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Parental leave benefits and breastfeeding in Germany: effects of the 2007 reform

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Abstract

While breastfeeding is associated with health benefits for both mothers and children, it may also make it difficult for mothers to return to the labor market early. Maternity and parental leave regulations have been developed to mitigate this conflict. In 2007, Germany passed a reform introducing a new parental leave benefit (Elterngeld). In this paper, we address the question of whether the new parental leave benefit impacts breastfeeding initiation and duration in Germany. We use the reform as an exogenous policy variation to obtain causal evidence on breastfeeding behavior, applying a difference-in-differences approach. Mothers in particular benefit from the reform especially if they were employed prior to childbirth or if they have a household income above the income threshold of the previous parental leave scheme (treatment group). The reform did not bring significant changes within the first year of a child’s life for all other mothers (control group). We draw on representative survey data from the Socio-Economic Panel (SOEP) study. Three breastfeeding measures are used for the 2004 to 2009 cohorts: (1) breastfeeding at birth; (2) breastfeeding for at least 4 months; and (3) breastfeeding for at least 6 months. We find no effect of the Elterngeld reform on breastfeeding initiation but do observe an effect on breastfeeding duration. Our results are robust over various sensitivity tests, including placebo regressions, the application of matching approaches, and controlling for regional indicators, among others. Thus, our empirical results provide evidence that the reform’s goal of allowing parents to spend more time with their children during the first year of life also impacted breastfeeding behavior.

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Notes

  1. While most of the studies report correlations between breastfeeding and health outcomes, in those by Kramer et al. (2008) and Fitzsimons and Vera-Hernandez (2013) mothers are randomly treated with breastfeeding promotion or assistance. These studies support the assumption that breastfeeding is beneficial for children’s cognitive development. Their findings are, however, less conclusive with regard to other health outcomes. A recent sibling study finds no significant long-term breastfeeding benefits in sibling pairs in which one child was breastfed and the other was not (Colen and Ramey 2014); however, this study does not account for exclusive breastfeeding duration, for example. Another recent study indicates that breastfeeding has long-term benefits for intelligence (Victora et al. 2015). In this study, participants were followed up until the age of 30, which is a considerably long-term observation period.

  2. With data from ten European countries, Pronzato (2009) shows that paid leave increases the probability of staying at home in the first year of a child’s life. Contrary to other findings, this study concludes that longer periods of job protection increase the probability of returning to work.

  3. Some federal states such as Baden-Wurttemberg and Bavaria provided a benefit for an additional 12 months prior to 2007.

  4. It has to be noted that the replacement rate under the new parental leave benefit is between 67 and 100 % for parents with a net income below €1000 per month, i.e., the lower the income, the higher the replacement rate (Spiess and Wrohlich 2008).

  5. While employed mothers are entitled to Elterngeld after these 8 weeks, others (e.g., mothers who are students or self-employed as well as fathers) are entitled from the birth of the child onwards.

  6. A study by Kottwitz et al. (2011) also provides new data on breastfeeding but does not cover breastfeeding as a main focus.

  7. The figures refer to children who are breastfed at all, not necessarily exclusively. Exclusive breastfeeding refers to feeding with breast milk only, without “other liquids or solids (except vitamin/mineral drops, syrups)” (Kersting and Dulon 2002), while any breastfeeding refers to feeding with breast milk regardless of additional feeding or not.

  8. Dropping these 53 cases should not lead to a systematic bias as births are almost randomly distributed over a calendar year. However, we performed an analysis for breastfeeding at birth versus no breastfeeding initiation for the full sample of children, which yielded similar results.

  9. Multiple pregnancies by the same mother are taken into account by estimating the robust variance in the multivariate regression models that adjust for within-cluster correlation (Rogers 1993).

  10. Missing information is mainly due to late survey entry of respondents with children who had already outgrown the newborn age so they were not asked to answer the newborn-specific questionnaire.

  11. Baby-Friendly Hospital is an initiative supported by UNICEF and the WHO. The aim is “to implement practices that protect, promote and support breastfeeding” (World Health Organization and UNICEF 2009). Practices to provide a hospital environment that supports breastfeeding include the training of health care staff, providing information and assistance on breastfeeding to pregnant women and new mothers, encouragement of breastfeeding initiation within 30 min after birth, and 24-h rooming-in of mothers with their newborn child. The number of certified baby-friendly hospitals in Germany rose from 19 to 51 out of more than 800 hospitals with a maternity unit in our observation period 2004–2009 (BFHI 2013).

  12. Data on certified baby-friendly hospitals in 2006–2009 were provided to the authors by the “Babyfreundliches Krankenhaus” initiative (BFHI 2014). Hospital data from 2006 were linked with data from the 2004 and 2005 birth cohorts.

  13. The choice of a 20 km distance is justified by the fact that 98 % of the German population can access a hospital within 20 min by car, i.e., a distance of 20 km at a speed of 60 km/h (Beivers and Spangenberg 2008). As geographic coordinates are not available for all households, a separate category for those missing cases was included in the estimation to avoid further dropping of observations.

  14. As described above, after 6 months, only parents with a maximum household income of or below €16,500 (€13,500 for single parents) received a benefit of €300 or more per month prior to the reform. A separate robustness check was performed for breastfeeding at 6 months by allocating non-working mothers with an annual household income of more than €16,500 to the treatment group as they benefit from new parental leave reform after 6 months. This specification, however, does not change our main findings.

  15. In the case of parallel employment calendar spells (such as women who reported both working part-time and being a homemaker), employment is given priority when coding employment status before pregnancy. The category “in education” comprises all women who stated that they were in the vocational or tertiary educational system.

  16. Matching is based on observable characteristics. If selection into treatment and control groups is affected by unobservables, such as personality traits or other preference measures, this would bias our results. However, unobserved characteristics are assumed to be stable or to follow the same trend in the treatment and control groups throughout the entire period of observation. Hence, mothers’ unobserved characteristics are captured by combining the matching approaches with a DiD estimator where breastfeeding outcomes are compared for mothers in the treatment and control groups before and after the reform.

  17. Propensity score matching and entropy balancing are performed using the Stata software modules PSMATCH2 (Leuven and Sianesi 2003) and EBALANCE (Hainmueller and Xu 2011), respectively.

  18. Only mothers in the treatment group are considered in this comparison. The picture does not change if mothers who were not in employment prior to pregnancy are also excluded.

  19. It has to be noted that almost all children who are in day care attend publicly funded day care centers.

  20. Missing data from the official statistics on publicly funded day care slots for children under three in 2004 and 2005 were imputed by using day care information from 2002 (data were provided by the German Federal Statistical Office; Statistisches Bundesamt 2013a).

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Acknowledgments

The authors are grateful to Silke Anger, Emilia del Bono, Christian Krekel, Jan Marcus, Nicolas Ziebarth, two anonymous referees, and the editors for their helpful comments. We also thank the “Babyfreundliches Krankenhaus” initiative for providing data on certified Baby-friendly hospitals in Germany. We gratefully acknowledge a PhD scholarship of the Research Training Group SOCLIFE at the University of Cologne (GRK 1461, funded by the German Research Foundation) to Anja Oppermann and a fellowship of the International Max Planck Research School on the Life Course (LIFE, www.imprs-life.mpg.de) to Anita Kottwitz during their work on this research project. The manuscript was written while Anja Oppermann was a visiting researcher at DIW Berlin (research departments: German Socio-Economic Panel Study and Education and Family).

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  1. DIW Berlin, Mohrenstraße 58, 10117, Berlin, Germany

    Anita Kottwitz & C. Katharina Spiess

  2. iFQ, Schützenstraße 6a, 10117, Berlin, Germany

    Anja Oppermann

  3. Freie Universität Berlin, Boltzmannstraße 20, 14195, Berlin, Germany

    C. Katharina Spiess

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  1. Anita Kottwitz
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Kottwitz, A., Oppermann, A. & Spiess, C.K. Parental leave benefits and breastfeeding in Germany: effects of the 2007 reform. Rev Econ Household 14, 859–890 (2016). https://doi.org/10.1007/s11150-015-9299-4

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