Estimating the effects of paid family leave on breastfeeding behavior in the United States

Abstract

Breastfeeding provides substantial health benefits for both mothers and infants, yet participation rates in the United States remain unequal across racial and socioeconomic groups. Black mothers are significantly less likely to initiate breastfeeding than white mothers. This thesis examines whether state-level Paid Family Leave (PFL) policies improve breastfeeding outcomes, with a focus on Black mothers. Using data from the CDC Pregnancy Risk Assessment Monitoring System (PRAMS) from 2000 to 2022 and labor force data from IPUMS CPS, I analyze four states that implemented PFL policies: New Jersey, New York, Rhode Island, and Washington. I estimate the policy treatment effects using difference-in-differences, triple difference, event studies, and synthetic control methods. Findings indicate that PFL is associated with a 2 percentage point increase in breastfeeding initiation relative to baseline rates. Effects are larger for Black mothers, who see increases of 7 percentage points on average. These results are robust across multiple estimation strategies. Although impacts on breastfeeding duration are limited, the findings suggest that PFL policies meaningfully promote breastfeeding initiation and may serve as a tool to reduce disparities in maternal and infant health.