Maternity benefits and breastfeeding
Providing structural support for breastfeeding is good for all
Canadaís maternity benefits for mothers returning to the workplace rank among the best in the world. We share this honored position with countries such as Sweden and Norway, long known for their commitment to maternal social supports. Canadaís parental leave benefits are, however, not without cracks, and leave some sectors of the workforce without maternal workplace protection. Women who are self-employed, those who work part-time or are temporarily employed, may not meet the eligibility requirements and receive no benefits. As women are for the most part the primary nurturers, ironically it is because of their family commitments that they and themselves in these categories.
Maternity benefits for working mothers and parents remain the responsibility of the federal government. Canadaís Employment Insurance (EI) gives paid maternity leave for 15 weeks and paid parental leave for 35 weeks for a total of 50 weeks. To this an additional 15 weeks of sick leave may be added for a total of 65 weeks of leave. The provinces and territories can, however, add their weight to improving supports for mothers returning to the workplace, as Quebec has recently done. Quebec was able to negotiate funds from the feds to expand eligibility to include self-employed new mothers. This important step can be seen as a precedent for other provinces to plug the loopholes and improve eligibility to these important supports.
Breastfeeding breaks are another essential area of workplace support that remains vulnerable. A motherís ability to express and store breastmilk is vital if she is to practice breastfeeding for the recommended duration of two years and beyond.
Current status requires mothers to negotiate their lactation needs with their employer. The right to a workplace negotiated arrangement to continue lactation was an important legal precedent won in 1997 by Michelle Poirier vs. the Province of British Columbia (see, INFACT Canada Newsletter Summer Ď97). Unfortunately, many women remain reluctant to request time and space for their breastfeeding needs since they fear this may compromise their employment status.
Although Canadaís maternity benefits for working mothers are among the
best in the world, there are still some cracks in our support system.
Nevertheless, the legal recognition of workplace supports for breastfeeding women provided by Poirier vs. British Columbia creates a valuable opportunity to expand labour regulations and include breastfeeding breaks in maternity benefits legislation.
Good policies lead to good health
Social supports for mothers and parents not only facilitate the critical role of nurturing but also validate the considerable societal contribution that women make when breastfeeding their children. Breastfeeding spares the government significant health and other social and educational costs because breastfed children are healthier throughout their lives. Although it is difficult to put a dollar amount on the savings generated by breastfeeding mothers, for a country like Canada it is likely in the billions of dollars annually.
Our health care providers and breastfeeding support groups have made great strides in convincing women that "breast is best." But are we doing enough to ensure that the decision to breastfeed can be readily exercised? It is of course the context of social and institutional supports that enable a mother to actually implement her decision to breastfeed and as the recommendations are exclusively for six months with duration to two years and beyond, support systems are needed that go well beyond the breastfeeding friendly maternity services stage.
Breastfeeding and workplace policies
Hong Kong In Hong Kong, where breastfeeding rates are very low, a survey of support facilities for breastfeeding hospital employees found that in government-funded hospitals support was much higher than in privately funded hospitals; only 14 out of 19 hospitals surveyed had a designated room for breastfeeding workers and only five of these rooms had doors that could be locked; only two of the hospitals allowed breaks as needed to express milk; 10 had to use their regular break and meal times.
Dodgson J E, Chee Y O, Yap T S. Workplace breastfeeding supports for hospital employees. Adv Nurs 47: 91-100, 2004
United States For most new mothers in the United States the average maternity leave is less than three months. A motherís breastfeeding capacity after returning to the workplace is dependent on the goodwill of her employer. A survey of company- sponsored lactation programs found that mothers continued to provide breastmilk for their infants when doing so was facilitated. The lactation programs provided: information on the importance of breastfeeding or the services of a lactation consultant and a private room equipped with the means to pump her milk. The survey found that 79 per cent of mothers returning to work tried pumping and of these 98 per cent were successful. The mothers expressed their milk for a mean duration time of 6.3 months and the mean age of their infants when they stopped expressing was nine months. The survey concluded that the workplace lactation program enabled mothers to provide breastmilk for their babies for as long as they wanted.
Ortiz J, McGilligan K, Kelly P. Duration of breastmilk expression among working mothers enrolled in an employer-sponsored lactation program. Pediatr Nurs 30: 111-119, 2004
Brazil Brazil is often cited as a model for breastfeeding support. It is world renowned for its more than 150 human milk banks and its strong national legislation implementing the International Code of Marketing of Breastmilk Substitutes, which regulates the marketing and availability of infant formulas. A qualitative study comparing 15 mothers who exclusively breastfed to mothers who were already feeding other foods to their infants found that the availability of free child care centres at the workplace was an important contributing factor to maintaining exclusive breastfeeding after mothers returned to work.
Osis M J, Duarte G A, Padua K S, Hardy E, Sandoval L E, Bento S F. Exclusive breastfeeding among working women with free daycare available at workplace. Rev Saude Publica 38: 172-179, 2004
Australia Educating about the need to balance work and breastfeeding was a project taken on by the Primary Health Care Research and Information Service. In recognition of the need to support breastfeeding when women return to the workplace, a "workplace information kit" was developed based on previous successful strategies. Over 50,000 kits were distributed across Australia to workplaces, employers and women. As well the kits were translated into Arabic, Chinese, Turkish, Spanish and Vietnamese. The kit was found to be useful in providing information to help develop solutions to balancing work and breastfeeding. Further work, however, was needed to assist workplaces in implementing specific policies and procedures.
McIntyre E, Pisaniello D, Gun R, Sanders C, Frith D. Balancing breastfeeding and paid employment: a project targeting employers, women and workplaces. Health Promot Int 17: 215-222, 2002
Impact on infant mortality, child health and development
Studies that have investigated the impact of parental leave on child health show a positive effect on health and mortality outcomes.
Using statistical models, the Tanaka1 analysis determined that a 10 week extension of paid leave predicts a 2.5 per cent drop in overall infant deaths with a greater impact on the post neonatal period of 4.1 per cent.
The effects of other leave on infant mortality is not significant because of lower uptake rates by parents.
The study concludes that paid job protected leave is effective in significantly reducing infant mortality, while unpaid leave has no significant effect. This, the author suggests, may be the result of mothers returning to work earlier because of economic need. As well the author notes that more information is needed to study the length of leave taken by parents, the duration of breastfeeding and pre-natal care in order to understand the importance of social policies in providing a better environment for infant health.
In sharp contrast to other industrialized countries, US mothers2 return to work very quickly after giving birth. Approximately a third of new mothers return to work within three months. For most mothers, maternity leave is determined by employer policies, which typically offer up to six weeks (through vacation, sick days or temporary disability coverage). In some situations longer leave is available but is generally unpaid. Some states have passed regulations requiring job protected leave varying from four weeks up to 18 weeks. By 1993 the federal Family and Medical Leave Act was passed and provides for 12 weeks, however without provision of pay, but with job protection for those who qualify.
Using statistical models, the Berger et al. paper looked at the impact of a motherís return to work on health developmental outcomes for their children.
After controlling for demographic and state variables, they found that children whose mothers returned to work after 12 weeks are 2.4 percentage points less likely to receive well-baby care; 7.5 percentage points less likely to be breastfed and 3.4 percentage points less likely to receive all immunizations. The most significant impact was on breastfeeding. On average 58.4 per cent of the women in this category breastfed and did so for an average of 11.1 weeks. This was 4.5 fewer weeks of breastfeeding when compared to mothers who returned to work after a longer period than 12 weeks. For those returning to fulltime work before 12 weeks the impact of reduced breastfeeding was even greater ó infants were 14 points less likely to be breastfed. These children were also more likely to have externalizing behaviour problems at age four.
The authors note that US policy makers should consider extending parental leave coverage by providing means for paid leave and longer leave.
1. Tanaka S. Parental Leave and child health across OECD countries. The Economic Journal 115:F7-F27, 2005
2. Berger L M, Hill J, Waldfogel J. Maternity Leave, early maternal employment and child health and development in the US. The Economic Journal 115: F29-F47, 2005
WORKPLACE SUPPORTS: WHAT WORKS?
Ā Job protected paid maternity leave
Ā Paid breastfeeding breaks when returning to work
Ā On-site easy access child care
Ā Facilities to express and store breastmilk
Ā Clinical breastfeeding help
Ā Positive public and workplace attitudes
Federal Labour Standards revision
The revision of Canadaís Federal Labour Standards, currently underway, provides an important opportunity to petition for the inclusion of paid breastfeeding breaks into Canadaís Labour Code. INFACT Canadaís representative to the Breastfeeding Committee of Canada (BCC), Johanna Bergerman, recently submitted a proposal on behalf of the BCC to do just that.
"Paid breastfeeding breaks are good for business. Employers who are supportive of breastfeeding bene.t from increased staff retention and loyalty and from a family-friendly corporate imageÖMothers who sustain breastfeeding reduce their lifetime risk of breast cancer. Children who breastfeed enjoy better health.."
óBCC submission to the Labour Standards review hearings 09/05
The BCC submission can be viewed at: www.breastfeedingcanada.ca
What you can do
Ā Write letters requesting paid breastfeeding breaks to:
Minister Responsible for Human Resources and Skills Development,
House of Commons Ottawa, Ontario, K1A 0A6