Maternity Leave, Early Maternal Employment and Child Health and Development in the US

This paper uses data from the National Longitudinal Survey of Youth to explore links between mothers' returns to work within 12 weeks of giving birth and health and developmental outcomes for their children. OLS models and propensity score matching methods are utilised to account for selection bias. Considerable associations between early returns to work and children's outcomes are found suggesting causal relationships between early returns to work and reductions in breastfeeding and immunisations, as well as increases in externalising behaviour problems. These results are generally stronger for mothers who return to work full-time within 12 weeks of giving birth. New mothers in the US return to work very quickly by international standards. A third of new mothers in the US return to work within 3 months of giving birth (Klerman and Leibowitz, 1990, 1994, 1999; Smith and Bachu, 1999). These figures stand in sharp contrast to figures for other advanced industrialised nations. In Germany, Sweden and the UK, for instance, only about 5% of new mothers return to work so quickly (Gustafsson et al., 1996). The fact that US mothers return to work so quickly is a potential concern if early returns to work result in negative outcomes for their children. Staying home for at least 6 weeks after delivery (8 weeks if the delivery was by Caesarean section) allows new mothers time to recover from birth, facilitates breastfeeding and may help prevent some adverse health consequences for the mother and child. Indeed, in many countries, maternity leave laws specifically prohibit mothers from working until at least 6 weeks have elapsed. And, in most industrialised countries, maternity leave laws provide for an extended period ofjob-protected leave, at least a portion of which is paid. The situation in the US is very different. In the US, the primary source of maternity leave coverage has been employer policies, whether established voluntarily or as part of collective bargaining agreements. Under these employer policies, a new mother can typically stay home for up to 6 weeks, as long as she has the available leave time (e.g., through vacation, sick days, and/or temporary disability coverage) and obtains a doctor's note. In some instances, a longer period of leave is permitted but rarely with pay. Beginning in the early 1970s, some US states passed maternity leave laws requiring firms to provide job-protected leaves to at least some employees. The most generous of these laws provide 18 weeks of leave; the least generous, only 4 weeks of leave. US policy was somewhat formalised in 1993, with the passage of the federal Family and Medical Leave Act (FMLA). Although the FMLA is limited * Funding for this research was provided by the National Institute of Child Health and Human