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Larose MP, Haeck C, Lefebvre P, Merrigan P. Examining the impact of a change in maternity leave policy in Canada on maternal mental health care visits to the physician. Arch Womens Ment Health 2024; 27:775-783. [PMID: 38411866 PMCID: PMC11405480 DOI: 10.1007/s00737-024-01448-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 02/12/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Maternity leave is a critical employee benefit that allows mothers to recover from the stress of pregnancy and childbirth and bond with their new baby. We aimed to examine the association between the extension of a maternity leave policy and maternal use of mental health services and prescription drugs in a universal public healthcare system. METHODS This study uses administrative medical records from 18,000 randomly selected women who gave birth three months before and after an extension of the maternity leave policy. More specifically, mothers who gave birth after January 1st 2001, were entitled to 50 weeks of paid maternity leave, while mothers who gave birth before that date were entitled to only 26 weeks of paid maternity leave. Medical records were analyzed over a seven-year period (i.e., from October 1998 to March 2006). We examined the number and costs of mothers' medical visits for mental health care in the five years following delivery, as well as maternal use of prescribed medication for mental health problems. RESULTS We found that mothers with extended maternity leave had - 0.12 (95%CI=-0.21; -0.02) fewer medical visits than mothers without a more generous maternity leave and that the cost of mental health services was Can$5 less expensive per women. These differences were found specifically during the extended maternity leave period. CONCLUSIONS The extra time away from work may help mothers to balance new family dynamics which may result in less demand on the healthcare system.
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Affiliation(s)
- Marie-Pier Larose
- INVEST Flagship Research Center, Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland.
| | - Catherine Haeck
- Département des sciences économiques, Université du Québec à Montréal, P.O. 8888, Box "A", Montreal, QC, Canada
| | - Pierre Lefebvre
- Département des sciences économiques, Université du Québec à Montréal, P.O. 8888, Box "A", Montreal, QC, Canada
| | - Philip Merrigan
- Département des sciences économiques, Université du Québec à Montréal, P.O. 8888, Box "A", Montreal, QC, Canada
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2
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Goodman JM, Lara-Mejía V, Hernández-Cordero S, Vilar-Compte M. Breastfeeding among women employed in Mexico's informal sector: strategies to overcome key barriers. Int J Equity Health 2024; 23:144. [PMID: 39044248 PMCID: PMC11264414 DOI: 10.1186/s12939-024-02147-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/07/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Rates of exclusive breastfeeding fall below recommended levels, particularly among women in paid employment. In Mexico, more than half of women are in informal employment, meaning they lack many of the protections that may support breastfeeding. METHODS In-depth interviews with 15 key informants representing government agencies (n = 6 organizations), NGOs (n = 4), international organizations (n = 2), and academia (n = 2) in Mexico. Interviews were conducted between March and June 2023. To understand and describe barriers to breastfeeding among informally employed women in Mexico according to key informants and the current and potential policies to address these barriers, we conducted a qualitative thematic analysis. RESULTS Current policies to promote, protect, and support breastfeeding predominantly apply to all employed women, but respondents expressed concern that they did not provide adequate protection for women in informal employment. Additional themes concerned the need for relevant programs to be institutionalized and coordinated, discussions of breastfeeding as a right, and the legal equivalence (whether true in practice or not) of formal and informal workers. CONCLUSIONS Women employed in Mexico's informal sector face a dearth of maternity protections. According to key informants, few policies exist to promote, protect, and support breastfeeding among employed women, in general, but the economic vulnerability and challenging working conditions of women in informal employment exacerbates their situation. The lack of access to formal labor protections, such as paid maternity leave, creates a significant barrier to breastfeeding for women in the informal sector. Recommendations include short-term policies to fill gaps in social protection for informally employed women, as well as longer-term solutions such as the development of universal social protection programs and supporting formalization.
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Affiliation(s)
- Julia M Goodman
- OHSU-PSU School of Public Health, Vanport Building, Ste. 510, 97201, Portland, OR, USA.
| | - Vania Lara-Mejía
- Instituto de Investigaciones para el Desarrollo con Equidad (EQUIDE), Universidad Iberoamericana, Ciudad de México, Mexico
| | - Sonia Hernández-Cordero
- Instituto de Investigaciones para el Desarrollo con Equidad (EQUIDE), Universidad Iberoamericana, Ciudad de México, Mexico
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3
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Arora K, Wolf DA. Paid Leave Mandates and Care for Older Parents. Milbank Q 2024. [PMID: 38899473 DOI: 10.1111/1468-0009.12708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/03/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Policy Points We examined the effect of the Paid Family Leave policy (PFL) and Paid Sick Leave policy (PSL) on care provision to older parents. We found that PSL adoption led to an increase in care provision, an effect mainly attributable to respondents in states/periods when PSL and PFL were concurrently offered. Some of the strongest effects were found among women and unpartnered adult children. PFL adoption by itself was not associated with care provision to parents except when PFL also offered job protection. Paid leave policies have heterogeneous effects on eldercare and their design and implementation should be carefully considered. CONTEXT Family caregivers play a critical role in the American long-term care system. However, care responsibilities are known to potentially conflict with paid work, as about half of family caregivers are employed. The federal Family and Medical Leave Act passed by the US Congress in 1993 provides a nonuniversal, unpaid work benefit. In response, several states and localities have adopted the Paid Family Leave policy (PFL) and Paid Sick Leave policy (PSL) over the last two decades. Our objective is to examine the effect of these policies on the probability of personal care provision to older parents. METHODS This study used longitudinal data from the Health and Retirement Study (1998-2020). Difference-in-differences regression models were estimated to examine associations between state- and local-level PFL and PSL mandates and personal care provision to older parents. We analyzed heterogeneous effects by the type of paid leave exposure (provision of job protection with PFL and availability of both PSL and PFL [with or without job protection] concurrently). We also examined results for different population subgroups. FINDINGS PSL implementation was associated with a four- to five-percentage point increase in the probability of personal care provision. These effects were mainly attributable to respondents in states/periods when PSL and PFL were concurrently offered. The strongest effects were found among adult children who were employed at baseline, women, younger, unpartnered, and college educated. PFL implementation by itself was not associated with care provision to parents except when the policy also offered job protection. CONCLUSIONS Paid leave policies have heterogeneous impacts on personal care provision, potentially owing to differences in program features, variation in caregiving needs, and respondent characteristics. Overall, the results indicate that offering paid sick leave and paid family leave, when combined with job protection, could support potential family caregivers.
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Affiliation(s)
| | - Douglas A Wolf
- Maxwell School of Citizenship and Public Affairs, Syracuse University
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4
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Lall MD, Jayaprakash N, Carrick A, Chang BP, Himelfarb NT, Thomas Y, Wong ML, Dobiesz V, Raukar NP. Consensus-Driven Recommendations to Support Physician Pregnancy, Adoption, Surrogacy, Parental Leave, and Lactation in Emergency Medicine. Ann Emerg Med 2024; 83:585-597. [PMID: 38639673 DOI: 10.1016/j.annemergmed.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/17/2024] [Accepted: 03/11/2024] [Indexed: 04/20/2024]
Abstract
The emergency department clinical environment is unique, and guidelines for promoting supportive and equitable workplace cultures ensure success and longevity for pregnant persons and parents in emergency medicine. There is paucity, variability, and dissatisfaction with current parental (historically referred to as maternity and paternity) leave policies. This paper describes the development of consensus-derived recommendations to serve as a framework for emergency departments across the country for incorporating family-friendly policies. Policies that foster a family-inclusive workplace by allowing for professional advancement without sacrificing personal values regardless of sex, gender, and gender identity are critical for emergency medicine recruitment and retention.
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Affiliation(s)
- Michelle D Lall
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA.
| | - Namita Jayaprakash
- Department of Emergency Medicine, Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - Angela Carrick
- Kansas College of Osteopathic Medicine, Wichita, KS; Department of Emergency Medicine, Hutchison Regional Medical Center, Hutchison, KS
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY
| | - Nadine T Himelfarb
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Ynhi Thomas
- Henry J.N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX
| | - Matthew L Wong
- Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Valerie Dobiesz
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Neha P Raukar
- Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN
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5
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Mehta A, Spitz J, Sharma S, Bonomo J, Brewer LC, Mehta LS, Sharma G. Addressing Social Determinants of Health in Maternal Cardiovascular Health. Can J Cardiol 2024; 40:1031-1042. [PMID: 38387722 DOI: 10.1016/j.cjca.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024] Open
Abstract
Cardiovascular diseases (CVDs) remain the number-one cause of maternal mortality, with over two-thirds of cases being preventable. Social determinants of health (SDoH) encompass the nonmedical social and environmental factors that an individual experiences that have a significant impact on their health. These stressors disproportionately affect socially disadvantaged and minority populations. Pregnancy is a physiologically stressful state that can unmask underlying CVD risk factors and lead to adverse pregnancy outcomes (APOs). Disparities in APOs are particularly pronounced among individuals of color and those from economically disadvantaged backgrounds. This variation underscores healthcare inequity and access, a failure of the healthcare system. Besides short-term negative effects, APOs also are associated strongly with long-term CVDs. APOs therefore must be identified as a cue for early intervention, for the prevention and management of CVD risk factors. This review explores the intricate relationship among maternal morbidity and mortality, SDoH, and cardiovascular health, and the implementation of health policy efforts to reduce the negative impact of SDoH in this patient population. The review emphasizes the importance of comprehensive strategies to improve maternal health outcomes.
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Affiliation(s)
- Adhya Mehta
- Department of Internal Medicine, Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, New York, USA
| | - Jared Spitz
- Department of Cardiovascular Medicine, Inova Health System, Falls Church, Virginia, USA
| | - Sneha Sharma
- Department of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jason Bonomo
- Department of Cardiovascular Medicine, Inova Health System, Falls Church, Virginia, USA
| | - LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Laxmi S Mehta
- Department of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Garima Sharma
- Department of Cardiovascular Medicine, Inova Health System, Falls Church, Virginia, USA.
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Rosenberg J, Nardella D, Shabanova V. State paid family leave policies and breastfeeding duration: cross-sectional analysis of 2021 national immunization survey-child. Int Breastfeed J 2024; 19:37. [PMID: 38796467 PMCID: PMC11128124 DOI: 10.1186/s13006-024-00646-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 05/18/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND Paid parental leave policies may promote breastfeeding, which can have short- and long-term health benefits for both members of the birthing person-infant dyad. In the United States, where 56% of the workforce qualifies for unpaid federal medical leave, certain states have recently enacted paid parental and family leave policies. We aimed to assess the extent to which living in states with versus without paid family leave was associated with feeding regimens that included breastfeeding. METHODS In this cross-sectional analysis of the 2021 National Immunization Survey-Child, we assessed feeding outcomes: (1) exclusively breastfed (only fed breastmilk-never infant formula-both before and after six months of age), (2) late mixed breastfeeding (formula after six months), (3) early mixed breastfeeding (breastfed, formula before six months), and (4) never breastfed. We conducted Pearson χ2 to compare social-demographic characteristics and multivariable nominal regression to assess extent to paid family leave was associated with breastfeeding regimens, compared with never breastfeeding. RESULTS Of the 35,995 respondents, 5,806 (25% of weighted respondents) were from states with paid family leave policies. Compared with never breastfeeding, all feeding that incorporated breastfeeding-exclusive breastfeeding, late mixed feeding (breastfed, formula introduced after six months), and early mixed feeding (breastfed, formula introduced before six months)-were more prevalent in states with paid family leave policies. The adjusted prevalence ratio (aPR) and differences in adjusted prevalence compared with never breastfeeding in states with versus without paid family leave policies were: aPR 1.41 (95% CI 1.15, 1.73), 5.36% difference for exclusive breastfeeding; aPR 1.25 (95% CI 1.01, 1.53), 3.19% difference for late mixed feeding, aPR 1.32 (95% CI 1.32, 1.97), 5.42% difference for early mixed feeding. CONCLUSION States with paid family leave policies have higher rates of any breastfeeding and of exclusive breastfeeding than states without such policies. Because all feeding types that incorporate breastfeeding were higher in states with paid family leave policies, expansion of paid family leave may improve breastfeeding rates.
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Affiliation(s)
- Julia Rosenberg
- Department of Pediatrics, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA.
| | - Deanna Nardella
- Department of Pediatrics, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA
- National Clinician Scholars Program, Yale University, 333 Cedar St, New Haven, CT, USA
| | - Veronika Shabanova
- Department of Pediatrics, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA
- Department of Biostatistics, Yale School of Public Health, 333 Cedar St, New Haven, CT, USA
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7
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Ajetunmobi O, McIntosh E, Stockton D, Tappin D, Whyte B. Levelling up health in the early years: A cost-analysis of infant feeding and healthcare. PLoS One 2024; 19:e0300267. [PMID: 38776279 PMCID: PMC11111004 DOI: 10.1371/journal.pone.0300267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 02/25/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Although breastfeeding is recommended as the optimal form of nutrition in the first six months, it is not sustained as the predominant mode of feeding infants in Scotland. This study estimated the impact of infant feeding choices on primary and secondary healthcare service costs in a 13-year birth cohort. METHOD Using linked administrative datasets, in a retrospective cohort design of 502,948 singletons born in Scotland between 1997 and 2009, we estimated the cost of GP consultations and hospital admissions by area deprivation and mode of infant feeding up to 6-8 weeks for ten common childhood conditions from birth to 27 months. Additionally, we calculated the potential healthcare savings if all infants in the cohort had been exclusively breastfed at 6-8 weeks. Discounting of 1.5% was applied following current health economic conventions and 2009/10 used as the base year. RESULTS Over the study period, the estimated cost of hospital admissions in the cohort was £111 million and £2 million for the 2% subset of the cohort with primary care records. Within each quintile of deprivation, exclusively breastfed infants used fewer healthcare services and incurred lower costs compared to infants fed (any) formula milk. At least £10 million of healthcare costs may have been avoided if formula-fed infants had been exclusively breastfed within the first 6-8 weeks of birth. CONCLUSIONS This study using a representative birth cohort demonstrates how breastmilk can promote equitable child health by reducing childhood illness and healthcare utilisation in the early years.
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Affiliation(s)
- Omotomilola Ajetunmobi
- Public Health Scotland (Formerly Information Services Division, NHS National Services Scotland), Edinburgh, Scotland, United Kingdom
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Diane Stockton
- Public Health Scotland (Formerly NHS Health Scotland), Edinburgh, Scotland, United Kingdom
| | - David Tappin
- Child Health, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Bruce Whyte
- Glasgow Centre for Population Health, Glasgow, Scotland, United Kingdom
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8
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Raub A, Heymann J. Workplace rights around pregnancy and childbirth. BMJ 2024; 385:q1050. [PMID: 38754912 DOI: 10.1136/bmj.q1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Affiliation(s)
- Amy Raub
- WORLD Policy Analysis Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Jody Heymann
- WORLD Policy Analysis Center, University of California Los Angeles, Los Angeles, CA, USA
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
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Andres EB, Du X, Pang SSL, Liang JN, Ye J, Lee MH, Tarrant M, Yung SSF, Johnston JM, Lok KYW, Quan J. Extended Paid Maternity Leave Associated With Improved Maternal Mental Health In Hong Kong. Health Aff (Millwood) 2024; 43:707-716. [PMID: 38709965 DOI: 10.1377/hlthaff.2023.00742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
In July 2020, Hong Kong extended statutory paid maternity leave from ten weeks to fourteen weeks to align with International Labour Organization standards. We used the policy enactment as an observational natural experiment to assess the mental health implications of this policy change on probable postnatal depression (Edinburgh Postnatal Depression Scores of 10 or higher) and postpartum emotional well-being. Using an opportunistic observational study design, we recruited 1,414 survey respondents with births before (August 1-December 10, 2020) and after (December 11, 2020-July 18, 2022) policy implementation. Participants had a mean age of thirty-two, were majority primiparous, and were mostly working in skilled occupations. Our results show that the policy was associated with a 22 percent decrease in mothers experiencing postnatal depressive symptoms and a 33 percent decrease in postpartum emotional well-being interference. Even this modest change in policy, an additional four weeks of paid leave, was associated with significant mental health benefits. Policy makers should consider extending paid maternity leave to international norms to improve mental health among working mothers and to support workforce retention.
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Affiliation(s)
| | - Xinyu Du
- Xinyu Du, University of Hong Kong, Hong Kong SAR, China
| | | | | | - Jiaxi Ye
- Jiaxi Ye, University of Hong Kong
| | | | - Marie Tarrant
- Marie Tarrant, University of British Columbia, Kelowna, British Columbia, Canada
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10
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Tugrul H, Stuckler D, Aassve A. Long-term impact of parenting-related leave policies on adolescents' well-being: a systematic review of quasi-experiments. Eur J Public Health 2024; 34:272-282. [PMID: 38197325 PMCID: PMC10990559 DOI: 10.1093/eurpub/ckad228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Parenting-related leave policies have gained increasing endorsement across Organisation for Economic Co-operation and Development (OECD) countries in recent decades. Previous reviews have focused on the short-term impacts and found predominantly positive effects on children. Although there is a growing interest in the long-term impact during adolescence and young adulthood, a comprehensive assessment of this aspect is currently lacking. METHODS We systematically reviewed studies from three electronic databases (Scopus, Web of Science and PubMed), which used quasi-experimental design and examined policies legislating the introduction or expansion of parenting-related leave policies in North America or Europe. We looked at studies focused on well-being beyond the age of 12 and analyzed the findings across different domains of well-being: health, education and labour market outcomes. RESULTS The quasi-experimental evidence is rather limited. The introduction of leave policies or gender-specific quotas produces substantial benefits in the long run. Further, maternal socioeconomic and educational background appears to play a substantial moderating role between leave and adolescents' well-being. Adolescents with mothers who have higher levels of education have demonstrated a more pronounced advantage from the extended time spent together, thereby accentuating pre-existing disparities. CONCLUSIONS Though the expansion of already long leaves might not generate significant outcomes, the introduction of leave policies or gender-specific quotas produces substantial long-term benefits. This evidence entails considerable policy implications for countries that lack a national leave policy or offer only short durations of paid leave, such as the USA.
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Affiliation(s)
- Hande Tugrul
- Department of Social and Political Sciences, Bocconi University, Milano, Italy
| | - David Stuckler
- Department of Social and Political Sciences, Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milano, Italy
| | - Arnstein Aassve
- Department of Social and Political Sciences, Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milano, Italy
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Nardella D. Pumps: A Possible Tool to Promote More Equitable Lactation Outcomes. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2024; 97:99-106. [PMID: 38559458 PMCID: PMC10964822 DOI: 10.59249/mwyw7163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Pregnant individuals and infants in the US are experiencing rising morbidity and mortality rates. Breastfeeding is a cost-effective intervention associated with a lower risk of health conditions driving dyadic morbidity and mortality, including cardiometabolic disease and sudden infant death. Pregnant individuals and infants from racial/ethnic subgroups facing the highest risk of mortality also have the lowest breastfeeding rates, likely reflective of generational socioeconomic marginalization and its impact on health outcomes. Promoting breastfeeding among groups with the lowest rates could improve the health of dyads with the greatest health risk and facilitate more equitable, person-centered lactation outcomes. Multiple barriers to lactation initiation and duration exist for families who have been socioeconomically marginalized by health and public systems. These include the lack of paid parental leave, increased access to subsidized human milk substitutes, and reduced access to professional and lay breastfeeding expertise. Breast pumps have the potential to mitigate these barriers, making breastfeeding more accessible to all interested dyads. In 2012, The Patient Protection and Affordable Care Act (ACA) greatly expanded access to pumps through the preventative services mandate, with a single pump now available to most US families. Despite their near ubiquitous use among lactating individuals, little research has been conducted on how and when to use pumps appropriately to optimize breastfeeding outcomes. There is a timely and critical need for policy, scholarship, and education around pump use given their widespread provision and potential to promote equity for those families facing the greatest barriers to achieving their personal breastfeeding goals.
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Affiliation(s)
- Deanna Nardella
- National Clinician Scholars Program, Department of
Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Pediatrics, Yale School of Medicine, New
Haven, CT, USA
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12
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Fowler LA, Quiñones-Cordero MM, Sidani JE, Bernhart JA, Mendoza-Vasconez AS, Bannon SM, Unni EJ. The urgency of restructuring the landscape of behavioral medicine: Commentary from early-career diversity institute scholars. Transl Behav Med 2024; 14:149-155. [PMID: 37897410 PMCID: PMC10890817 DOI: 10.1093/tbm/ibad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2023] Open
Abstract
Structural and systemic barriers entrenched in academia have sustained for decades, and resulted in a lack of diversity in leadership positions, inequitable workloads for women and underrepresented racial/ethnic groups, and increasing issues with retention of faculty, particularly following the COVID-19 pandemic. Increasing opposition to diversity, equity, and inclusion (DEI) efforts in higher education via legislation, policies, and general anti-DEI sentiment contextualizes the importance of prioritizing DEI. The goal of this commentary is to open discussion among academic institutions regarding changes in DEI culture that will facilitate the growth of diverse early-career faculty (ECF). We use an adapted framework which incorporates DEI into a faculty competency model to (i) guide our discussion of the rationale for restructuring academic systems to promote DEI and (ii) recommend strategies for institutional progress for ECF that can translate across academic institutions. Implementing policies and practices that seek to recruit, retain, and support historically underrepresented ECF are needed, and may involve faculty mentorship programs, establishing equitable funding mechanisms, reforming faculty evaluation practices, and examining and correcting inequities in faculty workloads. The onus is on institutions to recognize and replace the exclusionary practices and biases that have existed within their walls, and continuously promote and monitor their DEI efforts and initiatives to ensure their efficacy. Inclusive academic cultures that demonstrate their value of diversity and commitment to equity promotion at all levels of the organization, including among ECF, are necessary for ensuring excellence in scholarship in academia.
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Affiliation(s)
- Lauren A Fowler
- Sexuality, Health, and Gender Center, Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Maria M Quiñones-Cordero
- Elaine C. Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, Rochester, NY, USA
| | - Jaime E Sidani
- Department of Behavioral & Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - John A Bernhart
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | | | - Sarah M Bannon
- Brain Injury Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth J Unni
- Department of Social, Behavioral, and Administrative Sciences, Touro University College of Pharmacy, New York, NY, USA
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13
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Humphreys KL, Garon-Bissonnette J, Hill KE, Bailes LG, Barnett W, Hare MM. Caregiving relationships are a cornerstone of developmental psychopathology. Dev Psychopathol 2024:1-14. [PMID: 38389283 PMCID: PMC11341779 DOI: 10.1017/s0954579424000300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
The interdisciplinary field of developmental psychopathology has made great strides by including context into theoretical and empirical approaches to studying risk and resilience. Perhaps no context is more important to the developing child than their relationships with their caregivers (typically a child's parents), as caregivers are a key source of stimulation and nurturance to young children. Coupled with the high degree of brain plasticity in the earliest years of life, these caregiving relationships have an immense influence on shaping behavioral outcomes relevant to developmental psychopathology. In this article, we discuss three areas within caregiving relationships: (1) caregiver-child interactions in everyday, naturalistic settings; (2) caregivers' social cognitions about their child; and (3) caregivers' broader social and cultural context. For each area, we provide an overview of its significance to the field, identify existing knowledge gaps, and offer potential approaches for bridging these gaps to foster growth in the field. Lastly, given that one value of a scientific discipline is its ability to produce research useful in guiding real-world decisions related to policy and practice, we encourage developmental psychopathology to consider that a focus on caregiving, a modifiable target, supports this mission.
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Affiliation(s)
| | | | - Kaylin E. Hill
- Vanderbilt University, Department of Psychology and Human Development
| | - Lauren G. Bailes
- Vanderbilt University, Department of Psychology and Human Development
| | - Whitney Barnett
- Vanderbilt University, Department of Psychology and Human Development
| | - Megan M. Hare
- Vanderbilt University, Department of Psychology and Human Development
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Kaseda ET, Arentoft A, Bangen KJ, Mahmood Z, Thomas K, Kim SH, Tan A, Prieto S, Dawson EL, Riegler K, Sullivan-Baca E, Ellison RL. Parental, caregiving, and family leave during clinical neuropsychology postdoctoral training: Recommendations and guidelines from the Women in Neuropsychology (WIN) committee and Education Advisory Committee (EAC) of the Society for Clinical Neuropsychology (SCN; APA division 40). Clin Neuropsychol 2024; 38:247-261. [PMID: 37270409 DOI: 10.1080/13854046.2023.2217673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/18/2023] [Indexed: 06/04/2023]
Abstract
Objective: Parental and other caregiving leave is important to postdoctoral fellows, yet there is no field-wide recommendation for leave policies among clinical neuropsychology postdoctoral training programs, which is of particular relevance given the two-year requirement for eligibility for board certification. The aims of this manuscript are to (a) discuss general guidelines and recommendations for leave policies, both informed by prior empirical evidence as well as relevant existing policy guidelines from various academic and healthcare organizations, and (b) use vignettes to provide possible solutions for potential leave scenarios. Method: A critical review of literature on family leave from public policy and political science, industrial-organizational psychology, academic medicine, and psychology was conducted and findings were synthesized. Results and Conclusions: Fellowship training programs are encouraged to adopt a competency-based model that permits flexibility in leave during training without necessarily requiring an extended end date. Programs should adopt clear policies and make this information readily available to trainees and think flexibly about training options that best meet the training needs and goals of each individual. We also encourage neuropsychologists at all levels to engage in advocacy for broader systemic supports of trainees seeking equitable family leave.
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Affiliation(s)
- Erin T Kaseda
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Alyssa Arentoft
- Department of Psychology, California State University, Northridge, CA, USA
| | - Katherine J Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Zanjbeel Mahmood
- Department of Psychology, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, CA, USA
| | - Kelsey Thomas
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Stella H Kim
- McGovern Medical School, Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alexander Tan
- Department of Neuropsychology, Children's Health Orange County, Orange, CA, USA
| | - Sarah Prieto
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Erica L Dawson
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Kaitlin Riegler
- Pennsylvania State University, University Park, PA, USA
- Psychology Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | | | - Rachael L Ellison
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
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Smith H, Wojcieszek AM, Gupta S, Lavelanet A, Nihlén Å, Portela A, Schaaf M, Stahlhofer M, Tunçalp Ö, Bonet M. Integrating international policy standards in the implementation of postnatal care: a rapid review. BMJ Glob Health 2024; 8:e014033. [PMID: 38267069 PMCID: PMC10846851 DOI: 10.1136/bmjgh-2023-014033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/06/2023] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION International legal and political documents can assist policy-makers and programme managers in countries to create an enabling environment to promote maternal and newborn health. This review aimed to map and summarise international legal and political documents relevant to the implementation of the WHO recommendations on maternal and newborn care for a positive postnatal experience. METHODS Rapid review of relevant international legal and political documents, including legal and political commitments (declarations, resolutions and treaties) and interpretations (general comments, recommendations from United Nations human rights treaty bodies, joint United Nations statements). Documents were mapped to the domains presented in the WHO postnatal care (PNC) recommendations; relating to maternal care, newborn care, and health systems and health promotion interventions, and by type of human right implied and/or stated in the documents. RESULTS Twenty-nine documents describing international legal and political commitments and interpretations were mapped, out of 45 documents captured. These 29 documents, published or entered into force between 1944 and 2020, contained content relevant to most of the domains of the PNC recommendations, most prominently the domains of breastfeeding and health systems interventions and service delivery arrangements. The most frequently mapped human rights were the right to health and the right to social security. CONCLUSION Existing international legal and political documents can inform and encourage policy and programme development at the country level, to create an enabling environment during the postnatal period and thereby support the provision and uptake of PNC and improve health outcomes for women, newborns, children and families. Governments and civil society organisations should be aware of these documents to support efforts to protect and promote maternal and newborn health.
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Affiliation(s)
- Helen Smith
- International Health Consulting Services Ltd, Liverpool, UK
| | - Aleena M Wojcieszek
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Shuchita Gupta
- Department of Maternal, Newborn, Child and Adolescent and Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Antonella Lavelanet
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Åsa Nihlén
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent and Health and Ageing, World Health Organization, Geneva, Switzerland
| | | | - Marcus Stahlhofer
- Department of Maternal, Newborn, Child and Adolescent and Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Mercedes Bonet
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Hoang Roberts LN, Zwaans BMM, Vollstedt A, Sharrak A, Han E, Fischer M, Sirls L, Padmanabhan P. Maternity Leave Satisfaction Among Physicians Compared with Nonphysician Professionals. J Womens Health (Larchmt) 2024; 33:33-38. [PMID: 37639698 DOI: 10.1089/jwh.2023.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Objective: The objective of this study was to compare maternity leave satisfaction between physicians and nonphysicians. Currently, paid maternal leave is not guaranteed in the United States, resulting in palpable dissatisfaction among parents. Previous studies have shown associations between length of paid leave and career satisfaction and maternal happiness. Materials and Methods: A Qualtrics® electronic survey was distributed to female professionals through email and social media from April 2019 to March 2020. Inclusion criterion was ≥1 child by birth or adoption, or active pregnancy. Continuous and categorical data were analyzed using two-sample t-test and chi-square, respectively. Results: Of 808 respondents, 77% were physicians. Mean age at birth/adoption of first child was higher in physicians versus nonphysicians (32.1 years vs. 29.7 years; p < 0.001). Physicians took shorter maternity leave than nonphysicians (10.9 weeks vs. 12.0 weeks, p = 0.017) with half of that time paid by employers (5.4 weeks vs. 5.9 weeks, p = 0.2). Dissatisfaction was high among physicians (85.1%) and nonphysicians (92.4%) that correlates with maternity leave compensation dissatisfaction (49% vs. 71.3%, p < 0.001). Thirty-four percent of physicians versus 41% of nonphysicians stated that their health was negatively impacted by maternity leave length. Physicians and nonphysicians reported similar incidences of depression, and breastfeeding, delivery, and other postpartum complications. When queried, 38.8% of physicians and 57% of nonphysicians said they would desire >16 weeks of paid maternity leave (p < 0.001). Conclusions: In conclusion, dissatisfaction among professional women on maternity leave duration and compensation is high in the United States. Given health implications for both mother and child, this should invite further discussion and changes.
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Affiliation(s)
| | - Bernadette M M Zwaans
- Department of Urology, Beaumont Health, Royal Oak, Michigan, USA
- William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Annah Vollstedt
- Department of Urology, University of Iowa, Iowa City, Iowa, USA
| | | | - Esther Han
- Orlando Health Medical Group, Orlando, Florida, USA
| | - Melissa Fischer
- Department of Urology, Beaumont Health, Royal Oak, Michigan, USA
- William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Larry Sirls
- Department of Urology, Beaumont Health, Royal Oak, Michigan, USA
| | - Priya Padmanabhan
- Department of Urology, Beaumont Health, Royal Oak, Michigan, USA
- William Beaumont School of Medicine, Rochester, Michigan, USA
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17
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Garon-Carrier G, Ansari A, Margolis R, Fitzpatrick C. Maternal Labor Force Participation During the Child's First Year and Later Separation Anxiety Symptoms. HEALTH EDUCATION & BEHAVIOR 2023; 50:792-801. [PMID: 37522632 PMCID: PMC10638856 DOI: 10.1177/10901981231188137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Separation anxiety symptoms are frequent among preschool-aged children, but it is also a possible gateway for diagnosis of separation anxiety disorder. Early maternal employment after childbirth can increase the risk for the development of separation anxiety symptoms. From an economic perspective, however, securing employment is one effective strategy to ensure child well-being. This study investigated how mothers' participation in the labor force (vs. maternal leave) and the financial state of families when the child was 5 months old was prospectively associated with separation anxiety symptoms. This study is based on 1,295 Canadian families with children assessed longitudinally from 17 months to age 6 on their levels of separation anxiety. Separation anxiety was measured during face-to-face interviews with the mothers. Maternal labor force participation, financial status, and risk factors were measured at 5 months. Results adjusted for propensity scores and for sample weight revealed that children of working mothers, despite having sufficient income (n = 245, 18.9%), were at higher risk of separation anxiety during early childhood. In contrast, maternity leave was most beneficial for children's separation anxiety, whether they were in a family with sufficient income (n = 950, 73.4%) or temporary low income (n = 100, 7.7%). Children of mothers in maternity leave were at risk of heightened separation anxiety only if they experienced chronic economic hardship. Therefore, maternity leave uptake could help prevent the development of separation anxiety. Providing families with opportunity to care for the baby as their main occupation during this sensitive developmental period could help improve children's mental health.
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Affiliation(s)
| | - Arya Ansari
- The Ohio State University, Columbus, OH, USA
| | | | - Caroline Fitzpatrick
- Université de Sherbrooke, Sherbrooke, Quebec, Canada
- University of Johannesburg, Johannesburg, South Africa
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18
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Machen JL, Raaum SE, Patel R, Cioletti A. What to Expect When They're Expecting: Addressing Policy Nuances of Resident Parental Leave. Am J Med 2023; 136:1124-1129. [PMID: 37567377 DOI: 10.1016/j.amjmed.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/06/2023] [Indexed: 08/13/2023]
Affiliation(s)
- Julie L Machen
- Department of Internal Medicine, Cone Health Teaching Service, University of North Carolina School of Medicine, Greensboro.
| | - Sonja E Raaum
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City
| | - Rajvi Patel
- Department of Internal Medicine, Dell Medical School at the University of Texas at Austin
| | - Anne Cioletti
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City
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19
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Gribble KD, Smith JP, Gammeltoft T, Ulep V, Van Esterik P, Craig L, Pereira-Kotze C, Chopra D, Siregar AYM, Hajizadeh M, Mathisen R. Breastfeeding and infant care as 'sexed' care work: reconsideration of the three Rs to enable women's rights, economic empowerment, nutrition and health. Front Public Health 2023; 11:1181229. [PMID: 37886047 PMCID: PMC10599145 DOI: 10.3389/fpubh.2023.1181229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/11/2023] [Indexed: 10/28/2023] Open
Abstract
Women's lifelong health and nutrition status is intricately related to their reproductive history, including the number and spacing of their pregnancies and births, and for how long and how intensively they breastfeed their children. In turn, women's reproductive biology is closely linked to their social roles and situation, including regarding economic disadvantage and disproportionate unpaid work. Recognizing, as well as reducing and redistributing women's care and domestic work (known as the 'Three Rs'), is an established framework for addressing women's inequitable unpaid care work. However, the care work of breastfeeding presents a dilemma, and is even a divisive issue, for advocates of women's empowerment, because reducing breastfeeding and replacing it with commercial milk formula risks harming women's and children's health. It is therefore necessary for the interaction between women's reproductive biology and infant care role to be recognized in order to support women's human rights and enable governments to implement economic, employment and other policies to empower women. In this paper, we argue that breastfeeding-like childbirth-is reproductive work that should not be reduced and cannot sensibly be directly redistributed to fathers or others. Rather, we contend that the Three Rs agenda should be reconceptualized to isolate breastfeeding as 'sexed' care work that should be supported rather than reduced with action taken to avoid undermining breastfeeding. This means that initiatives toward gender equality should be assessed against their impact on women's ability to breastfeed. With this reconceptualization, adjustments are also needed to key global economic institutions and national statistical systems to appropriately recognize the value of this work. Additional structural supports such as maternity protection and childcare are needed to ensure that childbearing and breastfeeding do not disadvantage women amidst efforts to reduce gender pay gaps and gender economic inequality. Distinct policy interventions are also required to facilitate fathers' engagement in enabling and supporting breastfeeding through sharing the other unpaid care work associated with parents' time-consuming care responsibilities, for both infants and young children and related household work.
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Affiliation(s)
- Karleen D. Gribble
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
| | - Julie P. Smith
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Tine Gammeltoft
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Valerie Ulep
- Philippine Institute for Development Studies, Quezon City, Philippines
| | - Penelope Van Esterik
- Department of Anthropology, York University, Toronto, ON, Canada
- Department of Sociology and Anthropology, University of Guelph, Guelph, ON, Canada
| | - Lyn Craig
- School of Social and Political Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Catherine Pereira-Kotze
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Deepta Chopra
- Institute of Development Studies, University of Sussex, Brighton, United Kingdom
| | - Adiatma Y. M. Siregar
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
| | - Mohammad Hajizadeh
- School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Roger Mathisen
- Alive and Thrive East Asia Pacific, FHI Solutions, Hanoi, Vietnam
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20
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Chang CY, Liu SR, Glynn LM. One size doesn't fit all: Attitudes towards work modify the relation between parental leave length and postpartum depression. Arch Womens Ment Health 2023:10.1007/s00737-023-01374-5. [PMID: 37737880 DOI: 10.1007/s00737-023-01374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
The present study aimed to investigate the relationship between parental leave length and maternal depressive symptoms at six- and twelve-months postpartum and whether this relation was influenced by women's attitudes towards leave, whether leave was paid or unpaid, and the reason they returned to work. The sample included 115 working women recruited during pregnancy as part of a larger longitudinal study. Analyses revealed that maternal attitudes toward leave influenced the association between leave length and depressive symptoms. Specifically, longer leaves were associated with increased depressive symptoms for women who missed their previous activities at work. Furthermore, women who missed work and had leave for 16 weeks or more, exhibited higher depressive symptoms at six- and twelve-months. Last, results also indicated that women who returned to work solely for monetary reasons exhibited more depressive symptoms at six-months postpartum than those who returned to work for other reasons. This study is among the first to show that women's attitudes towards parental leave and their individual reasons for returning to work are important factors to consider that may have potential implications for parental leave policies.
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Affiliation(s)
| | - Sabrina R Liu
- Department of Human Development, California State University, San Marcos, San Marcos, CA, USA
| | - Laura M Glynn
- Department of Psychology, Chapman University, Orange, CA, USA
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21
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Feld LD, Sarkar M, Au JS, Flemming JA, Gripshover J, Kardashian A, Muir AJ, Nephew L, Orloff SL, Terrault N, Rabinowitz L, Volerman A, Arora V, Farnan J, Villa E. Parental leave, childcare policies, and workplace bias for hepatology professionals: A national survey. Hepatol Commun 2023; 7:e0214. [PMID: 37639705 PMCID: PMC10461944 DOI: 10.1097/hc9.0000000000000214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The presence of workplace bias around child-rearing and inadequate parental leave may negatively impact childbearing decisions and sex equity in hepatology. This study aimed to understand the influence of parental leave and child-rearing on career advancement in hepatology. METHODS A cross-sectional survey of physician members of the American Association for the Study of Liver Diseases (AASLD) was distributed through email listserv in January 2021. The 33-item survey included demographic questions, questions about bias, altering training, career plans, family planning, parental leave, and work accommodations. RESULTS Among 199 US physician respondents, 65.3% were women, and 83.4% (n = 166) were attendings. Sex and racial differences were reported in several domains, including paid leave, perceptions of bias, and child-rearing. Most women (79.3%) took fewer than the recommended 12 paid weeks of parental leave for their first child (average paid leave 7.5 wk for women and 1.7 for men). A majority (75.2%) of women reported workplace discrimination, including 83.3% of Black and 62.5% of Hispanic women. Twenty percent of women were asked about their/their partners' pregnancy intentions or child-rearing plans during interviews for training. Women were more likely to alter career plans due to child-rearing (30.0% vs. 15.9%, p = 0.030). Women were also more likely to delay having children than men (69.5% vs.35.9%). CONCLUSIONS Women reported sex and maternity bias in the workplace and during training interviews, which was more frequently experienced by Black and Hispanic women. As two-thirds of women had children during training, it is a particularly influential time to reevaluate programmatic support to address long-term gender disparities in career advancement.
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Affiliation(s)
- Lauren D. Feld
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Monika Sarkar
- Department of Medicine, Division of Gastroenterology & Hepatology, University of California San Francisco, San Francisco, California, USA
| | - Jennifer S. Au
- Department of Organ Transplant, Division of Gastroenterology and Hepatology, Scripps Clinic, La Jolla, California, USA
| | - Jennifer A. Flemming
- Department of Medicine and Public Health Sciences, Queen’s University, Ontario, Canada
| | - Janet Gripshover
- Department of Transplant Surgery, Ronald Regan UCLA Medical Center, Los Angeles, California, USA
| | - Ani Kardashian
- Department of Medicine, Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Andrew J. Muir
- Department of Medicine, Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lauren Nephew
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Susan L. Orloff
- Department of Surgery, Division of Abdominal Organ Transplantation, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Norah Terrault
- Department of Medicine, Division of Gastroenterology and Liver, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Loren Rabinowitz
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna Volerman
- Departments of Medicine and Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Vineet Arora
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jeanne Farnan
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Erica Villa
- Dipartimento di Specialità Mediche, Struttura Complessa di Gastroenterologia, Universita Degli Studi Di Modena E Reggio Emilia, Modena, Italy
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22
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Courtin E, Rieckmann A, Bengtsson J, Nafilyan V, Melchior M, Berkman L, Hulvej Rod N. The effect on women's health of extending parental leave: a quasi-experimental registry-based cohort study. Int J Epidemiol 2023; 52:993-1002. [PMID: 36240451 PMCID: PMC10396408 DOI: 10.1093/ije/dyac198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/30/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Parental leave policies have been hypothesized to benefit mothers' mental health. We assessed the impact of a 6-week extension of parental leave in Denmark on maternal mental health. METHODS We linked individual-level data from Danish national registries on maternal sociodemographic characteristics and psychiatric diagnoses. A regression discontinuity design was applied to study the increase in parental leave duration after 26 March 1984. We included women who had given birth between 1 January 1981 and 31 December 1987. Our outcome was a first psychiatric diagnosis following the child's birth, ascertained as the first day of inpatient hospital admission for any psychiatric disorder. We presented cumulative incidences for the 30-year follow-up period and reported absolute risk differences between women eligible for the reform vs not, in 5-year intervals. RESULTS In all, 291 152 women were followed up until 2017, death, emigration or date of first psychiatric diagnosis. The median follow-up time was 29.99 years, corresponding to 10 277 547 person-years at risk. The cumulative incidence of psychiatric diagnoses at 30 years of follow-up was 59.5 (95% CI: 57.4 to 61.6) per 1000 women in the ineligible group and 57.5 (95% CI: 55.6 to 59.4) in the eligible group. Eligible women took on average 32.85 additional days of parental leave (95% CI: 29.20 to 36.49) and had a lower probability of having a psychiatric diagnosis within 5 years [risk difference (RD): 2.4 fewer diagnoses per 1000 women, 95% CI: 1.5 to 3.2] and up to 20 years after the birth (RD: 2.3, 95% CI: 0.4 to 4.2). In subgroup analyses, the risk reduction was concentrated among low-educated, low-income and single women. CONCLUSIONS Longer parental leave may confer mental health benefits to women, in particular to those from disadvantaged backgrounds.
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Affiliation(s)
- Emilie Courtin
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Andreas Rieckmann
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Bengtsson
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Vahe Nafilyan
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- King’s Business School, King’s College London, London, UK
| | - Maria Melchior
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM UMR S 1136, Sorbonne University, Paris, France
| | - Lisa Berkman
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - Naja Hulvej Rod
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
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23
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Arnautovic TI, Dammann CEL. The neonatal perspective of paid family medical leave (PFML). J Perinatol 2023; 43:1055-1058. [PMID: 35132148 DOI: 10.1038/s41372-021-01300-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/16/2021] [Accepted: 12/09/2021] [Indexed: 12/24/2022]
Abstract
Paid family medical leave (PFML) offers infants, parents, and society at large numerous health and economic benefits. It has been shown to improve neonatal and maternal outcomes, breastfeeding rates, familial relationships, and decrease gender inequalities in the workplace. Though the economic feasibility of PFML has been well established in many countries, the USA lacks a cohesive and comprehensive federal PFML policy. Neonatal healthcare providers play a critical role in impacting neonatal health and should actively advocate for the development and promotion of a federal PFML policy, particularly one that is inclusive of both mothers and fathers and is at least 12 weeks in duration.
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Affiliation(s)
- Tamara I Arnautovic
- Division of Newborn Medicine, Department of Pediatrics, Tufts Children's Hospital, Tufts University School of Medicine, Boston, MA, USA.
| | - Christiane E L Dammann
- Division of Newborn Medicine, Department of Pediatrics, Tufts Children's Hospital, Tufts University School of Medicine, Boston, MA, USA
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24
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Raub A, Heymann J. Assessing national action through emergency paid leave to mitigate the impact of COVID-19-related school closures on working families in 182 countries. GLOBAL SOCIAL POLICY 2023; 23:247-267. [PMID: 38603401 PMCID: PMC9468866 DOI: 10.1177/14680181221123800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
In April 2020, nearly 1.6 billion learners were out of school. While a growing body of literature has documented the detrimental impact of these closures on children, less attention has been devoted to the steps countries took to mitigate the impact of these closures on working families. Paid leave is recognized as an important policy tool to enable working parents the time they need to respond to family needs without risking job or income loss. This article uses a novel data set to assess whether countries had policies in place prior to the pandemic to respond to increased care needs and the extent to which policies were introduced or expanded during the pandemic to fill the gap. Only 48 countries had policies in place prior to the pandemic that could be used to respond to the care needs created by school and childcare center closures. In the vast majority of these countries, the duration of leave in these policies was too short to meet the care needs of the pandemic or relied on parents reserving extended parental leave options. Only 36 countries passed new legislation during the pandemic, but the majority of those that did covered the full duration of closures. As countries continue to face COVID-19 and consider how to better prepare for the next pandemic, emergency childcare paid leave policies should be part of pandemic preparedness frameworks to prevent further exacerbating inequalities. The policies introduced during the pandemic offer a wide range of approaches for countries to identify feasible solutions.
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Affiliation(s)
- Amy Raub
- University of California, Los Angeles, USA; The University of Melbourne, Australia
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O'Hagan ET, Wallwork SB, Callander E, Stanton TR, Mychasiuk R. The Foundations for Chronic Low Back Pain Management may Start in Early Life. Exploring the Role of Caregiver Parental Leave on Future Low Back Pain in the Offspring. THE JOURNAL OF PAIN 2023; 24:939-945. [PMID: 36646402 DOI: 10.1016/j.jpain.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/02/2023] [Accepted: 01/07/2023] [Indexed: 01/15/2023]
Abstract
Chronic low back pain is difficult to treat and despite increased spending on health services, clinical outcomes for people with low back pain have not improved. Innovative, large scale initiatives seem necessary to stem the cost of low back pain. Psychological health contributes to the development and persistence of chronic low back pain and psychological interventions are important in the management of low back pain. Given the contribution of psychological health to low back pain development and management, it raises the question; can we support psychological health in later life by bolstering emotional development in early life, and reduce the burden of this common condition? Positive early life experiences, including those induced by extended paid parental leave, could bolster emotional development and support the psychological health necessary to manage low back pain in later life. We present the current state of evidence demonstrating the potential value of increasing support for parent-child relationships in early life to reduce the burden of low back pain in future generations. The current evidence is limited to cross-sectional associations, but strong preclinical data clearly shows the potential negative impacts of maternal separation on rodent pup health that compels consideration in human populations. PERSPECTIVE: The benefits stemming from enhanced child development include stable emotional foundations, possibly improving psychological health and low back pain management in the future. This perspective raises questions for future studies - within the context of low back pain, what ingredients bolster stable psychological health? And are these ingredients influenced by parental leave?
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Affiliation(s)
- Edel T O'Hagan
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Sarah B Wallwork
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Sydney, NSW, Australia
| | - Emily Callander
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Tasha R Stanton
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Sydney, NSW, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Clayton, VIC, Australia
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Hawkins SS. Paid Parental Leave Policies. J Obstet Gynecol Neonatal Nurs 2023; 52:182-190. [PMID: 37062347 DOI: 10.1016/j.jogn.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Despite evidence of the benefits of paid parental leave policies on maternal and child health, the United States remains the only high-income country without guaranteed paid parental leave. Since California implemented the first paid parental leave program in 2004, seven additional states have initiated programs, and five states will do so in the near future. In this column, I review federal parental leave policies in the United States, the relatively recent development of paid parental leave across states, and research findings and recommendations from professional organizations that support the implementation of a federal parental leave policy or state-led initiatives.
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Souza CBD, Melo DS, Relvas GRB, Venancio SI, Silva RPGVCD. Promotion, protection, and support of breastfeeding at work, and achieving sustainable development: a scoping review. CIENCIA & SAUDE COLETIVA 2023; 28:1059-1072. [PMID: 37042888 DOI: 10.1590/1413-81232023284.14242022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/28/2022] [Indexed: 04/13/2023] Open
Abstract
This article aims to map promotion, protection, and support strategies aimed at working women who breastfeed and their potential impact on achieving the Sustainable Development Goals (SDGs), in particular SDGs 5 (gender equality and women's empowerment) and 8 (decent work and economic growth). This study is a scoping review based on the Joanna Briggs Institute (JBI) framework, whose searches were performed in PubMed, Web of Science, Scopus, Social Science Research Network, and Open Knowledge Repository databases. This study's search obtained 576 publications, of which 33 were included in the study. The narrative synthesis was organized into three axes: 1) promotion; 2) protection, and 3) support for breastfeeding in the work context. Actions aimed at women who breastfeed at work have the potential to directly achieve SDGs 5 and 8, and indirectly achieve SDGs 1 and 10. Increased breastfeeding rates also help to achieve another four SDGs (2, 3, 4, 12). Actions aimed at working women who breastfeed can contribute directly and indirectly to the achievement of eight of the 17 SDGs, and should therefore be encouraged and reinforced.
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Affiliation(s)
- Carolina Belomo de Souza
- Departamento de Pediatria, Universidade Federal do Paraná. R. General Carneiro 181, 14º andar, Alto da Glória. 80060-900 Curitiba PR Brasil.
| | - Daiane Sousa Melo
- Faculdade de Saúde Pública, Universidade de São Paulo. São Paulo SP Brasil
| | - Gláubia Rocha Barbosa Relvas
- Escritório Regional de Saúde de Barra do Garças, Secretaria de Estado de Saúde de Mato Grosso. Barra do Garças MT Brasil
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Experiences of Female Nurses' Parental Leave in Taiwan: A Qualitative Study. Healthcare (Basel) 2023; 11:healthcare11050664. [PMID: 36900672 PMCID: PMC10001144 DOI: 10.3390/healthcare11050664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023] Open
Abstract
(1) Background: To counteract the recent severe decline in birthrates in Taiwan, a number of child welfare policies are being promoted. Parental leave is among the most discussed policies in recent years. Nurses are healthcare providers, but their own right to healthcare has not been well investigated and should receive more attention. (2) Aim: This study aimed to understand the experience journey of nurses in Taiwan from considering applying for parental leave to returning to work. (3) Methods: Qualitative design with in-depth interviews was conducted with 13 female nurses from three hospitals in northern Taiwan. (4) Results: Content analysis of the interviews revealed five themes, i.e., considerations for taking parental leave, support received from other parties, life experience during parental leave, concerns regarding the return to the workplace, and preparations for the return to the workplace. Participants were motivated to apply for parental leave due to the lack of help with childcare, the desire to care for their own child, or if their financial situation allowed it. They received support and help during the application process. Participants were happy that they could participate in important developmental stages of their child, but were concerned about disconnect from society. Participants were concerned about not being able to resume work. They successfully returned to the workplace through arranging childcare services, self-adapting and learning. (5) Conclusions: This study can serve as a reference for female nurses considering parental leave and provides insights to management teams for building a friendly nursing workplace and creating mutually beneficial situations.
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Johnson TJ, Meier PP, Robinson DT, Suzuki S, Kadakia S, Garman AN, Patel AL. The Role of Work as a Social Determinant of Health in Mother's Own Milk Feeding Decisions for Preterm Infants: A State of the Science Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:416. [PMID: 36979974 PMCID: PMC10046918 DOI: 10.3390/children10030416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/28/2022] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
In the United States, 10% of infants are born preterm (PT; <37 weeks gestational age) each year and are at higher risk of complications compared to full term infants. The burden of PT birth is borne disproportionately by Black versus non-Black families, with Black mothers significantly more likely to give birth to a PT infant. One proven strategy to improve short- and long-term health outcomes in PT infants is to feed mother's own milk (MOM; breast milk from the mother). However, mothers must make decisions about work and MOM provision following PT birth, and more time spent in paid work may reduce time spent in unpaid activities, including MOM provision. Non-Black PT infants are substantially more likely than Black PT infants to receive MOM during the birth hospitalization, and this disparity is likely to be influenced by the complex decisions mothers of PT infants make about allocating their time between paid and unpaid work. Work is a social determinant of health that provides a source of income and health insurance coverage, and at the same time, has been shown to create disparities through poorer job quality, lower earnings, and more precarious employment in racial and ethnic minority populations. However, little is known about the relationship between work and disparities in MOM provision by mothers of PT infants. This State of the Science review synthesizes the literature on paid and unpaid work and MOM provision, including: (1) the complex decisions that mothers of PT infants make about returning to work, (2) racial and ethnic disparities in paid and unpaid workloads of mothers, and (3) the relationship between components of job quality and duration of MOM provision. Important gaps in the literature and opportunities for future research are summarized, including the generalizability of findings to other countries.
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Affiliation(s)
- Tricia J. Johnson
- Department of Health Systems Management, Rush University, Chicago, IL 60612, USA
| | - Paula P. Meier
- College of Nursing, Rush University, Chicago, IL 60612, USA
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
| | - Daniel T. Robinson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Sumihiro Suzuki
- Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL 60612, USA
| | - Suhagi Kadakia
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
| | - Andrew N. Garman
- Department of Health Systems Management, Rush University, Chicago, IL 60612, USA
| | - Aloka L. Patel
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
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30
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Rollins N, Piwoz E, Baker P, Kingston G, Mabaso KM, McCoy D, Ribeiro Neves PA, Pérez-Escamilla R, Richter L, Russ K, Sen G, Tomori C, Victora CG, Zambrano P, Hastings G. Marketing of commercial milk formula: a system to capture parents, communities, science, and policy. Lancet 2023; 401:486-502. [PMID: 36764314 DOI: 10.1016/s0140-6736(22)01931-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/21/2022] [Accepted: 09/26/2022] [Indexed: 02/10/2023]
Abstract
Despite proven benefits, less than half of infants and young children globally are breastfed in accordance with the recommendations of WHO. In comparison, commercial milk formula (CMF) sales have increased to about US$55 billion annually, with more infants and young children receiving formula products than ever. This Series paper describes the CMF marketing playbook and its influence on families, health professionals, science, and policy processes, drawing on national survey data, company reports, case studies, methodical scoping reviews, and two multicountry research studies. We report how CMF sales are driven by multifaceted, well resourced marketing strategies that portray CMF products, with little or no supporting evidence, as solutions to common infant health and developmental challenges in ways that systematically undermine breastfeeding. Digital platforms substantially extend the reach and influence of marketing while circumventing the International Code of Marketing of Breast-milk Substitutes. Creating an enabling policy environment for breastfeeding that is free from commercial influence requires greater political commitment, financial investment, CMF industry transparency, and sustained advocacy. A framework convention on the commercial marketing of food products for infants and children is needed to end CMF marketing.
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Affiliation(s)
- Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland.
| | | | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | | | | | - David McCoy
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | | | | | - Linda Richter
- University of the Witwatersrand, DSI-NRF Centre of Excellence in Human Development, Johannesburg, South Africa
| | - Katheryn Russ
- Department of Economics, University of California, Davis, CA, USA
| | - Gita Sen
- Public Health Foundation of India, Bangalore, India
| | - Cecília Tomori
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | | | - Gerard Hastings
- Institute for Social Marketing, University of Stirling, Stirling, UK
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31
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Pérez-Escamilla R, Tomori C, Hernández-Cordero S, Baker P, Barros AJD, Bégin F, Chapman DJ, Grummer-Strawn LM, McCoy D, Menon P, Ribeiro Neves PA, Piwoz E, Rollins N, Victora CG, Richter L. Breastfeeding: crucially important, but increasingly challenged in a market-driven world. Lancet 2023; 401:472-485. [PMID: 36764313 DOI: 10.1016/s0140-6736(22)01932-8] [Citation(s) in RCA: 128] [Impact Index Per Article: 128.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/18/2022] [Accepted: 09/26/2022] [Indexed: 02/10/2023]
Abstract
In this Series paper, we examine how mother and baby attributes at the individual level interact with breastfeeding determinants at other levels, how these interactions drive breastfeeding outcomes, and what policies and interventions are necessary to achieve optimal breastfeeding. About one in three neonates in low-income and middle-income countries receive prelacteal feeds, and only one in two neonates are put to the breast within the first hour of life. Prelacteal feeds are strongly associated with delayed initiation of breastfeeding. Self-reported insufficient milk continues to be one of the most common reasons for introducing commercial milk formula (CMF) and stopping breastfeeding. Parents and health professionals frequently misinterpret typical, unsettled baby behaviours as signs of milk insufficiency or inadequacy. In our market-driven world and in violation of the WHO International Code for Marketing of Breast-milk Substitutes, the CMF industry exploits concerns of parents about these behaviours with unfounded product claims and advertising messages. A synthesis of reviews between 2016 and 2021 and country-based case studies indicate that breastfeeding practices at a population level can be improved rapidly through multilevel and multicomponent interventions across the socioecological model and settings. Breastfeeding is not the sole responsibility of women and requires collective societal approaches that take gender inequities into consideration.
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Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA.
| | - Cecília Tomori
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Sonia Hernández-Cordero
- Research Center for Equitable Development (EQUIDE), Universidad Iberoamericana, Mexico City, Mexico
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | | | | | | | - David McCoy
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Purnima Menon
- International Food Policy Research Institute, New Delhi, India
| | | | | | - Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Linda Richter
- Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
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32
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Raub A, Heymann J. Supporting children's health needs: an analysis of paid leave policies in 193 countries. Glob Public Health 2023; 18:2062028. [PMID: 35405079 DOI: 10.1080/17441692.2022.2062028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/18/2022] [Indexed: 12/31/2022]
Abstract
The COVID-19 pandemic has highlighted the extent to which national laws and policies shape public health and economic security. Paid leave policies enable parents to meet children's health needs while maintaining job and income security. These policies matter immensely to children's health every year. Yet, little is known about the extent to which policies exist to support the full range of childhood health needs. Using a novel dataset constructed from legislative text in 193 countries, this study assesses whether laws in place in 2019 are adequate to support meeting children's everyday, serious, and disability-related health needs. Globally, only half of the countries guaranteed working parents access to any paid leave that could be used to meet children's health needs. Only a third addressed everyday health needs, including leave that matters to reducing infectious disease spread. For serious health needs, even when paid leave was available, it was often too short for complex health conditions. Moreover, although all children require parental presence at medical appointments and for serious illness, fewer countries guaranteed paid leave to care for older children than younger. Addressing these gaps is crucial to supporting child health and working families during times of public health crisis and every year.
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Affiliation(s)
- Amy Raub
- WORLD Policy Analysis Centre, University of California Los Angeles, Los Angeles, CA, USA
- School of Social and Political Sciences, University of Melbourne, Melbourne, Australia
| | - Jody Heymann
- WORLD Policy Analysis Centre, University of California Los Angeles, Los Angeles, CA, USA
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33
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Heshmati A, Honkaniemi H, Juárez SP. The effect of parental leave on parents' mental health: a systematic review. Lancet Public Health 2023; 8:e57-e75. [PMID: 36603912 DOI: 10.1016/s2468-2667(22)00311-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/04/2022] [Accepted: 11/16/2022] [Indexed: 01/05/2023]
Abstract
Mental health disorders during the post-partum period are a common morbidity, but parental leave might help alleviate symptoms by preventing or reducing stress. We aim to summarise available evidence on the effect of different types of parental leave on mental health outcomes among parents. For this systematic review, we searched Ovid MEDLINE, Web of Science, PsycINFO, CINAHL, and Scopus from database inception to Aug 29, 2022, for peer-reviewed, quantitative studies written in English. We included studies if the exposure was postnatal parental leave; a relevant comparison group was present (eg, paid vs unpaid leave); and if indicators related to general mental health, including depression, anxiety, stress, and suicide, for either parent were evaluated or recorded at any time after childbirth. The Review is registered with PROSPERO (registration number CRD42021227499). Of the 3441 records screened, 45 studies were narratively synthesised. Studies were done in high-income countries, and they examined generosity by any parental leave (n=5), benefit amount (n=13), and leave duration (n=31). 38 studies were of medium or high quality. Improved mental health was generally observed among women (referred to as mothers in this Review) with more generous parental leave policies (ie, leave duration and paid vs unpaid leave). For example, increased duration of leave was generally associated with reduced risk of poor maternal mental health, including depressive symptoms, psychological distress and burnout, and lower mental health-care uptake. However, the association between fathers' leave and paternal mental health outcomes was less conclusive as was the indirect effect of parental leave use on partners' mental health.
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Affiliation(s)
- Amy Heshmati
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Centre for Health Equity Studies, Stockholm University and Karolinska Institutet, Stockholm, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Helena Honkaniemi
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Centre for Health Equity Studies, Stockholm University and Karolinska Institutet, Stockholm, Sweden
| | - Sol P Juárez
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Centre for Health Equity Studies, Stockholm University and Karolinska Institutet, Stockholm, Sweden
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34
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Dyess NF, Weikel BW, Barker JM, Garrington TP, Parker TA. Parental leave during pediatric fellowship training: A national survey. PLoS One 2022; 17:e0279447. [PMID: 36548290 PMCID: PMC9779013 DOI: 10.1371/journal.pone.0279447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Until recently, no uniform requirements for parental leave (PL) existed in graduate medical education. We implemented a national survey, with the objective of ascertaining fellows' perceptions of PL policies and their impact. This is the first study to focus exclusively on pediatric subspecialty fellows. METHODS An online survey instrument was created targeting pediatric fellows. RESULTS The survey was accessed by 1003 (25%) of the estimated 4078 pediatric subspecialty fellows and 853 (21%) submitted surveys. Respondent demographic data paralleled the data reported by the American Board of Pediatrics. Half of respondents did not know whether their program had a written PL policy. Over 40% reported ≥ 5 weeks of paid PL. Most indicated that fellows use vacation, sick leave, and unpaid time for PL. Almost half of respondents (45%) indicated that their program's PL policy increases the stress of having a child. Fellows chose establishing/extending paid leave and intentionally fostering a more supportive program culture as the most crucial candidate improvements. The importance of equitable PL polices between parent fellows and co-fellows was an important theme of our qualitative data. Fellows feel there is a moral misalignment between the field of pediatrics' dedication to maternal and child health and current PL policies governing pediatric trainees. CONCLUSIONS PL policies vary widely among pediatric fellowship programs and are often not known by fellows. Fellows are not satisfied with PL policies, which often exacerbate stress for new parents and burden their co-fellows. Targeted modification of several aspects of PL policies may improve their acceptance.
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Affiliation(s)
- Nicolle F. Dyess
- Division of Neonatology, Department of Pediatrics, University of Colorado, Aurora, Colorado, United States of America
| | - Blair W. Weikel
- Department of Pediatrics, University of Colorado, Aurora, Colorado, United States of America
| | - Jennifer M. Barker
- Division of Endocrinology, Department of Pediatrics, University of Colorado, Aurora, Colorado, United States of America
| | - Timothy P. Garrington
- Division of Hematology and Oncology, Department of Pediatrics, University of Colorado, Aurora, Colorado, United States of America
| | - Thomas A. Parker
- Division of Neonatology, Department of Pediatrics, University of Colorado, Aurora, Colorado, United States of America
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35
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YANG YTONY, WALLINGTON SHERRIEFLYNT, MORAIN STEPHANIE. Paid Leave for Fathers: Policy, Practice, and Reform. Milbank Q 2022; 100:973-990. [PMID: 36454162 PMCID: PMC9836238 DOI: 10.1111/1468-0009.12590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/23/2022] [Accepted: 06/30/2022] [Indexed: 12/03/2022] Open
Abstract
Policy Points Government policies that secure paid leave for all parents, regardless of gender, can reduce structural inequalities, while promoting fathers' engagement in parenting. Such policies are likely to be most effective when they secure full, or almost full wage replacement, and when they provide incentives for fathers to take leave. Organizations must also participate in the culture shift, providing workplaces that encourage paternity leave rather than reinforcing the "male breadwinner" stigma.
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Affiliation(s)
- Y. TONY YANG
- Center for Health Policy and Media Engagement, School of Nursing, Milken Institute School of Public HealthGeorge Washington UniversityWashington, DCUnited States
| | - SHERRIE FLYNT WALLINGTON
- School of Nursing, Milken Institute School of Public HealthGeorge Washington UniversityWashington, DCUnited States
| | - STEPHANIE MORAIN
- Johns Hopkins Berman Institute of BioethicsBaltimore, MDUnited States
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36
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Nicolás-López M, González-Álvarez P, Sala de la Concepción A, Giralt-López M, Lorente B, Velasco I, Wichner PSV, Ginovart G. Maternal mental health and breastfeeding amidst the Covid-19 pandemic: cross-sectional study in Catalonia (Spain). BMC Pregnancy Childbirth 2022; 22:733. [PMID: 36163015 PMCID: PMC9511438 DOI: 10.1186/s12884-022-05036-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background Covid-19 pandemic became an unexpected stressor for the entire population and, particularly, for pregnant women and lactating mothers. The alarming infectious risk together with the lockdown period could affect the emotional state of mothers-to-be, as well as breastfeeding rates, mother-baby bonding, or neonatal weight gain. The aim of this study is to describe the impact of this world health emergency in mother-baby pairs right after the first wave of Sars-Cov-2 pandemic (from March to May 2020). Study design A prospective observational study was carried out in mother–child dyads from those women who gave birth between June and August 2020 in a tertiary hospital. 91 mother-baby pairs were initially enrolled and 56 of them completed the follow-up. The study design had two separate steps: i) Step one: A clinical interview plus three psychometric tests (EPDS: Edinburgh Postnatal Depression Scale, PBQ: Postpartum Bonding Questionnaire and STAI-S: State-Trait Anxiety Inventory); ii) Step two: mother–child dyads were followed using a round of three brief telephone interviews (conducted at the newborn’s 7, 14 and 28 days of age) to accurately depict the newborn’s outcome in the neonatal period. Results In terms of maternal mental health, 25% of the sample screens positively in the EPDS, requiring further evaluation to rule out depressive symptoms. STAI-state and PBQ detect no abnormalities in either anxiety levels or mother–child bonding in our sample, as 100% of the mothers score below the cut-off points in each test (34 and 26 respectively). When comparing feeding practices (breast/bottle feeding) in 2020 to those practices during pre-pandemic years (2017–2019), a significant increase in breastfeeding was found in pandemic times. All newborns in the sample showed an adequate weight gain during their first month of life. Conclusion Women and newborns in our sample did not experience an increase in adverse outcomes in the neonatal period in terms of maternal mental health, breastfeeding rates, bonding and further neonatal development. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05036-9.
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Affiliation(s)
- Marta Nicolás-López
- Department of Pediatrics, Neonatal Unit, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n, 08916, Badalona, Spain. .,Department of Pediatrics, Neonatal Unit, Hospital Universitari Germans Trias I Pujol, Badalona, Spain.
| | - Pablo González-Álvarez
- Department of Pediatrics, Neonatal Unit, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n, 08916, Badalona, Spain
| | - Anna Sala de la Concepción
- Department of Pediatrics, Neonatal Unit, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n, 08916, Badalona, Spain
| | - Maria Giralt-López
- Department of Paidopsychiatry, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Beatriz Lorente
- Department of Gynecology and Obstetrics, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Inés Velasco
- Department of Gynecology and Obstetrics, Hospital Universitari Germans Trias I Pujol, Badalona, Spain.,Research Institute Germans Trias I Pujol (IGPT), Badalona, Spain
| | - Paula Sol Ventura Wichner
- Department of Pediatrics, Neonatal Unit, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n, 08916, Badalona, Spain.,Research Institute Germans Trias I Pujol (IGPT), Badalona, Spain
| | - Gemma Ginovart
- Department of Pediatrics, Neonatal Unit, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n, 08916, Badalona, Spain.,Department of Pediatrics, Neonatal Unit, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
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37
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Duffy S, O’Shea M, Bowyer D, van Esch P. Sexism in the silences at Australian Universities: Parental leave in name, but not in practice. GENDER WORK AND ORGANIZATION 2022. [DOI: 10.1111/gwao.12880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Sarah Duffy
- School of Business Western Sydney University Parramatta NSW Australia
| | - Michelle O’Shea
- School of Business Western Sydney University Parramatta NSW Australia
| | - Dorothea Bowyer
- School of Business Western Sydney University Parramatta NSW Australia
| | - Patrick van Esch
- Department of Marketing & Professional Sales Kennesaw State University Kennesaw Georgia USA
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38
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Brito NH, Werchan D, Brandes-Aitken A, Yoshikawa H, Greaves A, Zhang M. Paid maternal leave is associated with infant brain function at 3 months of age. Child Dev 2022; 93:1030-1043. [PMID: 35373346 PMCID: PMC9892990 DOI: 10.1111/cdev.13765] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The first months of life are critical for establishing neural connections relevant for social and cognitive development. Yet, the United States lacks a national policy of paid family leave during this important period of brain development. This study examined associations between paid leave and infant electroencephalography (EEG) at 3 months in a sociodemographically diverse sample of families from New York City (N = 80; 53 males; 48% Latine; data collection occurred 05/2018-12/2019). Variable-centered regression results indicate that paid leave status was related to differences in EEG power (ps < .02, R2 s > .12). Convergent results from person-centered latent profile analyses demonstrate that mothers with paid leave were 7.39 times as likely to have infants with EEG profiles characterized by increased higher-Hz power (95% CI, 1.9-36.9), potentially reflecting more mature patterns of brain activity.
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Affiliation(s)
- Natalie H. Brito
- Department of Applied Psychology, New York University, New York, New York, USA
| | - Denise Werchan
- Department of Population Health, NYU Langone Health, New York, New York, USA
| | | | - Hirokazu Yoshikawa
- Department of Applied Psychology, New York University, New York, New York, USA
| | - Ashley Greaves
- Department of Applied Psychology, New York University, New York, New York, USA
| | - Maggie Zhang
- Department of Applied Psychology, New York University, New York, New York, USA
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39
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Breastfeeding: The Basics, the History, and Barriers in the Modern Day. Obstet Gynecol Surv 2022; 77:423-432. [DOI: 10.1097/ogx.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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40
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Roselin D, Lee J, Jagsi R, Blair-Loy M, Ira K, Dahiya P, Williams J, Mangurian C. Medical Student Parental Leave Policies at U.S. Medical Schools. J Womens Health (Larchmt) 2022; 31:1403-1410. [PMID: 35704286 DOI: 10.1089/jwh.2022.0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: As medical training occurs during prime childbearing years, parental leave policies may affect the career and family choices of medical students. Materials and Methods: This cross-sectional study builds on existing research by quantifying the prevalence of formal policies for parental leave in highly ranked United States Medical Degree granting institutions, and analyzing the characteristics of those policies, with the objective of identifying existing best practices for future policy adopters to consider. Results: Only 14% of the medical schools reviewed had substantive, stand-alone parental leave policies, and the majority of schools had leave of absence policies without mention of parental leave. Discussion: Leveraging the authors' legal and medical expertise, this analysis highlights existing best practices for medical school leadership to consider, as they examine and develop their policies. Best practices utilized by institutions with the most robust parental policies include adopting a formal and public parental policy, providing a parental enrolled academic adjustment option, guaranteeing approval to take and return from leave/academic adjustment, and continuing health care and financial aid benefits. Given the role of childbearing as a factor associated with gender disparities in academic medicine, and potential impact on racial disparities for students of color, medical school leadership should consider implementation of best practice parental policies to promote equity and wellness of their students. In fact, the deficit of robust parental leave policies in most highly ranked schools may contribute to existing gender and racial disparities in violation with antidiscrimination law. Strengthening policies could increase equity in medical education with positive impacts on the patient population.
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Affiliation(s)
- Danielle Roselin
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Jessica Lee
- Center for WorkLife Law, Hastings College of the Law, University of California, San Francisco, California, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Blair-Loy
- Department of Sociology, Center for Research on Gender in STEMM, University of California, San Diego, San Diego, California, USA
| | - Kim Ira
- Center for WorkLife Law, Hastings College of the Law, University of California, San Francisco, California, USA
| | - Priya Dahiya
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Joan Williams
- Center for WorkLife Law, Hastings College of the Law, University of California, San Francisco, California, USA
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, Center for Vulnerable Populations, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco (UCSF), San Francisco, California, USA
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41
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Tomori C, Hernández-Cordero S, Busath N, Menon P, Pérez-Escamilla R. What works to protect, promote and support breastfeeding on a large scale: A review of reviews. MATERNAL & CHILD NUTRITION 2022; 18 Suppl 3:e13344. [PMID: 35315573 PMCID: PMC9113479 DOI: 10.1111/mcn.13344] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 01/08/2023]
Abstract
Globally women continue to face substantial barriers to breastfeeding. The 2016 Lancet Breastfeeding Series identified key barriers and reviewed effective interventions that address them. The present study updates the evidence base since 2016 using a review of reviews approach. Searches were implemented using the Epistomenikos database. One hundred and fifteen reviews of interventions were identified and assessed for quality and risk of bias. Over half of reviews (53%) were high- or moderate quality, with the remaining low or critically low quality due to weaknesses in assessment of bias. A large portion of studies addressed high-income and upper-middle income settings, (41%), and a majority (63%) addressed health systems, followed by community and family settings (39%). Findings from reviews continue to strengthen the evidence base for effective interventions that improve breastfeeding outcomes across all levels of the social-ecological model, including supportive workplace policies; implementation of the Baby-Friendly Hospital Initiative, skin to skin care, kangaroo mother care, and cup feeding in health settings; and the importance of continuity of care and support in community and family settings, via home visits delivered by CHWs, supported by fathers', grandmothers' and community involvement. Studies disproportionately focus on health systems in high income and upper-middle income settings. There is insufficient attention to policy and structural interventions, the workplace and there is a need for rigorous assessment of multilevel interventions. Evidence from the past 5 years demonstrates the need to build on well-established knowledge to scale up breastfeeding protection, promotion and support programmes.
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Affiliation(s)
- Cecília Tomori
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA.,Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Natalie Busath
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Purnima Menon
- International Food Policy Research Institute, Delhi, India
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Rhode Island, USA
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42
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Nguyen TT, Cashin J, Tran HTT, Vu DH, Nandi A, Phan MT, Van NDC, Weissman A, Pham TN, Nguyen BV, Mathisen R. Awareness, Perceptions, Gaps, and Uptake of Maternity Protection among Formally Employed Women in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4772. [PMID: 35457636 PMCID: PMC9031189 DOI: 10.3390/ijerph19084772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/30/2022] [Accepted: 04/12/2022] [Indexed: 02/01/2023]
Abstract
Maternity protection is a normative fundamental human right that enables women to combine their productive and reproductive roles, including breastfeeding. The aim of this study is to examine the uptake of Vietnam's maternity protection policy in terms of entitlements and awareness, perceptions, and gaps in implementation through the lens of formally employed women. In this mixed methods study, we interviewed 494 formally employed female workers, among whom 107 were pregnant and 387 were mothers of infants and conducted in-depth interviews with a subset of these women (n = 39). Of the 494 women interviewed, 268 (54.3%) were working in blue-collar jobs and more than 90% were contributing to the public social insurance fund. Among the 387 mothers on paid maternity leave, 51 (13.2%) did not receive cash entitlements during their leave. Among the 182 mothers with infants aged 6-11 months, 30 (16.5%) returned to work before accruing 180 days of maternity leave. Of 121 women who had returned to work, 26 (21.5%) did not receive a one-hour paid break every day to express breastmilk, relax, or breastfeed, and 46 (38.0%) worked the same or more hours per day than before maternity leave. Although most women perceived maternity leave as beneficial for the child's health (92.5%), mother's health (91.5%), family (86.2%), and society (90.7%), fewer women perceived it as beneficial for their income (59.5%), career (46.4%), and employers (30.4%). Not all formally employed women were aware of their maternity protection rights: women were more likely to mention the six-month paid maternity leave (78.7%) and one-hour nursing break (62.3%) than the other nine entitlements (2.0-35.0%). In-depth interviews with pregnant women and mothers of infants supported findings from the quantitative survey. In conclusion, although Vietnam's maternity protection policy helps protect the rights of women and children, our study identified implementation gaps that limit its effectiveness. To ensure that all women and their families can fully benefit from maternity protection, there is a need to increase awareness of the full set of maternity entitlements, strengthen enforcement of existing policies, and expand entitlements to the informal sector.
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Affiliation(s)
- Tuan T. Nguyen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (D.H.V.); (A.W.); (R.M.)
| | - Jennifer Cashin
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (D.H.V.); (A.W.); (R.M.)
| | - Ha T. T. Tran
- Research and Training Center for Community Development, Hanoi 11616, Vietnam; (H.T.T.T.); (N.D.C.V.)
| | - Duong H. Vu
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (D.H.V.); (A.W.); (R.M.)
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health and Institute for Health and Social Policy, McGill University, Montreal, QC H3A 1A3, Canada;
| | - Minh T. Phan
- Department of Legal Affairs, Ministry of Labor, Invalids and Social Affairs (MOLISA), Hanoi 11022, Vietnam; (M.T.P.); (B.V.N.)
| | - Nguyen D. C. Van
- Research and Training Center for Community Development, Hanoi 11616, Vietnam; (H.T.T.T.); (N.D.C.V.)
| | - Amy Weissman
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (D.H.V.); (A.W.); (R.M.)
- Asia Pacific Regional Office, FHI 360, Bangkok 10330, Thailand
| | - Toan N. Pham
- Institute of labor Science & Social Affairs, Ministry of Labor, Invalids and Social Affairs (MOLISA), Hanoi 11022, Vietnam;
| | - Binh V. Nguyen
- Department of Legal Affairs, Ministry of Labor, Invalids and Social Affairs (MOLISA), Hanoi 11022, Vietnam; (M.T.P.); (B.V.N.)
| | - Roger Mathisen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (D.H.V.); (A.W.); (R.M.)
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43
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Honkaniemi H, Katikireddi SV, Rostila M, Juárez SP. Psychiatric consequences of a father's leave policy by nativity: a quasi-experimental study in Sweden. J Epidemiol Community Health 2022; 76:367-373. [PMID: 34635548 PMCID: PMC8921563 DOI: 10.1136/jech-2021-217980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Parental leave use has been found to promote maternal and child health, with limited evidence of mental health impacts on fathers. How these effects vary for minority populations with poorer mental health and lower leave uptake, such as migrants, remains under-investigated. This study assessed the effects of a Swedish policy to encourage fathers' leave, the 1995 Father's quota, on Swedish-born and migrant fathers' psychiatric hospitalisations. METHODS We conducted an interrupted time series analysis using Swedish total population register data for first-time fathers of children born before (1992-1994) and after (1995-1997) the reform (n=198 589). Swedish-born and migrant fathers' 3-year psychiatric hospitalisation rates were modelled using segmented negative binomial regression, adjusting for seasonality and autocorrelation, with stratified analyses by region of origin, duration of residence, and partners' nativity. RESULTS From immediately pre-reform to post-reform, the proportion of fathers using parental leave increased from 63.6% to 86.4% of native-born and 37.1% to 51.2% of migrants. Swedish-born fathers exhibited no changes in psychiatric hospitalisation rates post-reform, whereas migrants showed 36% decreased rates (incidence rate ratio (IRR) 0.64, 95% CI 0.47 to 0.86). Migrants from regions not predominantly consisting of Organisation for Economic Cooperation and Development countries (IRR 0.50, 95% CI 0.19 to 1.33), and those with migrant partners (IRR 0.23, 95% CI 0.14 to 0.38), experienced the greatest decreases in psychiatric hospitalisation rates. CONCLUSION The findings of this study suggest that policies oriented towards promoting father's use of parental leave may help to reduce native-migrant health inequalities, with broader benefits for family well-being and child development.
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Affiliation(s)
- Helena Honkaniemi
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | | | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Sol P Juárez
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
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44
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Spittle AJ, McKinnon C, Huang L, Burnett A, Cameron K, Doyle LW, Anderson P, Baird M, Colditz P, Cruz M, Pussell K, Dalziel K, Eeles A, Newnham J, Hunt RW, Cheong J. Missing out on precious time: Extending paid parental leave for parents of babies admitted to neonatal intensive or special care units for prolonged periods. J Paediatr Child Health 2022; 58:376-381. [PMID: 34837659 DOI: 10.1111/jpc.15836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022]
Abstract
In Australia, approximately 18% of newborn babies are admitted to a neonatal intensive or special care nursery. While most babies admitted to a neonatal intensive or special care nursery are discharged home within a few weeks, around 6% of babies spend more than 2 weeks in hospital. For the parents of these babies, much of their leave entitlements (Australian Government Paid Parental Leave Scheme is up to18 weeks for the primary care giver and up to 2 weeks for partners) are used before their baby comes home from hospital. The time babies and parents spend together in the early developmental period, during the hospitalisation and when the baby is discharged home, is crucial for optimal child development and bonding. Yet care givers who have a baby admitted to neonatal intensive or special care for extended periods are not currently entitled to any extra parental leave payments in Australia. We recommend the Australian Paid Parental Leave Act is changed to allow primary carers access to 1 week of extra parental leave pay for every week in hospital (for babies admitted to hospital for more than 2 weeks), up to a maximum of 14 weeks. For fathers and partners of these babies, we recommend an additional 2 weeks of extra Dad and Partner Pay. The net cost, taking into account likely productivity benefits, would be less than 1.5% of the current cost of the scheme and would improve health and socio-economic outcomes for the baby, family and society.
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Affiliation(s)
- Alicia J Spittle
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Clare McKinnon
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Li Huang
- School of Global and Population Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alice Burnett
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Cameron
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Lex W Doyle
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Marian Baird
- Business School, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Colditz
- Perinatal Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Melanie Cruz
- Miracle Babies Foundation, Sydney, New South Wales, Australia
| | - Kylie Pussell
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kim Dalziel
- School of Global and Population Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Abbey Eeles
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia.,Monash Newborn Research, Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - John Newnham
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia
| | - Rod W Hunt
- Monash Newborn Research, Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Jeanie Cheong
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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45
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Tomori C. Overcoming Barriers to Breastfeeding. Best Pract Res Clin Obstet Gynaecol 2022; 83:60-71. [DOI: 10.1016/j.bpobgyn.2022.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/23/2022]
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46
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Browne CV, Takamura JC, Seo JY. Global Gender Inequality, Older Women, and the Call for Change in the United States. J Cross Cult Gerontol 2022; 37:339-353. [PMID: 36334227 PMCID: PMC9638432 DOI: 10.1007/s10823-022-09462-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/07/2022]
Abstract
Gender inequality that persists through much of their lives, from birth through adulthood, impacts women and their quality of life in their later years. With some variation this holds true in every nation in the global community. In older adults, the most apparent indication of gender inequality-and a linchpin-is the disproportionate impoverishment of older women compared to older men. We take stock of global policy directions toward equality for girls and women, focusing specifically on derived avenues for furthering and protecting the economic well-being of older women in the United States, cognizant that these directions can rebound with implications for nations worldwide.
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Affiliation(s)
- Colette V. Browne
- Thompson School of Social Work and Public Health, University of Hawai’i, Honolulu, HI USA
| | | | - Jin Young Seo
- Thompson School of Social Work and Public Health, University of Hawai’i, Honolulu, HI USA
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47
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Kraus MB, Reynolds EG, Maloney JA, Buckner-Petty SA, Files JA, Hayes SN, Stonnington CM, Vallow LA, Strand NH. Parental leave policy information during residency interviews. BMC MEDICAL EDUCATION 2021; 21:623. [PMID: 34922524 PMCID: PMC8684616 DOI: 10.1186/s12909-021-03067-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/22/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND During interviews, medical students may feel uncomfortable asking questions that might be important to them, such as parental leave. Parental leave policies may be difficult for applicants to access without asking the program director or other interviewers. The goal of this study is to evaluate whether parental leave information is presented to prospective residents and whether medical students want this information. METHODS Fifty-two program directors (PD's) at 3 sites of a single institution received a survey in 2019 to identify whether parental leave information is presented at residency interviews. Medical students received a separate survey in 2020 to identify their preferences. Fisher exact tests, Pearson χ2 tests and Cochran-Armitage tests were used where appropriate to assess for differences in responses. RESULTS Of the 52 PD's, 27 responded (52%) and 19 (70%) indicated that information on parental leave was not provided to candidates. The most common reason cited was the belief that the information was not relevant (n = 7; 37%). Of the 373 medical students, 179 responded (48%). Most respondents (92%) wanted parental leave information formally presented, and many anticipated they would feel extremely or somewhat uncomfortable (68%) asking about parental leave. The majority (61%) felt that these policies would impact ranking of programs "somewhat" or "very much." CONCLUSIONS Parental leave policies may not be readily available to interviewees despite strong interest and their impact on ranking of programs by prospective residents.
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Affiliation(s)
- Molly B Kraus
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
| | - Emily G Reynolds
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Jillian A Maloney
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Skye A Buckner-Petty
- Department of Quantitative Health Sciences, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Julia A Files
- Department of Internal Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Cynthia M Stonnington
- Department of Psychiatry and Psychology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Laura A Vallow
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Natalie H Strand
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
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48
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de Souza AC, Carbonera LA, Rocha E. Paid Parental Leave: Different Scenarios Around the World. Stroke 2021; 53:e23-e25. [PMID: 34875843 DOI: 10.1161/strokeaha.121.035919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ana Claudia de Souza
- Department of Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil (A.C.d.S., L.A.C.)
| | - Leonardo Augusto Carbonera
- Department of Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil (A.C.d.S., L.A.C.)
| | - Eva Rocha
- Department of Neurology and Neurosurgery (ER), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil (E.R.)
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49
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Fisher SD, Cobo J, Figueiredo B, Fletcher R, Garfield CF, Hanley J, Ramchandani P, Singley DB. Expanding the international conversation with fathers' mental health: toward an era of inclusion in perinatal research and practice. Arch Womens Ment Health 2021; 24:841-848. [PMID: 34431009 DOI: 10.1007/s00737-021-01171-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Paternal mental health is beginning to be recognized as an essential part of perinatal health. Historically, fathers were not recognized as being at risk for perinatal mental illnesses or relevant to maternal and infant health outcomes. The purpose of this paper is to provide an overview of paternal perinatal mental health, leading tools to assess paternal depression and anxiety, the impact of paternal mental health on mother and child health, and future directions for the field. An international team of paternal perinatal mental health experts summarized the key findings of the field. Fathers have an elevated risk of depression and anxiety disorders during the perinatal period that is associated with maternal depression and can impact their ability to support mothers. Paternal mental health is uniquely associated with child mental health and developmental outcomes starting from infancy and continuing through the child lifespan. Tailored screening approaches for paternal mental health are essential to support fathers early in the perinatal period, which would offset health risks for the family. Recommendations on paternal mental health are provided on four key areas to support father perinatal mental health: (1) intervention research, (2) clinical training, (3) national policy, and (4) the inclusion of fathers in the focus of the International Marcé Society for Perinatal Mental Health.
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Affiliation(s)
- Sheehan D Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA.
| | - Jesus Cobo
- Psychiatry Department, Corporació Sanitària Parc Taulí - CIBERSAM - I3PT - Universitat Autònoma de Barcelona (Sabadell, Barcelona), Barcelona, Spain
| | | | - Richard Fletcher
- College of Heath, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Craig F Garfield
- Department of Pediatrics, Ann& Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jane Hanley
- Perinatal MH Training CIC, Carmarthen, Wales, UK.,Swansea University, Swansea, Wales, UK
| | - Paul Ramchandani
- PEDAL Research Centre, Faculty of Education, University of Cambridge, Cambridge, UK
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50
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Glader L, Comeau M, Sanders L. Addressing Parent Employment as an Essential Issue in Child Health. Pediatrics 2021; 148:peds.2021-050448. [PMID: 34433690 DOI: 10.1542/peds.2021-050448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Laurie Glader
- Division of Complex Care, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Meg Comeau
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts
| | - Lee Sanders
- Division of General Pediatrics, Department of Pediatrics, Stanford Medicine, Stanford University, Stanford, California
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