Term of Award

Summer 2019

Degree Name

Doctor of Public Health in Public Health Leadership (Dr.P.H.)

Document Type and Release Option

Dissertation (restricted to Georgia Southern)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


College of Public Health

Committee Chair

Yelena Tarasenko

Committee Member 1

Kelly Sullivan

Committee Member 2

Nandi Marshall


Objective: Breastfeeding laws are expected to positively effect social and physical environments by creating opportunities and supportive environments for mothers to breastfeed, increasing access to available lactation resources, and expanding breastfeeding rights, to name but a few pathways. Positive effects of breastfeeding laws can improve breastfeeding outcomes, including those of neonates.

This study examined whether state breastfeeding policies influenced breastfeeding initiation and duration among U.S. women with a live birth from 2004 to 2016.

Methodology: The quasi-experimental study was based on data from the Pregnancy Risk Assessment Monitoring System and the National Conference of State Legislatures. The difference-in-differences model was used to estimate effects of breastfeeding laws comparing differences in breastfeeding prevalence before and after laws went into effect in states compared to those without relevant legislative changes during the study period. The overall adjusted effects of each type of law on breastfeeding outcomes and potential interaction effects of each type of law with maternal race and ethnicity, age, education, marital status, and WIC participation were examined using logistic regression analyses with post-estimated predicted probabilities and marginal effects.

Findings: Between 2004 and 2016, 85% of women initiated breastfeeding, and less than 60% continued breastfeeding for at least 8 weeks. There was no overall statistically significant difference in prevalence of breastfeeding initiation and continuation between states with and without workplace laws, supplementary workplace laws, or childcare laws in the unadjusted and adjusted analyses. However, several interaction effects were observed, particularly among mothers who typically have the lowest breastfeeding prevalence. Mothers with only 12 years of education residing in states with supplementary workplace laws had higher adjusted odds of breastfeeding initiation than those with fewer years of education. Hispanic and non-Hispanic black women residing in states with breastfeeding childcare laws had higher adjusted odds of breastfeeding initiation than their non-Hispanic white counterparts.

Conclusions: State breastfeeding laws tend to have differential effects by subpopulation groups. The implementation of comprehensive workplace and public breastfeeding policies has the potential to improve breastfeeding prevalence by reducing the gap in breastfeeding disparity.

OCLC Number


Research Data and Supplementary Material