Paid maternity leave extension and exclusive breastfeeding practice: evidence from Brunei

Background: Exclusive breastfeeding (EBF) of infants in their first 6 months postpartum is beneficial. However, maternal employment and short maternity leave impede EBF practice. In 2011, Brunei implemented a new Maternity Leave Regulation to extend paid maternity leave. Objectives: To compare the prevalence of EBF between employed and nonworking mothers in Brunei, before and after extending paid maternity leave, to determine its effect on EBF and to determine the effects of maternal and infant sociodemographic characteristics. Methods: Cross-sectional review of feeding records for infants born in 2010 (n = 6412, 85.5% all live births) and 2013 (n = 6680, 85.7%). Results: EBF prevalence at 6 months postpartum increased from 29% in 2010 to 41% in 2013. EBF prevalence was higher among multiparous mothers (P < 0.001), mothers of Malay ethnicity (P < 0.05), and mothers of girls (P < 0.01 only in 2013) in both years. EBF prevalence among government-employed mothers (81.0%, 67.7%, and 57.8%) was greater than it was among nonworking mothers (79.1%, 66.3%, and 56.9%) by 1.9, 1.4, and 0.9 percentage points, respectively, during the first 3 months of active paid maternity leave in 2013. Mothers employed in the government and private sectors showed greater increases in the practice of EBF (15.5 and 10.8 percentage points respectively) than nonworking mothers (8.8 percentage points) from 2010 to 2013. Conclusions: EBF prevalence increased after extending paid maternity leave, with the greatest increases seen among employed mothers. Maternal ethnicity, parity, and the sex of the infant were also correlated with EBF.