Motherhood Is Not A New Public Health Crisis; Lack of Paid Leave Is

The day after my daughter was born, the World Health Organization had already declared COVID-19 a global health emergency.  

As she followed our faces with newly focusing eyes, Italian officials began locking down towns, and the U.S. logged its first coronavirus death. Her cheeks plumped at one month when the first confirmed case appeared in our state of Missouri.  

At two months, she tried her gummy smile, as the U.S. led the world in confirmed cases and most of the country was ordered to stay at home.  

Waking in the middle of the night to nurse my daughter and scan the news was disorienting. I was an infectious disease physician on maternity leave during a pandemic.  

I wondered if I would be called into work early, and how bad would things have to be to leave my daughter too soon. What does it mean to have “all hands on deck?”  

Like me, millions of pregnant women and new parents have been coping with the realities of COVID-19. The tension of working parenthood, however, is not limited to global emergencies, nor is it a new phenomenon. 

For centuries, women have long worked with infants strapped to backs farming and laboring. But providing safety to new parents and infants has traditionally been a societal responsibility, one in which everyone benefits by ushering in a healthy new generation.  

One of those societal responsibilities is ensuring parental leave. Adequate parental leave is not something we should preserve despite a public health crisis—parental leave is essential public health. As the value of essential work is increasingly appreciated, parental leave needs to be expanded to all workers as the country rebuilds from this crisis.  

At the turn of the century, Dr. Sara Josephine Baker set up milk stations, allowing women to work in factories without having to choose between poverty and their child’s starvation. Dr. Baker’s work drastically reduced infant mortality in Hell’s Kitchen, even as the Spanish Flu pandemic raged. 

Motherhood Is Not A New Public Health Crisis; Lack of Paid Leave Is
Dr. Sara Josephine Baker of the New York City Health Department, circa 1912. (New York Review of Books)

Dr. Baker was correct; protecting this time for healing and parent-child bonding has lifelong health benefits, notes New America. These include fewer incidences of low birth weight, early-term births, child abuse and infant deaths as well as increased immunizations and improved parental mental health and lifespan. These benefits accrue to the whole of society.  

While Dr. Baker worked, the International Labor Organization held the Maternity Protection Convention of 1919, demanding 12 weeks of paid leave after birth, job protection and free peripartum healthcare. Several countries have since adopted these standards or more.  

The U.S. has not.  

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Motherhood Is Not A New Public Health Crisis; Lack of Paid Leave Is
Parental leave is increasingly common in white collar work, but it remains uncommon for blue collar and service workers—who have also been disproportionately affected by pandemic measures. (Susan Jane Golding / Flickr)

Parental leave is increasingly common in white collar work, with a Mercer study in 2019 finding 40 percent offer paid leave. Paid parental leave, however, remains uncommon for blue collar and service workers, who have also been disproportionately affected by pandemic measures. 

The World Economic Forum reports that, in contrast to many college-educated workers, blue collar and service workers are less able to work at home, and must choose between health and livelihood. They lack sick pay for self-isolation after exposure, experience more closure of relevant sectors and job loss and lack access to affordable healthcare.  

What occurs between pandemics—the caretaking and maintenance of social institutions—is critical. This is what helps us weather and recover from crisis.  

Robust social safety net and worker protections track closely with public health success. Coronavirus has highlighted the longstanding disrepair of the social safety net on which public health depends. Caregiving of families and the protection of workers is inseparable from public resilience in both crisis and good times.   

As industrialization increased in the early 20th century, policies protecting working families and the public’s health were indivisible. Since Dr. Baker’s pioneering work and the Maternity Protection Convention, it has become clear that paid family leave is public health.  

I recently returned to work, caring for patients with COVID-19 and other illnesses, supporting clinical trials and preparing for the next pandemic with the lessons learned from this one.  

I return to serve during this crisis having physically recovered from labor and delivery, with 12 weeks to bond with my daughter without the terror of unpaid bills. All workers deserve this right—but very few have it.  

Although medical associations including the American Academy of Pediatricians have recommended leave, medicine itself has not consistently extended this to its own workers. 

While new mothers no longer report returning to perform surgery 36 hours after labor, the National Institutes of Health reports there is still no standardized leave for medical residents.  

A Journal of the American Medical Association (JAMA) report shows hospital policies on leave for residents or faculty are not standardized. A third of programs offer no leave and some require use of paid time off, according to a study in Academic Medicine.   

Even when leave is offered, reports show most working mothers may not feel they can take this leave–physicians included. New mothers report they feel pressured by financial need, loss of opportunities or outright discrimination, as reported in a 2019 JAMA study

Our duties as caregivers and as essential workers are not in conflict, but the same effort. It is the steady acts of caring and maintenance that prepare us to weather crisis, in the hospital wards, the home and in our government.

Yes, the public has expressed public gratitude around the country for healthcare and other workers who risk harm by showing up, with nightly songs, clanging pots and even the flyover of Blue Angel fighter jets. 

But to protect those who protect everyone during crisis, public health workers need support with policies and resources—before, during and after crisis.  Employers and the public must recognize that this type of support is not a benefit but an entitlement. This support ensures the work gets done and ensures safe passage of the next generation.  

The Workers Bill of Rights is the right idea, protecting safety, fair pay, paid leave, health care and child care. Essential workers require this minimum. Following the passage of the $484 billion then $2 trillion coronavirus rescue packages, as policy makers map out a recovery, worker protections must be included in future proposals. Protecting workers protects us all, keeping the essential work of society going.  

My daughter now giggles uproariously and holds her wobbling head high, as my community cautiously makes plans to reopen.   

The mantra is that we are in this together. As the country endures and rebuilds, now is the time to back this up with policy and grant paid parental leave to all workers.  


Dharushana Muthulingam, MS, MD is an infectious disease physician, public health researcher and faculty at Washington University School of Medicine in St. Louis.