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Galtry, Callister / ASSESSING JOURNAL OF FAMILY ISSUES / March 2005 10.

1177/0192513X04270344 PARENTAL LEAVE

Assessing the Optimal Length of Parental Leave for Child and Parental Well-Being
How Can Research Inform Policy?
Judith Galtry Paul Callister Victoria University
Parental leave is a complex area of public policy. Concerns include health protection for working mothers, equal employment opportunities for women, access to adequate antenatal and birthing care, maternal recovery, optimal nutrition for infants, and gender equality within families. Given this complexity, the design of parental leave schemes, including the optimal length of leave, should ideally be based on research from a wide range of disciplines. Yet research literature generally focuses on single issues. In this article, the focus is widened to encompass mothers’ labor market outcomes, concerns surrounding childbirth and maternal recovery, parent-infant bonding, children’s cognitive development, breastfeeding, and associated with each of these, gender equity objectives. In light of information from a wide range of disciplines and based on two country models, Sweden and the United States, it is proposed that discussions about parental leave policy, including the appropriate length of leave, should take a broad, interdisciplinary perspective. Keywords: parental leave; health; labor markets; gender equality

Parental leave is a particularly complex and contentious area of public policy (International Labour Organization, 1997; Kamerman, 2000; Moss & Deven, 1999; OECD, 1995). Concerns include health protection for working mothers, equal opportunities for women workers, gender equity in the home, access to adequate antenatal and birthing care, and also the issue of payment, including who pays and how much (Heitlinger, 1993). Parental leave policy is relevant not only to parents and children but also to employers, co-workers, and the wider society. Given all these interest groups, as well as the multiple and sometimes conflicting goals behind
Authors’ Note: This study was supported by a grant from the Alfred P. Sloan Foundation while the authors were working at the Cornell Employment and Family Careers Institute, Cornell University, N.Y. We would like to thank Professor Phyllis Moen for her support.
JOURNAL OF FAMILY ISSUES, Vol. 26 No. 2, March 2005 219-246 DOI: 10.1177/0192513X04270344 © 2005 Sage Publications




various parental/maternity leave policies, it is perhaps not surprising that views about parental leave are widely divergent. Due to the complexity of parental leave discussions, research often focuses on only one aspect of leave. For instance, in the labor market literature, there is concern about how “time out” might affect earnings for mothers, with the implications for parent-infant bonding and attachment receiving little attention. In the health arena, consideration is given to the optimal length of leave necessary for both recovery from childbirth and breastfeeding, but the potential effects of leave policies on gender equity goals are not at the forefront of concerns. This article attempts to cross some of these disciplinary boundaries so that individual parents, professionals advising families, and those designing family policy might better gauge the optimal period of parental leave. Although some of the issues covered in this article are also relevant to adoption, the main focus is on leave associated with biological parenthood. This review examines concerns associated with parental leave. These include labor market outcomes with particular relevance to women, childbirth and maternal recovery, parent-infant bonding, children’s cognitive development, and breastfeeding. With these issues in mind, two very different models of leave—that of the United States and of Sweden—are then explored. In the United States, at the federal level only 3 months of unpaid leave are available under the 1993 Family and Medical Leave Act (FMLA), and eligibility criteria are restrictive, ruling out many contingent workers. By contrast, Sweden provides 480 days of paid parental leave with almost universal eligibility. However, it is also recognized that within particular countries, individual families will inevitably have their own sets of preferences and constraints, regardless of statutory provisions for leave. At this level also, then, decisions about the optimal length of leave are likely to be multifaceted and complex. In undertaking this review, there is awareness that factors other than those listed influence the optimal duration of leave. In particular, the nature, availability, and quality of early childhood education and care provisions that might be seen in many situations as an alternative to taking parental leave are significant factors in determining the best possible length of leave. However, while important, the issue of the effects of child care is extremely complex and should be the subject of a separate discussion (Galtry, 2002; McGovern, Gjerdingen, & Froberg, 1992). Finally, whereas researchers generally hope that policy will be based on up-to-date, high-quality research, in reality, research often has little direct influence on policy making (e.g., Shulock, 1999). Policymaking is a highly complex process, often involving a mix of personal views, popular



discourse, political bargaining, and the weighing of finite taxpayer resources against uncertain policy outcomes. As an example of this, the United States’ 1993 FMLA involved major trade-offs to secure the support of both Democrats and moderate Republicans. However, even though such trade-offs are inevitable, researchers still have a responsibility to try to identify “best practice” with the hope of better informing future debates around parental leave policy. This is ultimately the aim of this article. PARENTAL LEAVE, LABOR MARKET OUTCOMES, AND HOUSEHOLD INCOME If a mother leaves employment during pregnancy or after the birth of a child, she potentially faces some or all of the following costs:
• loss of earnings while not employed • loss of on-the-job training opportunities • depreciation of skills and experience and, at times, loss of confidence about participating in paid work • costs associated with signaling a lack of commitment to employers • reinforcement of traditional roles and responsibilities if, in two-parent, heterosexual families, the mother leaves paid work and the father takes over the role of sole “breadwinner”1

Parents potentially confront these costs whether or not they have the right to return to their job. However, some of the costs outlined above are more applicable to individuals in career-type occupations rather than to those in “dead-end” jobs. For example, some jobs have little or no on-thejob training, and employers may not necessarily expect contingent workers to have high levels of commitment. By contrast, for managers and professionals, signaling high commitment and loyalty to the company may be very important. If those parents taking “time out” do not have a guaranteed right to job protection, they potentially face further costs. These include the costs of job searches and possible unintended unemployment when wishing to reenter the labor force and loss of work-related benefits, such as subsidized health care, retirement income, and length of service-related benefits. The costs of undertaking unpaid caring work are well-documented (e.g., Folbre, 1994, 2001; Institute for Women’s Policy Research, 2000; National Alliance for Caregiving and National Center on Women and Aging, 1999; Wisensale, 2001). However, these costs tend to vary between countries. In those nations with well-developed and publicly funded



health care systems, such as Sweden, a period of time out from employment will not reduce access to health care in the same way that it often does in the United States. Nor will loss of household income be as great in those countries that have paid parental leave. Whereas it is difficult to determine any causal relationship between the generosity of parental leave schemes and the length of leave taken, certainly in the United States the lack of taxpayer-funded payment is associated with the uptake of relatively short leaves. In Sweden in 1995, 98% of mothers and 18% of fathers took 60 or more days of parental leave (Swedish National Social Insurance Board, 2001).2 In contrast, in the United States when asked about length of longest leave by reason for leave, only 29% of respondents to the Department of Labor’s 2000 FMLA survey reported taking more than 60 days for maternity or disability leave, whereas 10% reported taking a similar period of leave to care for a newborn, adopted, or foster child (U.S. Department of Labor, 2000). This research also suggests that many American parents would take more leave if they received financial support. Even in countries where leave is paid, there is some concern that longterm earnings are potentially reduced if leave periods are extended. There is a wide range of international literature quantifying the long-term costs of time out of paid work, particularly for women. Much of this research draws either directly or indirectly on human capital theory. Central to these understandings is the concept that tenure in paid work has a major impact on earnings. Examples of links between time spent in work and earnings have been found in a number of countries. For example, in the United States Shapiro and Mott (1994) found that wage premiums are substantially higher for women who are strongly attached to the labor force than for those with relatively weak labor market links. Using British longitudinal data, Waldfogel (1995) found a large wage premium associated with the use of maternity leave and return to work relative to quitting work. This finding is supported by subsequent research in both Britain and the United States (Joshi, Paci, & Waldfogel, 1999; Waldfogel, 1998). Ruhm (1998a), analyzing the economic consequences of paid parental leave in nine European countries between 1969 and 1993, notes that parental leave is associated with increases in women’s employment but reductions in women’s relative wages in those contexts where long-term leaves are common. In Sweden, Stafford and Sundström (1994) also measured the effects of time out of the labor force because of the birth of a child. They suggest that although there are significant costs associated with taking time out of paid work in Sweden, long-term earnings tend to recover. They also found that the costs were particularly high for men. Ac-



cording to Stafford and Sundström, some of the costs of time out of the workforce for men are attributable to “signaling” effects, namely, the perception that such men are less committed to their careers. They also observe that in the United States there is a particularly high career cost associated with time out to care for children. One explanation might be that in countries with a high level of income inequality, such as the United States, a period of time out of the workplace can be particularly expensive if, through signaling lowered commitment, it serves to slow promotion (Bell & Freeman, 2001). It is also likely that social norms play a role in determining the cost of time out of paid work. But social norms do not necessarily operate independently of economic incentives. Sweden is an example of a country in which there is strong financial reinforcement for parents to take time out following childbirth. Although research establishes that a long-term attachment to the labor force offers significant advantages for many workers in terms of lifetime earnings, this does not mean that taking a period of leave inevitably harms labor market prospects. There is clearly much variation in the effects on various groups and individuals of taking time out of paid work. These effects are dependent on factors such as levels of formal education, prior work experience and employment patterns following the birth of a child, occupational status, length of leave, the number of leaves taken over a life cycle, and employer attitudes. For parents with a pattern of intermittent attachment to the labor market, the costs of additional time out in terms of income growth are likely to be relatively low, even nil. The behavior of a parent following the period of leave can be just as important as the length of leave taken. For example, after a short period of leave, a full-time worker may undertake reduced weekly hours of paid work. This could have a greater effect on his or her long-term earnings than taking a longer period of leave followed by a return to full-time employment. The benefits of remaining “attached” to one employer also depend on the state of the labor market. In a period of full employment, re-entry into paid work may be relatively easy for some groups of workers. In addition, the cost of time out to mothers is not only dependent on their own behavior, but it is also determined by the behavior of both women and men who take no leave around childbirth and of individuals without children. Below-replacement fertility rates in most industrialized countries indicate that a significant proportion of women (and men) are no longer having children. In Nordic countries, there has been much emphasis on encouraging fathers to increase their uptake of parental leave. These efforts recognize the advantages to both children and fathers themselves of the latter’s involvement in child rearing, the potential costs to women associated with their



disproportionate uptake of leave, and the right, and indeed the responsibility, of men to be fully involved fathers (Carlsen, 1998; European Commission, 1994). In Sweden, encouraging men to take leave has been shown to have direct positive effects for women. For instance, Haas and Hwang (1999) report that mothers experience less of a decline in income from prechildbirth levels if their partners take a greater-than-average share of family leave entitlement. Finally, although not generally discussed in the parental leave literature, the number of times an individual takes leave may be just as important as the length of each leave. For example, the effect on a parent’s career of taking a 12-month leave period for one child may be far less than a parent of four children taking four periods of 6 months’ leave. In a review of the labor market literature, Blau, Ferber, and Winkler (2001) conclude that if parents demonstrate a strong labor market attachment prior to having children, a relatively short leave with a return to the same employer and to the same work pattern is likely to result in low or negligible lifetime earning costs. Generally, a short leave is determined to be around 3 months and a long leave 9 months or more (Ruhm, 1998a). Where individuals already exhibit a weak attachment to the labor force, additional time out is likely to have little impact on their income growth. By contrast, if there is no paid leave available, the actual loss of income while out of the labor force is very important for this group (Callister, 2002). Payment potentially allows a much larger group to take time out of work and to use longer periods of leave. It also signifies recognition by society that some parents might underinvest in leave if relying on their own financial resources. Therefore, in those situations where parents are totally dependent on their own financial means, the optimal length of parental leave may be quite different than what appears to be “best practice” based on medical and other research. PREGNANCY, CHILDBIRTH, AND MATERNAL RECOVERY A number of researchers have tried to estimate the optimal time out of work around pregnancy and childbirth from the perspective of maternal health. In terms of the prebirth period, if an employee’s occupational environment is potentially hazardous, she may need to be transferred to another job within the same firm or, if this is not possible, take a period of leave for her entire pregnancy. There are also certain medical conditions that require that women rest during various stages of pregnancy. More-



over, there is a high prevalence of musculoskeletal complaints among pregnant workers that are potentially exacerbated by heavy physical workloads (Treffers, 2000). Many workers, particularly those in nonmanual occupations, are nevertheless able to continue working during the later stages of pregnancy. In some settings, leave taken prior to childbirth may reduce the amount of leave time available in the postnatal period. This potentially disadvantages those employees whose occupations and job conditions pose difficulties to working throughout most of the pregnancy, but who nevertheless wish to take a period of postnatal leave to spend time with their newborn. In the postbirth period, the length of time required for optimal recovery from childbirth also depends on a range of factors. These include the birth experience as well as a host of other emotional, physiological, and sociocultural factors. For instance, maternal recovery is usually longer for women who have given birth by cesarean section. The United States has high rates of cesarean section births relative to many other countries (Gerrard, 2001). In private hospitals in America, the cesarean section rate is about 40%, compared to 25% in the public sector. By contrast, nearly 20% of births in the United Kingdom are by cesarean section. 3 Research undertaken in the United States also shows that a period of leave following childbirth substantially assists mothers’ physical and mental well-being (Gjerdingen, Froberg, & Kochevar, 1991; McGovern et al., 1997). The McGovern et al. (1997) study found that longer maternity leaves were associated with improved health after childbirth, although effects were nonlinear. Women taking leaves of 12, 15, and 20 weeks or more duration after childbirth reported greater vitality (>12 weeks), better mental health (>15 weeks), and fewer limitations to their daily roles (>20 weeks). In a review of the effect of parental leave on maternal physical and mental heath, Lero (2003) discusses how a wide range of factors influence the optimal length of leave. While Tulman and Fawcett (1991) have estimated that full recovery from childbirth can take up to 6 months or longer, other researchers note the effect of duration is also influenced by factors such as spousal and community support, marital concerns, the overall health of the mother, and infant temperament (Clark, Hyde, Essex & Klein, 1997; McKim, Cramer, Stuart, & O’Connor, 1999; Weinraub & Jaeger, 1991). With regard to leave duration and maternal mental health, Lero (2003) observes that it may not be involvement in employment or staying at home that is important but rather role quality, that is, the fit between a mother’s



actual and preferred role. Women who stay at home for extended periods but are concerned about role restrictions are at risk of depression. Finally, the benefits of time out of work to undertake a period of breastfeeding have traditionally been viewed, at least in many industrialized countries, as primarily accruing to the child (see next section). There is increasing evidence, however, of physiological and emotional benefits to mothers associated with breastfeeding. These include possible protective effects against breast cancer in premenopausal women (Newcomb et al., 1994), ovarian cancer (Gwinn, Lee, Rhodes, Layde, & Rubin, 1990; Hartge et al., 1989), and osteoporosis (Blaauw et al., 1994). One study also suggests that women who have been breastfed as infants have less chance of developing breast cancer in later life (Freudenheim et al., 1994). In relation to paid employment, both mothers and fathers or other partners may benefit from a breastfed child, as there is some indication that breastfed babies are less likely to become ill and thus be excluded from child care (Jones & Matheny, 1993). It is, however, difficult to determine from these studies the optimal duration of breastfeeding, including whether it is exclusive or partial, in terms of providing these benefits to mothers. Recent research on the association between breastfeeding and breast cancer nevertheless concludes that longer breastfeeding duration is strongly associated with reduced risk of breast cancer, having implications for women in developed countries, such as the United States (Collaborative Group on Hormonal Factors in Breast Cancer, 2002). Breastfeeding also offers mothers a range of other less easily quantifiable advantages in terms of their own well-being and self-esteem, as well as enhanced bonding with their offspring (Labbok, 2001). Overall, the literature on pregnancy, childbirth, and maternal recovery suggests that optimal leave duration will vary according to a wide range of factors, including the relative ease or difficulty of the individual’s pregnancy and childbirth. However, there is some indication that the optimal length of leave is likely to be in the order of months rather than weeks or days, particularly postbirth. PARENTAL LEAVE AND CHILD HEALTH

A period of time out of the workplace or a transfer to lighter work has been shown in some studies to reduce the risk of having a preterm or low birthweight infant, particularly among employees with heavy workloads



(Treffers, 2000). In a review of maternity protection in both developed and developing countries, Treffers (2000) notes that whereas it is difficult to draw any definitive conclusion about the relationship between working conditions and preterm birth, the potential consequences of prematurity (especially before 33 weeks) poses “such a considerable risk to the infant that any excess of pre-term birth caused by working conditions should be prevented, if possible, by adequate measures” (p. 2). Moreover, research shows an association between an individual’s birthweight and his or her subsequent risk of ischemic heart disease, hypertension, and diabetes mellitus (Barker, 1994). In the United States, low birthweight is also the primary cause of neonatal morbidity and mortality (Stevens-Simon & Orleans, 1999). One study that has examined parental leave entitlements specifically in relation to child health is Ruhm’s (2000b) analysis of 16 European nations in the period between 1969 and 1994. Focusing on the postbirth period from the 28th day after birth through the 1st year, Ruhm found that postnatal parental leave entitlements have a substantial effect in reducing infant mortality during early childhood. He attributed this, in large part, to the additional time afforded by leave for parents to invest in their infants. Ruhm concluded that “parental leave may be a cost-effective method of bettering child health” and that parental time is “an important input into the well-being of children” (p. 933). However, it is difficult in such studies to isolate a single factor such as parental leave entitlements from the wider social context, including support for public health programs.

In recent years, research has increasingly focused on the relationship between maternal employment and breastfeeding practice (e.g., Auerbach & Guss, 1984; Gielen, Faden, O’Campo, Hendricks-Brown, & Paige, 1991; Kearney & Cronenwett, 1991; Lindberg, 1996; Roe, Whittington, Fein, & Teisl, 1999; Visness & Kennedy, 1997). This includes a focus on the gender equity implications for both child-rearing practices and women’s labor market participation and economic outcomes (Galtry, 1997, 2000). There are compelling biomedical and, more controversially, economic rationales for including breastfeeding as an essential part of any study on the development, design, and duration of parental leave policies (American Academy of Pediatrics, 1997; Weimer, 2001). These include the association found between breastfeeding and enhanced cognitive development among infants (e.g., Angelsen, Vik, Jacobsen, & Bakketeig, 2001; Horwood & Ferguson, 1998; Morley, Cole, Powell & Lucas, 1988).



International recommendations now advise 6 months of exclusive breastfeeding (i.e., breastmilk without any additional fluid or food), with continued breastfeeding up to 2 years of age and beyond (World Health Organization, 2002). The American Academy of Pediatrics (1997) similarly recommends 6 months exclusive breastfeeding with continued breastfeeding for at least 1 year. Research also indicates that breastfeeding affords protection against certain illnesses in a dose-responsive manner, even within developed countries (Scariati, Grummer-Strawn, & Fein, 1997). Analyzing longitudinal data to determine if breastfeeding protects U.S. infants from developing diarrhea and ear infections, Scariati et al. (1997) found that the more breastmilk an infant receives in the first 6 months of life, the less likely he or she is to develop either of these conditions. Breastfeeding is nevertheless a time-intensive practice, particularly when it is exclusive (Auerbach, 1999; UNICEF, 1998). A number of studies show an association between the duration of time off work and breastfeeding duration (Bick, MacArthur & Lancashire, 1998; Lindberg, 1996; Roe et al., 1999; Visness & Kennedy, 1997). There also appears to be an association between the timing of return to work, the number of hours worked, and the effect on breastfeeding (Fein & Roe, 1998). For instance, in a survey of women who planned to return to work within 12 months of giving birth, Roe et al. (1999) found that there was competition between breastfeeding and employment, with the greatest decrease in breastfeeding duration occurring when employment was resumed in the first 12 weeks after birth. It was observed that each additional week of leave from work increased breastfeeding duration by almost half a week. Moreover, women who worked full-time (more than 34 hours a week) within 3 months of birth were most likely to stop breastfeeding. Roe et al. also observed an increase in breastfeeding frequency associated with time out of work, a finding that has implications for exclusive breastfeeding practice. In a nationally representative sample of new mothers, Ryan and Martinez (1989) compared the incidence and duration of breastfeeding among American mothers employed full-time outside the home with those not in paid employment. They found that whereas the same proportion of women in both groups (55%) initiated breastfeeding, those returning to full-time paid work were less likely to be breastfeeding their babies at 6 months. Only 10% of mothers in full-time paid employment breastfed their babies at 6 months of age compared with 24% of those not in paid employment. Lindberg (1996) observed that conflicts between breastfeeding and employment vary according to the intensity of the work with significantly more mothers employed on a part-time basis likely to breast-



feed and for longer periods than those in full-time work. Lindberg also found that women are more likely to stop breastfeeding in the month they enter employment, suggesting that these behaviors constrain each other. She concluded that for women to achieve the recommended 6 months of breastfeeding would require maternity leaves of at least 6 months. In his 16-country study, Ruhm (2000b) observed that whereas there is a range of mechanisms by which parental leave may benefit child health, generous maternity/parental leave policies may mean that women breastfeed their offspring for longer periods. According to Ruhm, although it is difficult to establish the exact effect of breastfeeding, based on previous studies “a reasonable guess is that a substantial parental leave entitlement might increase breastfeeding sufficiently to prevent 0.5 to 1.0 postneonatal deaths per 1000 live births” (p. 952). For mothers who wish to resume employment soon after childbirth or for those in countries without generous and widely accessible periods of leave, one alternative to taking a long period of leave to breastfeed is to express breastmilk (either by hand or breastpump) in the workplace. Frequent feeding or expression is critical for ensuring milk production; if a mother is unable to breastfeed or express/pump milk regularly, her supply will gradually diminish, often resulting in early termination of breastfeeding (Auerbach, 1999). If she has access to lactation breaks and facilities in the workplace, the mother may be able to resume employment and express and/or pump milk with relative ease. This may also represent a gender equity strategy for many families not only by enabling breastfeeding mothers to return to work earlier but also by introducing the possibility of fathers and other partners taking leave to bond with their infants. It is noteworthy that there is no established body of research on the effectiveness of breastmilk expression as a long-term strategy, including for exclusive breastfeeding. In general, the sooner a woman returns to work following childbirth, the more frequently she will need to express milk. This is because it takes several weeks for a good milk supply to become established. For instance, a study examining the experiences of American mothers found that women who return to paid employment after 16 weeks “often may have a well-established milk supply, and may have successfully negotiated one or more transient breastfeeding crises, thereby minimizing the potentially negative effects that employment can have on breastfeeding” (Auerbach & Guss, 1984, p. 960). 4 From the perspective of breastfeeding then, it would appear that the optimal length of postbirth maternity leave is at least 6 months. This, in combination with workplace nursing breaks and facilities for 12 months,



would greatly facilitate the time-intensive practice of exclusive breastfeeding, as well as providing minimum enabling conditions for employed mothers to continue breastfeeding according to best practice recommendations. A 1-year cap on breastfeeding breaks would also go some way to reassuring employers that the need for breastfeeding support in the workplace is not an open-ended measure. However, provided that good supports are in place for breastfeeding/expressing milk in the workplace, postbirth maternity leave provisions of around 16 weeks, as identified by Auerbach & Guss’s (1984) study, may be sufficient to support optimal breastfeeding practice. As yet, there is little evidence of workplace lactation support being widely available in the United States. Thus, whereas some individuals, particularly those with strong negotiating power with their employers, may successfully integrate breastfeeding and paid work under the current policy scenario, the design of optimal parental leave policy needs to take into account those workers with little negotiating power.

For both mothers and fathers, one of the benefits of having a period of time off work after the birth of a child is the increased potential for infantparent bonding. Although the term “bonding” is often used interchangeably with “attachment,” bonding generally refers to the newborn period, whereas attachment refers to a longer period of infancy. In an influential but subsequently much contested study, Bowlby (1952) studied children confined to institutions. Bowlby found that in many cases, these infants displayed inadequate emotional and personality development. He attributed this, controversially, to “maternal deprivation.” Similarly, Ainsworth (1967) claimed an association between the security of infant attachment and aspects of maternal care giving. Based on research in Uganda and later in Baltimore, Maryland, Ainsworth observed that distinct patterns of attachment evolve between infants and their mothers in the early years of life. She suggested that the nature of the maternal-infant relationship related to the level of responsiveness demonstrated by the mother to her newborn. According to Ainsworth, those mothers who responded more quickly to their infants’ cries at 3 months were more likely to have developed secure maternal-child attachments by 1 year. In the 1970s, Klaus and Kennell suggested that a “sensitive period” existed during the first few hours of life. The baby’s emotional development was seen as heavily reliant on close emotional contact with the mother,



and the bonding process was often related to the mother’s hormonal processes (Klaus & Kennell, 1976). However, studies that linked child development and well-being primarily to the immediate postbirth period and/or to the mother’s presence came to be seen as increasingly controversial by child development researchers. Among this group were those who wished to assert the importance of both biological parents to the child’s development, as well as those who felt that previous research had often been motivated by, and had resulted in, a form of mother blame. Other researchers pointed out that whereas the prevailing perception of “good development” predicated on mother-child inseparability had come to be regarded as a universal, ahistorical truth, it failed to take into account the specificities of diverse family types and employment arrangements. For instance, Lamb (1976) argued that fathers had been neglected, historically, in child development and attachment studies. In addition, many feminist writers criticized earlier accounts for the way in which they made many mothers feel guilty, in particular those who had not had the opportunity to bond or had not bonded with their offspring in the manner prescribed by the “experts” (see Hrdy, 1999). Later research generally emphasized the importance of viewing bonding more as a complex and enduring process “influenced by the parents’ perceptions of their infant, the reward value of the interactions, and even social and economic situations that may or may not complicate the parents’ lives” (Harris, 1993, p. 294). This was accompanied by the growing realization that parent-child attachments do not always occur immediately at birth but are more likely to be part of a gradually evolving and enduring process that is mutually influenced through “a process of familiarization and reciprocal interactions” (Harris, 1993, p. 293). Despite a greater focus on bonding than on issues of child health more generally in the parental leave research literature (McGovern et al., 1992), research on child development offers little guidance regarding the exact time required to make such a bond. However, in contrast to many other fields, such as those concerning health and labor markets, where deliberations about the effects on women and children of different policies and practices are more confined within specific disciplinary boundaries, discussions about bonding have become part of popular discourse in recent years. Concerns surrounding appropriate bonding times are thus the subject of much public and often highly charged debate. Moreover, bonding is a far more difficult phenomenon to test empirically than, for instance, the effects of lost wages related to time out of work or infant mortality rates.




It is more difficult to assess the psychological benefits than the potential physiological benefits to children of parents taking leave. There is a large amount of controversial and generally inconclusive historical literature on the effects of mothers’ employment on child development, including on cognitive development (see Hoffman, Youngblade, Coley, Fuligni, & Kovacs, 1999). Not surprisingly, debate continues about family-work factors that potentially influence the cognitive development of young children (e.g., Ruhm, 2000a; Han, Waldfogel, & Brooks-Gunn, 2001). This includes discussion of the effects of the mother’s and, to a lesser extent, the father’s employment in the early years of a child’s life. Ruhm (2000a), as well as Han et al. (2001), found that maternal employment early in the child’s life adversely affects his or her cognitive development. Using U.S. National Longitudinal Survey of Youth data, Ruhm (2000a) noted that maternal labor market involvement during the first 3 years of the child’s life “is predicted to have a small negative effect on the verbal ability of 3 and 4 year olds and a substantial detrimental impact on the reading and math achievement of 5 and 6 year olds” (p. 1). The mother’s employment during the 2nd and 3rd years of the child’s life also appears to “have less favorable or more deleterious consequences when the mother is also employed in the first year.” Ruhm further observed that “paternal and maternal employment have qualitatively similar effects, hinting at the importance of time investments by fathers” (Ibid). Han et al. suggest, however, that the father’s full-time presence in the home, if due to unemployment, negatively affects the infant’s cognitive development. Note that unemployment, an often involuntary situation, needs to be distinguished from a period of job-protected leave, where the father is generally making an active decision to be at home with the child. PARENTAL LEAVE, GENDER EQUITY, AND CHILD WELL-BEING: THE UNITED STATES AND NORDIC MODELS As shown, taking a long period of maternity/parental leave is potentially detrimental to new parents in terms of their employment and economic outcomes. This is especially relevant to women, given that in all countries, they take the majority of leave following childbirth (International Labour Organization, 1997). The labor market literature suggests



that a relatively short period of paid leave with a guarantee of job reinstatement is preferable in terms of women’s economic and employment interests. Aside from lack of payment, the United States model of a short leave period appears to fit this model. Whereas leave policies vary among different states, at the federal level only 3 months of unpaid leave is available under the 1993 FMLA. Moreover, due to strict eligibility criteria, many parents are not covered by the FMLA (Callister, 2002). As of the end of 2002, the United States was, along with Australia, one of only two industrialized countries without paid leave. Despite its apparent fit with research supporting a short period of leave for women’s economic well-being, 12 weeks does not appear to be sufficient either to protect children’s health or, in many cases, to promote optimal maternal well-being following childbirth. Although welfare provision is not the specific subject of this article, sociocultural ideologies about appropriate leave periods and parental time input for newborns and infants are also likely to have implications for welfare measures. For instance, in 1996, 3 years after the FMLA’s enactment, the United States Congress enacted the Personal Responsibility and Work Opportunities Reconciliation Act. This legislation requires that low-income mothers seek and accept employment from the time their babies are 3 months of age, with only 12 states, as of 2000, exempting them from any work obligation until the infant’s first birthday (Kamerman, 2000). This period matches the 12-week leave period provided under the FMLA, although in contrast to these welfare provisions, family and medical leave under the act is unpaid. Although the FMLA includes leave provision to care for dependents other than children (such as the elderly)—which renders it unique and arguably progressive in international terms (Hattiangadi, 2000)—it is premised on a narrow medical/disability model. This has important implications for the way in which children’s well-being is addressed. The fact that family leave is broader in its scope than most comparable countries’parental leave schema, including an intergenerational component (Wisensale, 2001)5, means that separating out specific provisions for re-assessment and possible redesign becomes potentially more difficult. This includes determining the appropriate length of leave to cover the childbearing and early child-rearing period. This broad-based and uniquely American approach, although at face value more inclusive and potentially less discriminatory than some other countries’ leave schemes (particularly those which provide only general-specific maternity leave), also reflects and reinforces a lack of prioritization of children’s well-being in United States’



family-work policy development (e.g., Kamerman & Kahn, 1991; Skocpol, 2000). The differences, for example, between parental leave schema in the Nordic countries and the United States are not only material (i.e., the FMLA’s provisions are brief, unpaid, and subject to restrictive eligibility criteria, whereas the former are universal, longer, and paid), they are also grounded in significant ideological differences. Most important, perhaps, the child is firmly at the center of the Scandinavian welfare state and its policy development (Esping-Andersen, 1996). Accordingly, children’s well-being is viewed as a public responsibility in which society is prepared to invest. Generous parental leave provisions in terms of accessibility, length, and payment, such as those exhibited in Norway, Sweden, and to a lesser extent, Denmark, are seen as fundamental to this “social investment” objective. For instance, in Sweden, whereas an extended period of job-protected paid parental leave was introduced in 1974, provision for job-protected maternity leave was introduced as early as the 1930s, followed by paid maternity leave in the 1950s (Haas, 1992; Moen, 1989; OECD, 1995; Sundström, 1991). Currently, under Sweden’s parental insurance scheme, which insures for income loss resulting from the care of infants, parents are entitled to paid parental leave for 480 days (as of January 2002).6 Three hundred ninety days are paid at 80% of previous earnings, and the remaining months are paid at a standard, flat rate. Two months are reserved for each parent—the “pappa” month and the “mamma” month—and cannot be transferred. Sweden is an example of a country that has invested heavily in public support of programs designed to improve children’s well-being, and clearly, parental leave policies are only one part of this investment strategy. Other features of the Swedish system include comprehensive health programs and high-quality, widely accessible early childhood education and care provisions. Overall, this social investment approach appears to have paid off. As evidence of this, Sweden has exemplary infant health statistics, including the lowest infant mortality rate among OECD countries (OECD, 1999).7 While cautioning that no simple correlation can be made between the two, Ruhm (1998b) noted that Sweden, which had the most generous parental leave policies of the nine Western European countries studied in this analysis8—Denmark, Finland, France, Greece, Ireland, Italy, Norway, the Federal Republic of Germany, and Sweden—had the fewest infant deaths—4.3 per 1,000 live births. Regarding the association observed by Ruhm between children’s well-being and parental time



available to invest in them, including through breastfeeding, it is also noteworthy that Sweden has high breastfeeding rates (including exclusive breastfeeding rates at 6 months) relative to most other industrialized countries (see Swedish National Board of Health and Welfare, 2000).9 In contrast, the United States has a relatively low breastfeeding rate, with its rates at 6 months identified as a particular cause for concern, especially among African American women (U.S. Department of Health and Human Services, 2000).10 Whereas breastfeeding practice is heavily influenced by wider sociocultural factors (Dettwyler, 1995; Greiner, 1990), it is nevertheless likely that these best practice recommendations for 6 months of exclusive breastfeeding, as well as the desire in many cases to continue breastfeeding, pose contradictory pressures for many new mothers in the United States (Galtry, 1997, 2001). In contrast, then, to the United States model, Swedish parental leave provisions have been developed with both children’s welfare and gender equity goals in mind (Haas & Hwang, 1999). For instance, the 1995 Swedish governmental report on equality, Shared Power and Responsibility, notes that Sweden’s parental insurance scheme is predicated not only on the objective of gender equality in both the labor market and home but also on the acceptance that both parents have rights and obligations in relation to their children (Swedish Ministry of Health and Social Affairs, 1995).11 Sweden thus provides a substantial period of paid, gender-neutral parental leave through its social insurance scheme. This statutory entitlement offers mothers the opportunity to breastfeed their infants exclusively in the early months after birth, with nearly all mothers doing so, while still retaining their attachment to the labor market (Galtry, 2001). However, Swedish leave policy has an inbuilt equity component that also offers the option of other work-family integrating configurations. More specifically, in two-parent families both parents have the opportunity to spend time, although not concurrently, with their infants. Moreover, policies have also been instituted to hasten gender equity by encouraging fathers to take a period of leave through the introduction and implementation in 1995 of a nontransferable paid “pappa month” (Haas & Hwang, 1999; Sundström & Duvander, 1999), with an additional pappa month introduced in early 2002.12 But how do the Nordic countries, Sweden in particular, fare in terms of actual progress toward gender equity, particularly with regard to women and men’s employment and respective use of parental leave? Significantly, even in these countries it is still primarily mothers who take the majority of parental leave (Moen & Forest, 1999). Nearly all Swedish moth-



ers access paid parental leave, taking on average 11 months of parental leave (Haas & Hwang, 1999).13 Rønsen and Sundström (1996) report that at 6 months after the birth, about one tenth of Swedish mothers had resumed employment; at 1 year, approximately 50% were back at work, and at 18 months after the birth, about 60% were back on the job. By the time the child was 3 years old, just over 80% of Swedish mothers had resumed active employment. Despite the fact that women take the majority of leave, Sweden has the highest proportion of men taking parental leave among industrialized countries. The nontransferable pappa month has affected the parental allowance days used by men. For instance, for those children born in 1993 or 1994, prior to the pappa month’s introduction, half the fathers did not use the allowance (Swedish National Social Insurance Board, 2001). By contrast, in 1995, only 23% of fathers took no parental leave up until the time a child was 4 years of age. Of those who took leave, 35% took between 1 and 29 days, 41% took between 30 and 59 days, and 19% took between 60 and 179 days. Yet, despite recent progress, Haas and Hwang (1999) note that the pappa month has not had the anticipated effect on fathers’ uptake of leave, with Sweden still having a long way to go if it is to achieve equal parental leave uptake by men and women. An optimal leave arrangement might, in fact, involve the mother ’s taking the first 6 months of parental leave to recover from childbirth and to breastfeed, with the father then taking a further 6 months of leave to maximize shared time input into the child. This would also avoid the entrenchment of traditional roles in employment and home life that often proves both costly to women and difficult to change at a later date (Bergmann, 1986).14 Whereas this suggested pattern can be observed in some Swedish families, research continues in Nordic countries to try to identify ways of supporting equal use of parental leave by men and women across the wider society (Carlsen, 1998). Although it is sometimes assumed that an emphasis on father care has little relevance to the United States policy scenario, a recent American study highlights the lack of fit between mothers’ preferred methods of care and the types and quality of care available. Based on a study of pregnant women who returned to paid employment within the 1st year postpartum and used nonmaternal child care, Riley and Glass (2002) found that the majority of the mothers (53%) surveyed preferred father care. Whereas for a variety of reasons only 23% primarily used father care, this preferred arrangement would appear to fit the Swedish model, with an emphasis on longer periods of leave and paternal involvement.



CONCLUSION AND POLICY IMPLICATIONS So what is the optimal length of parental leave? The research literature from a range of disciplines and perspectives gives us different answers. It seems that a relatively short period of leave following childbirth is less costly to most employees in terms of its long-term economic and employment effects. Certainly, when leave is unpaid, a short leave period is not as detrimental for parents. However, the adverse economic consequences of longer leave appear to be less observable in countries such as Sweden, where such behavior is more predictable. Overall, in the context of the United States it seems that a short parental leave period, such as the 3 months covered by the FMLA, is likely to have minimal impact on employees’ long-term earnings. With regard to fetal and maternal health, leave policies must include measures that offer pregnant workers the opportunity to take a period of their leave entitlement prior to childbirth. In the prenatal period, it is difficult to establish a universally appropriate length of leave, as this is largely determined by both the nature of the pregnancy and the type of job and working conditions. Following childbirth, women’s physical and mental health is often enhanced by a period of leave. Some research supports postnatal leave periods longer than 20 weeks to optimize women’s mental and physical health. However, if they are able to access the full 12 weeks following childbirth, the time period provided by the FMLA may be sufficient for many workers covered by this legislation. Yet, for those women who experience complications either during their pregnancy or following childbirth, 12 weeks will often be inadequate. The longer period of paid and universally available leave characterizing Swedish public policy allows women to determine better the most appropriate leave duration based on their personal circumstances. Although the issue of bonding is often a key component of discussions about the design of parental leave policy, the literature on this subject provides little guidance as to the optimal length of time required. However, in contrast to the historical emphasis on maternal-infant bonding, there is now increasing recognition of the benefits to both parents associated with the opportunity to bond with their infants. With regard to heterosexual couples, this means that parental leave schemes need to be designed, as has increasingly occurred in recent years, to allow both mothers and fathers to spend time with their offspring. In their different ways, both the United States and Swedish parental leave schemes allow for this. But the Swedish model goes much farther by providing financial incentives to en-



courage fathers to take longer leaves. However, this goal appears to be explicitly driven more by the wider societal ideal of gender equity than by theories of bonding. The literature on breastfeeding provides more direct guidance for the design of parental leave schemes. Current breastfeeding recommendations and research appear to support the provision of 6 months paid postnatal leave so that mothers can exclusively breastfeed their infants during this period. Longer duration of breastfeeding has also been shown to be protective against breast cancer in women. However, if an initial 6month period of leave following childbirth is warranted primarily on maternal and child health and, to a lesser extent, on cognitive development grounds, leave then comes to be seen as unavoidably female specific, that is, pertaining primarily to women. Herein lies the gender equity conundrum. In heterosexual, two-parent families, if equality both in the home and the workplace is to be achieved, parental leave needs to be shared equally by both parents, thereby avoiding the entrenchment of traditional roles and responsibilities. This then necessitates longer periods of leave so that parents can take leave consecutively. Paid leave lasting longer than six months would ensure that fathers have the opportunity to spend time with their child, as well as balancing the breastfeeding mother’s potential time input during the early months. One way of achieving this scenario would be to emulate some aspects of the Swedish public policy model. Although much progress is required if full gender equality is to be attained, Sweden has nevertheless managed to design and develop a parental leave policy package that recognizes and addresses the dual and often conflicting objectives of child health and gender equity. Although the United States is characterized by a very different institutional and public policy climate, measures that would enable both health-promoting behavior and equitable leave-taking practices between women and men need to be developed. The need to ensure equity and redistribution, as well as to enhance children’s life chances and opportunities regardless of their family context, provides one of the strongest arguments for government intervention and redesign of appropriate parental leave policy, including in terms of its duration. However, whereas research suggests that a period of leave supports breastfeeding duration, for a variety of reasons many new mothers either need to or wish to return to work before 6 months. In the United States, where leave is unpaid, many individuals are not covered by the FMLA, and the cost of being out of employment is also seemingly higher than in some other countries, the pressure for an early return to work is likely to be more intense. In countries such as the United States, workplace measures



are, therefore, required to enable employees returning to work immediately following childbirth to integrate their work and family commitments better. These include measures for “phasing back” through part-time work, shorter working days and/or flextime, as well as provisions for breastfeeding breaks and facilities. Such measures are also required to enable employees returning to work after a period of leave to continue breastfeeding. Within two-parent, heterosexual households, the model whereby mothers return to work before 6 months while continuing to express breast milk and fathers take an equivalent, subsequent period of leave appears to offer an alternative model to the traditional gender division of leave uptake. At face value, this scenario also seems ideal in terms of reconciling important health and gender equity concerns. However, insufficient research is available to unconditionally recommend this model. As yet, there is little evidence that provisions supportive of breastfeeding/breast milk expression are widespread in the United States workplace. Moreover, further research is required on the effectiveness of breast milk expression, including through the use of a breast pump, as a strategy for maintaining exclusive breastfeeding, particularly in the United States where this model appears to be far more prevalent than in Europe. In parental leave discussions, political and ideological considerations will always be important, with political trade-offs playing a critical role in the adoption of the FMLA. However, the design of parental leave schemes should, ideally, be informed by research. If these schemes are to be guided only by research on labor markets and gender equity, then short leaves seem the best policy option. But once biomedical research is considered, the design of parental leave becomes far more complex. This body of research points to the need for much longer leaves than are currently available in the United States. Ideally, postnatal leave should be for at least 6 months. Given the need of many pregnant workers for a period of prenatal leave, the overriding leave period may need to be even longer than this. This 6-month period is a minimum that does not cover the goal of gender equity in labor markets and households. But such leave would also require far wider eligibility criteria than is currently the case, as well as income support, especially for those who cannot afford to take time out of work without some form of income replacement. In addition, there needs to be legislation for breastfeeding breaks and facilities in the workplace, as stipulated in international law. Historically, American discussions of parental leave have not foregrounded medical research. The research literature suggests that in the future they should.



1. These traditional roles may also be difficult to change at a later time. Furthermore, if parents separate, the primary caregiver will generally become the custodial parent. 2. In 1995, 84% of Swedish mothers took 300 or more days of leave (Swedish National Social Insurance Board, 2001). 3. The World Health Organization notes that a country’s caesarean section rates should be no higher than 10%-15% (Gerrard, 2001). 4. Forty percent of those women who returned to paid employment before 16 weeks nevertheless continued to breastfeed beyond the infant’s first birthday (Auerbach & Guss, 1984). 5. Researchers and advocates for family and medical leave are divided on the value of initiatives proposing to limit paid leave to parental care alone. For instance, Wisensale (2001) argues that the FMLA was originally designed to provide intergenerational family care to enable eligible individuals to take time off from work to care for a child or an elderly parent. According to Wisensale, it is important to maintain this broad approach, given the impending reality of a large retirement population. 6. Separate provisions are also included for maternity leave (14 weeks) and paternity leave (10 days). 7. According to 1999 figures, after Poland, the United States had the highest infant mortality rates among OECD countries (OECD, 1999). 8. This analysis was later expanded to include 16 countries (Ruhm, 2000b). 9. Sweden is one of the leading countries among the developed nations with respect to breastfeeding practice. It not only has a high breastfeeding initiation rate—in 1997, at one week of age, 97% of infants were breastfed (93% exclusively, 4% partially)—but it is also notable for its breastfeeding frequency rates, especially for infants at six months of age. In this age group, fully 73% of all children born in 1998 were breastfed (41% exclusively breastfed and 32% partially breastfed) (Swedish National Board of Health and Welfare, 2000). 10. In 1998, 64% of American infants were breastfed (that is, received any amount of breast milk at all) in “the early postpartum period,” whereas at 6 months, only 29% of babies were breastfed (U.S. Department of Health and Human Services, 2000). 11. Sweden has for a long time promoted the notion of children’s rights and was, along with the other Nordic countries, a major force behind the development of the United Nations’ 1989 Convention on the Rights of the Child and in 1990 was one of the earliest countries to ratify it. 12. Another component of the Nordic family-work package, which is not directly the subject of this article but is nevertheless critical in facilitating the labor market attachment of leave-taking employees, is their extensive, high-quality, state-subsidized child care programs. In Sweden, for instance, child care provisions conjoin with the parental leave entitlement through the provision of paid parental leave for 15 months, followed by high-quality, subsidized day care. This particular policy configuration serves through economic incentives to shape and uphold the at-home ideal for the very young (followed by an out-of-home period in day care), which, to varying degrees, is at the heart of Nordic family-work policy. This policy package also has important fiscal implications—a factor that has sometimes been overlooked in international analyses supportive of the Swedish model (Galtry, 2001). 13. There are, however, variations in the timing of return to paid work among Swedish women. Stafford and Sundström (1994) suggest that there is a tendency for better paid and



more highly educated mothers to resume employment more rapidly after childbirth than those with lower education levels and lower rates of pay. 14. U.S. economist Barbara Bergmann argues that paid maternity leaves not only reinforce the notion that child rearing and other household chores are primarily the responsibility of women but also are “really another version of pay for housewives” (1986, p. 213).

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