Short reportMaternal leave policies and vaccination coverage: A global analysis
Highlights
► Examines the relationship between maternal leave policies and childhood vaccination outcomes around the world. ► Maternal leave is measured using full-time equivalent (FTE) weeks, which captures both time off and wage replacement. ► A 10% increase in FTE weeks is associated with a 16.3 and a 15.0 percent increase for BCG and DPT1 vaccinations. ► A 10% increase in FTE weeks is associated with 22.4, 25.3 and 22.2 percent increases in DPT3, measles and polio vaccinations. ► Vaccination rates may be lower where work obligations remove the opportunity for parents to access health services.
Introduction
The health benefits of childhood vaccination are clear, however even in places where vaccinations are free and widely available, uptake is not universal (Creese and Henderson, 1980, Soares, 2007, Trunz et al., 2006). While physical availability of vaccines, mass media campaigns, and maternal education are important factors for improving vaccination outcomes, perceived distance to clinics, poverty, transportation and parents' work schedules all create barriers to access (Danis et al., 2010b, Niederhauser and Markowitz, 2007, Paschal et al., 2009, Pérez-Cuevas et al., 1999; Racine and Joyce 2007; Semali, 2010, Shefer et al., 1999). Parental work schedules are a common concern, and diverse studies from the United States, Haiti and Indonesia report ‘conflicting work schedules’ as one reason why parents do not vaccinate their children (Coreil et al., 1994, McCormick et al., 1997, Niederhauser and Markowitz, 2007, Paschal et al., 2009). Herein, we assess whether sufficiently long paid maternal leave can provide families with the opportunity to vaccinate their children without necessitating a trade-off between earning income and providing preventive health care for infants.
Section snippets
Background
Paid maternal leave can remove the conflict between work and child health, and increases in leave availability and duration have been positively correlated with child health, specifically with breastfeeding outcomes and variations in child development (Baker and Milligan, 2006, Chuang et al., 2010, Ruhm, 2000, Staehelin et al., 2007). Ruhm (2000) finds that the most likely reason for this correlation is the increase in available time that parents can direct towards young children.
As vaccines
Methods
First, the current state of maternal leave relative to vaccination schedules is examined globally. Second, the impact of variation in paid maternal leave on vaccination rates is assessed using ordinary least squares (OLS) regression.
Results
The first part of our analysis examined current levels of maternal leave globally and how their duration relates to common immunization timing (BCG at 0 weeks, DPT1 at 6 weeks or more, DPT3 at 14 or more weeks, Polio at 14 or more weeks and Measles at 39 or more weeks).
Globally, 95% of countries provide enough paid maternal leave weeks to allow for DPT1 vaccination and 40% provide enough for DPT3 and Polio. Only 18% of countries provide sufficient paid maternal leave for the Measles
Discussion
In many countries there is a gap between the amount of maternal leave available and the amount that would allow for mothers to use leave as a time when their children can be fully vaccinated. While 159 countries provide enough FTE weeks to cover the first DPT vaccination, only 78 provide enough time for the completion of either the DPT or the Polio regimens, and only 19 countries provide enough time for children to be fully vaccinated against Measles.
By employing a global dataset, this research
Acknowledgements
We are deeply indebted to the team at the Institute for Health and Social Policy and the Project on Global Working Families for all the work that went into collecting data on maternal leave policies. In particular, this work would not have been possible without the deep commitment of Alison Earle on this initiative. Finally, this research was generously supported by the Canada Foundation for Innovation and the Fonds québecois de la recherche sur la société et la culture (FQRSC).
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