Bringing Parenting Policies in Line With Evidence at US Schools of Public Health

Becoming a parent and sustaining a new life is challenging. It is also transformative, with the power to alter the trajectory of an individual, a family, or a community. In the field of public health, our research clearly indicates that investments in paid parental leave, breastfeeding, and high-quality childcare are necessary and worthwhile.¹ Indeed, the American Public Health Association (APHA) recognizes the public health detriments that stem from a lack of workplace-based protections for parents in the United States and the imperative for supportive policies, stating, “APHA supports breastfeeding, paid maternity leave, and workplace accommodations for mothers in the United States.”¹ Schools of public health should be leaders in modeling such policies.

PARENTAL SUPPORT AT SCHOOLS OF PUBLIC HEALTH

An important new empirical study published in this issue of AJPH shows that our field is not living up to its ideals. Morain et al. (p. 722) reviewed publicly available policies on parental leave, lactation, and childcare for faculty and staff at the top 25 ranked schools of public health in the United States and then followed up with faculty affairs or human resources offices at each school to confirm these policies. In many cases, top schools of public health offer at least some support to new parents, yet the authors show that these policies fall short of our professional society’s own guidelines in many ways.

A sizeable portion of the top public health schools do not come close to achieving minimum standard policies supporting parents. Morain et al. show that 20% offer no paid childbearing leave to faculty, and 52% offer no paid childbearing leave to staff. For nonbirth parents, including adoptive parents, 32% of schools offer no paid leave to faculty, and 48% offer no paid leave for staff. More than one third of schools (36%) have no publicly available policy on lactation support, and 28% of schools have no university-based childcare options on campus. Recognizing the many thousands of faculty and staff employed at these 25 institutions, it is clear that too many of us, and our colleagues, are not experiencing what APHA implores of governments across the world: “policies and programs that promote increased availability of paid maternity leave and workplace accommodations for breastfeeding.”¹

ACCESS TO PARENTAL LEAVE

APHA states that, “the failure of the United States to ensure paid sick and family leave for all US workers harms individual workers and the public’s health.”¹ Indeed, a recent study showed that the chances of rehospitalization for both a mother and her infant were about 50% lower among women who took paid leave, compared with those who had unpaid leave or no leave.² Nationally, just over 60% of employed mothers reported having access to paid leave²; the current study shows that public health faculty have higher-than-average access to paid leave, whereas staff fall below the national average. This directly contradicts APHA’s stated commitments to ensuring access for “all US workers” and may have equity implications, because staff generally have lower income and are more racially and ethnically diverse than faculty. Additionally, as the authors point out, limited clarity of information on policies and frequent reliance on obtaining proof of clinical need may create obstacles to actually using leave.

ACCESS TO BREASTFEEDING SUPPORT

APHA asserts that “exclusive breastfeeding rates are unlikely to change substantially without workplace interventions supported by public policies.”¹ Schools of public health should lead this policy change, not lag behind. Morain et al. show that 64% of top schools of public health have publicly available policies on lactation support, but all of these simply cite university policies, and it is not clear to what extent these policies align with evidence or how they translate in practice. Workplace accommodations matter for breastfeeding success; women with access to both break time and private space to pump breastmilk at work are more than two times as likely as those who do not have these accommodations to be exclusively breastfeeding at six months.³ Additionally, APHA correctly notes that “there are documented barriers to breastfeeding once a mother returns to work, and even in instances in which accommodations exist, they are often inadequate.”¹ For example, eight of the top US public health schools require that women use regular paid breaks for expressing breastmilk, with any additional needed breaks being unpaid. Tying potential compensation penalties to the time required to pump is an unnecessary restriction, again with equity implications.

ACCESS TO CHILDCARE

Finally, childcare access helps mitigate the stress of returning to work. Although the current study shows that more than half of the top schools of public health have on-campus, university-run childcare options, almost all of these centers had lengthy waitlists, and at some schools, the center was located far from where the school of public health was located.

It is important to note that Morain et al. documented policies, not people’s experiences. Not everyone who is offered leave, lactation support, or university-based childcare is able to take it,⁴ so efforts to improve the policy environment for early parenting should pay careful attention to equity in design and implementation. The field of public health should put its values into practice, ensuring consistency between policy statements aimed at external audiences and our own experiences as public health professionals. Hypocrisy should not be the legacy we bequeath to the children we have while working as faculty and staff at schools of public health.

TOWARD A BETTER FUTURE

The core principles of feminism and equity should guide a path forward for schools of public health to implement policies and practices worthy of the substantial and conclusive evidence our field has produced about the value of parental leave, breastfeeding, and high-quality childcare for the health of parents, infants, families, and communities.¹ Pregnancy-related discrimination and gender inequities in the workplace are pernicious and long-standing.⁵ Structural racism pervades all aspects of pregnancy, childbirth, and parenting, producing staggering racial disparities in maternal and infant health.⁶ Schools of public health are not exempt from these forces. Evidence-based policies that support parenting are needed to help combat health inequities.

Schools of public health produce much of the evidence on which the APHA’s policy statements are based. We can lead not only in research but also in policy action on parental leave, lactation support, and childcare access. First, we can learn from the leaders among us. For example, Morain et al. showed that some schools of public health (e.g., Harvard, Yale, and Columbia) offer faculty leave policies that are more generous than university-wide policies. Second, the creation and implementation of new policies should be inclusive of and led by those most marginalized by current practices to achieve greater equity. The value of breastfeeding, parent–child bonding, and newborn development is well documented in our field. We have shouted these benefits from the rooftops while denying them to those inside our own home. It is time to take seriously our own advice and make the first year of life the best it can be for all families, including those of us working at schools of public health.