Journal of Occupational Health Psychology

© 2018 American Psychological Association 2018, Vol. 23, No. 4, 457– 470
1076-8998/18/$12.00 http://dx.doi.org/10.1037/ocp0000119

Identifying Job Characteristics Related to Employed Women’s

Breastfeeding Behaviors

Christiane Spitzmueller Jing Zhang

University of Houston California State University San Bernardino

Candice L. Thomas Zhuxi Wang

Saint Louis University University of Houston
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Gwenith G. Fisher Russell A. Matthews

Colorado State University University of Alabama

Lane Strathearn
University of Iowa

For employed mothers of infants, reconciliation of work demands and breastfeeding constitutes a
significant challenge. The discontinuation of breastfeeding has the potential to result in negative
outcomes for the mother (e.g., higher likelihood of obesity), her employer (e.g., increased absenteeism),
and her infant (e.g., increased risk of infection). Given previous research findings identifying return to
work as a major risk factor for breastfeeding cessation, we investigate what types of job characteristics
relate to women’s intentions to breastfeed shortly after giving birth and women’s actual breastfeeding
initiation and duration. Using job titles and job descriptors contained in a large Australian longitudinal
cohort data set (N ⫽ 809), we coded job titles using the U.S. Department of Labor (DOL)’s Occupational
Information Network (OⴱNET) database and extracted job characteristics. Hazardous working conditions
and job autonomy were identified as significant determinants of women’s breastfeeding intentions, their
initiation of breastfeeding, and ultimately their breastfeeding continuation. Hence, we recommend that
human resource professionals, managers, and public health initiatives provide breastfeeding-supportive
resources to women who, based on their job characteristics, are at high risk to prematurely discontinue
breastfeeding to ensure these mothers have equal opportunity to reap the benefits of breastfeeding.

Keywords: breastfeeding, lactation, job characteristics, OⴱNET

The prevalence of dual-career couples with small children has
steadily increased over the past decades, and data from the Bureau
of Labor Statistics indicate that in the United States, 64% of
women with young children are working (The U.S. Bureau of
Labor Statistics, 2016). In many countries, women return to work
within a few months of giving birth. For example, research sug-
gests that 80% of first-time mothers who were employed during
pregnancy return to work within 12 weeks postpartum (Laughlin,
2011), and for mothers with paid leave benefits in Australia, more
than half return to work within 6 –12 weeks postpartum (White-
house, Hosking, & Baird, 2008). Breastfeeding and the use of
breast pumps at work constitute work behavior and involve work-
related decision-making (Spitzmueller et al., 2016). As a result,
many employed mothers attempt to reconcile breastfeeding with
part- or full-time employment. Breastfeeding and the use of breast
pumps at work have important implications for understanding

This article was published Online First May 14, 2018.
Christiane Spitzmueller, Department of Psychology, University of Hous-
ton; Jing Zhang, Department of Management, California State University
San Bernardino; Candice L. Thomas, Department of Psychology, Saint
Louis University; Zhuxi Wang, Department of Psychology, University of
Houston; Gwenith G. Fisher, Department of Psychology, Colorado State
University; Russell A. Matthews, Department of Management, University
of Alabama; Lane Strathearn, Department of Pediatrics, University of
Iowa.
This study is based on work supported by the National Science Foun-
dation under the UH ADVANCE Institutional Transformation Grant
1409928, 2014-2019 and the Mountains and Plains Education and Re-
search Center Grant T42OH009229, funded by the Centers for Disease
Control and Prevention. Any opinions, findings, and conclusions or rec-
ommendations expressed in this material are those of the author(s) and do
not necessarily reflect the views of the National Science Foundation or the
official views of the Centers for Disease Control and Prevention or the
Department of Health and Human Services.
Correspondence concerning this article should be addressed to Chris-
tiane Spitzmueller, Department of Psychology, College of Liberal Arts and
Sciences, University of Houston, 126 Heyne Building, Houston, TX
77204-5022. E-mail: christianes@gmail.com

457
 458 SPITZMUELLER ET AL.
work-related behavior because they occur at work, and because
they take place during work hours— often requiring women to take
two to three breaks per day. Putting the reconciliation of breast-
feeding and work squarely into the domain of organizational
behavior research, employed mothers’ decision to continue breast-
feeding is oftentimes affected by women’s work experiences,
including her supervisor’s support for breastfeeding (Spitzmueller
et al., 2016).
Women’s return to work following maternity leave is a signif-
icant risk factor in breastfeeding cessation (Balkam, Cadwell, &
Fein, 2011; Fein, Mandal, & Roe, 2008). In general, research
suggests that breastfeeding cessation can result in negative conse-
quences for employers, mothers, and infants alike (Dieterich, Fe-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
lice, O’Sullivan, & Rasmussen, 2013). For example, employed
This document is copyrighted by the American Psychological Association or one of its allied publishers.
mothers who do not breastfeed their children are more likely to be
absent from work to attend to their sick infants (Bartick & Rein-
hold, 2010) than mothers who do breastfeed. Cost calculations
based on loss of work productivity among mothers who miss work
to care for infants who suffer from illnesses point to higher
absenteeism and health-care costs for mothers of artificially fed
infants (i.e., infants receiving formula rather than breast milk). For
instance, artificially fed infants are more likely to experience
increased infection risks and challenges related to food intake
regulation, pointing to important organizational costs of breast-
feeding discontinuation (Dieterich et al., 2013). In addition, there
is evidence that suggests that health-care costs for employers can
be higher for women who do not initiate breastfeeding or terminate
breastfeeding earlier than recommended. (Bartick & Reinhold,
2010). Costs associated with noninitiation or early termination of
breastfeeding are in part attributable to higher prevalence of re-
productive system cancers, Type II diabetes, and heart disease
(Najarian, Sutherland, & Groth, 1990) in women who discontinue
breastfeeding early. However, whereas many studies suggest pos-
itive health benefits for breastfeeding, for research assessing the
impact of breastfeeding-related institutional and policy changes,
studies only point to limited effects of institutional and policy
changes on maternal and child health (Baker & Milligan, 2008).
Still, the World Health Organization and the Centers for Disease
Control and Prevention have continued to issue recommendations
that support breastfeeding-friendly policies and institutional
changes.
We argue that breastfeeding behaviors constitute a target behav-
ior for human resource interventions geared toward improving
organizational and employee health and well-being. Studies con-
ducted across the past 2 decades demonstrated that a lack of milk
supply among mothers (which many women report as the ultimate
cause for breastfeeding cessation) is, in comparison with the risks
associated with full-time employment (Baxter, Cooklin, & Smith,
2009; Gielen, Faden, O’Campo, Brown, & Paige, 1991), not a
significant issue (Medina and Organ Systems Coordinating Center
[National Cancer Institute], 1987). Instead, it appears that lack of
breast milk is oftentimes a result of infrequent breastfeeding or
pumping, which results in reduced milk supply. Often, return to
work is intricately linked to less frequent breastfeeding or to the
decision to stop breastfeeding altogether (Guendelman et al.,
2009). Women who return to full-time work, which generally
requires women to pump breast milk at work multiple times per
day, appear to be at higher risk for breastfeeding cessation than
those who return to part-time work or those who stay at home
during the duration of breastfeeding (Fein et al., 2008).
However, a better understanding of why and how employment
decreases the likelihood of breastfeeding continuation is needed
because economic realities and maternal job and career trajectories
necessitate successful reconciliation of early motherhood and
work. We thus argue that we need to learn about the job charac-
teristics that play a role in women’s decisions to start and continue
breastfeeding. In this article, we heed Spitzmueller et al.’s (2016)
recent call to “identify what types of job characteristics and pro-
fessions pose particularly high risks for breastfeeding cessation”
(p. 23) to ultimately “develop targeted human resource and public
health interventions . . . that effectively counter the detrimental
impact of certain job characteristics on breastfeeding continuation”
(p. 23). Hence, we seek to identify what types of occupations and
job experiences prevent women from successfully reconciling
breastfeeding continuation with their work responsibilities. In
other words, the goal of the current article is to identify job
characteristics that may impact women’s decisions to start breast-
feeding or to discontinue breastfeeding prematurely.
We structure our article as follows: To explain why job char-
acteristics relate to breastfeeding behavior, we first introduce
breastfeeding as a work-related phenomenon.1 We argue that ex-
tensions of previous research are needed to more comprehensively
capture the role of work in determining breastfeeding, which
constitutes a complex, socially and physiologically determined
health behavior (Bai, Peng, & Fly, 2008; Balkam et al., 2011;
Spitzmueller et al., 2016). Second, we discuss the Occupational
Information Network (OⴱNET) as a data source that can be lever-
aged for the study of job characteristics as predictors of breast-
feeding continuation. Third, we apply derived propositions regard-
ing work characteristics that may be targeted by human resource
and public health interventions with the ultimate goal of enhancing
family health and well-being through prolonged breastfeeding
duration.
Research demonstrates that breastfeeding initiation and duration
were two “uniquely separate events” (Scott & Binns, 1999, p. 5),
and studies have been conducted to examine the predictors and
influence of both on myriad outcomes (Dennis, 2002; Turcksin,
Bel, Galjaard, & Devlieger, 2014). In the current article, we will
follow their practice by defining breastfeeding initiation and du-
ration as two different constructs. Specifically, we define breast-
feeding initiation as a dichotomous variable which includes “yes”
and “no,” and we define breastfeeding duration as a categorical
variable which includes multiple categories varying from shorter
breastfeeding time to longer breastfeeding time.
Breastfeeding as Work Behavior
Successfully breastfeeding in line with the standard medical
suggestions can be a challenge for new mothers who return to
work. The American Academy of Pediatrics advises women to
1
Note that the intent of this article is to provide information on empir-
ically grounded factors that can contribute to breastfeeding initiation,
continuation, and cessation. We do not intend to imply a value judgment
regarding women who choose to not breastfeed or who are unable to
breastfeed, and support the notion that women who decide not to or are
unable to breastfeed need to be equally supported by their employers,
coworkers, and supervisors.
 EMPLOYED WOMEN’S BREASTFEEDING BEHAVIORS
exclusively breastfeed (i.e., not feed anything other than breast
milk) their infants for the first 5– 6 months, and continue to
breastfeed while supplementing with solid foods for the remainder
of the child’s first year (Gartner et al., 2005). Within the United
States, given that over two thirds of women employed before
childbirth return to work within 12 weeks of giving birth (Han,
Ruhm, Waldfogel, & Washbrook, 2008), women who breastfeed
must reconcile breastfeeding with their work responsibilities
(Corbett-Dick & Bezek, 1997). Although mothers do not usually
bring their infants to work to breastfeed, attempting to provide
sufficient breast milk for the infant who may be at a child care
center or with a caregiver requires that women take between two
and three work breaks during an average work day to pump
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sufficient milk to meet the nutritional needs of their infants (Fein
This document is copyrighted by the American Psychological Association or one of its allied publishers.
et al., 2008). At work, breastfeeding mothers have to use a breast
pump during breastfeeding breaks to collect, store, and refrigerate
sufficient amounts of milk to meet their infants’ nutritional needs.
Average time taken for pumping sessions at work ranges from 5 to
22 min (with median pump time being around 12 min). Pump
breaks need to be scheduled at least twice daily to pump sufficient
milk to avoid having to supplement breast milk with formula
(Auerbach, 1990). Pumping of breast milk is particularly relevant
during the first 5 or 6 months of the infant’s life, where breast milk
should constitute the sole source of nutrition for the infant (Gartner
et al., 2005). However, even beyond that time frame, women’s
decisions to pump breast milk need to be supported by their
employers, as support for accommodating breastfeeding relates to
job satisfaction and other motivational outcomes (Jantzer, Ander-
son, & Kuehl, 2017).
We argue that women’s decisions to breastfeed are likely to be
impacted by their work experiences and the specific characteristics
of their jobs. In other words, we argue that work behavior and
work experiences affect women’s intentions to start breastfeeding
and their subsequent initiation of actual breastfeeding, as well as
breastfeeding duration (defined as the time they continue to breast-
feed). Breastfeeding intentions, initiation, and duration constitute
important attitudinal and behavioral aspects of breastfeeding in
relation to work. Women develop breastfeeding intentions or plans
on whether to breastfeed and for how long, along with strategies to
integrate breastfeeding in their daily lives.
Breastfeeding intentions are among the strongest predictor of
actual breastfeeding initiation (Wambach, 1997; Weber, Janson,
Nolan, Wen, & Rissel, 2011). Hence, breastfeeding intentions
constitute an important outcome that can be influenced by work
experiences. Spitzmueller et al. (2016) demonstrated recently that
breastfeeding intentions are indeed related to women’s work ex-
periences: Through analysis of an archival data set that followed
women from pregnancy through the first year of their infants’ life,
they show that pregnant women’s perceptions of workplace norms
regarding breastfeeding impact breastfeeding intention and dura-
tion. This supports breastfeeding intentions early on after child-
birth as an important precursor of subsequent breastfeeding behav-
ior. Thus, building on this initial research, we aim to explore not
only whether work experiences of returning mothers relate to
breastfeeding, but also whether job characteristics experienced
during pregnancy lead women to reflect on whether they will be
able to reconcile work and breastfeeding, and form long-term
breastfeeding intentions once they have established preliminary
breastfeeding experiences in the first few days after giving birth.
459
Up to now, only a limited amount of research sheds light on the
types of work experiences that are detrimental to the reconciliation
of breastfeeding and work. As health-care providers and policy-
makers are encouraging breastfeeding initiation and continuation,
we do not know whether certain types of jobs and job character-
istics facilitate continued breastfeeding while working and whether
other jobs and job characteristics present significant challenges for
women attempting to reconcile breastfeeding and work. Given the
limited previous attention to breastfeeding as a relevant outcome in
the domain of organizational behavior and industrial/organiza-
tional psychology, we derive exploratory research questions to
examine what work characteristics relate to breastfeeding contin-
uation.
OⴱNET as a Framework for Studying Job Analysis-
Derived Job Characteristics as Antecedents to
Breastfeeding
Oftentimes, job characteristics and job stressors are measured by
using employee self-reports (Auerbach, 1990). However, self-
reported job characteristics are not always directly related to objec-
tively measured job characteristics (Podsakoff, MacKenzie, Lee, &
Podsakoff, 2003; Podsakoff & Organ, 1986) and are oftentimes used
as a proxy for more objective measures of job characteristics (Kasl,
1998). Furthermore, resource- and demand-based theories of strain
emphasize the importance of objective realities versus individual
appraisal in assessing the impact of demands on employee strain
(Hobfoll, 2011). Although the use of more objective assessments of
job stressors is widely advocated, it is not necessarily commonly
implemented (Auerbach, 1990; Kasl, 1998).
From an intervention perspective, an almost-exclusive reliance
on self-report to measure job characteristics is problematic for at
least two reasons. First, if the goal is to design interventions that
target the redesign of job characteristics, then the utilization of
perceptually based descriptions of job characteristics may not
prove to be a solid base for altering job characteristics (Podsakoff
et al., 2003). This is particularly the case, as altering job charac-
teristics may not necessarily alter perceptions of these job charac-
teristics. Second, the relationship between job characteristics and
health is not always explained by perceptions of the same job
characteristics. For instance, objective job characteristics predict
hypertension, although perceptions of those same job characteris-
tics do not relate to hypertension (Kasl, 1998). Hence, the goal of
the current study is to build on research with subjective job
characteristics to identify specific, more objective job characteris-
tics that are derived from job analyses. Our approach is consistent
with an epidemiological research paradigm, in that we focus on
objective job characteristics and associated experiences that can
relate to breastfeeding cessation. We anticipate that the identifica-
tion of these more objective job characteristics, in conjunction with
the research on subjective job characteristics, will ultimately pres-
ent a better target for workplace interventions geared toward
supporting the reconciliation of maternal work and breastfeeding.
In an effort to study these objective job characteristics across
occupations that reflect organizational realities and that can be
used in policymaking, we rely on OⴱNET data to describe what
types of work experiences relate to successful breastfeeding con-
tinuation. The OⴱNET was a U.S. DOL-initiated and -funded
project aimed at collecting and summarizing job information about
 460 SPITZMUELLER ET AL.
occupations and has replaced the Dictionary of Occupational Titles
as a primary source of job information (Peterson, Mumford, Bor-
man, Jeanneret, & Fleishman, 1999; Peterson et al., 2001). The
OⴱNET project team, consisting of government-contracted con-
sulting firms and DOL representatives, collected comprehensive
job analysis information from incumbents on thousands of jobs
using a generic taxonomy. The taxonomy, which provides values
ranging from 0 to 100 as descriptors of occupational characteris-
tics, includes assessments of occupation-specific worker charac-
teristics and requirements, occupation-specific requirements, oc-
cupational requirements, and experience requirements (Peterson et
al., 1999, 2001).
Since its creation, work–family researchers have been using
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OⴱNET-derived job analysis data to supplement data from other
This document is copyrighted by the American Psychological Association or one of its allied publishers.
sources, such as self- and supervisor reports of working conditions
and experiences (Crouter, Lanza, Pirretti, Goodman, & Neebe,
2006; Goodman, Crouter, Lanza, & Cox, 2008). Recently, scholars
have demonstrated that OⴱNET descriptors of job demands, such
as decision latitude and role ambiguity, indeed predict employee
and family health and well-being outcomes (Johnson & Allen,
2013). Through the inclusion of OⴱNET information about occu-
pations in research studies, comparatively objective information
(in comparison with self-report assessments of stressors, which can
be influenced by individual differences including dispositions and
affect) can supplement other data sources. Although OⴱNET data
do not reflect each job incumbent’s unique role perfectly, it creates
a job analysis-based approximation that can provide useful infor-
mation about objective job features and their relationship with
organizationally and societally relevant outcomes (Johnson & Al-
len, 2013), such as breastfeeding.
OⴱNET job analyses-derived information translates well across
different cultural contexts: Taylor, Li, Shi, and Borman (2008)
established good transportability of OⴱNET for work activities and
worker requirements. In New Zealand, China, and Hong Kong,
they found almost identical item means for OⴱNET dimensions
across three occupations, and concluded that the transportability of
OⴱNET-based job analysis ratings across countries was adequate,
and that the utilization of OⴱNET in non-U.S. data sets constitutes
a viable option. A study conducted in eight European Union
countries supported similarities in task importance within the same
occupations across countries (Tijdens, De Ruijter, & De Ruijter,
2013). Similarly, Esposto and Meagher (2006), who performed
research within Australia, described OⴱNET as offering comple-
mentary extensions of the occupation characteristics provided by
reports written by the Australian Department of Education, Sci-
ence, and Training: OⴱNET provides more detailed descriptions
than the Australian Department of Education, Science, and Train-
ing reports of work skills, employability requirements, and work
environment that are applicable to Australian occupations. Overall,
although initially designed for use within the United States,
OⴱNET job characteristics have shown utility in studies across
culture, and their applicability to Australian contexts has been
documented (Esposto & Garing, 2012).
The Relationship Between Work Stressors and
Breastfeeding
Job characteristics can function as demands, requiring sustained
physical or psychological effort or skills to cope with, and lead to
depletion of personal resources, resulting in strain and ultimately
preventing employees from productively performing jobs (Bakker
& Demerouti, 2007). Long-term exposure to job demands can lead
to depletion of psychological or physiological resources and result
in lower perceived energy levels and physical symptoms. Job
resources, however, are characteristics of one’s job that facilitate
the accomplishment of goals, enhance self-realization and learn-
ing, and alleviate demand-induced costs.
We argue that the presence of job demands can lead to breast-
feeding cessation. Breastfeeding after the return to work requires
employed mothers to allocate time to breast pumping. Continued
breastfeeding further necessitates that employed mothers maintain
nutritious food intake conducive to continued breastfeeding, which
again requires allocation of resources to eating frequent healthy
meals (Picciano, 2003). Ultimately, adequate levels of energy and
maternal health are necessary to sustain breastfeeding over time
(Butte & King, 2005). Hence, depleted psychological resources
and lack of energy to allocate resources to breast pumping or to
sustain healthy food intake may lead to reduced breastfeeding over
time. In contrast, job resources relate to engagement and can serve
as facilitating enablers for behaviors that require resource expen-
diture. The reconciliation of breastfeeding and work falls in this
category: Pumping at work requires that women use resources to
effectively deal with incremental work demands.
Job autonomy, physical working conditions, and job-related
support are relevant to breastfeeding continuation because they
represent stressors and resources related to depletion of resources,
which in return may be detrimental to breastfeeding continuation.
Breastfeeding continuation requires substantial psychological and
physiological resources to be sustained and reconciled with full-
time work (Spitzmueller et al., 2016). Job stress models (Karasek,
1979; Karasek & Theorell, 1990; Siegrist, Siegrist, & Weber,
1986; Siegrist, 2002) have identified lack of job autonomy and
workload as prototypical job demands, which, if appraised as such,
can result in substantial negative outcomes. Resource depletion
through exposure to these high demands can lead to behavior-
based strain outcomes (Hobfoll, 1989).
Job autonomy, a construct similar to decision latitude, reflects
whether workers are able to make independent decisions about
how to do their work and what tasks and methods to use (Parker,
Axtell, & Turner, 2001). It is frequently considered to be a pro-
tective job resource that can mitigate the impact of demands. Job
autonomy enables employees to make decisions as to how and
when they accomplish their work tasks and what tools and meth-
ods they use to achieve their work goals (Spector, 1986). Job
autonomy is not synonymous with scheduling flexibility, as it
pertains to on-the-job experiences and decision latitude with re-
gard to work, whereas scheduling flexibility does not necessarily
come with job autonomy. Job autonomy is relevant for breastfeed-
ing, as women’s ability to adjust when and how they complete
tasks likely enables them to shift tasks around and select periods
for task completion that allow them to breast pump in between
tasks. In contrast, in low-autonomy jobs, women may have limited
ability to decide what to pursue and when, posing more severe
restrictions on their ability to engage in pumping. Neglecting the
need to pump frequently leads to lower levels of milk supply and
results in cessation of breastfeeding in many cases (Dobson &
Murtaugh, 2001).
 EMPLOYED WOMEN’S BREASTFEEDING BEHAVIORS
Hypothesis 1a: Job autonomy relates positively to breastfeed-
ing intentions, initiation, and duration.
Hypothesis 1b: The relationship between job autonomy and
breastfeeding initiation is mediated by breastfeeding
intentions.
Hypothesis 1c: The relationship between job autonomy and
breastfeeding duration is mediated by breastfeeding
intentions.
Physical working conditions can serve as another work demand.
In conceptualizing working conditions consistent with OⴱNET, we
specifically focus on working conditions that are hazardous (such
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as high exposure to noise, temperature extremes, or chemicals).
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Relationships between hazardous working conditions such as high
noise levels and strain are well documented. According to Jean,
Payne, and Thompson (2015), employed mothers who know they
are exposing their bodies to hazardous working conditions may be
less likely to breastfeed due to concerns regarding chemical ele-
ments crossing over into breast milk or concerns that hazardous
working conditions may alter their hormone levels in ways not
conducive to breast milk. Supporting these theoretical assertions,
hazardous working conditions demonstrably relate to elevated
blood pressure, cortisol, and norepinephrine levels (Tafalla &
Evans, 1997). In other words, hazardous working conditions relate
to strain not only based on employees perceiving them as stressful,
but also based on their potential to trigger physiological reactions.
Given these properties, we argue that hazardous working condi-
tions function as resource-depleting job demands that limit moth-
ers’ psychological and physiological resources and their ability to
maintain sufficient focus on nonwork demands, such as the pump-
ing of breast milk.
Hypothesis 2a: Hazardous working conditions (such as expo-
sure to extreme noise, temperature levels, or chemicals) relate
negatively to breastfeeding intentions, initiation, and duration.
Hypothesis 2b: The relationship between hazardous working
conditions and breastfeeding initiation is mediated by breast-
feeding intentions.
Hypothesis 2c: The relationship between hazardous working
conditions and breastfeeding duration is mediated by breast-
feeding intentions.
Research on support within the workplace suggests that support
can serve as a resource for employees. Meta-analytic research,
looking at support within organizations in general, shows that
perceptions of support are among the most powerful predictors of
employee outcomes, including but not limited to behavioral strain,
job attitudes, and performance (Riggle, Edmondson, & Hansen,
2009). Further meta-analytic work explored the specific role of
organizational and social support in the job stress process (Viswes-
varan, Sanchez, & Fisher, 1999). Organizational support predicted
not only perceptions of strain but also related to employees’
evaluations of stressors; employees tended to view stressors as less
severe when they were experiencing high levels of support.
Job-related support, or the likelihood that employers for certain
job types have supportive management that stands behind employ-
ees, can function as a resource that can relate to successful recon-
461
ciliation of work and breastfeeding. Viewed as a characteristic of
the occupation, job-related support represents a job analysis-based
work value that is related to company policies, supervision, and
human resources. The presence of job-related support from man-
agement can serve as a resource that demonstrates to employees
that the employer is genuinely interested in identifying solutions
that work for the employee and the organization (Rhoades &
Eisenberger, 2002) and is more likely to provide additional support
from company policy and/or management that can them help to
meet their job demands. Although much of the support research
focuses on individual employee perceptions of support within their
organization, the general level of support from management and
company policies is likely to vary across job types. We argue that,
similar to organizational support, jobs that are more likely to have
management that stands behind their employees will provide re-
sources to employees to help them cope with job demands. Hence,
we anticipate that working in occupations that come with high
levels of job-related support is likely to lead women to believe
their organization will support them in meeting their work and
nonwork demands, including breastfeeding.
Hypothesis 3a: Job-related support relates positively to breast-
feeding intentions, initiation, and duration.
Hypothesis 3b: The relationship between job-related support
and breastfeeding initiation is mediated by breastfeeding
intentions.
Hypothesis 3c: The relationship between job-related support
and breastfeeding duration is mediated by breastfeeding
intentions.
Method
We examined the relationship between work characteristics and
breastfeeding using data from a longitudinal Australian panel
study that was designed to track women and their children from
pregnancy through the child’s youth. The original panel study
collected data over a 15-year period. Due to the focus of the
current study on pregnancy and the postpartum return to work,
the present article is based on a narrow subset of these data that
were collected at 3–5 days postpartum and 6 months postpartum.
The use of this longitudinal data set allows us to draw stronger
inferences than what would be possible using a cross-sectional
design. Further, any examination of the impact of work character-
istics on breastfeeding outcomes requires variability in job char-
acteristics. Hence, data collection efforts geared toward a single
organization severely limit the number and variability of profes-
sions (and hence job characteristics) involved. As a result, an
analysis of women’s job characteristics within a single organiza-
tion might restrict the range of job characteristics women can
encounter, as many organizations employ individuals with similar
or complementary occupations, but not necessarily individuals
with occupations across the total spectrum of possible jobs. Hence,
sampling women across many organizations and industries pro-
vides access to a broader range of job characteristics than what
could be found in a study that collected data from employees
working in just a few organizations.
We used the data collected during pregnancy and at 6 months
postpartum. Specifically, the job title and job duty that were used
 462 SPITZMUELLER ET AL.
to retrieve job characteristics were collected during their first clinic
visit (during pregnancy), breastfeeding intention was collected at
3–5 days after giving birth, breastfeeding initiation and duration
were collected at 6 months postpartum, and demographic infor-
mation was collected at the first clinic visit.
Sample and Data Collection Procedure
Hypotheses were tested using data obtained from the Mater-
University of Queensland Study of Pregnancy (MUSP) in Aus-
tralia. The initial phase of the MUSP study began in 1981 when
more than 8,000 pregnant women were invited to join the study
during their first clinic visit at the Mater Mothers Hospital in
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Brisbane, Australia. Later phases have collected data on both
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mother and child at various times after the children were born,
when the children were around the ages of 6 months, 5 years, 14
years, and 21 years. However, for the purposes of the current
study, we focus solely on the data collected at 3–5 days post-
partum and 6 months postpartum. The study participants re-
ported their job title and duties during their first clinic visit,
before giving birth (toward the later part of their pregnancy).
Job characteristic variables obtained from the OⴱNET were
merged with the MUSP variables by the job title as an identi-
fier.
Information regarding occupation descriptions and variables
was obtained through the matching of the job titles provided by
the participants to the job titles listed on OⴱNET. Initial phases
of the coding process were conducted by five research assis-
tants. The following process was used for matching job titles:
(a) typed the participant-provided job title into the OⴱNET
database; (b) assessed the OⴱNet job title with the highest match
percentage, as designated by OⴱNET, to determine if the two
job titles matched; (c) if the OⴱNET job title with the highest
match percentage did not appear to be a good fit, the
participant-provided job title was reworded using synonyms
and reentered into the OⴱNET search field; and (d) this process
was repeated until the two job titles had an adequate match.
This process was performed independently by the five re-
search assistants. During the initial pilot-testing phases of the
OⴱNET matching, any discrepancies were discussed and a job
title was chosen based on those discussions. Once the research
assistants were consistently applying the coding process, four
additional research assistants were trained to assist in the final
OⴱNET coding for the data set. For the final coding process, a
minimum of four research assistants coded each job title. If at
any time anyone was unsure about the meaning of a word within
a job title, they looked up the Australian definition online. For
the final data set, only job titles with at least 50% agreement
among the researchers were included (average agreement ⫽
68%). The average agreement of 68% was before excluding job
titles with agreement ⬍50%. The overall agreement on retained
job titles was 82%.
Out of the total 175 job titles reported in the MUSP data set,
145 met this criterion and were retained in the final data set
(N ⫽ 4,730). A subsample of 809 mothers was further drawn
from this sample to examine the proposed set of hypotheses that
pertain to employed mothers’ breastfeeding intentions, initia-
tion, and continuation. Specifically, the inclusion criterion for
the analyses conducted for this study was that participants
returned to work (including full-time and part-time and self-
employed) within 6 months after giving birth to their child. In
all, 83.3% of the participants reported to be 20 –34 years old.
Among the participants, 84% were married, 86% were White,
and 62% reported an education level of high school.
Measures
Hazardous working conditions. Six items were selected
from the OⴱNET questionnaire to capture respondents’ working
conditions. Items include “How often does this job require work-
ing exposed to contaminants (such as pollutants, gases, dust, or
odors)?” “How often does this job require exposure to hazardous
conditions?” “How often does this job require exposure to hazard-
ous equipment?” “How often does this job require working indoors
in environmentally controlled conditions?” “How often does this
job require working exposed to sounds and noise levels that are
distracting or uncomfortable?” “How often does this job require
working indoors in noncontrolled environmental conditions (e.g.,
warehouse without heat)?” Responses to these items were coded
into a 5-point Likert-type scale from 1 (never) to 5 (every day).
Higher scores indicate less desirable working conditions. Cron-
bach’s ␣ for this scale was 0.85.
Job autonomy. Three items from the OⴱNET database were
selected to capture the decision latitude employees have in deter-
mining how to complete job tasks. The three items are “Job
requires developing one’s own ways of doing things, guiding
oneself with little or no supervision, and depending on oneself to
get things done” “How much decision making freedom, without
supervision, does the job offer?” and “To what extent is this job
structured for the worker, rather than allowing the worker to
determine tasks, priorities, and goals (reverse coded)?” Responses
were coded on a 5-point Likert scale from 1 (no freedom) to 5 (a
lot of freedom). Cronbach’s ␣ for this scale was 0.83.
Job-related support. Job-related support was captured by a
general support item score from the OⴱNET database. Job analysts
were instructed to ask themselves, “To what extent does this
occupation satisfy this work value?” by rating the item using a 1–7
scale from “very small extent” to “great extent.” The item read,
“Occupations that satisfy this work value offer supportive man-
agement that stands behind employees. Corresponding needs are
company policies, supervision: human relations, and supervision:
technical.”
Breastfeeding intention. Breastfeeding intention was as-
sessed by a single self-report item answered by participants at 3–5
days after giving birth. The item was “Are you breastfeeding or
intending to breastfeed your baby?” Responses were on a binary
scales with 1 ⫽ “No” and 2 ⫽ “Yes.”
Breastfeeding initiation. Breastfeeding initiation was calcu-
lated from the question “How long did you breast feed?” answered
at 6 months postpartum. Responses to this item were originally
coded into six categories, with 1 ⫽ “Still breastfeeding,” 2 ⫽ “4
months to 6 months,” 3 ⫽ “7 weeks to 3 months,” 4 ⫽ “3 weeks
to 6 weeks,” 5 ⫽ “2 weeks or less,” and 6 ⫽ “Not at all.” The
responses were recoded to compute dichotomous a breastfeeding
initiation variable with 0 ⫽ “No (response category of Not at all)”
and 1 ⫽ “Yes (all other response categories).”
Breastfeeding duration. Breastfeeding duration was mea-
sured by the question “How long did you breast feed?” answered
 EMPLOYED WOMEN’S BREASTFEEDING BEHAVIORS 463

at 6 months postpartum. Responses to this item were originally Table 2

coded into six categories, with 1 ⫽ “Still breastfeeding,” 2 ⫽ “4 Logistic Results for Job Autonomy on Breastfeeding Intention
months to 6 months,” 3 ⫽ “7 weeks to 3 months,” 4 ⫽ “3 weeks
to 6 weeks,” 5 ⫽ “2 weeks or less,” and 6 ⫽ “Not at all.” The Variable B SE OR [95% CI]
responses were recoded into four categories to derive an ordinal Age (13 to 19 yr)
variable, with 1 ⫽ “Not at all,” 2 ⫽ “Less than 6 weeks,” 3 ⫽ “7 20–34 yr ⫺0.42 0.74 0.65 [0.15, 2.81]
weeks to 6 months,” and 4 ⫽ “Still breastfeeding.” These catego- 34⫹ yr 0.27 0.58 1.31 [0.42, 4.08]ⴱⴱ
ries were used to align with periods that have been identified in the Education (Incomplete high)
Complete high ⫺1.65 0.51 0.19 [0.07, 0.52]ⴱⴱ
breastfeeding and medical literature as being qualitatively and Post high ⫺0.80 0.41 0.45 [0.20, 1.01]ⴱ
substantively different from each other and representing unique Ethnicity (White)
phases of the breastfeeding process (Kramer & Kakuma, 2004; Asian 1.63 0.78 5.10 [1.11, 23.50]ⴱ
Semenic, Loiselle, & Gottlieb, 2008). Abor-Islander 1.15 0.97 3.17 [0.47, 21.34]
Marital status (Single)
Controls. We controlled for respondents’ age, ethnicity, mar-
Living together 0.11 1.41 1.11 [0.07, 17.62]
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

ital status, education level, annual income, and birth history in our Married ⫺0.32 1.24 0.72 [0.06, 8.20]
This document is copyrighted by the American Psychological Association or one of its allied publishers.

study. Fein and colleagues (2008) found that being younger, un- Separated–Divorced–Widow ⫺0.06 1.18 0.94 [0.09, 9.46]
married, less educated, primiparous, poorer were each associated Income ($10,399 or less) 0.47 0.41 1.60 [0.71, 3.60]
with early discontinuation of breastfeeding. To alleviate the influ- Gave birth to child in past 5
years (No)
ence of these factors, we controlled for age, marital status, educa- 1 yr ago 1.23 0.81 3.44 [0.70, 16.91]
tion level, annual income, and birth history. Moreover, ethnicity 2 yr ago 1.73 0.88 5.62 [0.99, 31.84]ⴱ
was found to be associated with breastfeeding duration (Homer, 3 yr ago 1.90 0.89 6.71 [1.18, 38.26]ⴱ
Sheehan, & Cooke, 2002; Taveras et al., 2003). To alleviate its 4 yr ago 1.67 0.88 5.31 [0.94, 29.84]†
5 yr ago 0.92 0.90 2.50 [0.43, 14.66]
influence, we also controlled for ethnicity. The following control
Job autonomy 0.72 0.39 2.05 [0.95, 4.44]†
variables were collected using categorical variables: age (35 and Constant ⫺3.55 2.36 0.03
plus, 20 –34, and 13–19 years), ethnicity (White, Asian, and Arbor
Note. N ⫽ 809. OR ⫽ odds ratio; CI ⫽ confidence interval.
Islander), marital status (single, living together, married, and sep- †
p ⬍ .10. ⴱ p ⬍ .05. ⴱⴱ p ⬍ .01.
arated/divorced/widowed), education (incomplete high school,
complete high school, and post high school), and whether they
gave birth in the past 5 years (no births in the past 5 years, 1 year sion analysis was carried out on the remaining 608 participants.
ago, 2 years ago, 3 years ago, 4 years ago, and 5 years ago). The reference category is the mother who breastfed for less than 6
weeks; the other two categories are 7 weeks to 6 months and still
Analytic Strategy breastfeeding.
All control variables were entered in the model in the first step.
We used binary logistic regression analysis to examine the All hypothesized antecedents were entered in the second step.
antecedents of breastfeeding intentions and initiation (i.e., Hypoth- Logistic regression coefficients, odds ratios (ORs), and confidence
eses 1a-b, 2a-b, and 3a-b), because the dependent variables con- interval (CI) are reported in the Results section.
sisted of two response categories: yes and no. To test Hypotheses
1c, 2c, and 3c, we used ordinal logistic regression, because the
Results
dependent variable, breastfeeding duration, consisted of four ordi-
nal response categories: not at all, less than 6 weeks, 7 weeks to 6 Table 1 presents descriptive statistics and intercorrelations
months, and still breastfeeding. Of the 809 women, 201 indicated among study variables. Results of the binary logistic regressions
they did not initiate breastfeeding; thus, the ordinal logistic regres- are presented in Tables 2, 3, 5, 6, 8, and 9. In the first step, only

Table 1
Correlations and Reliabilities for Study Variables

Variable M SD 1 2 3 4 5 6 7 8 9 10 11

1. Age 1.94 0.40

2. Education 2.11 0.61 .08ⴱ
3. Ethnicity 1.16 0.47 .05 .02
4. Marital status 2.80 0.56 .31ⴱⴱ .02 ⫺.01
5. Income 1.76 0.43 .20ⴱⴱ .10ⴱⴱ ⫺.05 .16ⴱⴱ
6. Gave birth to child in past 5 years 1.27 1.43 ⫺.10ⴱ .01 .03 ⫺.06 .01
7. Working conditions 2.41 0.48 .07 ⫺.19ⴱⴱ .04 .04 .01 .02
8. Job autonomy 4.05 0.38 .02 .22ⴱⴱ ⫺.05 ⫺.06 .05 .01 ⫺.18ⴱⴱ
9. Support 4.17 0.88 .01 .24ⴱⴱ .00 .02 .09ⴱ .04 ⫺.15ⴱⴱ ⫺.20ⴱⴱ
10. BF intention 1.81 0.39 ⫺.01 .16ⴱⴱ ⫺.05 .04 .07 .02 ⫺.16ⴱⴱ .14ⴱⴱ .01
11. BF initiation 0.80 0.40 .01 .16ⴱⴱ ⫺.15ⴱⴱ .04 .08ⴱ .05 ⫺.16ⴱⴱ .15ⴱⴱ .02 .87ⴱⴱ
12. BF duration 2.54 1.06 .09ⴱ .24ⴱⴱ ⫺.06 .06 .12ⴱ ⫺.02 ⫺.15ⴱⴱ .09ⴱ .08ⴱ .66ⴱⴱ .73ⴱⴱ
Note. N ⫽ 573– 809. Pair-wise deletion was used in calculating correlation coefficients. BF ⫽ breastfeeding.
ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .01.
 464 SPITZMUELLER ET AL.

Table 3 Table 5
Logistic Results for Job Autonomy on Breastfeeding Initiation Logistic Results for Work Condition on Breastfeeding Intention

Variable B SE OR [95% CI] Variable B SE OR [95% CI]

Age Age
13–19 yr ⫺0.24 0.71 0.79 [0.20, 3.16] 13–19 yr ⫺0.40 0.74 0.67 [0.16, 2.89]
20–34 yr 0.34 0.54 1.40 [0.48, 4.07]ⴱ 20–34 yr 0.34 0.58 1.41 [0.45, 4.36]ⴱ
Education Education
Incomplete high ⫺1.23 0.47 0.29 [0.12, 0.74]ⴱⴱ Incomplete high ⫺1.61 0.51 0.20 [0.07, 0.54]ⴱⴱ
Complete high ⫺0.39 0.37 0.68 [0.33, 1.40]ⴱⴱ Complete high ⫺0.86 0.41 0.42 [0.19, 0.94]ⴱ
Ethnicity Ethnicity
White 2.27 0.80 9.68 [2.01, 46.71]ⴱⴱ White 1.65 0.80 5.19 [1.08, 24.96]ⴱ
Asian 1.47 0.94 4.35 [0.69, 27.61] Asian 1.21 0.99 3.34 [0.48, 23.43]
Marital status Marital status
Single ⫺0.83 1.34 0.44 [0.03, 5.99] Single 0.39 1.41 1.48 [0.09, 23.59]
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Living together ⫺0.64 1.23 0.53 [0.05, 5.93] Living together ⫺0.05 1.23 0.95 [0.09, 10.52]
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Married ⫺0.23 1.18 0.79 [0.08, 7.97] Married 0.25 1.17 1.29 [0.13, 12.69]
Income ($10,399 or less) 0.23 0.39 1.26 [0.59, 2.69] Income ($10,399 or less) 0.43 0.41 1.53 [0.69, 3.42]
Gave birth to child in past 5 years Gave birth to child in past 5 years
No 0.83 0.82 2.30 [0.46, 11.45] No 1.22 0.81 3.39 [0.70, 16.53]
1 yr ago 1.38 0.89 3.96 [0.69, 22.56] 1 yr ago 1.72 0.88 5.58 [0.99, 31.38]ⴱ
2 yr ago 1.52 0.89 4.58 [0.81, 26.01]† 2 yr ago 1.95 0.88 7.00 [1.24, 39.68]ⴱ
3 yr ago 1.43 0.89 4.18 [0.73, 23.85] 3 yr ago 1.69 0.88 5.44 [0.97, 30.47]
4 yr ago 1.45 0.98 4.26 [0.62, 29.17] 4 yr ago 0.89 0.90 2.42 [0.41, 14.18]ⴱ
Job autonomy 0.94 0.39 2.57 [1.20, 5.51]ⴱⴱ Work condition ⫺0.64 0.28 0.53 [0.30, 0.92]ⴱ
Constant ⫺4.98 2.33 0.01 Constant 0.55 1.83 1.74
Note. N ⫽ 809. OR ⫽ odds ratio; CI ⫽ confidence interval. Note. N ⫽ 809. OR ⫽ odds ratio; CI ⫽ confidence interval.
†
p ⬍ .10. ⴱ p ⬍ .05. ⴱⴱ p ⬍ .01. ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .01.

the control variables were included as predictors. In the second
step, the predictive effect of each hypothesized antecedent was
examined one at a time.
Hypothesis 1a stated that job autonomy relates positively to
breastfeeding intentions, initiation, and duration. Binary logis-
tic regression results showed that job autonomy was positively
related to breastfeeding intentions (B ⫽ 0.72, p ⫽ .07, OR ⫽
2.05, 95% CI [0.95, 4.44]), indicating women who worked in
jobs with high job autonomy were more likely to intend to
breastfeed (Table 2).
Similarly, job autonomy was positively related to breastfeeding
initiation (B ⫽ 0.94, p ⬍ .05, OR ⫽ 2.57, 95% CI [1.20, 5.51]),
suggesting that pregnant women who experienced jobs with one-
unit higher level of job autonomy were 2.57 times more likely to
initiate breastfeeding later after giving birth (Table 3). Finally, the
relation between job autonomy and breastfeeding duration was statisti-
cally significant (OR ⫽ ⫺0.54, p ⫽ .05, 95% CI [⫺1.088, ⫺0.001];
Table 4), but the direction of results was inconsistent with the first two
results. Results suggest that women who worked at a position with high
job autonomy were less likely to breastfeed for long period. The OR
was calculated using SPSS estimate procedures. Thus, hypothesis 1a
was partially supported.
Hypothesis 2a stated that hazardous working conditions (such as
exposure to extreme noise, temperature levels, or chemicals) relate
negatively to breastfeeding intentions, initiation, and duration. In
support of Hypothesis 2a, hazardous working conditions were
negatively related to breastfeeding intentions (B ⫽ ⫺ 0.64, p ⬍
.05, OR ⫽ 0.53, 95% CI [0.30, 0.92]), which suggests that women
who worked in jobs with a one-unit increase in hazardous physical
working conditions were 0.53 times less likely to intend to breast-
feed (Table 5).
As can be seen from Table 6, in further support of Hypothesis
2a, working conditions were also negatively related to breastfeed-
ing initiation (B ⫽ ⫺0.54, p ⫽ .06, OR ⫽ 0.58, 95% CI [0.33,

Table 4
Ordinal Regression Results for Job Autonomy on Breastfeeding Duration

Variable Level B SE Wald [95% CI]

Threshold Breastfeeding for 7 weeks to 6 months ⫺0.08 1.39 0.00 [⫺2.81, 2.65]
Still breastfeeding 1.65 1.40 1.40 [⫺1.08, 4.39]
Location Age 0.75 0.30 6.42 [0.17, 1.33]ⴱ
Education 0.68 0.17 15.27 [0.34, 1.02]ⴱⴱ
Ethnicity 0.23 0.32 0.51 [⫺0.40, 0.86]
Marital status ⫺0.06 0.21 0.08 [⫺0.46, 0.35]
Income 0.02 0.20 0.01 [⫺0.36, 0.41]
Birth history in past 5 years ⫺0.10 0.07 1.88 [⫺0.24, 0.04]
Job autonomy ⫺0.54 0.28 3.86 [⫺1.09, ⫺0.00]ⴱ
Note. N ⫽ 608. CI ⫽ confidence interval.
ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .01.
 EMPLOYED WOMEN’S BREASTFEEDING BEHAVIORS 465

Table 6 Table 8
Logistic Results for Work Condition on Breastfeeding Initiation Logistic Results for Organizational Support on
Breastfeeding Intention
Variable B SE OR [95% CI]
Organizational support
Age
13–19 yr ⫺0.22 0.71 0.80 [0.20, 3.20] Variable B SE OR [95% CI]
20–34 yr 0.42 0.54 1.51 [0.53, 4.35]ⴱ
Education Age
Incomplete high ⫺1.27 0.47 0.28 [0.11, 0.70]ⴱⴱ 13–19 yr ⫺0.43 0.73 0.65 [0.16, 2.72]
Complete high ⫺0.50 0.37 0.61 [0.30, 1.25]ⴱⴱ 20–34 yr 0.42 0.58 1.52 [0.49, 4.71]ⴱⴱ
Ethnicity Education
White 2.34 0.81 10.38 [2.11, 51.13]ⴱⴱ Incomplete high ⫺1.74 0.51 0.17 [0.06, 0.48]ⴱⴱ
Asian 1.53 0.95 4.61 [0.71, 29.87] Complete high ⫺0.99 0.41 0.37 [0.17, 0.83]ⴱ
Marital status Ethnicity
Single ⫺0.54 1.32 0.58 [0.04, 7.72] White 1.46 0.76 4.30 [0.98, 18.98]ⴱ
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Living together ⫺0.33 1.21 0.72 [0.07, 7.77] Asian 0.98 0.96 2.67 [0.41, 17.55]
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Married 0.09 1.16 1.09 [0.11, 10.58] Marital status

Income ($10,399 or less) 0.18 0.38 1.19 [0.56, 2.53] Single 0.51 1.38 1.67 [0.11, 24.90]
Gave birth to child in past 5 years Living together ⫺0.25 1.22 0.78 [0.07, 8.50]
No 0.77 0.81 2.15 [0.44, 10.56] Married 0.10 1.16 1.10 [0.11, 10.70]
1 yr ago 1.32 0.88 3.75 [0.67, 21.06] Income ($10,399 or less) 0.20 0.39 1.22 [0.57, 2.60]
2 yr ago 1.52 0.88 4.57 [0.81, 25.64]† Gave birth to child in past 5 years
3 yr ago 1.42 0.88 4.12 [0.73, 23.31] No 1.17 0.81 3.23 [0.66, 15.90]
4 yr ago 1.37 0.98 3.94 [0.57, 26.96] 1 yr ago 1.74 0.88 5.68 [1.01, 31.92]ⴱ
Work condition ⫺0.54 0.28 0.58 [0.33, 1.02]† 2 yr ago 1.87 0.89 6.46 [1.13, 36.94]ⴱ
Constant ⫺0.19 1.82 0.83 3 yr ago 1.66 0.88 5.24 [0.93, 29.47]†
4 yr ago 0.74 0.89 2.10 [0.36, 12.10]
Note. N ⫽ 809. OR ⫽ odds ratio; CI ⫽ confidence interval. Organizational support ⫺0.15 0.18 0.86 [0.61, 1.23]
†
p ⬍ .10. ⴱ p ⬍ .05. ⴱⴱ p ⬍ .01. Constant 0.10 1.91 1.10
Note. N ⫽ 809. OR ⫽ odds ratio; CI ⫽ confidence interval.
†
p ⬍ .10. ⴱ p ⬍ .05. ⴱⴱ p ⬍ .01.
1.02]), indicating that pregnant women who experienced a one-
unit increase in working in a hazardous physical environment were
0.58 times less likely to actually initiate breastfeeding. Finally,
contrary to Hypothesis 2a, the influence of hazardous working feeding intentions. Hypothesis 2b(c) stated that the relationship
conditions on breastfeeding duration was not significant (Table 7; between hazardous working conditions and breastfeeding initiation
OR ⫽ ⫺0.05, 95% CI [⫺0.48, 0.38], ns). Thus, Hypothesis 2a was (duration) is mediated by breastfeeding intentions. Hypothesis
partially supported. 3b(c) stated that the relationship between job-related support and
Hypothesis 3a posited that job-related support predicts breast- breastfeeding initiation (duration) is mediated by breastfeeding
feeding intention, initiation, and duration. Unexpectedly, and con- intentions. To test the mediational hypotheses, we conducted Sobel
trary to Hypothesis 3a, job-related support was not related to tests for indirect effects (Sobel, 1982) of a dichotomous mediator
breastfeeding intentions (B ⫽ ⫺0.15, OR ⫽ 0.86, 95% CI [0.61, and/or outcome using both equation by MacKinnon and Dwyer
1.23], ns; Table 8) or breastfeeding initiation (B ⫽ ⫺ 0.20, OR ⫽ (1993) and Sobel calculator by Preacher and Leonardelli (2016).
0.82, 95% CI [0.58, 1.16], ns; Table 9). However, the role of The results showed a significant indirect effect of hazardous
job-related support on breastfeeding duration was marginally sig- work conditions and job autonomy on breastfeeding initiation
nificant (OR ⫽ 0.21, p ⫽ .06, 95% CI [⫺0.01, 0.42]; Table 10). (Sobel ⫽ ⫺3.69, p ⬍ .01; Sobel ⫽ 3.24, p ⬍ .01 separately) after
Hypothesis 1b(c) stated that the relationship between job auton- controlling for breastfeeding intention. Thus, Hypotheses 2b and
omy and breastfeeding initiation (duration) is mediated by breast- 3b were supported.

Table 7
Ordinal Regression Results for Work Condition on Breastfeeding Duration

Variable Level B SE Wald [95% CI]

Threshold Breastfeeding for 7 weeks to 6 months 1.95 1.01 3.73 [⫺0.03, 3.93]ⴱ
Still breastfeeding 3.67 1.02 12.85 [1.66, 5.68]ⴱⴱ
Location Age 0.69 0.29 5.61 [0.12, 1.27]ⴱ
Education 0.63 0.17 13.48 [0.29, 0.97]ⴱⴱ
Ethnicity 0.28 0.32 0.73 [⫺0.35, 0.90]
Marital status ⫺0.02 0.21 0.01 [⫺0.42, 0.39]
Income 0.01 0.20 0.00 [⫺0.38, 0.39]
Birth history in past 5 years ⫺0.09 0.07 1.68 [⫺0.23, 0.05]
Work condition ⫺0.05 0.22 0.06 [⫺0.48, 0.38]
Note. N ⫽ 608. CI ⫽ confidence interval.
ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .01.
 466 SPITZMUELLER ET AL.

Table 9 maternal health are negatively affected by breastfeeding cessation,

Logistic Results for Organizational Support on reconciliation of breastfeeding and work constitutes an important
Breastfeeding Initiation public health outcome (Bartick, 2011; Strathearn, Mamun, Naj-
man, & O’Callaghan, 2009). Currently, our understanding of what
Variable B SE OR [95% CI] exact employment factors drive breastfeeding cessation is limited.
Age Heeding Spitzmueller et al.’s (2016) recent call to focus on the
13–19 yr ⫺0.28 0.69 0.76 [0.19, 2.94] identification of work experiences and job characteristics that can
20–34 yr 0.52 0.54 1.68 [0.58, 4.85]ⴱⴱ facilitate or complicate the reconciliation of breastfeeding and
Education work, we examined job autonomy, hazardous working conditions,
Incomplete high ⫺1.42 0.47 0.24 [0.10, 0.61]ⴱⴱ
Complete high ⫺0.63 0.37 0.53 [0.26, 1.09]† and job-related support as potential predictors of breastfeeding. To
Ethnicity avoid tapping perceptions of work characteristics rather than actual
White 2.10 0.75 8.13 [1.86, 35.50]ⴱⴱ work characteristics, we used OⴱNET descriptors based on wom-
Asian 1.24 0.90 3.45 [0.59, 20.18] en’s job titles and examined whether women’s work characteristics
Marital status
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Single ⫺0.27 1.30 0.77 [0.06, 9.84] related to their intentions to breastfeed, breastfeeding initiation,
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Living together ⫺0.48 1.21 0.62 [0.06, 6.61] and breastfeeding duration.
Married 0.00 1.15 1.00 [0.10, 9.58] Breastfeeding intentions or women’s plans to initiate breastfeed-
Income ($10,399 or less) ⫺0.03 0.36 0.97 [0.47, 1.58] ing related to job autonomy and hazardous working conditions:
Gave birth to child in past 5 years
The higher levels of job autonomy a pregnant woman experienced
No 0.75 0.81 2.12 [0.43, 10.48]
1 yr ago 1.40 0.88 4.04 [0.72, 22.56] at work, the more likely she was to form intentions to breastfeed.
2 yr ago 1.47 0.88 4.33 [0.77, 24.52]† Working in an occupation with high exposure to hazardous work-
3 yr ago 1.41 0.88 4.11 [0.73, 23.26] ing conditions, such as chemicals and noise, related negatively to
4 yr ago 1.13 0.95 3.11 [0.49, 19.85] women’s breastfeeding intentions. We identified similar effects for
Organizational support ⫺0.20 0.18 0.82 [0.58, 1.16]
Constant ⫺0.24 1.86 0.79 breastfeeding initiation—women in occupations that provide for
higher levels of autonomy and working conditions with limited
Note. N ⫽ 809. OR ⫽ odds ratio; CI ⫽ confidence interval. hazards were substantially more likely to initiate breastfeeding.
†
p ⬍ .10. ⴱ p ⬍ .05. ⴱⴱ p ⬍ .01.
Surprisingly, our investigation of the relationship of job char-
acteristics and breastfeeding duration provided some counterintui-
Similarly, Hypotheses 2c and 3c were supported. Breastfeeding tive results. Namely, job autonomy was negatively related to
intention mediated the relationship between hazardous work con- breastfeeding duration. Given meta-analytic findings and theoret-
ditions and job autonomy on breastfeeding duration (So- ical work on job stressors that frequently point to job autonomy as
bel ⫽ ⫺3.80, p ⬍ .01; Sobel ⫽ 3.31, p ⬍ .01 separately). a valuable resource that can predict engagement and relate posi-
The indirect effects of job-related support through breastfeeding tively to subjective well-being outcomes, we were surprised to find
intention on breastfeeding initiation and duration were not signif- that having more opportunities to autonomously decide on how to
icant (Sobel ⫽ 0.34, ns; Sobel ⫽ 0.34, ns respectively), thus complete work tasks and implement one’s own work decisions
Hypotheses 3b and 3c were not supported. related to a lower likelihood of breastfeeding continuation.
We offer several post hoc explanations of these findings and
encourage replication and grounded theory testing of the potential
Discussion
limits of work autonomy in relating to health and family-directed
Research across a variety of disciplines has conclusively dem- behaviors. First, higher levels of job autonomy may require moth-
onstrated that return to employment shortly after the birth of a ers to be consistently and continuously mentally engaged in their
child decreases the likelihood of breastfeeding continuation (Baker work, which may detract from their ability to focus on breastfeed-
& Milligan, 2008; Ogbuanu, Glover, Probst, Liu, & Hussey, 2011; ing. Second, relatively regimented work schedules (which are
Scott, Binns, Oddy, & Graham, 2006). Because both infant and more likely to be associated with low-autonomy jobs) may facil-

Table 10
Ordinal Regression Results for Organizational Support on Breastfeeding Duration

Variable Level B SE Wald [95% CI]

Threshold Breastfeeding for 7 weeks to 6 months 2.77 .91 9.30 [0.99, 4.54]ⴱⴱ
Still breastfeeding 4.48 .93 23.48 [2.67, 6.30]ⴱⴱ
Location Age 0.68 .29 5.42 [0.11, 1.24]ⴱ
Education 0.47 .17 7.65 [0.14, 0.80]ⴱⴱ
Ethnicity 0.48 .30 2.52 [⫺0.11, 1.08]
Marital status 0.01 .19 0.01 [⫺0.37, 0.39]
Income ⫺0.04 .20 0.04 [⫺0.42, 0.34]
Birth history in past 5 years ⫺0.11 .07 2.39 [⫺0.24, 0.03]
Organizational support 0.21 .11 3.61 [⫺0.01, 0.42]†
Note. N ⫽ 608. CI ⫽ confidence interval.
†
p ⬍ .10. ⴱ p ⬍ .05. ⴱⴱ p ⬍ .01.
 EMPLOYED WOMEN’S BREASTFEEDING BEHAVIORS
itate actual breastfeeding continuation because they may allow
women to take breaks at the exact same time every day. Similarly,
jobs higher in autonomy may be associated with higher job levels
and a higher workload; therefore, they may have less time avail-
able to take breaks needed for breastfeeding or pumping. This may
result in higher levels of automaticity and breast pumping routines
that may be conducive to the maintenance of adequate maternal
milk supply. Finally, the counterintuitive findings may be a result
of a suppression effect and not necessarily reflect a negative
relationship. Due to the significant positive bivariate correlation
and subsequent negative regression coefficient, it is possible that
there are moderators on this relationship that need to be further
explored in future research that accounts for this reversal of
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
directionality.
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Job-related support in contrast, although unrelated to breastfeed-
ing intentions and initiation, predicted whether women who started
breastfeeding were able to sustain breastfeeding. These findings,
that jobs where there is increased likelihood of management that
stands behind their employees are associated with increased
breastfeeding duration, are consistent with previous research that
points to organizationally supportive climates as enhancing em-
ployed women’s likelihood to reconcile breastfeeding and working
(Spitzmueller et al., 2016). The presence of support within partic-
ular jobs and an emphasis on policy and management standing
behind their employees may signal to employees that continuously
engaging in behaviors at work (e.g., pumping breast milk) that
support family health and well-being is indeed encouraged and
supported.
Limitations and Future Research Directions
Although the current study provides novel insights on the role of
actual job characteristics in women’s decisions to reconcile work
with breastfeeding, we acknowledge several limitations and pro-
vide suggestions for future research on this topic. First, our study
relies solely on OⴱNET as a data source to assess job characteris-
tics. Even though this information is useful because it is not
impacted by individual workers’ perceptions, we did not test how
these job characteristics translated into women’s breastfeeding-
related decision-making. Although it appears that women’s deci-
sion-making—which is probably more strongly reflected in their
intentions and decisions to initiate breastfeeding than in actual
breastfeeding continuation—relates to autonomy and hazardous
working conditions, our research does not shed light on the psy-
chological mechanisms that explain why women who experience
certain job characteristics make decisions regarding breastfeeding.
Thus, it would be exciting for future research to examine women’s
decision-making regarding work and breastfeeding more closely.
This can be accomplished, for instance, through diary studies that
use the theory of planned behavior (Ajzen, 1991) as a theoretical
framework that can connect job characteristics with perceptions
and decision-making and track women’s breastfeeding attitudes,
intentions, and behaviors. Particularly interesting insights can po-
tentially be gleaned from nuanced daily measures that track work
stressor exposure, support expression by coworkers and supervi-
sors, and daily data on women’s success in reconciling work
schedule demands with pumping or breastfeeding breaks.
This study relies on an Australian data set. Although strong
evidence supports the transportability of OⴱNET information to
467
other countries (Taylor et al., 2008), we recommend further rep-
lication and extension. We recommend collection of further
OⴱNET transportability data for developing countries, including
economies in sub-Saharan Africa (i.e., Nigeria, Africa’s largest
economy). The reconciliation of breastfeeding and work in jobs
contained in the informal economies in these countries would be
particularly insightful because the percentage of women who work
in the informal sector in developing countries is substantial. Sim-
ilarly, the availability of maternal benefits differs across countries.
Therefore, these relationships should be examined internationally
to help examine the influence of maternal benefits on these rela-
tionships.
In the current study, the demographics and control variables
were all categorical variables. Assessing the influence of age as a
continuous variable as well as expanded categories for ethnicity
and education would help provide a more nuanced examination of
the influence of demographic characteristics on breastfeeding be-
havior. Our results, for example, failed to replicate the findings by
Fein and colleagues (Fein et al., 2008) that age was positively
related to breastfeeding continuation—although our findings are in
the same direction, they are not statistically significant. One reason
for this null finding could be that the large categories such as
“20-34” or “above 35” mask the influence of the variable life and
career stages that can occur in these age ranges. Future research
should expand on our findings using demographic variables that
are continuous and with more descriptive categories, where appro-
priate.
Further, our study provides only a small glimpse of the mech-
anisms that can explain how and why women reconcile work with
breastfeeding. For instance, the current study does not allow us to
draw inferences about women’s perceptions of their organizational
context and contains limited information about shifts that may
occur in women’s decision-making as their identity changes
through the transition to becoming employed mothers (Ladge &
Greenberg, 2015). Future research could benefit from the integra-
tion of identity theory (Danna & Griffin, 1999; Frone, Russell, &
Cooper, 1995) and research on family-supportive organizations
(Allen, 2001). Theoretically, this study points to a different set of
predictors for conscious decisions regarding breastfeeding (inten-
tions and initiation) than for breastfeeding continuation.
In our study, we treat breastfeeding initiation and duration as
two separate constructs. However, in our study, breastfeeding
initiation and duration were defined using the same answers at 6
months postpartum survey. Specifically, we coded breastfeeding
initiation into “no” if the respondent’s answer was “not at all” and
“yes” if the respondent chose other answers. We argue that breast-
feeding continuation may be more strongly impacted by habits and
experiences that may not lead to a decision to discontinue breast-
feeding, but that may have an impact on women’s ability to take
sufficient work breaks to continue breastfeeding. Behavioral habits
such as breast milk expression at work, for example, have been
shown to be more strongly influenced by the current context (e.g.,
access to break time and space) and past performance (e.g., pre-
vious success in breast milk expression at work) than behavioral
goals (e.g., breastfeeding). Therefore, it is likely that breastfeeding
continuation is influenced by a wider array of workplace- and
experience-related factors than simply breastfeeding goals and
intentions. Incorporating behavioral habit research by examining
the daily relationships between the environment and breastfeeding
 468 SPITZMUELLER ET AL.
behavior on breastfeeding continuation could help expand our
understanding of how the workplace impacts breastfeeding con-
tinuation over time. Similarly, epidemiological research (Kasl,
1998) may provide further cues and directions with regard to
mechanisms that may explain relationships between objective
work characteristics and breastfeeding. For instance, physiological
reactions to hazardous working conditions may play a role in
hormonal systems, such as the oxytocin system, which are closely
linked to breastfeeding.
Also, our study provides little information about the women
who decide to not initiate or continue breastfeeding. However,
there are a host of important research questions that pertain to this
population: Although we know that many women who do not
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
initiate or continue breastfeeding experience guilt and other neg-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
ative emotions (Mozingo, Davis, Droppleman, & Merideth, 2000),
we know little about how their decision or inability to not breast-
feed affects their work identities. Are they more likely to retain a
stronger work-related identity than women who are consistently
engaged with their maternal identity and roles throughout the work
day? How do coworkers and supervisors react to women who do
not breastfeed—Are they more likely to be viewed as interperson-
ally cold or uncaring than women who do continue breastfeeding
and take pumping breaks at work?
Further, the work characteristics we examined are limited, and
further research on other breastfeeding-relevant job characteristics
is needed. For example, maternal work travel likely poses unique
challenges to employed breastfeeding mothers. Expectations that
travel will be required upon return to work may affect women’s
decision to initiate breastfeeding and may contribute uniquely to
employed mothers’ work–life interface experiences. Similarly, lac-
tation rooms or private spaces to pump and store breast milk are
instrumental components to the objective workplace environment
that can impact the success of breastfeeding at work (Bruk-Lee,
Albert, & Stone, 2016). Building off of the results of the current
study, future research could examine the potential buffering effect
of these instrumental lactation resources on the role of negative
conditions in the breastfeeding decision process. If mothers feel
that they have a safe lactation or storage space, the negative
influence of hazardous working conditions, for example, could be
lessened. Integrating the findings from the current study with the
influence of these additional workplace characteristics will help
inform evidence-based intervention research and policy.
Last, the data set used for this study has allowed us to examine
job characteristics as predictors of breastfeeding success in a large
sample containing women with a wide variety of occupational
responsibilities. Still, the archival nature of the data set resulted in
suboptimal measurement of a number of key study constructs. For
instance, and in the future, the utilization of multi-item measures
for all constructs along with detailed items capturing occupational
responsibilities will aid our understanding of job characteristics as
correlates of work–family interface experiences.
Practical Implications
From a policy perspective, the findings of this exploratory study
contain interesting avenues to impact breastfeeding among em-
ployed mothers, a coveted family-directed health behavior. The
current study points to lack of job autonomy and hazardous work-
ing conditions as risk factors that human resource personnel,
managers, supervisors, and perhaps pediatricians and obstetricians
can emphasize and address. For instance, providing pregnant
women with information on how lack of job autonomy and haz-
ardous working conditions do not necessarily make combining
working with breastfeeding impossible may help. Based on social
learning theory principles (Bandura, 1977), providing anecdotal
evidence about women who have managed to breastfeed despite
unfavorable working conditions may help.
Conclusion
The reconciliation of work and breastfeeding is an important
organizational and public health issue and poses a challenge for
women who return to work after giving birth. Given that the
majority of women return to work soon after giving birth in many
Western countries, this study provides insight on job characteris-
tics that may be relevant risk factors for breastfeeding cessation.
This study points to employed women’s experiences of hazardous
working conditions and low job autonomy as factors detrimental to
women’s intentions to breastfeed and their actual breastfeeding
initiation. Further, it points to job-related support as a potential job
characteristic that can facilitate the reconciliation of work and
breastfeeding. The current study also adds to the mounting evi-
dence suggesting that breastfeeding is a phenomenon that is
shaped by organizational behavior (Spitzmueller et al., 2016; Tar-
rant, Dodgson, & Tsang Fei, 2002) and factors such as job char-
acteristics, positioning this research squarely within the realm of
research in industrial/organizational psychology and management.
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Received September 21, 2016
Revision received February 6, 2018
Accepted February 14, 2018 䡲