A national paid maternity leave policy in the United States would benefit overall public health, researchers — including two from Yale’s Department of Psychiatry — concluded in a new systematic literature review, published in the Harvard Review of Psychiatry.
Simha Ravven, MD, Assistant Clinical Professor, and Kristin Budde, MD, MPH, Assistant Professor of Clinical Psychiatry, are among the authors of the publication, which explores the impact of paid maternity leave on the mental and physical health of mothers and children.
“Our initial goals were to synthesize the literature and understand the what benefits paid leave may objectively confer,” Ravven said.
There is no national paid family leave in the United States — only unpaid leave. As a result, “sweeping discrepancies exist in paid maternity leave policies in the United states — depending on a person’s employer and state of residence,” according to the paper.
Despite women representing 47% of the workforce, only 16% of employed American workers have access to paid parental leave through their workplace, they wrote. As many as 23% of employed mothers return to work within 10 days of giving birth, because they are unable to pay living expenses without an income.
“For the child, the first three to four months are an important period for regulation of physiology, behavior, and emotional development, as well as intense bonding and attachment between mother and child,” Ravven said. “In addition, the mother needs that time to recover physically and psychologically, to attend to her own doctor appointments, and to attend the well-baby visits every two weeks. Twelve weeks is a standard length in state policies and the standard amount of time used in most studies.”
Budde added: "I believe people are going to keep having babies, and we owe it to humanity to make it as easy as possible for them to be good parents."
Access to paid leave is associated with lower rates of postpartum maternal depression, they wrote. Additionally, paid maternity leave of six weeks or less was linked with mothers being four times less likely to establish breastfeeding within the first month, and doubled the likelihood of women giving up on breastfeeding compared with women who were not working.
Paid maternity leave is also directly correlated with decreased infant and child mortality, they found.
Ravven said she was pleased to discover an economic benefit for paid maternity leave. Benefits include labor force attachment, wage stability, and a 39% decrease in the use of public assistance in the year following birth. Women who took more than 30 days of paid leave were also more likely to report a wage increase in the next year of work, according to one study, she said.
She was also surprised by the gaps in research surrounding non-traditional families.
“Frankly, I was surprised by how much the existent literature is focused on leave for mothers, and the mother/child relationship,” Ravven said. “Care of infants and children isn’t as gendered as it once was. Fathers care for children, and family structures are diverse. By looking primarily at infants and mothers we are missing important information.”
“There is a diversity of family configurations, with same sex parents, and, increasingly, fathers taking on central care taking roles for their children. We need to study paid leave and fathers, and paid leave and families with same sex parents.”
The authors recommended that the United States develop a national paid maternity leave policy of at least 12 weeks, to allow all mothers “sufficient time to be home with their infants after the birth or arrival of the child, regardless of their employer or socioeconomic status.” A paid leave of this length would allow new mothers time to attend to their own postpartum medical and psychiatric care, as well as to take her infant to important pediatric visits in the first three months of life, they said.
Specifically, the authors recommend the passage of the Family Medical and Insurance Leave Act of 2019, introduced in the Senate by U.S. Sen. Kristin Gillibrand and in the House by U.S. Rep. Rosa DeLauro.
“Such a policy would have a beneficial effect on overall public health by improving mental and physical health outcomes for mothers, improving survival and also mental and physical health outcomes for children, and allowing progress in correcting the disparities that currently exist between higher- and lower-income mothers. Additionally, these benefits would yield positive effects on the overall U.S. economy.”
Budde said: "I hope we stop talking about parental leave and parenting as if they were European luxuries unrelated to work-life balance, success in the workplace, and childhood development."