Workplace rights around pregnancy and childbirth
BMJ 2024; 385 doi: https://doi.org/10.1136/bmj.q1050 (Published 16 May 2024) Cite this as: BMJ 2024;385:q1050
On 15 April 2024, after a public consultation that received over 100 000 comments, the US Equal Employment Opportunity Commission (EEOC) issued final regulations detailing employers’ obligation to provide reasonable accommodation to pregnant workers.1 These new regulations expand access to unpaid time off as a reasonable accommodation during pregnancy, for pregnancy termination, or after childbirth. A coalition of attorneys general from 17 states challenged this ruling on 25 April, focusing on provisions for pregnancy termination.2 Whether these new regulations are implemented or over-ruled by the courts will determine whether millions of pregnant and postpartum workers will get access to unpaid leave.
For readers from many countries, this may be surprising. The US is one of the few countries that has no national guarantee of paid maternal leave (the others being Papua New Guinea and five small Pacific island states).3 Moreover, half of all American workers, and more than two thirds of women aged 18-24, are not eligible for unpaid leave under the existing US Family and Medical Leave Act.4 The EEOC’s new regulations broaden pregnant and postpartum workers’ access to unpaid leave by expanding eligibility in three ways: eliminating the requirement for 1250 hours of work in the past year; eliminating the requirement for a minimum tenure of one year; and reducing the minimum employer size from 50 employees within a 75 mile radius to 15 employees.1
Over the past two decades, a substantial body of research has documented the health benefits of paid maternal leave.567 In California, one of a minority of US states that provides paid leave, the introduction of the policy in 2004 was associated with a 12% reduction in postneonatal mortality (deaths occurring at age 29-365 days).8 Studies of paid maternal leave in high and low income countries have also found that longer leave lowers infant mortality.910 Similarly, paid maternal leave has been shown across settings to support exclusive and continued breastfeeding,111213 one of the most important health interventions during infancy with important benefits for mothers as well as infants.7
New guarantees of paid maternal leave and increases to its duration also increase timely vaccination rates during infancy.1415 Studies in higher income settings have shown benefits for maternal mental health both postpartum and later in life.67 A wide range of other health benefits have also been associated with paid maternal leave.7 Moreover, paid maternal leave supports income security and continued economic opportunities for mothers,5 a critical social determinant of health for children.
In contrast, the absence of paid leave undermines maternal and child health overall and exacerbates health inequities. Research on the US Family and Medical Leave Act has shown that the unaffordability of unpaid leave, compounded by restrictive eligibility conditions, excludes 67% of Latino workers and 60% of Black workers from the benefits of unpaid leave compared with 55% of white workers.4 Conversely, overall use of maternity leave doubled after the introduction of paid family leave in California, with particularly large gains in leave taking seen among Black mothers, Latina mothers, mothers with a high school degree or less, and unmarried mothers.16
Need for action
The feasibility of guaranteeing paid maternal leave has been shown globally in 187 countries that span the political spectrum.3 Moreover, increasingly Americans’ support for paid family leave spans political divides: a 2023 survey found widespread support across Republicans, Democrats, and Independents.17
The health benefits of access to adequate well paid leave are too large for health professionals to ignore; we all need to be engaged in strengthening these policies. For countries without paid leave, the urgency to pass paid leave to improve population health and reduce health inequities is clear. At the same time, many countries with national paid leave policies in place have legal gaps that undermine health and exacerbate health inequalities. When paid leave is too short or payment is inadequate for families to afford to take leave,318 health suffers. Coverage also matters, but 40% of countries fail to guarantee paid leave related to pregnancy for self-employed workers, a group that includes some of the world’s poorest and most vulnerable women.3 Equally large is the gap in paid leave available to men, which has important health effects for women and children as well as being critical for gender equality.71920
The worldwide cost-of-living crisis has forced many families to make difficult choices between income and health. Paid leave powerfully supports families by providing time to recover and provide care while supporting current and future income, helping to keep families from having to choose between health and job security. Universal access to adequate paid leave related to pregnancy is long overdue and should be supported unequivocally by medical professionals.
Footnotes
Competing interests: We have read and understood BMJ policy on declaration of interests and have no interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.