Welfare work requirements limit breast-feeding, study shows

August 22, 2003
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ANN ARBOR—The work requirements in welfare reform have apparently decreased the number of children who are breast fed, a trend which may lead to higher healthcare rates. If welfare reform had not been adopted in 1996, national breast-feeding rates would have been 5.5 percent higher by 2000, according to a study published in the August issue of the journal Demography.

The researchers also examined breast-feeding rates of mothers enrolled in the Women, Infants and Children (WIC) nutrition program, a federal program for low-income women eligible for welfare. Among WIC mothers in states with the most stringent welfare work requirements, breast-feeding rates six months after birth were 22 percent lower than those of WIC mothers in other states, reported demographers Steven Haider of Michigan State University, Alison Jacknowitz of the RAND Graduate School, and Robert Schoeni of the University of Michigan.

“Studies have shown that breast-feeding decreases health care costs, and a reduction in breast-feeding may put a greater financial burden on the Medicaid program,” said Schoeni, a senior associate research scientist at the U-M Institute for Social Research (ISR), the world’s largest academic survey and research organization.

The team based its study of annual breast-feeding rates for 1990–2000 for all 50 states and the District of Columbia on the Ross Labs Mothers Survey, an annual mail survey of more than 100,000 new mothers. The study took into account the wide variety of state policies and the different dates those policies were enacted. The analysis focused on whether states required welfare mothers of infants to work, the number of work hours required, and the penalties faced if the work requirements were not met. States with the most stringent policies required 32 hours or more of work and withheld the entire family’s benefits if the requirement was unmet. Before the 1996 welfare reforms, mothers with infants were exempt from any work requirements.

The American Academy of Pediatrics recommends six to 12 months of breast-feeding for child health and development. Nationwide, breast-feeding rates among all women—including WIC mothers—rose during the 1990s, reflecting “the growing belief that breast milk is the optimal source of nutrition for infant health,” said Shoeni, who is also an associate professor at the U-M Gerald R.

Ford School of Public Policy and in the U-M Department of Economics. But the researchers found that breast-feeding rates among WIC mothers stagnated in states with the strictest welfare work policies.

The researchers suggested that as states refine their welfare programs, they “must weigh the potential health costs of requiring work for mothers with infants against the benefits of moving families toward self-sufficiency through employment.”

They found that the combination of requiring at least 17 hours of work a week and sanctioning policies that withhold a families’ entire benefit if work hours are not met—as is done in 28 states—had the most dramatic impact on breast-feeding rates. If states avoided this combination of policies, the “vast majority of harmful effects would be eliminated,” they reported.

States with the most stringent policies in 2000 (32 or more hours of work required for mothers with a six-month old and withheld the entire family’s benefits if the work requirement was unmet) were Arizona, New Jersey, Tennessee and Wisconsin.

States that required 17 to 31 hours of work for mothers with a six-month old and also withheld the entire family’s benefits if the work requirement was unmet in 2000 were Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Kansas, Kentucky, Louisiana, Mississippi, North Dakota, Nebraska, New Mexico, Michigan, Nevada, Ohio, Oklahoma, South Carolina, South Dakota, Virginia, West Virginia and Wyoming.

Demography is a peer-reviewed journal of the Population Association of America.

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Population Reference Bureau

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