Paid Leave and Maternal Depressive Symptoms After Childbirth: The Moderating Role of Perceived Fairness of the Division of Household Labor

Abstract

We examined whether using paid leave is directly linked to employed mothers’ depressive symptoms. In addition, we examined the moderating effect of employed mothers’ perceived fairness of division of household labor (housework and childcare) on the above association. We collected data from 92 employed mothers who were eligible to take paid leave and returned to the workplace after childbirth in Upstate New York State area. Using hierarchical regression analyses, we found that employed mothers’ paid leave use was not significantly associated with their levels of depressive symptoms. However, perceived fairness of division of household labor moderated the above association. Specifically, when employed mothers took paid leave, they reported lower levels of depressive symptoms than those who did not take leave when they perceived that the division of household labor was fair to them.

Keywords

paid leave maternal depressive symptoms division of household labor employed mothers childbirth

Beginning on January 1, 2018, the New York State government started to provide job-protected paid family leave to employees. According to the official website for New York State Paid Family Leave (PFL hereafter; New York State, 2018), the PFL Act provides paid time off—up to 12 weeks of paid leave at 67% of the average weekly wage by 2021—to allow both parents to bond with a new baby within the first year of childbirth. The official website of PFL states that because of this policy employees will no longer have to choose between maintaining a job and caring for their new baby, suffer the stress of weeks of lost wages, or fear losing their jobs (New York State, 2018). In addition, given that the aforementioned struggle, stress, and fear in the workplace can negatively impact employees’ job performance and turnover rates, PFL intends to increase employees’ retention rates and their productivity as well as reduce costs associated with hiring new employees; such efforts would beneficial for employers. PFL is not restricted to full-time employees. For example, part-time workers who work more than 20 hr per week over 26 consecutive weeks or who work less than 20 hr per week over 175 days can also take PFL; furthermore, employees can obtain the opportunity for PFL through only a small weekly payroll deduction (0.126% of their weekly wage; New York State, 2018). For this reason, PFL is a more generous and universal leave policy compared with the unpaid leave under the Family Medical Leave Act (FMLA hereafter) of 1993 and other states’ paid leave programs (National Partnership for Women & Families, 2019).

Given that employed mothers often experience difficulties managing the demands of paid work and child caregiving, they are exposed to role overload that may be deleterious for their mental health (Glynn et al., 2009; Hwang & Ramadoss, 2019). In particular, maternal depression is a risk factor for predicting poor individual well-being and child developmental outcomes (Deater-Deckard, 2003; Netsi et al., 2018). Furthermore, low-income women are exposed to higher postpartum depression compared with middle- or high-income women (Abrams et al., 2009; Rich-Edwards et al., 2006). For this reason, researchers have focused on the efficacy of efforts to alleviate employed mothers’ depressive symptoms for improving child and family well-being, and they suggest that paid leave can be an important resource for them to promote their psychological well-being (Hwang & Jung, 2016). However, although it is known that paid leave is beneficial for promoting employed mothers’ mental health in European countries (Avendano et al., 2015; Staehelin et al., 2007), less is known about the effects of paid leave on employed mothers’ depressive symptoms after childbirth, because unpaid leave based on the FMLA is the main family policy in the United States (Andres et al., 2016). Therefore, examining the effect of paid leave on maternal depressive symptoms can provide the rationale for expanding state paid leave policy to a national policy.

Regarding the effectiveness of paid leave, researchers have argued that the association between paid leave and maternal well-being should be considered within the familial context; for example, without husbands’ contribution to childcare and domestic work, employed mothers have to take on a homemaker role during the leave, which tends to worsen their mental health (Hwang, 2019; Hwang & Jung, 2016). Given that many employed mothers experience unequal division of household labor despite being in dual-income families (Claffey & Mickelson, 2009; Goñi-Legaz et al., 2010), it is possible that the effect of paid leave on maternal depressive symptoms can be mitigated or intensified according to employed mothers’ perceived fairness of the division of household labor. Although previous studies have mainly focused on the impact of paid leave on the gendered division of housework (Estes, 2011; Noonan, 2013), the moderating role of division of household labor in the association between paid leave and maternal depressive symptoms has not been studied yet. Therefore, in an effort to better understand how employed mothers’ paid leave use is related to maternal depressive symptoms, this study examined employed mothers’ perceived fairness of division of household labor as a moderator of the above associations.

Literature Review

Maternal Depressive Symptoms After Childbirth and Paid Leave

Becoming a parent may be an exhilarating and exhausting life event for women. Previous studies have consistently found that most women feel considerable emotional ups and downs after childbirth (Falah-Hassani et al., 2015; Robertson et al., 2004). This psychologically unstable condition is sometimes called postpartum blues, which are mild levels of mood lability, irritability, tearfulness, anxiety, and sleep/appetite disturbance (O’Hara & Wisner, 2014; Robertson et al., 2004). These symptoms are common in women and usually occur and disappear within 1 month after childbirth; thus, postpartum blues are distinct from postpartum depression (depression symptoms in the postpartum period; O’Hara & Wisner, 2014). However, postpartum blues could develop into depression if symptoms last several months or even a year (Falah-Hassani et al., 2015). According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013), the diagnostic criteria for depression are five or more symptoms of depressed mood, loss of interest or pleasure, appetite or weight changes, sleep difficulties, psychomotor agitation or retardation, fatigue or loss of energy, diminished ability to think or concentrate, feelings of worthlessness or excessive guilt, and suicidality that present within a 2-week period (Tolentino & Schmidt, 2018). Robertson and colleagues’ (2004) meta-analysis found that anxiety during pregnancy, history of psychiatric illness, stressful life events, and lack of support are major risk factors for postpartum depression.

According to role strain perspective, individuals have a fixed amount of resources (e.g., time and energy); therefore, adding a role (e.g., worker and mother) may create role overload, which leads to deleterious psychological outcomes (Goode, 1960; Hecht, 2001). For employed mothers, pregnancy, childbirth, and coming back to the workplace are major transitions; having a child may increase financial burden and conflicts between multiple roles in work and family domains. In this situation, paid leave can be an important resource to support mothers’ well-being by enabling them to take time to recover from the mental and physical strains of childbirth and to alleviate concerns about lost wages and jobs during their time off (Aitken et al., 2015; Poms et al., 2016). Although the United States has provided unpaid leave for employed parents, previous studies have found that even an unpaid leave has beneficial effects for employed mothers’ psychological and physical well-being, such as alleviating depressive symptoms (Chatterji & Markowitz, 2012), reducing parenting stress (Chatterji et al., 2013), and enhancing mental and physical health (Dagher et al., 2014; Grice et al., 2007). Based on the theoretical background and past findings in research, we hypothesized that employed mothers taking paid leave would be associated with a decrease in their depressive symptoms.

The Moderating Role of Perceived Fairness of the Division of Household Labor

Although the majority of both men and women have agreed that household labor should be fairly shared, women still perform 2 or 3 times as much childrearing and housework as men (Coltrane, 2000; Lam et al., 2012). The term “second shift” describes employed women’s role overload as a worker and housewife (Hochschild & Machung, 2012). A broader category of household labor includes housework—defined as “unpaid work done to maintain family members and/or a home” (Shelton & John, 1996, p. 300)—and childcare (Lee & Waite, 2005). Tasks considered to be housework include, for example, cooking, shopping for groceries, housecleaning, washing dishes, and doing laundry (Coltrane, 2000). According to a 2017 time-use study by the Bureau of Labor Statistics (2018), on an average day, women living in households with children under age 6 spent 2.4 hr on housework and 1.1 hr in physical childcare, which is higher than men, who spent 1.3 hr in household activities and 23 min in physical childcare. However, without considering couples’ contexts, simply comparing the gender difference in the amount of time spent in household labor can lead to misinterpretation. For example, couples make rational decisions to assign household labor according to their socioeconomic resources and work hours outside the home (Lam et al., 2012). It is possible that women perceive that the uneven distribution of household labor is fair based on their partners’ effort in housework and childcare or a considerable financial contribution to the household economy, for example, by making enough money to be able to buy their way out of household labor (e.g., hiring a nanny or housekeeper; Claffey & Mickelson, 2009). Therefore, rather than simply being related to the actual amount of time spent in household labor, employed mothers’ difficulties related to role overload in the family domain are most related to the perception of fairness regarding the division of household labor. Although studies investigating the moderating role of perceived fairness of household labor in the association between paid leave use and maternal depressive symptoms are rare, researchers have argued that the positive effect of work–family policy on employed mothers’ well-being can be diminished if gender inequality in household labor in the family is sustained (Hwang & Jung, 2016). For example, employed mothers who used paid leave after childbirth experienced more parenting stress than did those who did not use paid leave if they then took on the main caregiver role in their families and perceived a lack of support from their husbands (Hwang & Jung, 2016). According to Claffey and Mickelson (2009), women’s greater perception of fairness of the division of household labor is related to an increase in their psychological well-being. Therefore, it is possible that the positive effect of paid leave on maternal depressive symptoms can be intensified when employed mothers perceive that the division of household labor is fair to them. On the contrary, it is possible that the positive effect of paid leave on maternal depressive symptoms can be lessened when employed mothers perceive the division of household labor to be unfair to them. Therefore, we hypothesized that employed mothers’ perceived fairness of division of household labor would moderate the association between paid leave use and depressive symptoms. Specifically, we predicted that employed mothers who took paid leave and perceived the division of household labor as fair would report lower levels of depressive symptoms than employed mothers who took paid leave but perceived the division of household labor as unfair.

Method

Participants

Following the January 2018 enactment of the new paid family leave policy in New York, we surveyed employed mothers in dual-income couples who were eligible to take paid leave and who returned to their workplace after childbirth in the Central New York area in 2018. According to Reichman and colleagues (2001), sampling from hospitals has the advantages of increasing postpartum women’s response rates and reducing the costs of data collection. Therefore, after receiving Institutional Review Board (IRB) approval, we recruited participants from large hospitals in the Central New York area between January and August 2018. Employed mothers who visited the hospital for a postpartum checkup approximately 6 to 8 weeks after birth were told the purpose of the study and other information about it by a medical staff and researcher in the waiting room. Employed mothers who agreed to participate in the study were given a questionnaire and a consent form by a medical staff and researcher. They completed the survey in about 15 min during the hospital visit. As compensation, those who completed the survey received a $10 gift card by a medical staff and researcher. A total of 92 employed mothers participated in this study. We calculated the minimum sample size using G*Power 3.1.9.2, which is a power analysis program (Faul et al., 2009). The computed results showed that the minimum required sample size was 89 to have sufficient statistical power (power = .80, effect size f² = 0.24, number of predictors =14, α error probability = .05). Therefore, we constituted the final sample of 92 employed mothers in the present study.

Measures

Paid leave

We measured employed mothers’ paid and unpaid leave use through one binary response item, respectively (1 = yes, 0 = no). In this study, we utilized paid leave use as an independent variable and unpaid leave use as a control variable. For descriptive analysis, we measured employed mothers’ length of paid and unpaid leave using one continuous response item separately (report on a weekly basis).

Maternal depressive symptoms

Employed mothers’ depressive symptoms was measured by the Center for Epidemiologic Studies Depression (CES-D) scale short form (Björgvinsson et al., 2013; Radloff, 1977), which was designed to measure the frequency of depressive symptoms in the general population. This measure consists of four dimensions (e.g., depressive affect, somatic-retarded activity, positive affect/well-being, and interpersonal) measured with 10 items. Example items included “I was bothered by things that don’t usually bother me,” and “I felt depressed.” Response options were rarely or none of the time (1) to most or all of the time (4), with higher index scores representing more depressive symptoms. Results of the reliability test showed that Cronbach’s α was .75.

Perceived fairness of division of household labor

Given that household labor comprises housework and childcare (Coltrane, 2000), we separately measured employed mothers’ perceived fairness of the division of housework and childcare using two items from Claffey and Mickelson’s (2009) Perceived Fairness Scale; items included “Regarding the division of household chores, how do you feel about the fairness in your relationship with your spouse or partner?” and “Regarding the division of childcare, how do you feel about the fairness in your relationship with your spouse or partner?” Response options were very unfair (1) to very fair (5), with higher index scores representing more fairness of the division of housework and childcare.

Control variables

According to Lovejoy and colleagues’ (2000) meta-analysis, demographic factors, socioeconomic status, and job characteristics are significantly related to maternal depressive symptoms. In addition, stressful life events, such as separation or divorce, are associated with maternal depressive symptoms (Ertel et al., 2011). Furthermore, a large number of young children in families could be a risk factor contributing to maternal depressive symptoms (Wachs et al., 2009). Therefore, we utilized employed mothers’ age, race, education, marital status, divorce experience, number of children, employment status, and annual income as control variables. In addition, we utilized employed mothers’ unpaid leave use as a control variable. Employed mothers’ age and number of children were measured by one continuous response item separately. Employed mothers’ race was initially measured by one categorical response item (1 = White, 2 = African American, 3 = Hispanic, 4 = Asian, 5 = American Indian or Alaskan Native, 5 = Native Hawaiian or other Pacific Islander, and 6 = others). Based on employed mothers’ responses, we merged six categories into four groups (White, African American, Hispanic, and other groups). In addition, we created three binary response items of White (1 = yes, 0 = no), African American (1 = yes, 0 = no), and Hispanic (1 = yes, 0 = no), and then included them in the analysis. The reference group consisted of other racial groups labeled as other groups. Employed mothers’ education was measured by one ordinal response item, ranging from (1) some high school to (7) doctorate or professional degree. Employed mothers’ marital status (1 = legally married; 0 = living with a partner), whether they had been divorced (1 = yes, 0 = no), employment status (1 = full-time status, 0 = part-time status), and unpaid leave use (1 = yes, 0 = no) were each measured with one binary response item. Finally, employed mothers’ annual income was measured with one categorical response item (1 = under US$10,000 to 21 = US$200,000 or more).

Analytic Strategy

Before testing our hypotheses, we conducted descriptive and correlational analyses using SPSS 22.0 to explore means, standard deviations, and correlations among study variables. In addition, to compare participants who utilized paid leave and those who did not, we conducted independent sample t tests.

To test the hypotheses, we conducted a hierarchical regression analysis predicting employed mothers’ depressive symptoms through three models. In Model A, 10 control variables (employed mothers’ age, three binary variables of race, marital status, divorced experiences, education, number of children, employment status, annual income, and unpaid leave use) were entered into the model. In Model B, paid leave use, fairness of housework, and the interaction term for these two variables were entered into the model. In Model C, based on Model A, paid leave use, fairness of childcare, and the interaction term for these two variables were entered into the model. To minimize the multicollinearity issue, independent (paid leave use) and moderating variables (fairness of housework and childcare) were mean centered (M = 0) prior to inclusion in their regression equations (Aiken & West, 1991). In addition, we used mean substitution as a default option to account for the missing data using SPSS replace with mean function (less than 1 % of each variable).

Results

Descriptive Results

The results of descriptive analysis are presented in Table 1. Regarding participants’ demographic backgrounds, the mean age was 29.86 years, 41 mothers were White (44.6%), 31 were African American (33.7%), and eight were Hispanic (8.7%). Regarding participants’ education, 27 mothers had completed some college (29.3%), 25 employed mothers had completed high school or a GED (27.2%), and 13 had completed college or university education (14.1%). Forty-two mothers (45.7%) were legally married, five mothers were divorced (5.4%), and 64 mothers had full-time employment status (69.6%). The average of number of children was 2.17 and the average of annual income was between US$40,000 and US$50,000. The mean score of employed mothers’ depressive symptoms was 1.72 (SD = .51). In terms of paid leave use, 42 mothers used paid leave (45.7%) and the average length of leave was 2.90 weeks. In the case of unpaid leave use, 41 mothers used unpaid leave (44.6%) and the average length of leave was 3.03 weeks. A cross-tabulation of employed mothers’ length of paid and unpaid leave is presented in Table 2.

Table 1.

Participants’ Demographic Information.

Variables	Range	Employed mothers(n = 92)
Variables	Range	n (%)	M (SD)
Age			29.86 (5.41)
Race
White		41 (44.6)
African American		31 (33.7)
Hispanic		8 (8.7)
Other groups		12 (13.0)
Education	1–8		4.60 (1.67)
Some high school		9 (9.8)
High school or GED		25 (27.2)
Training after high school		3 (3.3)
Some college		27 (29.3)
College or university graduate		13 (14.1)
Master’s degree		11 (12.0)
Doctorate or professional degree		3 (3.3)
Marital status	0–1		0.45 (0.50)
Legally married		42 (45.7)
Living with a partner		50 (54.3)
Divorce experience	0–1		0.05 (0.22)
Yes		5 (5.4)
No		87 (94.6)
Number of children			2.17 (1.28)
Employment status	0–1		0.70 (0.45)
Full-time status		64 (69.6)
Part-time status		27 (29.3)
Annual income	1–21		4.42 (3.26)
Depressive symptoms	1–4		1.72 (.51)
Paid leave
Paid leave use	0–1		0.46 (0.50)
Yes		42 (45.7)
No		50 (54.3)
Length of paid leave			2.90 (3.58)
Unpaid leave
Unpaid leave use	0–1		0.45 (0.50)
Yes		41 (44.6)
No		51 (55.4)
Length of unpaid leave			3.03 (3.76)
Perceived fairness of division of household labor
Fairness of housework	1–5		3.81 (1.29)
Fairness of childcare	1–5		3.88 (1.21)

Table 2.

A Cross-Tabulation of Employed Mothers’ Length of Paid and Unpaid Leave.

	Length of unpaid leave (weeks)													Total
	0	1	2	3	4	5	6	7	8	9	10	11	12	Total
Length of paid leave (weeks)
0	32	0	0	0	1	1	6	1	8	0	1	0	2	52
1	0	0	0	1	0	1	0	0	0	0	0	0	0	2
2	0	0	0	0	0	0	0	0	0	0	0	0	0	0
3	1	0	0	1	0	0	0	0	0	0	0	0	0	2
4	2	0	0	0	1	0	0	0	0	0	0	0	0	3
5	0	0	0	0	1	0	0	0	0	0	0	0	0	1
6	2	0	0	0	0	0	0	0	0	0	0	0	0	7
7	0	0	0	0	0	0	4	0	1	0	0	0	0	0
8	14	1	0	0	0	0	5	1	2	0	0	0	2	25
Total	51	1	0	2	3	2	15	2	11	0	1	0	4	92

To compare employed mothers who utilized paid leave and those who did not, we conducted independent sample t tests. We divided participants into two groups (utilized paid leave group and did not utilize paid leave group) and compared the two groups’ mean scores for study and control variables. Results showed that all variables were not significantly different across two groups. The results of correlation analysis are presented in Table 3. Employed mothers’ perceived fairness of housework and childcare were negatively correlated with depressive symptoms (r = −.33, p < .01; r = −.39, p < .001). However, paid leave use was not correlated with depressive symptoms.

Table 3.

Bivariate Correlations Among Study Variables (n = 92).

Variables	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15
1. Age	—
2. White	.01	—
3. African American	−.14	−.63***	—
4. Hispanic	.07	−.27**	−.22*	—
5. Education	.38***	.30**	−.38***	−.06	—
6. Legally married	.29**	.40***	−.42***	−.12	.45***	—
7. Divorce experience	.23*	−.02	−.17	.09	.08	−.02	—
8. Number of children	.33**	−.29**	.20**	.22*	−.30**	−.31**	.19	—
9. Full-time status	.23*	.01	−.01	−.22*	.23*	.16	−.26*	−.05	—
10. Annual income	.45***	.24*	−.23*	.01	.49***	.48***	.10	−.20	.25*	—
11. Unpaid leave use	.09	−.01	.05	−.04	.06	.05	−.11	−.13	.34**	.15	—
12. Depressive symptoms	.06	−.27*	.08	.29*	−.05	−.16	.37***	.13	−.18	−.01	−.14	—
13. Paid leave use	.04	.05	−.01	.02	.04	−.01	.16	.13	.02	.03	.14	−.03	—
14. Fairness of housework	−.20	.02	−.04	−.10	−.21*	−.02	−.04	−.11	−.07	−.23*	.04	−.33**	.16	—
15. Fairness of childcare	−.07	.02	.04	−.29**	−.09	.10	−.14	−.16	.08	−.09	.06	−.39***	.18	.76***	—

p < .05. **p < .01. ***p < .001.

Testing the Hypothesized Model

The results of the hierarchical regression analysis are presented in Table 4. Regarding the first hypothesis, contrary to our expectations, paid leave use was not significantly associated with depressive symptoms in Models B and C. Consequently, mothers who used paid leave did not have significantly lower depressive symptoms than those who did not use paid leave. However, in terms of the second hypothesis, we found significant interaction effects in Models B and C. Specifically, two types of interaction terms (paid leave use and fairness of housework in Model B, paid leave use and fairness of childcare in Model C) were negatively associated with depressive symptoms (β = −0.29, p < .01 in Model B; β = −0.18, p = .047 in Model C).

Table 4.

Results of Hierarchical Regression Predicting Maternal Depressive Symptoms (n = 92).

	Model A			Model B			Model C
Variables	B	SE B	β	B	SE B	β	B	SE B	β
Constant	1.71	0.34		2.09	0.32		1.93	0.33
Age	0.00	0.01	0.05	0.00	0.01	0.04	0.01	0.01	0.06
White	−0.14	0.16	−0.14	−0.23	0.15	−0.23	−0.21	0.15	−0.21
African American	0.10	0.18	0.10	−0.01	0.16	−0.01	0.03	0.17	0.03
Hispanic	0.39	0.23	0.22	0.26	0.22	0.14	0.17	0.23	0.10
Education	0.00	0.03	−0.01	−0.03	0.03	−0.10	−0.02	0.03	−0.06
Legally married	−0.06	0.13	−0.06	−0.03	0.11	−0.03	−0.04	0.12	−0.04
Divorce experience	0.68	0.25	0.31**	0.70	0.23	0.32**	0.63	0.24	0.28*
Number of children	−0.03	0.05	−0.09	−0.06	0.04	−0.16	−0.06	0.05	−0.15
Full-time status	−0.03	0.13	−0.02	−0.04	0.12	−0.04	−0.02	0.12	−0.02
Annual income	0.01	0.02	0.03	−0.01	0.01	−0.07	−0.01	0.02	−0.01
Unpaid leave use	−0.11	0.10	−0.11	−0.09	0.09	−0.09	−0.09	0.10	−0.09
Paid leave use				0.04	0.09	0.02	0.03	0.10	0.03
Fairness of housework				−0.16	0.04	−0.42***
Fairness of childcare							−0.14	0.04	−0.32**
Paid Leave Use × Fairness of Housework				−0.23	0.07	−0.29**
Paid Leave Use × Fairness of Childcare							−0.17	0.08	−0.18*
ΔR²	.13			.28			.22
F for change in R²	2.21*			3.53***			2.90**

p < .05. **p < .01. ***p < .001.

To figuratively explain the results, we present two graphs in Figure 1 using online software that can calculate the simple slopes (Dawson, 2014). As shown in Figure 1, when employed mothers did not take paid leave, perceived fairness of housework and childcare were not associated with level of depressive symptoms. However, when employed mothers took paid leave, they reported high levels of depressive symptoms when their perception was that the division of housework and childcare was unfair to them. On the contrary, when employed mothers took paid leave, they reported low levels of depressive symptoms when they perceived the division of housework and childcare as fair to them. These results indicate that moderating effects of perceived fairness of housework and childcare were shown when employed mothers took paid leave. In other words, employed mothers in this sample, paid leave use is effective for reducing their levels of depressive symptoms when they perceive that the division of household labor is fair to them. Consequently, our findings support the second hypothesis that employed mothers’ perceived fairness of division of household labor is an important moderator of the effect of paid leave on depressive symptoms.

Figure 1.

The moderating effects of employed mothers’ perceived fairness of housework (upper graph) and childcare (bottom graph) in the association between paid leave use and depressive symptoms.

Discussion

The purpose of this study was to determine whether using paid leave is directly related to employed mothers’ level of depressive symptoms. In addition, we examined the moderating effect of employed mothers’ perception of the fairness of division of household labor on the above association. Thus, we were able to examine how paid leave is related to employed mothers’ psychological well-being in the context of division of household labor.

In terms of the first hypothesis, contrary to our expectation, employed mothers’ paid leave use was not significantly associated with their level of depressive symptoms. However, regarding the second hypothesis, we found that employed mothers who took paid leave reported low levels of depressive symptoms compared with those who did not take paid leave when they perceived the division of household labor with their spouses or partners to be fair. Consequently, based on the sample of 92 employed mothers, our findings imply that to explain the effect of paid leave on employed mothers’ psychological well-being, familial context should be considered. Gjerdingen and Center (2005) found that after childbirth, employed wives’ childcare and housework responsibilities substantially increased compared with their employed husbands. A previous study (Hwang & Jung, 2016) showed that employed wives who took paid maternity leave reported greater parenting stress compared with those who did not take paid maternity leave because of the lack of support from their husbands, which led employed wives to have a more demanding caregiver role during the leave. Our findings are in alignment with that study’s findings. We found that employed mothers who took paid leave reported higher levels of depressive symptoms than those who did not take paid leave when they perceived division of housework and childcare to be unfair to them. That is what the “second shift” idea is all about, that working women are unfairly put in a situation of having far more labor at home than their male partners, so it would stand to reason that that unfairness would often continue when they had time off from work (i.e., their household responsibilities would increase to an unfair extent). For these reasons, it is our interpretation that employed mothers’ extra burden of parenting and housework in the family domain can be a barrier diminishing the effects of paid leave policy on their psychological well-being.

Based on the sample of 92 employed mothers, we found that paid leave use is considered beneficial for alleviating employed mothers’ depressive symptoms after childbirth when there is an equitable division of household labor with a spouse or partner. This finding is linked to previous studies explaining the positive effect of paid leave on maternal well-being (Andres et al., 2016; Chatterji & Markowitz, 2012). In addition, our finding supports the rationale for paid leave policy, the assumption that paid leave is essential for employed women’s well-being by enabling them to take time to recover from the mental strains of childbirth without concerns about lost wages during the time off and career discontinuity after leave (Aitken et al., 2015; Poms et al., 2016). It is generally accepted that maternal depressive symptoms have deleterious effects on individual and familial well-being, such as mental health, life satisfaction, and marital relationships (Goodman, 2004). In the organizational context, depressive symptoms in employed mothers is closely related to poor job performance and reduced work productivity (Lerner & Henke, 2008). Furthermore, regarding child outcomes, maternal depressive symptoms are considered to be a risk factor predicting parenting stress, which adversely affects child development (Deater-Deckard, 2003). Given that how to reduce employed mothers’ depressive symptoms is an important issue in both the work and family domains, the findings of this study suggest that improvement in spouses’ or partners’ egalitarian gender role attitudes would maximize the effects of paid leave on maternal well-being. In other words, fathers’ contribution to childcare and domestic work give employed mothers rest from the burden of worker and caregiver responsibilities and alleviate their depressive symptoms after childbirth.

This study showed that more than half of employed mothers did not use paid leave even though they were eligible to take paid leave in their workplace. Some employed mothers may not need paid leave because they already have enough support from family members or networks. It is also possible that employed mothers have concerns about using paid leave because of possible disadvantages in performance review and career advancement, which would dampen their motivation for using paid leave. Regarding this issue, paid leave policy causes occupational gender segregation; for example, companies are required to pay for the additional costs of recruiting and training new workers to fill in for working mothers during their time off for childbirth (Estévez-Abe, 2005). Based on the cost and benefit perspective, hiring women is a potential costs for employers; therefore, long absences for childbirth make employed women less valuable in the organizational context (Boling, 2015). Therefore, additional studies are required to examine how organizational contexts influence the association between paid leave use and employed mothers’ well-being.

Limitations

Although we provide insight into the relationship between paid leave and maternal well-being in the American context, the findings should be interpreted cautiously for several reasons. First, the sample size of this study was small (N = 92); thus, the findings need to be replicated with a lager sample. Second, although we measured employed mothers’ paid leave use with one binary response item, we did not assess the reasons why employed mothers did not take paid leave. Therefore, the results of this study provide limited information about participants’ reasons for their decisions about whether to take paid leave. Third, regarding the association between paid leave and maternal depressive symptoms, there may be a selection effect in the results. For example, employed mothers who have depressive symptoms may use paid leave more than those who with no depressive symptoms. However, we did not allow for examination of the directionality of this association. Fourth, although we tried to focus on the association between paid leave and maternal depressive symptoms in the familial context, we only included mothers’ perceptions of fairness in the division of household labor, not fathers’ perceptions of fairness in the division of household labor as well as fathers’ paid leave taking. Fifth, this study is a cross-sectional study; thus, the causal relationship between paid leave use and maternal depressive symptoms cannot be explained by the results. To investigate the causal direction of the relationship between paid leave and maternal well-being, a more rigorous research design (e.g., longitudinal quasi-experimental research design) may be needed. Finally, this study is a regional study, with the sample concentrated in the Upstate New York area. Therefore, the results of the study cannot be generalized to other populations and more studies in other parts of the states in the United States are needed.

Implications for Practice

Notwithstanding some limitations, this study advances understanding of how paid leave is associated with employed mothers’ depressive symptoms in the familial context. The findings of this study indicate that employed mothers’ perceptions regarding the fairness of the division of household labor are important moderators of the positive effect of paid leave on maternal depressive symptoms. Based on this study’s findings, two implications can be derived from the present study. First, in relation to policy research, researchers and policy makers need to pay attention to the familial context. In this study, we found a synergistic effect of paid leave and spouses’ or partners’ contribution to the division of household labor on employed mothers’ psychological well-being in the U.S. context. Therefore, additional studies are encouraged to examine the effectiveness of work–family policies on child and family well-being within the familial context. Especially, future paid leave studies should recognize factors that may influence perceived division of labor, such as maternal gatekeeping.

Second, researchers and policy makers need to examine the optimal length of paid leave that is acceptable to both employer and employee. In this study, the average length of paid leave among 92 employed mothers was less than 3 weeks. It is possible that the in significant relationship between paid leave use and maternal depression could be caused by short paid leave periods. In other words, short-term paid leave may be insufficient to promote employed mothers’ well-being. Andres and colleagues (2016) also mentioned that longer term leave rather than shorter term leave is more effective in reducing maternal depressive symptoms. However, given that long-term paid leave can cause challenges in the workplace that increase the opportunity costs of using paid leave (Estévez-Abe, 2005), employed mothers may be forced to use short-term paid leave due to pressure from their family-unsupportive organizational environments. Without employers’ cooperation, the positive effect of paid leave cannot be delivered to employed mothers. In addition, the use of and experiences with paid leave can be influenced by women’s position in the occupational hierarchy. Therefore, how to reduce the opportunity costs of using paid leave should be addressed within the organizational context.

Conclusion

We provide empirical evidence to researchers and policy makers that paid leave use is related to employed mothers’ psychological well-being. In addition, we provide insight into the ways the gender egalitarian division of household labor is important to achieve policy success. This study enables us to expand the spectrum of paid leave policy by providing information about why paid leave is important and how paid leave affects maternal well-being through the familial context. The information acquired from the results would help us understand many fundamental and lingering questions, including the effectiveness of paid leave for enhancing maternal well-being among dual-income couples in the United States.

Footnotes

Acknowledgements

Some portion of data in the present study were used for Woosang Hwang’s unpublished doctoral dissertation at Syracuse University.

Disposition editor: Sondra J. Fogel

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Woosang Hwang

References

Abrams

L. S.

Dornig

Curran

(2009). Barriers to service use for postpartum depression symptoms among low-income ethnic minority mothers in the United States. Qualitative Health Research, 19(4), 535–551. https://doi.org/10.1177/1049732309332794

Aiken

L. S.

West

S. G.

(1991). Multiple regression: Testing and interpreting interactions. SAGE.

Aitken

Garrett

C. C.

Hewitt

Keogh

Hocking

J. S.

Kavanagh

A. M.

(2015). The maternal health outcomes of paid maternity leave: A systematic review. Social Science & Medicine, 130, 32–41. https://doi.org/10.1016/j.socscimed.2015.02.001

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

Andres

Baird

Bingenheimer

J. B.

Markus

A. R.

(2016). Maternity leave access and health: A systematic narrative review and conceptual framework development. Maternal and Child Health Journal, 20, 1178–1192. https://doi.org/10.1007/s10995-015-1905-9

Avendano

Berkman

L. F.

Brugiavini

Pasini

(2015). The long-run effect of maternity leave benefits on mental health: Evidence from European countries. Social Science & Medicine, 132, 45–53. https://doi.org/10.1016/j.socscimed.2015.02.037

Björgvinsson

Kertz

S. J.

Bigda-Peyton

J. S.

McCoy

K. L.

Aderka

I. M.

(2013). Psychometric properties of the CES-D-10 in a psychiatric sample. Assessment, 20, 429–436. https://doi.org/10.1177/1073191113481998

Boling

(2015). The politics of work-family policies. Cambridge University Press.

Bureau of Labor Statistics. (2018). American time use survey. U.S. Department of Labor.

10.

Chatterji

Markowitz

(2012). Family leave after childbirth and the mental health of new mothers. Journal of Mental Health Policy and Economics, 15(2), 61–76. https://doi.org/10.3386/w14156

11.

Chatterji

Markowitz

Brooks-Gunn

(2013). Effects of early maternal employment on maternal health and well-being. Journal of Population Economics, 26(1), 285–301. https://doi.org/10.1007/s00148-012-0437-5

12.

Claffey

S. T.

Mickelson

K. D.

(2009). Division of household labor and distress: The role of perceived fairness for employed mothers. Sex Roles, 60(11–12), 819–831. https://doi.org/10.1007/s11199-008-9578-0

13.

Coltrane

(2000). Research on household labor: Modeling and measuring the social embeddedness of routine family work. Journal of Marriage and Family, 62(4), 1208–1233. https://doi.org/10.1111/j.1741-3737.2000.01208.x

14.

Dagher

R. K.

McGovern

P. M.

Dowd

B. E.

(2014). Maternity leave duration and postpartum mental and physical health: Implications for leave policies. Journal of Health Politics, Policy and Law, 39(2), 369–416. https://doi.org/10.1215/03616878-2416247

15.

Dawson

J. F.

(2014). Moderation in management research: What, why, when and how. Journal of Business and Psychology, 29, 1–19. https://doi.org/10.1007/s10869-013-9308-7

16.

Deater-Deckard

(2003). Parenting stress. Yale University Press.

17.

Ertel

K. A.

Rich-Edwards

J. W.

Koenen

K. C.

(2011). Maternal depression in the United States: Nationally representative rates and risks. Journal of Women’s Health, 20(11), 1609–1617. https://doi.org/10.1089/jwh.2010.2657

18.

Estes

S. B.

(2011). How are work–family policies related to the gendered division of domestic labor? Sociology Compass, 5(3), 233–243. https://doi.org//10.1111/j.1751-9020.2010.00357.x

19.

Estévez-Abe

(2005). Gender bias in skills and social policies: The varieties of capitalism perspective on sex segregation. Social Politics: International Studies in Gender, State & Society, 12(2), 180–215. https://doi.org/10.1093/sp/jxi011

20.

Falah-Hassani

Shiri

Vigod

Dennis

C. L.

(2015). Prevalence of postpartum depression among immigrant women: A systematic review and meta-analysis. Journal of Psychiatric Research, 70, 67–82. https://doi.org/10.1016/j.jpsychires.2015.08.010

21.

Faul

Erdfelder

Buchner

Lang

A. G.

(2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160.

22.

Gjerdingen

D. K.

Center

B. A.

(2005). First-time parents’ postpartum changes in employment, childcare, and housework responsibilities. Social Science Research, 34(1), 103–116. https://doi.org/10.1016/j.ssresearch.2003.11.005

23.

Glynn

Maclean

Forte

Cohen

(2009). The association between role overload and women’s mental health. Journal of Women’s Health, 18(2), 217–223. https://doi.org/10.1089/jwh.2007.0783

24.

Goñi-Legaz

Ollo-López

Bayo-Moriones

(2010). The division of household labor in Spanish dual earner couples: Testing three theories. Sex Roles, 63(7–8), 515–529. https://doi.org/10.1007/s11199-010-9840-0

25.

Goode

W. J.

(1960). A theory of role strain. American Sociological Review, 25(4), 483–496.

26.

Goodman

J. H.

(2004). Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. Journal of Advanced Nursing, 45(1), 26–35.

27.

Grice

M. M.

Feda

McGovern

Alexander

B. H.

McCaffrey

Ukestad

(2007). Giving birth and returning to work: The impact of work-family conflict on women’s health after childbirth. Annals of Epidemiology, 17(10), 791–798. https://doi.org/10.1016/j.annepidem.2007.05.002

28.

Hecht

L. M.

(2001). Role conflict and role overload: Different concepts, different consequences. Sociological Inquiry, 71(1), 111–121. https://doi.org/10.1111/j.1475-682X.2001.tb00930.x

29.

Hochschild

Machung

(2012). The second shift: Working parents and the revolution at home. Viking.

30.

Hwang

(2019). The effects of family-friendly policies and workplace social support on parenting stress in employed mothers working nonstandard hours. Journal of Social Service Research, 45(5), 659–672. https://doi.org/10.1080/01488376.2018.1501790

31.

Hwang

Jung

(2016) Does paid maternity leave affect infant development and second-birth intentions? Family Relations, 65(4), 562–575. https://doi.org/10.1111/fare.12214

32.

Hwang

Ramadoss

(2019). Associations between supervisor and coworker support and parenting stress among employed mothers with nonstandard work schedules. Journal of Social Service Research. Advance online publication. https://doi.org/10.1080/01488376.2019.1635554

33.

Lam

C. B.

McHale

S. M.

Crouter

A. C.

(2012). Parent–child shared time from middle childhood to late adolescence: Developmental course and adjustment correlates. Child Development, 83(6), 2089–2103. https://doi.org/10.1111/j.1467-8624.2012.01826.x

34.

Lee

Y. S.

Waite

L. J.

(2005). Husbands’ and wives’ time spent on housework: A comparison of measures. Journal of Marriage and Family, 67(2), 328–336. https://doi.org/10.1111/j.0022-2445.2005.00119.x

35.

Lerner

Henke

R. M.

(2008). What does research tell us about depression, job performance, and work productivity? Journal of Occupational and Environmental Medicine, 50(4), 401–410. https://doi.org/10.1097/JOM.0b013e31816bae50

36.

Lovejoy

M. C.

Graczyk

P. A.

O’Hare

Neuman

(2000). Maternal depression and parenting behavior: A meta-analytic review. Clinical Psychology Review, 20(5), 561–592. https://doi.org/10.1016/S0272-7358(98)00100-7

37.

National Partnership for Women & Families. (2019). State paid family and medical leave insurance law. https://www.nationalpartnership.org/our-work/resources/economic-justice/paid-leave/state-paid-family-leave-laws.pdf

38.

Netsi

Pearson

R. M.

Murray

Cooper

Craske

M. G.

Stein

(2018). Association of persistent and severe postnatal depression with child outcomes. JAMA Psychiatry, 75(3), 247–253. https://doi.org/10.1001/jamapsychiatry.2017.4363

39.

New York State. (2018). New York State paid family leave programs. https://www.ny.gov/programs/new-york-state-paid-family-leave

40.

Noonan

(2013). The impact of social policy on the gendered division of housework. Journal of Family Theory & Review, 5(2), 124–134. https://doi.org/10.1111/jftr.12008

41.

O’Hara

M. W.

Wisner

K. L.

(2014). Perinatal mental illness: Definition, description and aetiology. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(1), 3–12. https://doi.org/10.1016/j.bpobgyn.2013.09.002

42.

Poms

L. W.

Fleming

L. C.

Jacobsen

K. H.

(2016). Work–family conflict, stress, and physical and mental health: A model for understanding barriers to and opportunities for women’s well-being at home and in the workplace. World Medical & Health Policy, 8(4), 444–457. https://doi.org/10.1002/wmh3.211

43.

Radloff

L. S.

(1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.

44.

Reichman

N. E.

Teitler

J. O.

Garfinkel

McLanahan

S. S.

(2001). Fragile families: Sample and design. Children and Youth Services Review, 23(4–5), 303–326. https://doi.org/10.1016/S0190-7409(01)00141-4

45.

Rich-Edwards

J. W.

Kleinman

Abrams

Harlow

B. L.

McLaughlin

T. J.

Joffe

Gillman

M. W.

(2006). Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. Journal of Epidemiology & Community Health, 60(3), 221–227. https://doi.org/10.1136/jech.2005.039370

46.

Robertson

Grace

Wallington

Stewart

D. E.

(2004). Antenatal risk factors for postpartum depression: A synthesis of recent literature. General Hospital Psychiatry, 26(4), 289–295. https://doi.org/10.1016/j.genhosppsych.2004.02.006

47.

Shelton

B. A.

John

(1996). The division of household labor. Annual Review of Sociology, 22, 299–322. https://doi.org/10.1146/annurev.soc.22.1.299

48.

Staehelin

Bertea

P. C.

Stutz

E. Z.

(2007). Length of maternity leave and health of mother and child—A review. International Journal of Public Health, 52(4), 202–209. https://doi.org/10.1007/s00038-007-5122-1

49.

Tolentino

J. C.

Schmidt

S. L.

(2018). DSM-5 criteria and depression severity: Implications for clinical practice. Frontiers in Psychiatry, 9, Article 450. https://doi.org/10.3389/fpsyt.2018.00450

50.

Wachs

T. D.

Black

M. M.

Engle

P. L.

(2009). Maternal depression: A global threat to children’s health, development, and behavior and to human rights. Child Development Perspectives, 3(1), 51–59. https://doi.org/10.1111/j.1750-8606.2008.00077.x