Paid family leave improves breastfeeding, postpartum depression rates

Key takeaways:

• Strong paid family and medical leave was linked to higher breastfeeding odds vs. little to no paid leave.
• Strong paid leave was also linked to lower postpartum depression odds vs. little to no paid leave.

In U.S. states with strong paid family and medical leave, there was a greater likelihood of breastfeeding and lower odds of postpartum depression symptoms, with stronger associations among those with Medicaid, researchers reported.

“Having to return to work is one of the main reasons that postpartum people do not continue to breastfeed. While the decision on method of feeding is a very personal decision, paid leave allows postpartum people the space to make the decision between breast and bottle feeding,” Madeline F. Perry, MD, a resident obstetrician and gynecologist at Northwestern University Feinberg School of Medicine, told Healio. “Paid leave has previously been found to reduce the rates of postpartum depression and subsequently reduce the rates of self-harm and suicide. Paid family and medical leave allows postpartum people the time to recover after pregnancy and childbirth, bond with their neonate and seek appropriate medical care and support if mental health conditions arise.”

Perry and colleagues conducted a cross-sectional study using data from 143,131 respondents from the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2016 to 2019 for 43 U.S. states and Washington, D.C. Researchers evaluated the associations between state paid family and medical leave with rates of breastfeeding, postpartum depression symptoms and postpartum visit attendance.

Overall, 26.2% of respondents lived in the eight states and Washington, D.C., with the most generous paid family and medical leave, 20.5% lived in nine states with some paid leave and 53.3% lived in 26 states with little or no paid leave. Regarding breastfeeding, 54.8% of respondents reported breastfeeding at 6 months or at the time of the survey, ranging from 59.5% of respondents in the most generous states to 51% in the least generous states. Postpartum depression symptom reports ranged from 11.7% of respondents in the most generous states to 13.3% in the least generous states (P < .001 for both).

When adjusting for respondent characteristics, residents of states with the strongest paid leave had a 9% higher likelihood of breastfeeding (adjusted incidence rate ratio [IRR] = 1.09; 95% CI, 1.07-1.11) compared with residents of states with the least generous paid leave. This likelihood rose to 32% in analyses of respondents with Medicaid insurance (aIRR = 1.32; 95% CI, 1.23-1.39).

Generous state paid leave was significantly associated with lower likelihood for postpartum depression symptoms compared with states with least generous paid leave (aOR = 0.85; 95% CI, 0.76-0.94). In addition, more generous state paid leave was also associated with a significant increase in postpartum visit attendance (aIRR = 1.03; 95% CI, 1.01-1.04) among respondents with Medicaid.

Postpartum visit attendance was 90.9% overall with no significant differences in state postpartum visit attendance rates between the most and least generous states.

“We need both research and political action moving forward. Future research focusing on workers’ understanding and use of paid family and medical leave benefits and further demonstrating the already known economic and workplace benefits of paid family and medical leave will help to further build a body of evidence supporting paid family and medical leave,” Perry said. “Importantly though, we need political action. A majority of Americans are in support of paid family and medical leave. We need legislators at the local, state and national level to come together and develop paid family and medical leave policies.”

For more information:

Madeline F. Perry, MD, can be reached at madeline.perry@nm.org.