Pandemic policies and breastfeeding: A cross-sectional study during the onset of COVID-19 in the United States

Abstract

The United States is one of the few countries, and the only high-income country, that does not federally mandate protection of postpartum employment through paid postpartum maternity and family leave policies. At the onset of the COVID-19 pandemic in the U.S., stay-at-home orders were implemented nationally, creating a natural experiment in which to document the effects of de facto paid leave on infant feeding practices in the first postpartum year. The purpose of this cross-sectional, mixed-methods study was to describe infant and young child feeding intentions, practices, decision-making, and experiences during the first wave of the COVID-19 pandemic in the U.S. Quantitative and qualitative data were collected March 27–May 31, 2020 via online survey among a convenience sample of respondents, ages 18 years and older, who were currently feeding a child 2 years of age or younger, yielding 1,437 eligible responses. Nearly all (97%) respondents indicated an intention to feed their infant exclusively with human milk in the first 6 months. A majority of respondents who were breastfeeding (66%) reported no change in breastfeeding frequency after the implementation of COVID-19 stay-at-home orders. However, thirty-one percent indicated that they breastfed more frequently due to stay-at-home orders and delayed plans to wean their infant or young child. Key themes drawn from the qualitative data were: emerging knowledge and perceptions of the relationship between COVID-19 and breastfeeding, perceptions of immune factors in human milk, and the social construction of COVID-19 and infant and young child feeding perceptions and knowledge. There were immediate positive effects of stay-at-home policies on human milk feeding practices, even during a time of considerable uncertainty about the safety of breastfeeding and the transmissibility of SARS-CoV-2 via human milk, constrained access to health care services and COVID-19 testing, and no effective COVID-19 vaccines. Federally mandated paid postpartum and family leave are essential to achieving more equitable lactation outcomes.

Perinatal care and breastfeeding education during the COVID‐19 pandemic: Perspectives from Kenyan mothers and healthcare workers

“…Another study also found that participants in the United Kingdom who had stopped BF were more likely to have been told by health professionals or friends and family that BF was unsafe or to have been told that having symptoms of COVID‐19 did not allow BF (Costantini et al, 2021 ). Similar findings were reported during the first wave of the COVID‐19 pandemic in the United States (Palmquist et al, 2022 ).…”

“…For example, one mother stated, 'I was employed but we went to online sessions, and I had planned to resign so as to breastfeed, but Mothers desired to receive more in-person support from peers, family, childcare providers and lactation specialists during their lactation periods (Snyder & Worlton, 2021). A larger mixedmethods study conducted during this same period for the United States found that 66% of participants who were BF before the COVID-19 stay-at-home orders continued BF and of these 31% breastfed for longer than they had initially planned due to increased close proximity to their infants (Palmquist et al, 2022). Perceptions of the importance of BF and human milk in providing immunological protection to their infants were a key factor to continue BF despite the circulation of conflicting guidance from HCW.…”

The Role of Nurses, Midwives, and Doulas in Breastfeeding Education and Rates: Changes During the COVID-19 Pandemic

“…Our nding does not align with studies reporting a decrease in breastfeeding rates and support during the pandemic (6, 8). However, these ndings align with the literature reporting that COVID-19 stay-at-home orders delay breastfeeding cessation plans (32).…”

Implementing recommended breastfeeding practices in healthcare facilities in India during the COVID-19 pandemic: a scoping review of health system bottlenecks and potential solutions

“…While our analysis highlights that the challenges to breastfeeding existed across all the six pillars, these were complex and systemic. It is inadequately understood as to how populations and health systems respond to public health emergencies given their unique lived experiences, risk perceptions and preparedness ( 61 ). Nevertheless, breastfeeding practices continue to be amenable to socio-cultural influences, at least in resource constrained settings ( 62 – 64 ).…”