Abstract
Breastfeeding is not (only) about the individual feeding choice of a woman, but also about a society supporting breastfeeding—it was the theme of my latest President's Column, 1 and it is the driving force behind the newest statement of the Academy of Breastfeeding Medicine, “Paid maternity leave: Importance to society, breastfeeding, and sustainable development.” 2
One of the major barriers a woman must overcome to make this individual choice is financial hardship they may suffer when they decide to exclusively breastfeed for the first 6 month after birth, as the WHO and many medical societies recommend. Unfortunately, in many places of the world, there are high individual costs when mothers choose not to be separated from their children in these first 26 weeks. Most countries have at least some regulations on maternal leave in place, but in many countries, the maternal leave is not long enough, and the payment is not high enough to cover the loss of income in this period, an income many families depend on.
In many countries, maternity leave doesn't cover all working women, or even most working women, and may only apply to women in certain types of jobs. It may exclude self-employed women and women who work in informal sectors, so despite legislation there might be hardly any coverage of women, because this sector may be so extensive. Sometimes a maternity leave period will have repercussions for the career of the women involved—making it harder for women to choose this option. Sometimes there are no regulations at all at country level, leaving it to employers to provide maternal leave, the USA being one of the very few countries where there is no countrywide legislation in place.
Sound legislation on maternity leave for all women, independent of the kind of work they are doing, creates a situation where all are winning. We all know the numerous ways breastfeeding contributes to the physical and mental health of children and their mothers, an influence that continues way beyond the actual time of the breastfeeding period. Paid maternity leave has been shown to raise breastfeeding rates, resulting in lower incidence of mortality and morbidity and lower health care costs for a society. Moreover, employee satisfaction rises considerably when maternity leave is in place. Employees are more motivated and feel more connected to the company, and the overall productivity of the employee is enhanced, so individual companies also profit from a well-established maternal leave period. The economic value of breastfeeding and the positive environmental influence of breastfeeding, which clearly reduces the carbon print, add to the positive impacts of paid maternal leave for society.
Authors from around the world—breastfeeding experts with background in economics, pediatrics, public health, and gynecology—have contributed to this statement, highlighting these many different aspects of protecting the mother–infant dyad in the first months after birth, making a very convincing case to follow the recommendations of WHO and ILO, and to have legislation to paid maternity leave for all women who gave birth and parental leave for all families in this critical period. The breastfeeding woman must feel a community around her. Breastfeeding is not the choice of a woman, but of both parents. So—as it appears well from Figure 1, combined with the ABM statement—it is ultimately useful for society to understand the ecological system, showing interacting factors that influence whether a mother can afford to breastfeed and think about the division of tasks within the family, the parenting. It is not enough to have a paid maternity leave for 6 months, but the woman needs to be supported by the partner in the care of the child and supported by a society that supports breastfeeding. 3 A multidisciplinary approach to breastfeeding support in our society will make exclusive breastfeeding for 26 weeks and continuing breastfeeding with adequate complementary feeding for as long mother and child wish to do so not only a desirable, but also an achievable goal.
Thanks go to the international authors, breastfeeding experts from a variety of countries with backgrounds in pediatrics, gynecology, preventive medicine, and economics and to the Protocol Committee of the Academy of Breastfeeding Medicine for this highly needed document. It forms the scientific framework to make the case for paid maternity leave, because in the long-run societies cannot afford to not have paid maternity and parental leave in place. It shows that this is not only about paid maternity leave.
Now it is up to us all, physicians and nonphysicians, members of the Academy of Breastfeeding Medicine and readers of this statement, to urge our governments to put in place legislation to guarantee full-paid maternity leave for at least 6 months for all who have given birth, and to encourage our patients to fight for their right to take paid maternal and parental leave. National Breastfeeding Committees, medical societies, and labor organizations should work hand in hand to achieve a fair regulation. The recommendations of this Statement are a valuable guide for this endeavor. It will be one of the most effective ways to support breastfeeding.