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Pregnancy, Breastfeeding, and Women’s Employment

Does the pursuit of infant health come at a high financial price for mothers?

Motivated by a recent study linking higher regional unemployment in Spanish provinces to lower neonatal mortality, a March article in The Atlantic magazine asked whether mothers who work less have healthier babies (Khazan 2014). In fact, although findings are mixed cross-nationally, there is some evidence that in the US and in Spain that babies born during recessions have lower rates of birth defects, lower neonatal mortality, and healthier birth-weights (Aparicio and Gonzalez 2014; Dehejia and Llera-Muney 2004).

However, these findings should be interpreted with caution. Most fundamentally, these studies link the regional unemployment rate with better maternal and infant outcomes—irrespective of pregnant women’s own unemployment status (Aparicio and Gonzalez 2014; Dehejia and Llera-Muney 2004). In fact, the article on Spanish mothers explicitly notes that the effect of regional unemployment is not explained by the mother’s own employment status (Aparicio and Gonzalez 2014). Instead, it seems that regardless of their own employment status, fertility-age women engage in healthier behaviors during recessions, drinking and smoking less, and exercising and sleeping more. Given this causal path, it would be illogical to suggest that pregnant mothers should universally quit their jobs to protect their babies’ health.

The suggestion that perhaps pregnant women should forego employment to improve infant health parallels the controversy over the societal and institutional mandate to breastfeed. US public health guidelines recommend exclusive breastfeeding for six months (Center for Disease Control), despite the dearth of evidence establishing a firm causal link between breastfeeding in developed countries and improved infant and child health (Filteau 2000; Hediger et al. 2001; Kovar et al. 1984; Kramer et al. 2001; Kramer et al. 2009). Unfortunately, breastfeeding is incompatible with many job environments. Indeed, women who breastfeed for the recommended six months or longer suffer more severe and more prolonged earnings losses than do mothers who breastfeed for shorter durations or not at all, in part because mothers who breastfeed longer reduce their labor supply to a greater extent (Rippeyoung and Noonan 2012).

More generally, the question of whether pregnant and nursing women should sacrifice their employment to pursue the probably-nonexistent benefits of unemployment and moderate-to-nonexistent benefits of (exclusive) breastfeeding echoes broader concerns regarding the financial cost of motherhood. Under the doctrine of intensive motherhood, women are expected to go to any lengths to maximize their childrens’ well-being (Hays 1996). But motherhood lowers lifetime earnings substantially, even for women who do not leave their jobs (Budig and England 2001; Miller 2011). While infant health is undoubtedly a laudable goal, children also benefit from adequate family income. Given that many mothers want or need to remain employed, it would be most productive to focus on the workplace conditions most conducive to positive infant and maternal health behaviors and outcomes, rather than suggesting that expecting or nursing mothers quit their jobs.

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Aparicio, Ainhoa and Libertad Gonzalez. 2014. "Newborn Health and the Business Cycle: Is It Good to Bo Born in Bad Times?" IZA Discussion Paper No. 8031.

Budig, Michelle J. and Paula England. 2001. "The Wage Penalty for Motherhood." American Sociological Review 66:204-225.

Dehejia, Rajeev and Adriana Llera-Muney. 2004. "Booms, Busts, and Babies' Health." The Quarterly Journal of Economics 119:1091-1130.

Filteau, S. M. 2000. "Role of breast-feeding in managing malnutrition and infectious disease." Proceedings of the Nutrition Society 59:565-572.

Hays, Sharon. 1996. The Cultural Contradictions of Motherhood. New Haven, CT: Yale University Press.

Hediger, Mary L., Mary D. Overpeck, Robert J. Kuczmarski, and W. June Ruan. 2001. "Association Between Infant Breastfeeding and Overweight in Young Children." Journal of the American Medical Association 285:2453-2460.

Khazan, Olga 2014. "Do Moms Who Work Less Have Healthier Babies?" The Atlantic.

Kovar, Mary Grace, Mary K. Serdula, James S. Marks, and David W. Fraser. 1984. "Review of the Epidemiologic Evidence for an Association Between Infant Feeding and Infant Health: Methodological Considerations." Pediatrics 74:615-617.

Kramer, Michael S., et al. 2001. "Promotion of Breastfeeding Intervention Trial (PROBIT): A Randomized Trial in the Republic of Belarus." Journal of the American Medical Association 285:413-420.

Kramer, Michael S., et al. 2009. "A Randomized breastfeeding promotion intervention did not reduce child obesity in Belarus." Journal of Nutrition 139:417S-421S.

Miller, Amalia. 2011. "The Effect of Motherhood Timing on Career Path." Journal of Population Economics 24:1071-1100.

Rippeyoung, Phyllis L. F. and Mary C. Noonan. 2012. "Is Breastfeeding Really Cost-Free? Income Consequences of Breastfeeding for Women." American Sociological Review 77:244-267.

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