Maternity Leave Length Impact on Breastfeeding and Postpartum Depression

Abstract

Introduction In January 2016, the U.S. Department of Defense increased the duration of paid maternity leave for active duty service members from 6 weeks to 12 weeks. Our study aims to determine the impact of maternity leave length on breastfeeding duration and postpartum depression rates in active duty service members. Materials and Methods An institutional review board-approved survey of 9 questions was given to patients at the Brooke Army Medical Center Obstetrics and Gynecology Clinic. Patients were offered voluntary participation if they had delivered a baby while on active duty in the preceding 20 years. The survey included questions about length of maternity leave, duration of breastfeeding, age at delivery, route of delivery, and whether the patient suffered from postpartum depression. Results A total of 214 surveys were collected. Fisher exact test was used to compare rates of breastfeeding and postpartum depression between the 2 groups. A total of 87% of service members initiated breastfeeding. Among women who had 6 weeks versus 12 weeks of maternity leave, 51.64% versus 56.96% breastfed up to 6 months, p = 0.45. The overall rate of postpartum depression was 13.5%. Among women who had 6 weeks versus 12 weeks of maternity leave, 16.1% versus 9.5% reported postpartum depression, p = 0.11. Conclusion The ideal maternity leave duration is unknown. With recent changes to the Department of Defense maternity leave policy, we aimed to evaluate the effect this had on breastfeeding and postpartum depression rates. No statistically significant difference was seen when we compared rates of breastfeeding in women who had 6 weeks versus 12 weeks of maternity leave. Further research is required to determine the ideal maternity leave duration and best practices to promote breastfeeding. When looking at postpartum depression, our study shows that postpartum depression was noted in 16% of patients who took 6 weeks versus 9% of those who took 12 weeks of maternity leave. No statistically significant difference was seen; however, this was likely because of the small sample size. Only 29 out of 214 women suffered from depression regardless of length of maternity leave. More research is needed to determine if maternity leave length does indeed impact postpartum depression rates.

Association Between Length of Maternity Leave and Breastfeeding Duration in the United States

“…28,33 One military study of 857 mothers found a statistically significant increase in breastfeeding duration through 9 months ( P =.003) and breastfeeding exclusivity through 6 months ( P =.016) after the policy change increased the length of maternity leave from 6 to 12 weeks 31 ; another military study of 214 active-duty mothers found a 5.4%, nonstatistically significant, increase in the percentage of service members who breastfed up to 6 months after the same policy change. 32 One cross-sectional study found that a 1-week increase in total maternity leave was associated with a 4.2-day increase in breastfeeding duration ( P =.022). 38 Shortened durations of maternity leave and early return to work contribute to the decrease in infants who are exclusively breastfed, which was suggested in all 23 included articles.…”

“…Thirteen articles (56.5%) used national survey data, including the National Immunization Survey, the National WIC Infant and Toddler Feeding Practices Study Survey, and the Centers for Disease Control and Prevention's Infant Feeding Practices Study II, to analyze the relationship between maternity leave and breastfeeding duration. [18][19][20][21][22][23][24][25][26][27][28][29][30] Eight articles (34.7%) used local survey data, of which two articles (8.7%) studied activeduty military mothers, 31,32 three (13.0%) used statewide survey data, [33][34][35] and three (13.0%) were cohort studies at local hospitals. [36][37][38] The remaining two articles (8.7%) provided narrative information based on previous literature.…”

“…In general, the characteristics of leave reported among studies were heterogeneous. Except for the two military studies, 31,32 the articles relied on breastfeeding parents to self-report their leave. [18][19][20][21][22][23][24][25][26][27][28][29][30][33][34][35][36][37][38] Reporting of parental leave length taken varied greatly among the included studies, ranging from less than 6 weeks to longer than 12 weeks.…”

“…39 The other narrative review found a statistically significant difference in duration of breastfeeding between nonworking mothers (25.1 weeks) and working mothers (16.5 weeks). 40 Seven articles (30.4%) reviewed mothers who received only paid leave 24,28,[31][32][33][34]40 ; nine articles (39.1%) analyzed a combination of paid and unpaid leave 19,[21][22][23]25,26,30,39,40 ; one article (4.3%) reviewed unpaid leave 20 ; and five articles (22.7%) did not specify the type of leave. 18,27,29,35,37 One retrospective cohort study of 1,384 mothers found that those who received at least 12 weeks of paid maternity leave were more likely to initiate (adjusted OR 2.83, 95% CI, 1.23-6.48) and continue breastfeeding for at least 6 months (adjusted OR 2.26, 95% CI, 1.20-4.26) than those who did not receive any paid leave.…”

“…47 Both prior reviews provide valuable informa-tion; however, we have identified a need for an updated review that includes more recent research in the United States. This review includes eight articles 19,[27][28][29][31][32][33]37 published after 2018 and seven articles 18,20,22,23,35,39,40 published before 2018 that were not included in either of the prior reviews (Table 1).…”