While I was pregnant, my husband and I decided to move closer to family. My due date was February 2017. I had planned to use my six weeks of paid maternity leave from Vanderbilt University (where I was an attending), complete the academic year, and start my new job in July of 2017. Then I had a miscarriage…

After the miscarriage, it was impossible to conceive again, deliver a baby, and complete maternity leave before July 2017. However, I already had two job interviews set up with that timeline in mind. If I took a new job and was pregnant, I would give birth before working a full year. That would mean no Family and Medical Leave Act (FMLA) protection for unpaid maternity leave, and forget paid leave. I called to cancel both of the interviews. I believed it would be better to stay at Vanderbilt, where I had already earned paid maternity leave.

The first job interview was at a community shop that did not offer benefits. I called and tried to explain I could not leave my job with paid maternity leave for a job with no benefits and no maternity leave. I thought my reason for cancelling the interview was clear, but my contact asked me to further explain my concerns. The conversation went something like this:

“I cannot come pregnant to a job that is going to pay me $40,000 less while I make partner, that will cost an extra $13,000 per year for health insurance, and leave behind six weeks of paid maternity leave, which is a $30,000 benefit.”

Now they understood the dollars-and-cents of the situation. I doubt this predominately male group had ever been confronted with these issues before and therefore had never thought about them or needed to address them.

The second job interview was at another academic institution. Again, it would be a pay cut, but I would have fantastic health insurance. I would get six weeks of paid leave, but there was a catch. There, women accrued paid sick days for maternity leave. It takes about one year to accrue six weeks of leave. I would be allowed to use sick time I had not yet accrued. Then as I earned sick time, it would be used to pay back my maternity leave debt. However, if I got sick after the baby was born and needed paid leave, there would not be any available.

Inadvertently, I negotiated for paid maternity leave at the community shop. I was asked several times when I would be able to start, and I consistently answered I could not leave my job with paid maternity leave and health insurance while I was planning to get pregnant, so I did not know when I could start. This resulted in a contract offer with an increased signing bonus and six weeks of paid maternity leave.

Leave Policy in the United States

Did you know that the United States is one of only six countries out of 193 in the United Nations that do not mandate paid maternity leave? We are in the company of Papua New Guinea, Suriname, and a few South Pacific islands.¹ Unfortunately, only 12 percent of US workers in the private sector can get paid leave through their employers.² Currently, women are the primary breadwinners in 40 percent of US households with children.³ As a result, 23 percent of surveyed women in 2012 reported taking two weeks or fewer off because they could not afford to take more time.²

After World War II, with the devastation of the European workforce and infrastructure, United Nations representatives agreed to a minimum of 14 weeks of paid leave at two-thirds of a worker’s salary. Now, 50 countries provide six months or more of paid leave.⁵ Most countries are financing paid leave through employment-related social insurance, similar to Social Security or unemployment, but others require the employer to pay the benefit.⁶

In 1993, the United States implemented FMLA, which provides 12 weeks of unpaid leave if you have worked more than 1,250 hours (one year full-time) at a company with at least 50 employees. Forty percent of American workers do not meet these requirements.⁷

Some states and cities have taken matters into their own hands. California’s Paid Family Leave program provides six weeks of leave at 55 percent of a worker’s wage if the worker is eligible for disability.⁸ San Francisco has mandated that employers pay the remaining 45 percent of an employee’s salary capped at 67 percent of the statewide average weekly wage. New Jersey and Rhode Island have similar programs offering partial paid leave for six weeks.

Paid maternity leave is linked to better health for mothers and babies. A 2014 study showed that women who received 12 weeks or more of paid maternity leave had lower rates of postpartum depression.⁹ The Centers for Disease Control and Prevention reports that women with 12 weeks of paid leave are more likely to breastfeed for six months.¹⁰ Paid maternity leave is also linked to a lower infant mortality rate.¹¹

Emergency medicine remains a male-dominated specialty with a majority of male leadership. I believe most men have never thought about these issues. Likewise, women often believe it is their choice to have children and, therefore, children are solely their burden to bear. But the birth of the next generation is essential to the survival of our society and economy. The birth of children is a burden that needs to be carried on the shoulders of both men and women. As such, we should support paid maternity leave and paternity leave.

Fathers who take paternity leave have higher satisfaction with parenting and increased engagement in caring for their children.^12–15 Children with engaged fathers have fewer behavioral problems and better mental health outcomes. Also, longer paternity leaves and increased time spent with fathers caring for very young children are associated with higher cognitive test scores in children.^12,13,16,17

We should all be enabled to take part in the birth and early days of our children’s lives—for our health and the health of the next generation.

Dr. Hoper is an emergency physician at East Central Iowa Acute Care at UnityPoint St. Luke’s Hospital in Cedar Rapids, Iowa.

References

1. Maternity leave benefits. UN data website. Accessed July 13, 2017.
2. DOL factsheet: paid family and medical leave. US Department of Labor website. Accessed July 13, 2017.
3. Wang W, Parker K, Taylor P. Breadwinner moms. Pew Research Center website. Accessed July 13, 2017.
4. Pozniak A, Wen K, Olson K, et al. Family and medical leave in 2012. US Department of Labor website. Accessed July 13, 2017.
5. Deahl J. Countries around the world beat the U.S. on paid parental leave. NPR website. Accessed July 13, 2017.
6. Maternity and paternity at work. International Labour Organization website. Accessed July 13, 2017.
7. FMLA is working. US Department of Labor website. Accessed July 13, 2017.
8. California Paid Family Leave Act brochure. State of California Employment Development Department website. Accessed July 13, 2017.
9. Dagher RK, McGovern PM, Dowd BE. Maternity leave duration and postpartum mental and physical health: implications for leave policies. J Health Polit Policy Law. 2014;39(2):369-416.
10. Mirkovic KR, Perrine CG, Scanlon KS. Paid maternity leave and breastfeeding outcomes. Birth. 2016;43(3):233-239.
11. Nandi A, Hajizadeh M, Harper S, et al. Increased duration of paid maternity leave lowers infant mortality in low- and middle-income countries: a quasi-experimental study. PLoS Med. 2016;13(3):e1001985.
12. Nepomnyaschy L, Waldfogel J. Paternity leave and fathers’ involvement with their young children: evidence from the American Ecls–B. Community Work Fam. 2017:10(4):427-453.
13. Huerta MDC, Adema W, Baxter J, et al. Fathers’ leave, fathers’ involvement and child development: are they related? Evidence from four OECD countries. OECD Social, Employment and Migration Working Papers. 2013;140:67.
14. Hass L, Hwang CP. The impact of taking parental leave on fathers’ participation in childcare and relationships with children: lessons from Sweden. Community Work Fam. 2008;11(1):85-104.
15. Tanaka S, Waldfogel J. Effects of parental leave and work hours on fathers’ involvement with their babies: evidence from the Millennium Cohort Study. Community Work Fam. 2007;10(4):409-426.
16. Sarkadi A, Kristiansson R, Oberklaid F, et al. Fathers’ involvement and children’s developmental outcomes: a systematic review of longitudinal studies. Acta Pediatrica. 2008;97(2):153-158.
17. Flouri E, Buchanan A. The role of father involvement in children’s later mental health. J Adolesc. 2002;26(1):63-78.