Variations in breastfeeding practices across Europe can be partly explained by differences in social policies, particularly the length of maternity leave (for example, Sweden, Finland, and Portugal offer long, well-paid maternity leave), as well as paternity leave and the flexibility of parental leave arrangements, which support breastfeeding in terms of both initiation and duration.

According to the conceptual model proposed by The Lancet Breastfeeding Series, the determinants of breastfeeding depend on the sociocultural context, the practices of the breast-milk substitute industry, the health care system, the composition of the family or community, and the workplace. Individual factors, including the mother-child relationship, also come into play. “Baby-Friendly” hospitals (IHAB) also play a role in promoting the initiation of breastfeeding.¹
On the workplace and employer side, while regulations exist regarding their obligations toward breastfeeding mothers, continuing to breastfeed upon returning to work can nevertheless prove particularly difficult.

In Europe, breastfeeding remains a socially differentiated practice. Indeed, it is observed that women with higher levels of education, greater financial means, and those in senior management positions breastfeed more than women with lower levels of education, fewer financial resources, and those in blue-collar or white-collar jobs. To reduce this inequality, it is necessary to better understand the social determinants associated with continuing breastfeeding, particularly structural determinants such as employment. Indeed, women who breastfeed more are those who have chosen part-time work or a temporary career break—choices that lead to a decrease in income and affect women’s professional careers.

Better supporting working mothers who choose to breastfeed is not only a public health issue but also a crucial element in the fight against gender inequalities and, more broadly, social health inequalities from the very beginning of life. Indeed, early intervention during the first two years of life after birth is critical for a child’s development and the health of the adult they will become. This concept of the “first 1,000 days,” launched by UNICEF, enables a comprehensive approach to maternal and child health to promote environments conducive to the harmonious development of the fetus and the newborn.

The objective of this literature review was therefore to identify the characteristics of maternal employment that support continued breastfeeding upon returning to work.

¹ The Baby-Friendly Hospital Initiative (BFHI) was launched in 1991 by the WHO and UNICEF. This initiative aims, in particular, to promote breastfeeding. The results of the Santé publique France study of BFHI hospitals in France will be featured in the next “Article of the Month” section: “3 Questions for…”.

This study reveals that being self-employed, working in a non-manual profession with flexible hours, having access to lactation rooms at work, receiving support from colleagues, and benefiting from a workplace breastfeeding support policy are the most important factors that encourage mothers to continue breastfeeding. These conditions are believed to foster mothers’ autonomy, capability, and motivation, which play a crucial role in breastfeeding practices. Thus, the barriers and enablers to breastfeeding upon returning to work relate to three interrelated dimensions of employment: 1. the type of employment (e.g., employment status, job title), 2. working conditions (e.g., flexibility), and 3. the work environment (e.g., social support, facilities). These dimensions are, however, rarely investigated together in studies and public health initiatives.

It is particularly important to prioritize support for socioeconomically disadvantaged mothers who are employed and choose to breastfeed, given the multitude of adverse factors to which these mother-child dyads are exposed.

Policy guidelines or workplace interventions are therefore necessary to promote work-life balance: for example, targeting low-skilled or precarious jobs by increasing flexibility and reorganizing manual workstations to make them less stressful could be a relevant approach to reducing social inequalities in health, particularly in relation to breastfeeding practices.

More broadly, promoting work-life balance at this crucial time of a child’s arrival must address the issue of gender inequalities in domestic work. Thus, this study also advocates for actions at a broader level in Europe, including the implementation of regulations on well-paid, flexible, and equitable parental leave for both parents.

Santé publique France’s strategy regarding breastfeeding is to promote an environment conducive to breastfeeding in general, including the workplace.