Abstract
Introduction
Despite the numerous benefits of breastfeeding, there remain some costs to the practice. Because of this, a mother's decision to breastfeed or formula feed is more complex than just assessing the health and environmental benefits. Few studies and fewer breastfeeding promotion campaigns have examined the potential drawbacks of breastfeeding; yet, by better understanding the costs of breastfeeding and addressing them, it is likely that more women will be able to achieve their breastfeeding goals. In our research, we examine two costs of breastfeeding: the impact of breastfeeding on mothers' time in paid work and on fathers' time in unpaid work in the home. Our goal is not to discourage women from breastfeeding but rather to encourage policy makers and breastfeeding advocates to address some of the potential negative consequences of engaging in the practice.
Breastfeeding and Women's Earnings
One factor that has been studied extensively is the relationship between type of infant feeding and mother's employment. Most past research demonstrates that breastfeeding is highly incompatible with paid employment. 3 Women who are most successful at breastfeeding, especially for long durations, tend to be either professional women, who have flexibility and privacy during the working day, or women married to high-earning spouses, who can afford to be full-time at-home mothers. Most of the research in this vein has looked at work as a barrier to breastfeeding, proposing two solutions to this obstacle: (1) make work more breastfeeding friendly or (2) encourage women to work less or not at all after birth.
Considering that work and breastfeeding are incompatible for most women in the United States, we asked: What price do women pay in terms of earned income in order to breastfeed for the recommended durations? (Rippeyoung PLF, Noonan MC. Is Breastfeeding Truly Free? The Economic Consequences of Breastfeeding for Women. Unpublished paper presented at the Annual Meeting of the American Sociological Association, Detroit, MI, 2009). For example, women who want to breastfeed may find it necessary to reduce their work effort in order to breastfeed, by taking an unpaid leave, working fewer hours, or quitting their jobs. 4 These actions will result in lost current income, as well as lost future income via earnings depreciation and/or foregone earnings appreciation when they return to work. An example of this was put to words in sociologist Sharon Hays's qualitative research on motherhood in the United States, when a respondent stated: 5
The first time cost me $20,000 in savings to nurse her for six months. That's what I burned through by staying home! I couldn't afford to do that the second time. You can think you're going to nurse for six months, but wait ‘til you see what that costs when your salary isn't coming in.
In our research, we wanted to know whether this woman's experience combining work and breastfeeding was generalizable to other mothers. To address this question, we used the National Longitudinal Survey of Youth 6 to follow women from 1 year before birth to 5 years after birth. Our sample included women who worked in the year prior to their first childbirth. We found that, in fact, women who breastfed for longer than 6 months experienced more earnings loss than women who breastfed for less than 6 months or not at all. As breastfeeding duration increased, earnings decreased. The main reason for the relationship between type of infant feeding and earnings was that women who breastfed for longer durations were more likely to decrease their time at paid work.
It is important to note that we cannot be certain that the decision to breastfeed caused mothers to reduce their time in paid work. For example, the pattern we observed may be a result of concurrent “choices” that women are making (i.e., after having a baby a woman chooses both to breastfeed and to become a stay-at-home mom). Regardless, the important message from our research is that women who meet the recommended breastfeeding targets—targets that are associated with “good mothering”—are economically penalized for doing so.
Breastfeeding and Father Involvement in Infant Care
The second issue that we investigated was the impact of breastfeeding on father involvement in infant care. We were curious to see if breastfeeding let men “off the hook,” so to speak, for caring for their children. There is little existing nationally representative research on this topic. There are, however, many small qualitative studies examining how women make infant feeding decisions, and one common refrain is that they chose to feed their infants formula in part because they wanted their baby's fathers to be more bonded with the baby and to be more involved in caring for the infant. 7 Although breastfeeding advocates often note that fathers can be very involved in caring for a breastfed infant8,9 (i.e., by performing non–feeding-related infant care), empirical research investigating this issue is limited.
Our study uses the Early Childhood Longitudinal Study Birth Cohort data 10 to examine the relationship between type of infant feeding and fathers' self-reports of involvement in a wide range of parenting activities. 11 Frequency of involvement in these activities was measured at two time points: when the infant was 10 months old and again when the toddler was 2 years old. The activities included feeding, bathing, dressing, and diapering the infant, as well as more nurturing activities like soothing the baby when upset or putting the infant to sleep at night.
Our analysis revealed a rather low level of infant involvement for all fathers, but with differences based on type of infant feeding at the first time point: Fathers of breastfed 10-month-old infants performed nearly every activity less frequently than the fathers of formula-fed infants. This result is likely a conservative estimate of the true relationship between method of infant feeding and father involvement in infant care because younger babies would need to be breastfed more frequently and thus likely be even more of the mother's responsibility. In order to see if there was a long-term relationship between method of infant feeding and father involvement in infant care, we examined the father's involvement when the infants were 2 years old. We split the fathers into three categories: Those with children who were never breastfed, those with children breastfed for less than 6 months, and those with children breastfed for longer than 6 months. Overall, the three groups of fathers were very similar with respect to their reported involvement in infant care.
Although our research suggests that breastfeeding does not have a permanent long-lasting impact on father involvement in infant care, the fact that fathers do less when infants are currently being breastfed may be one explanation for why women stop breastfeeding before the recommended duration. If women find that breastfeeding leads to an unfair division of labor in the home, they may be reluctant to continue the practice. Future research should explore this possibility.
Proposed Solutions
Overall, our research suggests two costs associated with long-duration breastfeeding. Compared with women who formula-feed or breastfeed for short durations, women who breastfeed for at least 6 months have greater earnings losses after birth and have partners who report less involvement in infant care. For academics interested in addressing gender inequality at work and at home, the simplest solution would be to advocate formula over breastmilk. Another solution would be to develop new technologies to make formula the same as breastmilk and bottles the same as breasts: Invent the perfect formula, make the perfect bottle. This could be a possibility if our government devoted the same resources and funding into breastfeeding substitute technology as is being poured into other social problems, such as developing alternative energy sources.
However, even if new breastfeeding substitutes were developed, this would not necessarily be an ideal solution for women. As feminist breastfeeding advocate and critical theorist Bernice Hausman 12 argues, breastfeeding is something that women's bodies do, and to deny them the right to use their bodies is an injustice. Thus, we argue that social policies need to move beyond encouraging women either to engage in a practice that leads to a loss of financial and familial autonomy (i.e., breastfeeding) or to engage in a practice that leads to a loss of autonomy over their bodies (i.e., formula feeding). So, how might we address some of the costs of breastfeeding?
First, we need data that will better inform social policy. Currently, there are few nationally representative surveys that collect data on method of infant feeding and paid and unpaid work. Longitudinal data are especially needed because they allow researchers to better establish the proper time order between key variables. For example, longitudinal data allow researchers to track changes in individual women over time to see how breastfeeding impacts their home and work lives.
Second, it is essential that the state take at least partial responsibility for the care of infants via paid parental leave, as is done in all industrialized countries except the United States. 13 Several empirical studies have shown a positive association between paid parental leave and duration of breastfeeding.14,15 Thus, paid parental leave has the potential to increase breastfeeding rates and extend the duration of breastfeeding among those engaging in the practice.
Third, we need more baby-friendly workplaces that view workers as individuals with responsibilities outside of the workplace. Few families today have a stay-at-home parent who can care for a new infant; employers need to work harder to accommodate this reality and support breastfeeding workers. 3 Support of breastfeeding in the workplace made progress in 2010 with the adoption of the federal Breastfeeding Promotion Act. 16 This law requires large employers to provide breastfeeding employees, who are hourly workers, with space and unpaid time off during the workday to express milk. Although this law is a step in the right direction, there remains a need for a federal policy that provides paid time off for all breastfeeding mothers, regardless of the size of their workplace and pay type, and that has penalties for employers who do not comply with the regulation. This is crucial as smaller firms with low wages and part-time employees have historically been laggards when it comes to employee benefits. 17
Fourth, public health campaigns that promote breastfeeding need to shift their focus away from mothers and toward employers, communities, and fathers. Most women know that breastfeeding offers numerous health benefits for their child, but for some women the costs outweigh these benefits. Thus, rather than pressuring women to breastfeed, campaigns should be redirected toward encouraging employers to develop programs that support breastfeeding employees. Our society needs to raise public awareness of the benefits of breastfeeding and public breastfeeding laws. Fathers and partners should be encouraged to support breastfeeding by engaging in more housework and infant care. Breastfeeding advocacy groups could design posters with slogans encouraging fathers to support their partners if they choose to breastfeed (e.g., “Dads who do the dishes are doing the best for their breastfed babies”). Such notices could be put in the offices of medical doctors who tend to see more men (e.g., urologists and proctologists) and in men's rest rooms and locker rooms.
A most radical “solution” is to get men breastfeeding. Men have the capacity to lactate, and, in some cases, men are capable of nourishing infants with their breastmilk. 18 We raise this possibility not because we think it would be possible to legislate, or even that it would be a good idea to take away a mother's unique place in her infant's world. Instead, we introduce this idea because it challenges us to think more carefully about what society is asking of mothers when we recommend exclusive breastfeeding of infants for a minimum of 6 months. Would we find greater societal support of breastfeeding if both men and women engaged in the practice?
As much as many say it is, breastfeeding is not “free,” and pretending it is will neither solve the problems that women who wish to breastfeed face, nor will it increase breastfeeding rates. Only by discussing the costs associated with breastfeeding in an open and honest manner can creative policies be designed to support women and breastfeeding. Otherwise, society will continue to free-ride off the breasts of women. 19
Footnotes
Disclosure Statement
No competing financial interests exist.