Breastfeeding, schooling, and income: Insights from the Indonesian Family Life Survey

Association between breastfeeding duration and educational achievement in England: results from the Millennium Cohort Study

OBJECTIVE

To evaluate the association between breastfeeding duration and educational outcomes at the end of secondary education among children from the Millennium Cohort Study.

DESIGN

Cohort study comparing school results at age 16 according to breastfeeding duration.

SETTING

England.

PARTICIPANTS

Children born in 2000-2002 (nationally representative sample).

EXPOSURE

Self-reported breastfeeding duration (categorised).

MAIN OUTCOME MEASURES

Standardised school assessments taken at the end of secondary education (General Certificate of Secondary Education (GCSEs), marked 9-1) in English and Mathematics, categorised as: 'fail, marks <4', 'low pass, marks 4-6' and 'high pass, marks ≥7 (equivalent to A-A*)'. Additionally, overall achievement was measured using the 'attainment 8' score (adding the marks of eight GCSEs, English and Mathematics double weighted; 0-90).

RESULTS

Approximately 5000 children were included. Longer breastfeeding was associated with better educational outcomes. For example, after full adjustment for socioeconomic markers and maternal cognitive ability, in comparison with children who were never breastfed, those who were breastfed for longer were more likely to have a high pass in their English and Mathematics GCSEs, and less likely to fail the English GCSE (but not the Mathematics GCSE). Additionally, compared with those never breastfed, those breastfed for at least 4 months had, on average, a 2-3 point higher attainment 8 score (coefficients: 2.10, 95% CI 0.06 to 4.14 at 4-6 months; 2.56, 95% CI 0.65 to 4.47 at 6-12 months and 3.09, 95% CI 0.84 to 5.35 at ≥12 months).

CONCLUSIONS

A longer breastfeeding duration was associated with modest improvements in educational outcomes at age 16, after controlling for important confounders.

Breastfeeding, schooling, and income: Insights from the Indonesian Family Life Survey

Recent research has highlighted associations of breastfeeding with IQ, schooling, and income, but uncertainty about such links remains. The Indonesian Family Life Survey, representative of 83% of the Indonesian population, provides data on breastfeeding, parents' years of schooling, wealth, and other family characteristics in 1993-1994, as well as schooling and income in 2014-2015 for 5,421 children of those families. Using linear regressions and controlling for village or neighbourhood, as well as propensity score matching, we analysed breastfeeding associations for boys and girls separately, when regularly fed foods/beverages other than breast milk is significantly associated with years of schooling in 2014-2015 for girls, but not for boys, after controlling for the village or neighbourhood of residence in 1993-1994. For girls, ages 1 to 1.9, 2 to 2.9, 3 to 3.9, and >4 months, relative to ages <1 month, are associated with an additional 0.41 to 0.46 years of schooling, with p values of 0.086, 0.071, 0.043, and 0.026, respectively. No comparable estimate for boys attains statistical significance. Using propensity score matching yields similar results. Associations with annual income in 2014-2015 are not statistically significant, either for all children, or for either sex. Our finding suggests that delaying regular feeding of foods/beverages other than breast milk beyond 1 month may help girls' schooling but has no observable association with annual income, perhaps because of lower labour force participation by women. Also, the inclusion of controls for village or neighbourhood of residence reduces confounding.