Significant maternal health changes in response to a small change in actual days of parental leave taken by fathers suggest days at home are used when it really matters.

Research on parental leave in Sweden shows that when fathers take just a few extra days off during the first months of a child’s life, mothers’ health benefits significantly.

In 2012, Sweden introduced “Double Days” into its parental leave system, allowing fathers to be at home not just for the first 10 days after the birth of a child, but also up to 30 more days during the first year while the mother is still at home. These parental leave days can be taken at any time and in any combination, including as single days off., meaning fathers can be available more often to help at difficult moments. For example, they might help with post-childbirth complications, breastfeeding difficulties, mothers’ medical appointments or simply times when the mother is feeling particularly unhappy or stressed.

This new parental leave arrangement for fathers has had significant impacts on mothers’ physical and mental health. According to a new study:

  1. The number of fathers taking more than 10 days off in the first 60 days increased by 50% (from 7.8% to 11.7%). These days of parental leave were taken mostly in the first three months. (The first 180 days saw a 24% increase in the number of men taking extra days, from 24.6% to 30.5%.) These results don’t reflect fathers’ using these days in place of sick leave– the number of sick days taken by fathers didn’t change.
  2. Fathers used these extra days of parental leave sparingly – the average was only 1-2 extra days by each father in the first six months.
  3. Nonetheless, fathers’ taking such days produced significant health benefits for mothers, and particularly mothers with pre-birth medical conditions.
  • Mothers were 14% less likely to have an inpatient or specialist outpatient visit for childbirth related complications (falling from 10.7% to 9.2%). The decrease was mostly in months 4-6.
  • Mothers were 11% less likely to be prescribed an antibiotic in the first six months (from 17.3% to 15.4%).
  • Mothers were 26% less likely to be prescribed an anti-anxiety drug in the first six months (from 1.2% of mothers to 0.9%). The change was mostly in the first three months.

Such significant health changes in response to such a small change in days of parental leave taken suggest that fathers are staying home on days when it really matters. For example, in the modified parental leave system, fathers are more likely to take at least one day of leave on the same day as the mother has an engagement with the health system, particularly if the mother has a previous medical condition.

The researchers also looked at the impact of grandparents living nearby. Surprisingly, having grandparents nearby was not associated with less use of the additional parental leave by fathers in the first months. However, when no grandparents lived nearby, mothers’ health benefitted more from fathers’ taking extra days of parental leave.

These strong results raise substantial issues for how parental leave is organised and also how health is managed.

Parental leave

Until now the focus has been on fathers taking time off to be alone with the child for a consolidated period – a “sequential” and “lumpy” approach, as the researchers describe it. The aim is to promote father-child bonding, change gender norms and improve maternal labor market outcomes. The new system in Sweden highlights another purpose of parental leave, relating to health of mothers, leading to an important modification in its configuration. (This is not to say that traditional leave taking does not benefit maternal health. In a UK study, for example, mothers reported better health outcomes for themselves when the father took paternity leave just after the birth. In a Swedish study, when fathers took paternity leave, mothers were more likely to breastfeed.)

The study also puts the spotlight on interdependence in families, showing that the expansion of choice for one parent benefits the other one directly. The parental leave debate is dominated by considerations of individual decision-making by fathers, as if they make their choices independently of the family. In this study, the researchers describe the situation quite differently: they look at how “the household decides, on a day-to-day basis, whether the father should work in the labor market or stay at home with the mother and child”.

The researchers recommend further studies to see whether the mother-child relationship improves when fathers take additional parental leave, given that this relationship is influenced by the mother’s physical and mental well-being.

Managing health

The researchers recommend more attention to the environment at home in the management of maternal health, rather than just in the medical system. Mothers spend most of their time at home, after all, and not at medical appointments. They quote Dr Neel Shah, a leading maternal health expert at Harvard Medical School:

“What’s important to understand is that most maternal deaths happen after women have the baby and the fundamental failure is not unsafe medical care but lack of adequate social support…a lot of the risks around childbirth happen after the baby is born during that vulnerable time when you’re trying to care for an infant while also taking care of your household and doing all the things we expect of moms.”

A key aspect of the home environment for a mother with a newborn is the presence of the father. In the light of these health management considerations, the researchers recommend that family leave should be extended beyond parental leave to the illness of any family member.

Header photo: Sandor Weisz. Creative Commons. 

References

 Persson P & Rossin-Slater M (2019), When dad can stay at home: Fathers’ workplace flexibility and maternal health, Stanford Institute for Economic Policy Research