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Chapter 12 144 It is simple enough—breastfeeding is the biologic norm, and it is good for babies and mothers. On this point, most would agree. However, like many other relationships in women’s lives, maintaining a breastfeeding relationship can be complicated. Many factors influence both initiation and duration of breastfeeding, including the employment of the breastfeeding mother.1 Women’s employment is also influenced by many factors, including race, education, and economic conditions.2 Seldom, however, have the factors that influence both employment and breastfeeding been addressed together in research studies, either in the health or public policy literature. In keeping with the Social-Ecological Model, this chapter first reviews the scientific evidence on how employment characteristics, race, and socioeconomic status influence breastfeeding levels. In order to facilitate discussion and research, a conceptual framework for the relationship between these factors is presented below. We then discuss each set of factors and how they contribute to explaining breastfeeding rates, focusing on the ways in which they interact to re-create social inequities.3 Second, we argue that women’s emergence into the regular labor force over previous decades created social expectations for working mothers that fit uneasily with public policy, and we discuss recent actions at the state and federal levels to address this disconnect. We particularly highlight the ways in which breastfeeding policy simultaneously advantages some women while disadvantaging others, most often intersecting with socially constructed class and race identities.4 Working out Work Race, Employment, and Public Policy Jennifer C. Lucas and Deborah McCarter-Spaulding Working out Work 145 Race and Socioeconomic Status Important racial disparities have been documented in breastfeeding rates, with black women being less likely to breastfeed than nonblack women, contributing to higher infant mortality in black infants.5 In contrast, Hispanic women have been reported to be more likely than non-Hispanic to breastfeed, in spite of relative socioeconomic disadvantage.6 Asian women have the highest breastfeeding initiation and continuation at three months of all racial and ethnic groups. Immigrant women also had higher breastfeeding initiation and duration rates than nonimmigrant women, suggesting that acculturation has a detrimental effect on breastfeeding outcomes.7 Socioeconomic status (SES) is also acknowledged as a variable influencing breastfeeding, with higher income mothers breastfeeding longer, regardless of race.8 While race and SES are acknowledged as important variables, it is clear that their relationship to breastfeeding and to each other is complex at best.9 In particular, race and socioeconomic status influence the employment characteristics of childbearing and breastfeeding women.10 Employment Characteristics: Structural Employment of the breastfeeding mother is known to influence breastfeeding initiation, duration, and exclusivity (breastfeeding only, or in combination with formula-feeding). Each of these breastfeeding outcomes is important to consider, as the health benefits of breastfeeding are dose-related, thus longer and more exclusive breastfeeding will potentially increase the benefits of breastfeeding to mother and infant. Interventions to promote and support breastfeeding would differ depending on which variable—initiation, duration, or exclusivity—is being addressed. Research findings on the influence of employment on breastfeeding vary somewhat but suggest that returning to work outside the home decreases breastfeeding initiation, duration, and exclusivity. It appears that the more hours a woman works (work intensity), the greater the negative effect of employment on breastfeeding. The length of time a woman stays home prior to returning to outside employment also has an effect on breastfeeding duration. The most negative effect of employment on breastfeeding occurs during the first three months after birth.11 Women make breastfeeding decisions based on employment characteristics first, rather than making employment decisions based on their breastfeeding relationship.12 More educated women, as well as women who were Asian or white were more likely to work full time, and more educated women returned to work sooner after birth, particularly if they worked full time. Sociologist Barbara Reskin notes that occupational segregation occurs not only by sex, but also by ethnicity, resulting in women of color having jobs that pay less and have fewer benefits, fewer hours of work, and fewer opportunities for advancement.13 Women who work in professional, managerial, salaried, or particularly fulfilling or autonomous occupations are more likely to breastfeed .14 Mothers in small companies or those who work atypical hours are more likely to initiate breastfeeding, supporting the notion that women’s breastfeeding decisions are based on having employment they believe will be compatible and supportive of breastfeeding...


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