Maternal Health and Wellbeing

Childbirth in the United States is hazardous to women’s health. While rates of maternal mortality have been falling in other advanced economies, the rate of women dying in childbirth in the United States increased, from 12 to 14 per 100,000 births, between 1990 and 2015, a rate higher than in Bosnia, Libya, and Kazakhstan. And once mothers give birth, an estimated 10 to 15 percent will experience postpartum depression.

The research, what little there is, on how the length of paid leave affects maternal health shows positive effects on mental and physical health. The question is difficult to study in the U.S., largely because there is little paid leave and little variation in leave: Most first time mothers in the United States return to work within 12 weeks, the time allotted by the unpaid Family Medical Leave Act. But rigorous U.S. and international studies find that adequate periods of paid leave have significant, positive effects on maternal physical and mental health, an increase in breastfeeding, which has health benefits for mother and child, and a reduction in maternal stress and intimate partner violence. Leaves of fewer than 12 weeks have been associated with higher maternal depression and anxiety, reduced sensitivity to the infant and knowledge of infant development, negative impact on self-esteem, work stress and overload, and marital dissatisfaction.

• Psychological distress: A 2013 longitudinal study of Australian two-parent families found that the length of a mother’s leave after childbirth affected her mental health, the quality of parenting, and couple relationships. Psychological distress was significantly less likely among mothers who took more than 13 weeks of paid leave or 26 to 52 weeks in total. Leaves longer than 26 weeks, however, were associated with “distant” parenting. Mothers who experienced workplace problems during pregnancy were also more likely to report feeling rushed and their couple relationship as “unhappy” or “argumentative” two to three years later.
• Physical health: Although state, employer, and private temporary disability insurance typically cover up to six weeks for a woman to recover from a vaginal birth and eight weeks from a Cesarean section, (C-sections make up about one-third of all U.S. births) a Minnesota study following more than 400 mothers for 12 months after childbirth found that women had a number of physical symptoms and illnesses that persisted long after six weeks, including respiratory symptoms, dizziness, hot flashes, hemorrhoids, constipation, fatigue, sexual concerns, and hair loss. An Australian study found that 94 percent of new mothers reported one or more health problem six months after childbirth. Yet women underreport these issues—more than a quarter reported they hadn’t talked to a health professional.
• Mental health: Researchers assume that since the stress of juggling childbirth, recovery, caregiving, and professional work are likely greater than a mother's ability to cope, she’s at a higher risk for depression. As a result, taking an adequate amount of paid time off may help mothers to physically recover from childbirth and adjust to new caregiving and professional responsibilities. One study found increasing the length of maternity leave from under eight weeks to eight to 12 weeks showed the biggest improvement in mental health, and that increasing the length of leave by one week could reduce depressive symptoms by 6 to 7 percent.

Longer paid leaves also have long-term benefits. Another U.S. study found that increased length of paid leave is associated with decreased depressive symptoms until six months after childbirth. Using European data, one long-term study found that longer maternity leaves are associated with greater mental health years later in old age.