Paid family leave boosted postpartum wellbeing, breastfeeding rates

The U.S. remains one of the few countries without federally mandated paid parental leave, despite its major potential health benefits.

A new Northwestern Medicine study has found postpartum individuals living in states with generous mandated paid family and medical leave (PFML) are more likely to breastfeed and less likely to experience postpartum depression symptoms compared to those living in states with little or no mandated state-paid leave. The findings were even more pronounced among lower-income populations covered by Medicaid.

“By increasing mothers’ ability to breastfeed and reducing postpartum-depressive symptoms, strong state paid family and medical leave laws provide a major boost to the health of postpartum women and infants,” said corresponding author Joe Feinglass, a research professor of general internal medicine at Northwestern University Feinberg School of Medicine. “The differential generosity of these laws is one reason states differ so widely in health status and life expectancy across the U.S.”

Having to return to work is one of the main reasons individuals stop breastfeeding.”

Previous studies have largely looked at pregnancy outcomes in a single state before and after they implemented PFML. This study captured a more national picture by examining states included in the Centers for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System (PRAMS) database (43 states and the District of Columbia).

“Mental health conditions are the leading cause of maternal mortality in the U.S., with perinatal depression symptoms affecting about one in eight new mothers,” said senior author Dr. Madeline Perry, a fourth-year resident in obstetrics and gynecology at Feinberg. “Our study adds to previous research that has also found paid leave reduces the rates of postpartum depression symptoms.”

State-by-state breakdown

Newly postpartum women living in the eight states with the most generous PFML coverage had a 9% greater likelihood of breastfeeding at six months postpartum compared to the 26 states with little or no PFML legislation, the study found.

In states with medium PFML coverage, there was a 10% lower likelihood of developing postpartum depression symptoms after controlling for individual respondent characteristics.

“We also suspected these findings would be greatest among newly postpartum individuals whose delivery was covered by Medicaid, as lower-income mothers were more likely to be forced to return to work more quickly, and this is ultimately what we found,” Perry said.

Among postpartum individuals with a Medicaid-covered delivery, those living in states with the most generous paid family and medical leave coverage had a 32% greater likelihood of breastfeeding at six months postpartum and a 15% lower likelihood of having postpartum depression symptoms, the study found.

Benefits of paid leave

Infant and maternal health benefits of breastfeeding abound, including gastrointestinal function and neurodevelopment in infants. Postpartum individuals who breastfeed have a decreased risk of breast, ovarian and endometrial cancer, and breastfeeding reduces the development of obesity, cardiovascular disease and type two diabetes as children grow into adulthood.

“Having to return to work is one of the main reasons mothers stop breastfeeding,” Perry said. “While the decision on the method of feeding infants is very personal, paid leave allows women the space to actually make the decision to breastfeed in the months after a baby is born.”

Critical in advancing health, economic equity

PFML is fundamentally different than the Family and Medical Leave Act (FMLA), which provides unpaid, job-protected leave to certain workers, Perry said. Although FMLA is legally mandated in all states in the U.S., it lacks income replacement. Many workers with low incomes cannot afford to take leave without pay, and these same people often do not have access to PFML. 

“While FMLA has been associated with an improvement in some postpartum outcomes, these improvements are only seen in a higher-income population," Perry said. “Countrywide PFML is critical to advancing health and economic equity.”

The study was published Nov. 2 in Obstetrics and Gynecology (i.e. the “Green Journal”).