Unconditional cash and breastfeeding among low-income mothers: Evidence from Baby’s First Years

• In Event: Baby’s First Years: Early Findings from a Poverty Reduction Intervention in Early Childhood

Abstract

Breastfeeding is associated with a wide range of health benefits for infants and their mothers (Meek & Noble, 2022), yet U.S. women, particularly women living with low income, face multiple obstacles when attempting to breastfeed. While 83% of U.S. mothers initiate breastfeeding, few breastfeed exclusively for 6 months (24.9%), with even lower rates of breastfeeding among low-income populations (CDC, 2022). Breastfeeding can be difficult; many women report receiving little professional or personal support in their breastfeeding efforts (e.g., Bai & Wunderlich, 2013), as well as challenges with lactation and pumping milk (e.g., Odom et al., 2013). These barriers can be particularly impeding for low-income mothers, who may be unable to access and/or afford professional lactation help, breastfeeding pumps, and other supports (Mercier et al., 2018; Ray et al., 2018). Employment also influences breastfeeding behavior: mothers who return to work full-time and/or shortly after giving birth have lower rates of breastfeeding initiation and shorter breastfeeding durations (Mirkovic et al., 2016), while women who work in administrative or manual labor positions also breastfeed less (Kimbro, 2006). As low-income women are more likely to work in these roles and less likely to have paid maternity leave, employment patterns may partially explain disparities in breastfeeding rates by socioeconomic status.

Improving the economic situation of low-income women could therefore increase breastfeeding initiation and duration by providing mothers the resources to purchase breastfeeding supports and/or delay returning to work. To assess the role of poverty reduction on breastfeeding behavior, we evaluate the impact of a reliable, unconditional, monthly cash transfer on breastfeeding behaviors among participants in the Baby’s First Years study, which randomized mothers to receive $333/month or $20/month for the first several years of their children’s lives. Prior to treatment assignment, mothers were asked about their intentions to breastfeed. Most mothers (77%) planned to breastfeed and reported anticipating breastfeeding for an average of 9.6 months. Follow-up measures were collected around the time of the infant’s first birthday. Among those who intended to breastfeed, 94% reported ever-breastfeeding. However, mothers reported breastfeeding for a much shorter duration than intended: 4.4 months on average. We conducted intent-to-treat analyses on ever-breastfeeding, length of breastfeeding, exclusive breastfeeding, and age at which formula was introduced. Table 1 shows that we found no statistically detectable impacts on any of these measures.

To understand the underlying processes that influence breastfeeding behavior among our study population, we will utilize data on income, household structure, birth hospital, and maternal well-being to investigate the factors within the control sample that predict breastfeeding initiation, breastfeeding duration, and mothers’ ability to meet their breastfeeding intention. These results will provide a richer understanding of the socioeconomic factors beyond employment and social support that predict mothers’ breastfeeding practices as well as inform heterogeneity analyses using the full sample to assess whether poverty reduction improves breastfeeding rates among certain subgroups. Together, our intent-to-treat estimates along with our exploratory analyses on factors that predict breastfeeding practices can inform the design of programs aimed at improving breastfeeding rates among low-income populations.

Authors

• Laura Stilwell, Duke Univeristy
  Presenting Author

• Lisa Gennetian, Duke University

• Katherine Magnuson, University of Wisconsin - Madison

• Greg J Duncan, University of California, Irvine

• Sarah Halpern-Meekin, University of Wisconsin-Madison

• Hirokazu Yoshikawa, New York University

• Nathan A Fox, University of Maryland - College Park

• Kimberly G Noble, Teachers College, Columbia University