Motherhood as citizenship? An examination of social policy influences on breastfeeding initiation and duration among European mothers

Background: This study examines how European welfare state arrangements and social policies influence the association between breastfeeding and the social status of women within society. We include different social policy types: welfare regimes, maternity leaves, the prevalence of breastfeeding friendly hospitals (BFHs) and the International Code of Breast Milk Substitutes. We examine whether these social policies and services predict breastfeeding initiation and/or duration. Methods: Eurobarometer data is used to compare initiation and duration levels across 24 European countries within a multilevel regression framework. The 24 countries included in our analyses are divided into six distinct welfare regimes (Anglo-Saxon, Bismarckian, Southern, Nordic, Postcommunistic and Former-USSR). Breastfeeding initiation is defined as mothers who breastfed at least one child versus mothers who did not breastfeed any. Breastfeeding duration measures the months the mother indicated to have breastfed her last child. Results: Our results show that there is an important social policy dimension to the issue of infant feeding. Cross national variation in infant feeding partially reflect policy influences, with highest levels of initiation found in Nordic and CEE regimes and lowers levels found in the Anglo-Saxon and Bismarckian regimes. In addition, the International Code of Breast Milk Substitutes negatively associates with initiation, but positively with duration. BFHs only have a small positive effect on initiation. Conclusion: Our results clearly show an important contextual dimension of infant feeding, where social policies seem to play a distinctive role. Cross national infant feeding differences partially reflect welfare regime and breastfeeding specific policy influences, where social policies influence the relationship between women’s socioeconomic status and BFI and BFD across 24 European countries. Welfare states may thus have an important impact on breastfeeding initiation and duration via the mediation of socioeconomic position and how maternal roles are reconciled