Breastfeeding Medicine

Physicians blogging about breastfeeding

Breastfeeding and Maternity Leave

with 11 comments

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.

Written by gcalnen

June 26, 2010 at 2:44 pm

Posted in Uncategorized

11 Responses

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  1. It’s great that so many people are advocating for a national paid maternity leave. I just don’t seen how this won’t affect women’s equality in the workplace. If a woman takes 3 months as maternity leave, she is out of the running for promotions, projects, etc. Also the company has to find someone to fill her position while she is gone. Women without children and men don’t take this leave; therefore they would be seen as more desirable employees. Regardless of what is morally right or wrong, or the ethics of the situation, I just don’t see how a woman could take an extended period of time off in America without it adversely affecting her position.


    June 26, 2010 at 5:00 pm

  2. Great post! The sad thing is it is hard to imagine who will fight for paid maternity leave, other than the underfunded breastfeeding organizations like ABM and USBC etc. Certainly, the breastpump companies won’t be fighting for it! I personally think 3 months is too little. At that point moms are just beginning to enjoy their babies and it is very hard to go back to work. I think paid maternity leave should ideally be 4-6 months, though I think that flexible arrangements that allow moms to work part-time from home, or have workplace childcare allowing them to breastfeed in person, would be great too and give women the most options.

    Best for Babes

    June 26, 2010 at 7:53 pm

  3. Thank you, Dr. Calnen! Amen. U.S. leave policy is meager, compared not just to developed nations but developing nations too. If my memory is correct, we are one of only four out of about 168 nations which does not provide paid maternity leave. (The others are Lesotho, Swaziland, and Papua New Guinea.) Why is it that we give lip service to the importance of parenting but our policies do not recognize that it is valuable work–a labor of love, sure, but also labor that, done well, benefits our communities and our nation? We are so focused on commerce that activities that do not involve the exchange of money do not count when we take the measure of our overall health.

    I believe in Sweden they actually require men to take paternity leave, for gender equity–to address the issue that Meghan brings up above. Aside from the value of supporting new families in crucial, potentially vulnerable moments, there are solid public health reasons to do this, too, for men–men who take paternity leave live longer, on average, than those who do not.


    June 26, 2010 at 10:23 pm

  4. One more thing, and apologies if it is already familiar: A study of twenty-five years of data from OECD countries found that extending paid job protected maternity leave by ten weeks reduced postneonatal mortality by 3.7 to 4.5 percent (Ruhm, Christopher. 2000. “Parental Leave and Child Health.” Journal of Health Economics 19(6): 931-960.) Unpaid maternity leave had no significant effect. (Didn’t find this on my own, but in Jane Waldfogel’s 2006 book _What Children Need_.)


    June 26, 2010 at 10:37 pm

  5. Sad thing is, our own govt. won’t model the ideal as shown in The Business Case for Breastfeeding. I work for WIC and recently one of our administrators made a comment at a staff meeting — in regards to the fact that there were several employees expecting babies in the near future — “We’re not gonna pay you all to breastfeed your babies.” These women had to go above the boss’ head to secure their FMLA!


    June 27, 2010 at 8:41 pm

  6. In places like France with generous maternity leave policies, half the working mothers never return to the workplace after the first (often only) child. They just never go back. Which brings us back to the question of why women are encouraged to pursue careers during their prime fertile years in the first place, or why the industrial model is considered the only possible option that women should seek to pursue additional rights for/in.

    Maternity leave that is generous doesn’t seem to actually keep women in the industrial workforce and it is interesting that it keeps being offered up as the only possible solution to increase breastfeeding.

    A Lady

    June 29, 2010 at 2:25 am

  7. I live in Canada and I had a year off with each of my 3 sons. It was 6 months, but changed to 12 months in 2001. I was still able to climb the ‘corporate ladder’ even when I was off work. I’m now a clinical nurse educator and being on maternity leave never hindered my ability to change jobs.

    It’s known and expected that women who are off on maternity leave in Canada get the same treatment as those who are working. I even accrued vacation and seniority during my time off. I dud not once worry that I wouldn’t get my job back, or wouldn’t be considered for new jobs because I was pregnant. The laws protected me against any prejudices and I knew I could call on our labour laws to back me up if needed. The thing is, it’s never needed! Employers KNOW this is the law and they follow it.

    It would obviously be a huge change in culture in the U.S but Canada is a great example of a country that makes the system work.

    As an RN, I was able to get 85% of my full pay for 6 months and 55% for the 2nd 6 months. Not to mention the gov’t cuts me a cheque every month for childcare expenses (even though I’m married with decent income). It’s amazing really, I know I’m so very lucky…and when I hear about women in the U.S who have to leave their babies 6 weeks post c-section, it makes me sad for them…these poor babes want and deserve their mommies and these mommies deserve to be with their babies…

    There is so much literature about role strain in mothers, and with the luxury of having one year off, I was able to bond with my babies, enjoy them, breastfeed them, and have that special time before I went back into the real world of having multiple roles and demands. I still question my decision to work fulltime…but I feel so blessed to have had one year off with each of my boys. It helps relieve that role strain that so many women experience, even if just temporarily…and I’m fairly certain it helps to establish and foster a healthy breastfeeding relationship that is sustainable because moms & babes are where they should be — TOGETHER!


    June 30, 2010 at 10:36 pm

    • I understand that the labor laws are there to back you up. However what’s to stop a company from lumping your position in with 50 other lay-offs/firings due to the economy? It is labeled as downsizing and is perfectly legal (especially in the US). In the US it is also illegal to discriminate against pregnant women and mothers; however that doesn’t stop companies from legally doing so. I’ve known women who were fired/let go during their pregnancies probably because the company didn’t want to pay paid leave for them. But as I pointed out, especially in today’s economy, job loss is not uncommon and she would have an impossible time proving her firing was due to the pregnancy.

      Obviously this is unethical business, but the businesses don’t really care about their employees, just the bottom line.

      More paid leave may benefit society as a whole, but why would an individual business care? If the infant mortality rate is lowered, it doesn’t earn the business any more money.

      I guess my main point is that you cannot legislate compassion.


      July 9, 2010 at 10:26 pm

  8. I am Canadian. We are very lucky to have such wonderful benefits for maternity leave. We currently receive a full year of benefits – 55% of our regular wages – or maximum of approximately $750 bi weekly. This year can be split between both parents. A mothers job is also secure for an additional year.

    I have never experience any prejudice being a woman in child bearing years; my employers helped me celebrate the birth of my first child, and encourage a second.
    In addition to assisting a mother with extended breastfeeding, I personally feel that extended maternity leave benefits assists with anxiety and post postpartum depression, and healthy bonding between mother and child. This goes further than just breastfeeding (FYI I did breastfeed 10 months, 4 months exclusively).

    Both Federal and Provincial governments offer programs for parent and child for a healthy start. To me it is incredible that two of the wealthiest countries on our planet can be so different in how to give our children the best start in life.


    July 1, 2010 at 6:59 am

  9. I just read the CDC’s 2011 Breastfeeding Report Card, which shows that only 35% of women in the U.S. are exclusively breastfeeding at 3 months. They cite the fact that only 5% of U.S. infants are born in “Baby-Friendly” hospitals; however, I think that the absence of a national paid maternity leave mandate and workplace cooperation are the main factors. We are so far behind most countries in paid leave. Why is there not a national movement. What can we do to get more involved and get the attention of policy-makers?


    June 27, 2012 at 10:17 am

  10. Breastfeeding protects your baby from a long list of illnesses. Numerous studies from around the world have shown that stomach viruses, lower respiratory illnesses, ear infections, and meningitis occur less often in breastfed babies and are less severe when they do happen.


    February 13, 2014 at 2:03 am

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