Imagine being pregnant and laboring for 12 hours experiencing contractions periodically increasing in strength and then pushing out a 6-pound baby. Then, within less than a week, still bruised and sore, you have to make the hard decision to go back to work at your minimum wage job where you stand all day. You must leave behind your newborn baby even though it breaks your heart because you cannot afford to take the needed time to recover if you are not receiving your paycheck. The sad reality is that 1 in 4 mothers return to work within 10 days of giving birth because they do not receive paid maternity leave [1]. The lack of nationally required paid maternity leave in the US is unethical because it puts an unrealistic physical and mental burden on women to work, sometimes in physically demanding jobs, soon after giving birth. This has been shown to contribute to postpartum depression, negatively impact the developing relationship between mother and child, and damage the physical health of the mother and the baby. Furthermore, it disproportionately targets women who are already financially struggling because they have no option other than to start working again to support themselves and their new child.
Maternity leave is a period of time prior to and after a woman gives birth when she has an excused absence from work. Paid maternity leave is when the woman gets paid during this leave of absence [2]. Unpaid maternity leave is good because it ensures that the mother does not lose her job in the time allotted for the maternity leave while she is recovering and getting used to life with her new baby. However, unpaid maternity leave is not remotely as beneficial as paid maternity leave, which ensures not only job security but also financial stability during the transitional period of welcoming a new child [3]. The United States offers 12 weeks of unpaid parental leave for those who qualify, which includes most employed individuals that work at companies with 50 or more employees [1]. However, there is no federally mandated paid maternity leave for all working citizens. This makes the United States the only wealthy country in the world that does not ensure paid parental leave [3]. Although the Federal Employee Paid Leave Act does make paid parental leave accessible to all Federal employees, this still leaves out a majority of citizens because most people are not directly employed by the federal government [2]. As a result, for many the possibility of maternity leave is up to individual states and private companies [4]. At the moment the only states or districts in the US which have mandated paid maternity leave are California, New Jersey, Rhode Island, New York, Washington, Massachusetts, Oregon, and Washington DC [5]. Colorado is in the process of instituting paid maternity leave in the next year. It is important to note, though, that the length of this maternity leave is less than in other nations and less than what is recommended by experts, which is at least 6 weeks [5]. At the moment, only 23 percent of American workers have access to paid family leave, a statistic that includes federal employees [3]. The result of this is that in the US 33% of American women do not take any maternity leave and 16% of women only take between 1 and 4 weeks [6]. Overall, a majority of women in the U.S. are unable to take the medically recommended amount of time which is at least 6 weeks due to financial restraints [3].
International policy on paid maternity leave starkly differs from that of the US. While it is somewhat of a controversial topic in the United States, around the world 186 countries provide some form of paid maternity leave [3]. Among countries that are a part of the Organization of Economic Cooperation and Development (OCED), including Mexico, Australia, Canada, the United States, and most of Europe, the average paid maternity leave is 18 weeks. However, the U.S. is the only country from the OECD that does not provide federally mandated paid parental leave for all not just federal employees. The country with the longest weeks of paid leave after giving birth is Estonia providing 85 weeks. Furthermore, of the 7 countries in the world that do not offer a federally guaranteed form of paid maternity leave; the US is the only wealthy nation among them [6]. GDP does not explain this disparity as many other nations with lower GDPs than the US – like Brazil – have formed regulations [3]. Around the world, subsidized parental leave is considered standard and is rarely questioned. U.S. policy and culture surrounding paid parental leave is an outlier globally.
The physical toll birth takes on the body and the recovery required are only a few of the reasons why paid maternity leave is so universally accepted around the world. In addition, many women experience postpartum hormone imbalances that can cause many symptoms including mood changes. Some more specific symptoms of a vaginal delivery include vaginal and rectal pain and bruising, incontinence, bleeding, and trouble with bowel movements [7]. Another form of delivery is via cesarean section which is a major surgery after which patients will most likely have soreness around their incision and will be instructed to take the same precautions anyone would after abdominal surgery including avoiding excessive physical activity, getting plenty of rest, not lifting anything heavy, and generally taking it easy for at least a few weeks [8]. Both forms of delivery result in difficulty standing or being mobile for extended periods of time, which make it necessary for women to rest following delivery. However, the specifics of any of these symptoms depend on the duration of delivery and whether any complications occurred [7]. Generally, healthcare professionals recommend that women have at least 6 weeks of maternity leave to properly recover. However, most women still do not fully return to some form of full physical ability until at least 6 months after delivery and sometimes more [4]. In addition, other studies have linked women taking less than eight weeks of paid maternity leave to poorer physical and mental health.
Paid maternity leave is not only beneficial for the woman but the relationships and emotional health of the entire family. Paid maternity leave has been correlated with secure attachment between mother and child, and greater empathy and academic success for the child [1]. Fathers or non-birthing parents who are able to take leave tend to be more involved throughout their child’s life. Parenting the child is viewed as a shared effort by both parents instead of what occurs in traditional, patriarchal families where women take on a vast majority of the child-rearing and household work [3]. Furthermore, the relationship between the parents is also shown to be much more stable with much lower rates of physical and emotional abuse [1]. Having the time that paid parental leave affords is important for the emotional bonds between the parents and their child.
The health of the baby is also positively correlated with paid parental leave. Babies whose parents take leave have an increased chance of being up to date on their vaccinations, being engaged in breastfeeding, securing maternal attachment, having better infant health, and displaying fewer behavioral issues [1]. This time in a baby's life is one that sets the trajectory for the rest of their lives. Putting in place federal requirements for paid maternity leave will improve the health and well-being of future generations and, therefore, enhance the development of our nation [3].
The benefits of paid maternity leave are not only health-related but also financially related. After giving birth, many women need time off to recover and have to weigh forfeiting their job. However, many who do continue to work are paid less or given fewer opportunities to advance as having a child is seen as a liability. This pattern is known as the motherhood penalty. This so-called penalty is exemplified by the fact that each year women and their families lose an estimated $22.5 billion in wages after having children [6]. From a financial standpoint, paid parental leave creates continuity in income and employment, removes financial punishments that women experience from having children, and provides stability during this major life change [3].
The impacts of having no federally mandated paid maternity leave are not felt equally by all pregnant people. Lower-income women disproportionately experience the impact financially as well as suffering relatively more mental and physical health repercussions. Studies show that lower-income women are 58% more likely to forgo maternity leave [6]. Of employees who make $30,000 or less annually, 38% receive any form of paid leave. Juxtaposed with the fact that 74% of females making 75k or more receive paid maternity leave, one can assume there is a disparity in job benefits. Additionally, higher-income individuals may have the resources to stay home for a period of time to recover even if they are not getting paid - a possibility not afforded to their lower-income counterparts. This is especially concerning because lower-income women who give birth generally already have limited access to healthcare throughout their pregnancy and experience more birth complications. It follows that lower-income individuals would require a longer period of time for childbirth recovery but instead receive even less time. This plays into the inter-generational health disparity based on socioeconomic class. When these women are not able to recover properly, both they and their newborns have long-term psychological and physical health impacts, which they potentially pass on to future generations [1].
Based on the evidence presented thus far, including medical necessity and the emotional and physical benefits for the mother and the baby, there is clear evidence that paid maternity leave is a human right. Foremost, it is essential to ensure that basic health needs are met equally across socioeconomic classes. The lack of nationally required paid maternity leave also violates all 4 of the central bioethical principles outlined by Beauchamp and Childress which are known as the Georgetown Mantra [9]. These are central principles in bioethics used to evaluate systems and situations. These 4 principles are nonmaleficence, beneficence, justice, and autonomy. Nonmaleficence means do not harm [9]. Nonmaleficence is not being met in this situation, as many levels of harm are being done to women and their children in the current system. Beneficence means to do good [9]. This is also not being met because if one is violating the rule to do no harm then one cannot be doing good. Justice, as defined as ‘rendering unto each what is due,’ is not being met either. A lack of paid maternity leave gives no regard to the health, safety, or best interest of birthing people [9]. The government is not doing its job of protecting vulnerable members of society. Finally, autonomy is also not being met because that would require the decision to return to work to be made without extreme pressure from outside factors [9]. In this situation, many women are under extreme financial pressure to return to work and cannot afford to take a prolonged period of time off to recover. In no way do current policies on paid maternity leave adhere to any central bioethical principles and can, therefore, be evaluated as unethical.
While the argument in favor of nationally mandated paid maternity leave is strong in terms of the benefits for individual women, their children, and their families, there is also a strong argument for the societal benefit [5]. As a country, we require women to both work in order to sustain our economy and to have children to sustain our population. The workforce of the United States requires women in order to maintain their economic standing in the world and requires women to bear the children of the next generation, which will also be the workforce of the next generation [5]. Societies of countries that have federally imposed mandatory paid maternity leave experience tangible benefits including increased economic productivity which the U.S. is currently overlooking.
Paid maternity leave required by the federal government serves the interest of the physical, mental, and financial health of the women giving birth, their children, and their families. Maternity leave is not a vacation or a luxury, but a human right necessary for recovering from the birth process and for nurturing the next generation of the population. While some may argue that it is financially impossible, many countries with lower GDPs have already ensured that women have access to this right. Ethically, for the birthing people, the children, and the society of the United States and the world, the only choice is to prioritize women’s health and women’s rights and pass legislation to require paid maternity leave for all in the United States. Women should not be shamed or prevented from having a career or having children. Women deserve to be treated with dignity and respect and deserve to have time to recover after giving birth without fear of repercussions.
Work Cited
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