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Tuesday Jan 12, 2016

U.S. Needs More Than Baby Steps on Paid Maternity Leave

Maybe, just maybe, Americans are finally waking up to a truth that has already been accepted globally: Paid maternity leave has far-reaching health implications for both mothers and their children, including facilitating breastfeeding.

Last month, Air Force Secretary Deborah Lee James said that branch of the U.S. military will triple its paid maternity leave(www.usatoday.com) benefit to 18 weeks, following the example set by the Navy back in August.

The international corporate world also took some big steps in the past year. Nestlé, the largest food and beverage marketer in the world, announced that it was extending its paid parental leave(www.huffingtonpost.com) for primary caretakers from six weeks to 14 weeks for its workers globally, and it also will allow employees to take 12 unpaid weeks.

Nestlé CEO Paul Bulcke said in an interview with Fortune(fortune.com) that supporting breastfeeding was one of the primary drivers behind changing the company's policy. That's an interesting step for a company that has been boycotted off and on for decades for the way it markets its infant formula.

The World Health Organization recommends(www.who.int) that women should breastfeed for as long as two years, and the AAFP recommends breastfeeding for at least 12 months.  (The Academy's breastfeeding toolkit has resources for moms and practices.)

It is well documented that breastfeeding is healthy for both mothers and babies, boosting immunity, increasing bonding, reducing risk of postpartum depression and decreasing risk of morbid obesity in babies. With an ever-growing amount of data that support breastfeeding, why does our country have such a dismal rate of mothers who breastfeed past the first six months of life?

Roughly 80 percent of U.S. mothers are breastfeeding during the first 48 hours postpartum, according to the CDC. That drops to approximately 20 percent by six months. Disparities become more pronounced when looking further into the demographics. Women who breastfeed beyond six months tend to be Caucasian, have higher household incomes, stay home and be more educated. Those least likely to breastfeed tend to be black working moms who are less educated and are from homes with lower household incomes.

Although there are many factors that contribute to these shameful statistics, a major one is the persistent lack of parental leave for the vast majority of U.S. workers(thinkprogress.org). This is despite studies that indicate mothers who have sufficient time to transition into parenting not only are more successful with breastfeeding, they also use less sick days, are more productive, suffer less burnout and demonstrate more loyalty to their employer.

The United States is the only industrialized country in the world(ilo.org) that does not support some kind of paid parental leave. Many people have little or no time off, even unpaid. Particularly for those affected by poor postnatal outcomes, taking time off could mean risking one's job.

Some might argue that the Family Medical Leave Act, which guarantees one's job after return from a leave due to birth, adoption or the serious illness of a loved one for up to 12 weeks, is sufficient. However, the law does not require the leave to be paid and it generally applies only to people who have worked at least 12 months for an employer who has at least 50 employees.

Unfortunately, only about 12 percent of U.S. employers offer paid maternity or paternity leave, according to the Society for Human Resource Management. That's down from 17 percent in 2010.

No one can deny that becoming a parent is a life-defining moment, one that requires time to which to adjust. However, how can one take that time when there are bills to pay? In my second year of residency, I took only two weeks off after delivering my second child because I was allotted only eight weeks of paid time off and I already had used five weeks for bedrest. (I needed my last week of vacation time for job interviews.)

So why is paid leave so important to one’s ability to breastfeed? Simply put, if I have to return to work before my milk even has time to be established, then how can I be successful in maintaining my supply? Furthermore, women are expected, or perhaps feel pressured, to make up for the time they were away on leave.

Becoming a mother is one of the hardest, yet most rewarding, accomplishments I have under my belt. Let’s not lessen the impact and powerful message working mothers make when they embrace their many important roles both in and out of work. We should celebrate our many roles, including providing nourishment for our children.

Marie-Elizabeth Ramas, M.D., is the new physician member of the AAFP Board of Directors.

Posted at 12:10PM Jan 12, 2016 by Marie-Elizabeth Ramas, M.D.

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