By Abigail Jorgensen and Emily Martin
The time period immediately following the birth or adoption of a child can be particularly difficult for parents as they perform the mental, emotional, and physical tasks associated with welcoming a new child. At the same time, women may also be recovering from childbirth, lactating, and suffering severe lack of sleep. In all but eight countries in the world, employers provide women with paid maternity leave in order to support their health and the health of their families. However, these benefits are not legally required to be offered in a few countries, including Suriname, Papua New Guinea, and the United States.
Paid maternity leave is good for women and their families, and it should be a key component of a just society. Below, we present four of the ways in which paid maternity leave benefits the health of women and their families.
Paid maternity leave protects mothers’ mental health.
Perinatal mood and anxiety disorders (PMADs) are an area of major concern for health workers and support teams following the introduction of a new child into a family. Including depression, anxiety, Obsessive-Compulsive Disorder and others, PMADs affect up to 20% of parents, including non-gestational and adoptive parents (Senecky et al 2009; Mott et al 2011; Da Costa et al 2015; Stadtlander 2015). PMADs can result in emotional distress; feelings of helplessness, guilt, or despair; exhaustion; decreased appetite and energy; substance abuse; partner violence; and suicidality in parents.
Furthermore, infants whose caregiver(s) experience a PMAD are more likely to have difficulty sleeping; feeding struggles; abnormal brain matter formation; and delay in motor, communication, and relational milestones. Long term, these children are also more likely to have behavioral problems and lower self-esteem. Finally, children whose parents are anxious or depressed tend to internalize this stress and, in turn, show signs of anxiety and depression.
Paid maternity leave can lessen the prevalence or severity of PMADs. When maternity leave lasted between 15 and 24 weeks compared to fewer than 9 weeks, mothers reported both less depression and higher life satisfaction. Similarly, when maternity leave lasted more than 13 weeks, mothers’ psychological distress was significantly lower. Additionally, a maternity leave of at least 12 weeks has been shown to result in a 15% decrease of maternal symptoms of depression.
As impressive as this is, paid maternity leave does even more. This same decrease in symptoms (15%) was seen in a comparable sample after just 8 weeks of maternity leave that was paid. Another study found that longer maternity leave continued to lower the rate of depression up until six months of leave, when the effect began to plateau.
At the same time, full support of families requires more than paid maternity leave. Other pro-family policies, such as paternity leave or paternal flex scheduling, can also promote the health of the entire family. Paternal accommodations in particular support women’s mental health. For example, when fathers have flexible leave in the first six months after birth, mothers were 26% less likely to be prescribed anti-anxiety medication.
Paid maternity leave protects mothers’ physical health.
The intense experience of childbirth or welcoming an adopted child leaves women vulnerable to physical complications. Paid maternity leave provides women with necessary space and rest to recover.
Pregnancy and birth are physically demanding processes: 25% of mothers report feeling like they have not yet recovered physically from childbirth six months after the event. Even when a woman has a few weeks of feasible maternity leave, her birth experience may result in long-lasting medical trauma, either from vaginal lacerations or major abdominal surgery (i.e. a cesarean section). Immediate trauma to the perineum or abdomen takes time to recover from: 20% of women who gave birth vaginally report still feeling perineal discomfort or pain two months after birth. 22% of women who gave cesarean birth reported feeling persistent pain a full year afterwards. Women who give birth need time postpartum to recover from these stressors on their body.
Compelling women to go back to work – whether through a lack of leave or a lack of financial support to make leave feasible – requires exertion from someone whose body has just undergone a major and exhausting event. Exhaustion is an additional concern to physical trauma for childbirth recovery. 49% of women who have given birth report that they have not returned to their normal levels of energy six weeks after childbirth, and this proportion is even higher among women recovering from a cesarean section.
When paid, maternity leave was associated with lower levels of reported pain postpartum, particularly in the neck, shoulders, and back. Furthermore, paid maternity leave resulted in lower blood pressure and in less incidence of mothers smoking, suggesting that stress levels are more manageable for mothers who do not return to work a few days after giving birth.
There are additional health benefits to paid leave, even when mothers did not give birth. Adoptive or foster moms still experience the lack of sleep, additional stress, and physical demands of caring for a new child. These factors, combined with a demand to return to work in order to keep their job or to support their family financially, set moms up for exhaustion and illness, whether they have experienced childbirth or not.
As with mental health, paternity accommodations and leave also support mothers’ physical health. When fathers are able to take leave or have flexible schedules for the first six months after birth, mothers experience 14% fewer medical care provider visits for problems related to childbirth, and they are prescribed 11% fewer antibiotics, indicating that they experience fewer infections. These effects increase when there are no grandparents of the child who reside nearby, making the father the only available family support. Paternity leave or flexible scheduling for fathers facilitates more efficient maternal recovery.
Paid maternity leave supports infant health.
Maternity leave, specifically paid leave, supports infant health in three major ways. First, a perfectly healthy baby is expected to have four doctor’s visits in the first two months of life (Bright Futures and American Academy of Pediatrics 2021). However, babies may have illnesses or medical complications such as jaundice, weight gain concerns, colds, or fevers; these all mean additional visits to the doctor. Parental leave allows caretakers to take the baby to these appointments without having to call off work.
Second, paid leave has a noticeable impact on preventing infant death. Infants are most vulnerable shortly after birth: almost half of the deaths of children under the age of five occur in the first four weeks of life (World Health Organization 2011). Parents who have time to bond with their children are more likely to notice symptoms of dangerous illnesses or conditions and to seek medical care before those symptoms progress. These factors may be why increases in paid parental leave have been causally linked to decreasing rates of infant mortality. Statistically, “a 10-week increase in paid leave is predicted to reduce infant mortality rates by between 2.5% and 3.4%. By contrast, unpaid leave is unrelated to infant mortality, which makes sense if parents are reluctant to take time off work when wages are not replaced.” While unpaid leave does not have noticeable advantages for infant mortality, paid maternity leave can save lives.
Third, paid maternity leave facilitates increased rates of nutrition through breastmilk, an increasingly focal point in efforts of government agencies and advocacy groups due to its nutritional and immunological benefits. The American Academy of Pediatrics recommends that infants be breastfed for one year or longer, and the World Health Organization recommends the same for two years or longer. However, societal support for working mothers who are trying to meet these recommendations is slim. This may be a critical reason why, in 2017, while 84% of infants in the United States breastfed at some point, at six months old only 58% were still breastfeeding, and at a year old only 35% were still breastfeeding (CDC Breastfeeding Report Card 2020). While there are various barriers to positive breastfeeding relationships, some of these stem from lack of maternity leave and could be removed with better policies.
One specifically challenging recommendation is that infants be exclusively breastfed for six months (i.e. infants receive no form of nutrition or liquid other than breastmilk). Only 47% of infants in the United States meet this criterion by the age of 3 months, and less than 26% of infants do so by 6 months. Furthermore, the World Health Organization specifies that “[i]nfants should be breastfed on demand – that is as often as the child wants, day and night. No bottles, teats or pacifiers should be used.” Without the ability to bring a child to work, working mothers cannot meet this recommendation. One prohibitive element of the workplace is that children are not typically allowed to accompany mothers to work; in fact, in a survey of U.S. workers, only 3% of respondents said that their organization allows children to accompany parents to work. In this case, mothers who need to go to work must pump. While pumping still provides infants with the benefits of breastmilk, it usually does not meet the recommendation of avoiding bottle use. In this way, workplace culture – combined with a lack of maternity leave – stands at odds with the health recommendations for infant nutrition.
Maternity leave removes some of the barriers inherent to feeding breastmilk to babies, as evidenced by the fact that extensions in leave correspond to extensions in length of time breastfeeding. The early weeks of nursing or pumping are particularly important to the success of the mother’s goals, since that is when the body sets expectations for supply based on demand. Maternity leave, which most often immediately follows birth or adoption, occurs at the best possible time to facilitate this feeding relationship. This is even more important for adoptive mothers, who may have more appointments and spend more time inducing lactation due to the lack of help from pregnancy hormones.
Paid maternity leave facilitates stronger family bonds.
In addition to the physical health of multiple parties, paid maternity leave can create stronger bonds among family members. Babies and mothers bond better when paid maternity leave is available and taken. For babies at the age of 4 months, mothers with fewer than 6 weeks of maternity leave had more negative interactions with them than mothers who had over 12 weeks.
Paid maternity leave also facilitates better long-term behavioral and emotional abilities in children. This positive impact has even been shown to extend three years or more. Children whose mothers had less leave were more likely to experience major behavioral and emotional issues at the age of 3. This was exacerbated when mothers experienced mental health struggles, which was also more likely with less maternal leave. Reducing families’ stress from lack of time or income makes for success not only in the short term, but also for years after birth.
The numerous medical benefits of maternity leave, and specifically of paid maternity leave, are clear. Without the necessary leave, women are more at risk for emotional, mental, and physical health complications after having or welcoming a new child. Instituting paid maternity leave at the organizational level protects mothers’ and infants’ physical health, relieves stressors, and provides opportunities for stronger family bonds. Organizations, especially those committed to holistic health, ought to implement paid maternity leave as a foundational aspect of that commitment. Similarly, we ought to speak up for just and pro-family business policies that make for healthy workers and healthy families.