Breastfeeding and Maternity Leave

It is mystifying that those of us truly interested in advocating for breastfeeding spend so much of our time trying to make employment outside of the home more compatible with breastfeeding, never acknowledging the fact that it is employment, per se, that constitutes the problem.   A study recently published online in the Archives of Disease in Childhood  has demonstrated that mothers are significantly more likely to breastfeed if they care for their infants themselves than if they have others care for their infants for them (Medscape Medical News, June 24, 2010).   The results of the study are a reaffirmation of a truth so basic that it should be self-evident: in order to breastfeed, mothers must be with their infants.  

So, what conclusion can we draw from this? Should a woman indeed be kept barefoot and in the kitchen?

I don’t think so.

Those days are fading into a past to which, thankfully, we will never retreat, even though we have a long way to go in terms of establishing equal rights and opportunities for women in the workplace.  Rather, in order to bring motherhood and employment into true alignment, we need to start giving serious consideration to the need for a national paid maternity leave policy.

At least in the United States, maternity leave is not really valued as an integral part of employment.   It’s supposed to be short and sweet, so that the mother can return to her “true” calling, which is to work outside the home.   There is a tragic dichotomy here, a division of life separating our daily activities into a work side and a home side, and unfortunately the work side almost always prevails in our thinking.   What we really need to understand is that maternity leave is an inextricable aspect of employment, not simply something “extra” which an employee has to arrange for herself.   It is not a fringe benefit, it is not a negotiable option, and it is not a necessary encumbrance to be minimized or eliminated: it is a human right to which all working mothers are entitled:

In order to prevent discrimination against women on the grounds of marriage or maternity and to ensure their effective right to work, States Parties shall take appropriate measures… to introduce maternity leave with pay or with comparable social benefits without loss of former employment, seniority or social allowances.”

-Article 11, Section 2 (b) of the United Nations Convention on the Elimination of All Forms of Discrimination against Women, December 18, 1979.     

More than thirty years after the release of this declaration, we in the United States are hardly even talking about a national paid maternity leave policy.   Why?

I think it is because we assess the worth of a person, man or woman, by how much he or she works.   We tend to forget that a mother (or a father, for that matter), can be on an extended parental leave and still be considered to be employed.   It’s as though parental leave is regarded as a state of suspended animation, an unnatural or at least an unproductive form of hibernation from which the worker should rouse herself as soon as possible in order once again to become a truly productive member of society, as though mothering an infant at home is not to be considered something truly valuable.   Perhaps it isn’t valuable to us only because it can’t be immediately translated into monetary terms.   This kind of logic has even insinuated itself into the mindset of well-intentioned breastfeeding advocates.   Consider this argument in favor of worksite breastfeeding accomodations, presented in The Business Case for Breastfeeding:

Employees whose companies provide breastfeeding support… also feel the support eases their transition back to work and enables them to return from maternity leave sooner.   (My emphasis).

What’s the rush?   Shouldn’t the point of a maternity leave be to extend the period of breastfeeding, especially exclusive breastfeeding, and not shorten it?   And isn’t the assumption here that feeding the infant expressed breast milk while the mother is at work is just as good as direct breastfeeding? Certainly the feeding of expressed breast milk is far more preferable to formula feeding, but it is not nearly as good as putting the baby directly to the breast.

  Only a national paid maternity leave policy will move us toward the objective of exclusive and extended breastfeeding.   Without it, we might as well put our Healthy People goals on a library shelf and forget about them.   They will never become a reality. 

This is more than a human rights issue; it is a public health issue as well.   The tragedy of our discussion of a maternity leave policy is that it has never been framed as a public health issue.   Never before in the history of mankind has there been such a tremendous influx of women into the workforce as we have witnessed in the past century, and especially the last half-century.   The adverse repercussions of this early separation of infants from their mothers on such a grand scale are yet to be fully worked out; however, considering the state of physiological and neurological immaturity into which the newborn infant is born, the social and health costs are bound to be considerable.   The practice of breastfeeding is clearly one of the victims in terms of desired health outcomes, but I suspect it will not be the only one.

This is not to say that all mothers should be required to stay home with their infants for months after delivery.   All families are different.   It is entirely conceivable that under certain circumstances infants would fare far better if their mothers were to return to work sooner rather than later.   Life is complex.   One size doesn’t fit all.   The point is that the option to remain at  home with the young infant should be left to the parents, not the employer.  

We are far from the point of adopting a national paid maternity leave policy in this country, especially a reasonable maternity leave of months rather than weeks. But we must begin the process.   Putting into place breastfeeding-friendly workplace accommodations is laudable, but it shouldn’t be considered a substitute for maternity leave.     

Jerry Calnen, MD, is a pediatrician and is president of the Academy of Breastfeeding Medicine.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.