment dynamics and breastfeeding challenges for mothers in the workforce. Our objectives were to examine the associations between maternity leave length and type of maternity leave (paid vs. unpaid) with breastfeeding initiation and breastfeeding duration during the pandemic, and to compare our findings with pre-pandemic data.

Our sample was 3,683 recently postpartum women, currently in the workforce, who had given birth between March-December 2020 in the US. Data were obtained from the Pregnancy Risk Assessment and Monitoring System (PRAMS) survey, a population-based surveillance system developed by the Centers for Disease Control (CDC) in the US. We examined associations between taking longer maternity leave compared with shorter (≥ 3 vs. < 3 months), and breastfeeding initiation or continuation (at 1, 2, and 3 months after delivery). We also examined heterogeneity in the associations between maternity leave and breastfeeding by a range of characteristics.

During COVID, having a longer maternity leave was not associated with breastfeeding initiation or continuation. These results contrast with pre-pandemic findings from the same cohort, in which a longer maternity leave was associated with more breastfeeding. In tests of heterogeneity in our current analysis, women who were younger, not married, less educated, or who did not receive any pay during their leave were less likely to continue breastfeeding if they took a shorter maternity leave than if they took a longer maternity leave.

The COVID pandemic created a natural experiment for exploring associations between employment and breastfeeding among women in the workforce. Our results suggest that the conditions of the pandemic may have minimized average differences in breastfeeding outcomes by maternity leave length because more women were at home. However, our study highlighted that benefits were concentrated among women who were older, more educated, married, and who received paid leave, reinforcing the urgent need to support women who face greater economic and social disadvantages within the US.

The online version contains supplementary material available at 10.1186/s13006-025-00779-5.

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