Got milk? Workplace factors related to breastfeeding among working mothers

• DOI: http://doi.org/10.1002/job.2061
• Date: 01 July 2016
• Published date: 01 July 2016

Got milk? Workplace factors related to

breastfeeding among working mothers

CHRISTIANE SPITZMUELLER

1,2

*, ZHUXI WANG

2

, JING ZHANG

2

,

CANDICE L. THOMAS

2

, GWENITH G. FISHER

3

, RUSSELL A. MATTHEWS

4

AND

LANE STRATHEARN

5

1

Lagos Business School, Lagos, Nigeria

2

Department of Psychology, University of Houston, Houston, Texas, U.S.A.

3

Department of Psychology, Colorado State University, Fort Collins, Colorado, U.S.A.

4

Department of Psychology, Bowling Green State University, Bowling Green,Ohio, U.S.A.

5

Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, U.S.A.

Summary The American Academy of Pediatrics recommends that women breastfeed because of improved health out-

comes for mothers and children. Because maternal employment during the first year of the child’s life has

been identified as a reason for breastfeeding cessation, we develop and test a role-theory-based framework

to explain women’s continuation of breastfeeding after return to work (Study 1) and report results of an

exploratory study linking breastfeeding at work with job attitudes and well-being (Study 2). Applying survival

analysis to a longitudinal dataset gathered by the Centers for Disease Control (Study 1), we identify pregnant

women’s perceived employer support for breastfeeding as a predictor of women’s breastfeeding goal inten-

tions. Supervisors’negativeworkplace remarks about breastfeeding relatedto an eightfold increase of women’s

likelihood to discontinue exclusive breastfeeding and perceived support for breastfeeding after return to work

predicted exclusive breastfeeding continuation. Resultsof Study 2 suggest that women who return to work and

continue breastfeeding experience more family-to-work conflict and overload than women who do not recon-

cile work and breastfeeding. Further, results of Study 2 provide preliminary evidence suggesting that percep-

tions of supervisor and coworker support for breastfeeding relate positively to general perceptions of

organizational support and negatively to depressive symptoms. Copyright © 2015 John Wiley & Sons, Ltd.

Keywords: breastfeeding; workplace support; work–family conflict

One of the most influential factors contributing to low breastfeeding initiation and continuation rates is maternal

employment, with full-time employment posing a particular risk (Fein, Mandal, & Roe, 2008; Mandal, Roe, & Fein,

2010). In countries such as the United States where legal frameworks provide only limited access to paid maternity

leave, employment and breastfeeding have to be reconciled if breastfeeding is to be continued. As outlined in the

American Academy of Pediatrics (AAP) comprehensive 2005 policy statement (Gartner et al., 2005), the effect of

American women’s return to work on breastfeeding continuation poses a significant public health concern because

it is widely accepted that breastfeeding is related to significant health benefits for both infant and mother. Although

the host of breastfeeding benefits for mother and child have prompted many nations to promote breastfeeding

through hospital interventions, generous maternity leave policies and other support mechanisms, only a few coun-

tries (such as Norway and Canada) have almost entirely eliminated the need for women to reconcile breastfeeding

and work through a maternity policy that provides paid maternity leave of approximately 1 year. In most othercoun-

tries (such as many Western European countries), work experiences shape breastfeeding continuation (Lundberg

et al., 2008). However, the exact work experiences and mechanisms that promote or discourage breastfeeding are

not sufficiently well understood.

*Correspondence to: Christiane Spitzmueller, Department of Psychology, University of Houston, 123b Heyne, Houston, Texas 77204-5022,

U.S.A. E-mail: christianes@gmail.com

Copyright © 2015 John Wiley & Sons, Ltd.

Received 22 September 2014

Revised 28 September 2015, Accepted 2 October 2015

Journal of Organizational Behavior, J. Organiz. Behav. 37, 692–718 (2016)

Published online 4 November 2015 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/job.2061

Research Article

Hence, the goals for the current paper are to (1) introduce role-theory-based factors that impact breastfeeding

goals and actual breastfeeding behaviors (Study 1); (2) evaluate the model’s predictions by applying survival

analysis to a large panel dataset (Study 1) collected by the US Centers for Disease Control and Prevention; and

(3) to establish that breastfeeding-related experiences at work relate to organizationally relevant health and well-

being outcomes for mothers (Study 2).

Health and organizational benefits of breastfeeding

According to the AAP, health benefits of continued breastfeeding include a host of outcomes and apply to both

mother and child: Mothers of breastfed infants are less likely to experience ovarian or breast cancer later in life,

are less likely to suffer from postpartum depression, and are more likely to return to their prepregnancy weight

compared with mothers who did not breastfeed (Eidelman, 2012). At the same time, breastfed infants have lower

mortality rates, are less susceptible to infections (Eidelman, 2012; Grummer-Strawn, Li, Perrine, Scanlon, & Fein,

2014), and are less likely to be obese later in life. Furthermore, breastfeeding may also enhance the mother-infant

relationship, as evidenced by reduced rates of maternally perpetrated child neglect (Strathearn et al., 2009). These

health outcomes for mother and child have implications for decreased healthcare costs and lower levels of workplace

absenteeism on the part of the mother.

Given the cumulative evidence in favor of breastfeeding, the AAP has issued a recommendation encouraging

mothers to exclusively breastfeed their infants for the first 6months (i.e., not feed infants anything other than breast

milk) and continue breastfeeding (while supplementing with solid foods) until the child is at least 12 months old (see

AAP policy statement: Gartner et al., 2005). Despite AAP recommendations, only about 75 percent of women in the

United States initiate breastfeeding, 15 percent exclusively breastfeed at 6 months, and only 24 percent breastfeed

during the entire first year. Recent analyses (Bartick & Reinhold, 2010) suggest that if 90 percent of women

breastfed exclusively for 6 months, annual cost savings of $13 billion and 911 fewer infant deaths could be achieved

in the United States. Global recommendations issued by the World Health Organization go even further than AAP

recommendations and advise women to continue breastfeeding for the first 2 years of the child’s life. Despite the

public health advisories in support of breastfeeding, breastfeeding remains a highly personal choice that mothers

make. Our goal in this paper is not to question this choice, but to investigate how and why workplace factors can

contribute to breastfeeding continuation and particularly exclusive breastfeeding continuation.

Women who return to work full-time on average breastfeed their infants for 2 months less than women who stay

home (McKinley & Hyde, 2004), and one study (Guendelman et al., 2009) found that whether women returned to

work within the first 6 weeks after birth was the strongest predictor of women’s decisions to discontinue

breastfeeding. Further, the age of baby when mothers start work again relates closely with breastfeeding cessation

(Kimbro, 2006), with the likelihood of cessation coinciding with work resumption being lower as the infant’s age

increases. With 64 percent of mothers of young children working (U.S. Department of Labor, Bureau of Labor

Statistics, 2010), further examination of the employment-related factors that impact breastfeeding continuation of

working mothers is indispensable.

For women to successfully reconcile breastfeeding and work, the exact requirements and support systems that can

facilitate breastfeeding and particularly exclusive breastfeeding during the first 6months need to be better under-

stood. One important factor appears to be the amount of break time required for women to continue exclusive

breastfeeding: Research on the utilization of breast pumps (Auerbach, 1990) shows that pumping time itself ranges

between 5 and 22 minutes, with median pump time approximating 12 minutes (not accounting for set up, cleaning, or

placing pumped milk in a refrigerator/freezer). In order for exclusive breastfeeding to be maintained for 6 months,

working women have to express breast milk at work at least twice during an 8-hour workday, posing significant

challenges for organizations because of the required scheduling of pumping breaks (Auerbach, 1990).

Many organizations have implemented support programs (e.g., designated rooms for breast milk expression and

provision of pamphlets informing employees of health benefits) to enhance the likelihood that employees continue to

WORK AND BREASTFEEDING 693

Copyright © 2015 John Wiley & Sons, Ltd. J. Organiz. Behav. 37, 692–718 (2016)

DOI: 10.1002/job