Maternity leave utilization and its relationship to postpartum maternal and child health outcomes Open Access
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Maternity leave is a critical employee benefit that provides essential time for mothers to heal from the stresses of pregnancy and childbirth and bond with a new baby. It is also associated with a number of health benefits for mother and child, including improved maternal mental health, increased breastfeeding duration and reduced infant and child mortality. Yet, the U.S. lags behind other industrialized countries in both the provision and utilization of maternity leave coverage. This dissertation research project explores the relationship between maternity leave and maternal and child health in the U.S. through three separate but related studies.In the first study we analyze maternity leave utilization over time. U.S. mothers’ participation in the labor force has increased dramatically over the last several decades. Yet, little is known about how maternity leave utilization patterns have kept pace to support mothers in the workplace. This study provides the first long-term assessment of trends in maternity leave utilization in the U.S. following implementation of the Family and Medical Leave Act (FMLA) more than 20 years ago. We analyze recent, nationally representative survey data from four cycles of the National Survey of Family Growth (NSFG) using a repeat, cross-sectional design to examine changes over time in maternity leave utilization among women with births between 1960 and 2010. Overall, U.S. mothers took maternity leave for 65 percent of births and received some pay for their maternity leave for 42 percent of births between 1960 and 2010. Linear trends show increased utilization leading up to implementation of FMLA and a decline following the policy for both paid and unpaid leave. Results also indicate significant disparities in utilization for low-income and unmarried women. This study highlights the unreliable nature of maternity leave in the U.S., where as recently as 2010, more than one-third of working women with recent births were unable to take maternity leave. Unfortunately, our findings do not indicate a sustained increase in access to maternity leave following implementation of FMLA. These findings provide new impetus to support recent efforts to advance paid leave and enhance the FMLA.The second study takes a broad perspective to probe both the correlates of maternity leave utilization in the U.S. and the related health benefits for mother and child. While maternity leave is known to affect health, the relationship between maternity leave and health outcomes in the U.S. has not been formally and comprehensively assessed to guide public health research and policy in this area. This systematic review of the peer- reviewed scholarly literature aims to address this gap. We identified 37 studies to be included in the review, extracted key data for each of the included studies and assessed study quality using the “Weight of the Evidence” approach. The literature generally confirms a positive, though limited correlation between maternity leave coverage and utilization. Likewise, longer maternity leaves are associated with improved breastfeeding intentions and rates of initiation, duration and predominance as well as improved maternal mental health and early childhood health outcomes. However, the literature points to important disparities in access to maternity leave that carry over into health outcomes, such as breastfeeding. We present a conceptual framework synthesizing what is known to date related to maternity leave access and health outcomes.The third study draws on findings from the second study to consider therelationship between maternity leave utilization and breastfeeding initiation and duration in the U.S. This analysis uses recent, nationally representative NSFG data to investigate whether women who take maternity leave in the U.S. are more likely to initiate and sustain breastfeeding than women who do not. Our unadjusted estimates indicate women who take maternity leave are more likely to initiate breastfeeding and breastfeed for longer durations than those who do not take maternity leave. However, after controlling for underlying differences through propensity score matching and regression adjustments, we find no significant effect from maternity leave exposure, paid or unpaid, on breastfeeding outcomes. The propensity score-matched regression models show only maternity leaves ≥12 weeks increase the odds of breastfeeding for six months or more. This study indicates that in the U.S. access to maternity leave does not increase the odds of breastfeeding, unless provided for extended durations. Our findings indicate 12 weeks of maternity leave or more may serve as a baseline threshold for policies supporting breastfeeding outcomes. This study also underscores the relatively low overall levels of maternity leave access and utilization as well as breastfeeding rates in the U.S. As currently utilized, maternity leave appears to barely move the needle in terms of providing support for improving breastfeeding outcomes in the U.S.