New Jersey’s Paid Family Leave Policy: Effect on Breastfeeding Practices among Postpartum Women

Background: Breastfeeding is beneficial to maternal and infant health. Lack of paid maternity leave has been found to be a barrier to breastfeeding. In the U.S., five states and the District of Columbia have implemented, or are in the process of implementing, paid family leave policies which may support breastfeeding. While some evidence suggests state paid family leave policies are associated with increased breastfeeding rates, the results are mixed.

Objective: To estimate the impact of a paid family leave policy on breastfeeding practices in New Jersey.

Methods: We applied a difference-in-difference model to estimate change in maternal breastfeeding initiation and duration before and after NJ implemented a paid leave policy (July 1, 2009) compared to two comparison states. We used 2007-2012 data from the Pregnancy Risk Assessment Monitoring System (PRAMS), a state-based surveillance system to assess maternal behaviors and experiences shortly before, during, and after pregnancy. Maryland and Delaware, adjacent to NJ, had 2007-2012 PRAMS data available, and pre-policy trends on breastfeeding outcomes similar to NJ. Outcomes included whether women ever breastfed their infant (initiation) and whether breastfeeding continued at 4, 8 and 12 weeks postpartum (duration). We estimated a multi-variate linear regression model, controlling for potential confounders that might affect breastfeeding practices and women’s decision on maternal leave; which included maternal age, race/ethnicity, education, insurance coverage, pregnancy intention, previous live births, infant sex (from PRAMS), state unemployment rate and per capita income (from Census), and state breastfeeding score (from CDC’s Maternity Practices in Infant Nutrition and Care Survey). We conducted subgroup analyses to estimate the heterogeneous policy effects across women’s race/ethnicity and education.

Results: Before the policy change in NJ, 80% of women initiated breastfeeding with 68%, 58%, and 51% breastfeeding duration at 4, 8, and 12 weeks, respectively. In both NJ and the comparison states, rates of breastfeeding initiation and duration increased over time. After policy implementation, no significant change was found in breastfeeding initiation or breastfeeding at 4 or 8 weeks between women residing in NJ and comparison states. However, compared with women residing in comparison states, the likelihood of any breastfeeding among NJ women at 12 weeks increased by 5 percentage points (p=0.04). After policy implementation in NJ, the probability of any breastfeeding at 8 and 12 weeks increased by 13.7 and 15.5 (p<0.01) percentage points respectively for non-Hispanic Blacks, and increased 14.8 (p=0.02) and 13.2 (p=0.04) percentage points respectively for women with less than a high school education had a compared with these sub-populations in the comparison states. The results were insignificant for other race/ethnicity groups and women with high school or higher education.

Conclusions and Policy Implications: NJ’s paid family leave policy had a positive impact on breastfeeding duration, particularly among those with traditionally lower rates of breastfeeding. These results provide evidence of the benefits of a paid family leave policy for states who have implemented or are considering passing a paid family leave policy.