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Wednesday Apr 29, 2015

Family Leave Policies Failing U.S. Families

It has been more than 20 years since President Clinton signed the Family Medical Leave Act (FMLA) into law, guaranteeing 12 weeks of unpaid leave to employees for certain family or medical reasons. That law was an important first step, but a number of restrictions on FMLA -- size of employer, length of employment and full-time vs. part-time employment -- render it useless to roughly 40 percent of U.S. workers(www.npr.org).

Even more troubling is that since FMLA became law, little progress has been made nationally to support working parents with newborn or adopted children. President Obama, however, vowed to prioritize paid leave earlier this year in his State of the Union Address.

Here I am with my daughter at our mom-and-baby yoga class. Maternity leave not only gave me time to focus on the care of my child but also time for us to bond.

The United States lags far behind most developed countries on this issue. In fact, an International Labour Organization report(ilo.org) published last year examined information from 185 countries and territories and found only two that did not offer some form of paid maternity leave. Sadly, the two exceptions were Papua New Guinea and the United States.

A map(www.theatlantic.com) published last June by The Atlantic graphically illustrates how poorly we compare to the rest of the world. Only three states(www.ncsl.org) (California, New Jersey and Rhode Island) offer some form of paid family leave.

I recently returned to work after the birth of my daughter and am grateful for a revamped parental leave policy at my job that is more in line with those that benefit families in other advanced countries. Not only did I benefit directly from this support, I was proud that my workplace acknowledged the importance of supporting all of its staff -- and our families -- during one of our most important life events.

This is significant because we strive to be leaders in the communities where we work. For our patients, many of whom come from low-income, disadvantaged populations with poor health outcomes, we are better equipped to advocate for their rights when we are able to see first-hand the impact of such policies.

Why should we, as family physicians, be leading the charge for paid parental leave? Family leave has broad public health implications, from maternal mental health(www.ncbi.nlm.nih.gov) and breastfeeding (www.ncbi.nlm.nih.gov) to infant mortality and child development(www.ncbi.nlm.nih.gov).

Depression
In my clinic, we screen for postpartum depression at every well-child check. The questions are built into our electronic health record system. Research has found that women experience a wider range of disorders now being called maternal mental illness, a term that recognizes the symptoms of postpartum depression can begin any time from before the baby is born through the first year after giving birth. A 2013 article in JAMA Psychiatry(www.ncbi.nlm.nih.gov) found that one in five women suffer from depression during the first postpartum year. Another study(jhppl.dukejournals.org) found that returning to work less than six months after childbirth increased the risk of postpartum depression.

Additional research is needed on this topic, but it is becoming more apparent that there is a correlation between maternal mental health and the kind of support -- financial as well as social -- women receive during that critical postpartum period.

Breastfeeding
The AAFP recommends that "all babies, with rare exceptions, be breastfed and/or receive expressed human milk exclusively for the first six months of life" and that breastfeeding "should continue with the addition of complementary foods throughout the second half of the first year."

Although laws now require that workplaces accommodate employees who need to pump, the reality is that it can still be difficult. I am fortunate to work in a supportive atmosphere where my pumping sessions are scheduled so that no patients are scheduled during that time, and my staff are protective of that time. A colleague of mine has almost given up pumping during the day because her clinic has done nothing to ensure that she has the time or necessary staff arrangements to make pumping an actuality.

If mothers had the option of staying home for the first six months, knowing their leave was at least partially paid and that their job was protected, perhaps the rate of breastfeeding in this country(www.cdc.gov) would be closer to our goals.

Child Health
It's not news that the United States doesn't lead by example when it comes to infant mortality. In 2014, the infant mortality rate was 6.1 deaths per 1,000 live births(www.cdc.gov), which put our nation last on a list of 26 developed nations.

Research has shown that when maternity leave increases, infant mortality rates decrease. Years before the United States adopted FMLA, research showed(libres.uncg.edu) that 10 weeks of maternity leave decreased infant mortality rates 1 percent to 2 percent, and 30 weeks produced a 7 percent to 9 percent reduction. Although our infant mortality rates are the result of many variables, we should not ignore the fact that they are higher than those of every other advanced country, even as our parental leave policies trail behind theirs.

Families that are struggling with an infant whose health is failing shouldn't also be faced with financial concerns and possible job loss when they need to take extra time to care for that child.

Child development is intricately linked to the maternal-child relationship and has lasting effects on the child's health(www.ncbi.nlm.nih.gov).

Many of my pediatric patients in the Bronx struggle with obesity, learning disabilities and mental health disorders. I often wonder what their future will be like. Will they still be living in the Bronx, dealing with a low-paying job, struggling with the physical ailments that result from being obese their entire lives? What if their mothers had the opportunity to have a supportive maternity leave that ensured some wages and a job to return to postpartum? This is an area of health that is multifactorial, but if a multipronged approach is needed to improve the mental and physical health of the children we care for, certainly better parental leave should be one of those prongs.

It comes as no surprise that unpaid parental leave disproportionately impacts low-income, single and minority mothers and fathers. As family physicians, we are the ones who care for the patients in rural areas, the patients who are uninsured, the patients who have problems accessing medical care. We must advocate for the health of these patients on a broader scale, and helping them secure a substantial parental leave could have significant health implications for them and their families.

Finally, although much of the research on this topic evaluates maternity leave, fathers' access to a protected and paid time off after the birth of a child is also important and, not surprisingly, is yet another place where we lag behind many other countries. Research shows that paternity leave benefits women and their communities(www.theatlantic.com).

For the health of the families we have dedicated our careers to caring for, and for the health of the communities we work in, we, as family physicians, need to join the fight for a better parental leave policy nationwide.

Margaux Lazarin, D.O., M.P.H., provides comprehensive family health services, including osteopathic manipulation, at a community health center in the Bronx, N.Y. She is actively involved in teaching residents and medical students to deliver evidenced-based care to underserved communities.

Posted at 03:59PM Apr 29, 2015 by Margaux Lazarin, D.O.

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