Variations in breastfeeding practices across Europe can be explained in part by differences in social policies, primarily the length of maternity leave (for example, Sweden, Finland, and Portugal offer long and well-paid maternity leave), but also paternity leave and the availability of flexibility for parents to share leave, which encourages both the initiation and continuation of breastfeeding. According to the conceptual model proposed by the Lancet Breastfeeding Series, the determinants of breastfeeding depend on the socio-cultural context, the practices of the infant formula industry, the healthcare system, the composition of the family or community, and the workplace. Individual factors also come into play, including the mother-child relationship. "Baby-Friendly" hospitals (BFHI) also play a role in encouraging mothers who are starting to breastfeed¹.

Turning to the workplace and employers, while regulations exist governing the rights of breastfeeding mothers, continuing to breastfeed upon returning to work can be particularly difficult.
In Europe, breastfeeding remains a socially stratified practice. In fact, we observe that the most highly educated women, those who are financially better off, and women in senior management roles breastfeed more frequently than less educated women, women with lower incomes, and women in jobs with less responsibility or in manual roles. To reduce this inequality, we need to improve our understanding of the social determinants associated with continuing to breastfeed and, in particular, structural determinants such as employment. This is important given that women who breastfeed more are those who have chosen to work part-time or take a temporary break from employment, and this is a choice that results in a drop in income and affects women’s careers. Improving support for working mothers who choose to breastfeed is not only a public health issue, but also a crucial component in the fight against gender inequalities and, more broadly, social inequalities in health from early childhood. This is because early intervention in the first two years of life after birth has a decisive impact on a child’s development and the health of the adult they will become. The "First 1000 Days," a campaign launched by UNICEF, promotes a holistic approach to the health of mothers and children to foster environments in which pregnancies and newborns can thrive.

The aim of this literature review was therefore to identify which aspects of women’s employment enable mothers to continue breastfeeding when they return to work.

¹The "Baby-Friendly Hospital Initiative" (BFHI) was launched in 1991 by the WHO and UNICEF. One of the main aims of this initiative is to promote breastfeeding. The results of a Santé publique France study of BFHI hospitals in France will be covered in the next "Article of the Month: 3 questions for..."

This study reveals that being self-employed, working in a non-manual profession with flexible hours, having a room to breastfeed in at work, receiving support from colleagues, and having a workplace breastfeeding support policy in place are the most important factors that encourage mothers to continue breastfeeding. These conditions appear to foster a sense of freedom, capability, and motivation in mothers, playing a crucial role in breastfeeding practices. This means that the barriers and enablers for breastfeeding when returning to work relate to three interrelated aspects of employment: 1) the type of job (e.g., job status, job title), 2) working conditions (e.g., flexibility), and 3) the work environment (e.g., social support, facilities). However, these aspects are rarely examined together in public health studies and initiatives.

The top priority is to take action to support working mothers who are socioeconomically disadvantaged and who choose to breastfeed, which is of key importance given the many barriers these mother-child pairs face.

This means introducing policy guidelines or workplace interventions to promote a balance between work and family life: for example, low-skilled or insecure jobs could be targeted and encouraged to increase flexibility or reorganize manual workstations to reduce the stress they cause, as a way to address social inequalities in health, with a particular focus on breastfeeding practices.

More broadly, promoting work-life balance during this crucial time of a new baby’s arrival must address the issue of gender inequalities in domestic work. In this regard, this research also calls for action on a larger scale in Europe, with the implementation of regulations on parental leave that is well-paid, flexible, and fair for both parents.

Santé publique France’s breastfeeding strategy is to promote breastfeeding-friendly environments everywhere, including in the workplace.