Capstone:MaternityLeaveandBreastfeedingDuration
JenniferGelfand
MPH
1.0Introduction
Maternalandchildhealthisamultifacetedtopicthathasmultiplepartiesinvolved,
includingmother,child,partner,healthcarepractitionersandPublichealthpolicies.
Althoughhealthprofessionalsseemtounderstandthephysiologicalneedsthatwillleadto
overallhealthformotherandchild,theoverallhealthofmotherandinfantreliesheavilyon
PublicHealthpolicyandgovernmentalsupport.Maternalandchildhealthisdefinedbythe
WorldHealthOrganization(WHO)as,“thehealthofwomenandinfantduringpregnancy,
childbirthandthepostpartum.”PublicHealthprofessionalsanalyze,developand
implementprogramstosupportandprotectthehealthofmothersandtheirinfants.Partof
thisinvolvesexamininggovernmentalandinternationalpoliciesthatareusedtosupport
familiesduringthissensitiveperiod.InitiativesincludetheBabyFriendlyHospital
Initiative,WHOhealthrecommendations,maternalandchildsupportpoliciesand
employmentinsurance.
Alargepartofmaternalandinfanthealthisbreastfeeding.Therearemanybenefits
ofbreastfeeding,bothformotherandinfant,anditisconsideredthe“goldstandard”for
infantfeeding.TheWHOunderstandstheimportanceofpromotingbreastfeeding,andhas
recommendedexclusivebreastfeedingforthefirstsixmonthsofinfancy(WHO,2011).
Breastfeedingisphysically,psychologically,economicallyandsociallybeneficialformother
andchild.Ininfants,breastfeedingdecreasesratesofdiarrhea,otitismediaandrespiratory
infectioninthefirstthreemonths(StatisticsonBreastfeeding,2014;Turck,2005).Further,
exclusivebreastfeedingforthefirstsixmonthsisassociatedwithlowerincidencesof
allergicdiseasesininfantswithparentsorsiblingswhohaveallergies(Turck,2005).Lower
incidencesofobesityandhypertensionlaterinlife,andincreasedperformanceoncognitive
developmenttestsarealsoassociatedwithbreastfeeding(Turck,2005).Formothers,
breastfeedingisassociatedwithreturningtoprepregnancyweightsooner,decreasedrisk
ofbreastandovariancanceranddelayedmenstruationafterbirth(Turck,2005).
Breastfeedingisanimportantpartofmother-infantbonding,andhasbeenshowntorelieve
psychologicalstressinmothers.Further,breastfeedingmaybeconsideredaneconomic
advantage,asitdoesnotcostmoneybesidesadequatefeedingofthemother.
Itisclearthatthebenefitsofbreastfeedingareprominentforbothmotherandchild,
butwestillseealackofittoday.Forexample,Francehasanextremelylowprevalenceof
breastfeeding,withonly58%ofinfantsbeingbreastfedwhenleavingthematernityward
(Turck,2005).Whyarewomennotbreastfeeding?Thereareavarietyofreasons,both
individualandcollective.Personalpreferencesplayarole,aswellasculturalnormsand
values.However,maternalsupportplaysagreatrole,specificallyintermsoffinances.To
furtherunderstandthefinancialsupportfornewmothers,wehavetolookatpoliciesthat
governmentsimplementtosupportthispracticefortheirresidents.TheGovernmentof
Canadadefinesmaternityleaveas“employmentinsurancebenefitsthatareofferedto
biologicalmothers,includingsurrogatemothers,whocannotworkbecausetheyare
pregnantorhaverecentlygivenbirth”.Canadahasanother“parentalleavebenefits”
sectionforparentswhoarecaringforanewbornornewlyadoptedchild.Overall,countries
haveimplementedpoliciesthatpayamother,andsometimesfather,tostayathomeduring
aperiodofpregnancyandafterachild’sbirth.Finances,durationandemployer
contributionvariesbetweencountries,andcompaniesmaychoosetocontributeto
maternityleavefundsorleaveitcompletelyuptothegovernment.Thesepoliciesplaya
crucialroleinthedurationofbreastfeeding,asmanywomenhavetoreturntoworkonce
theirfundingendsfromthegovernment.Proximityisakeydeterminantinbreastfeeding,
meaningwhenamothergoesbacktoworkbreastfeedingusuallyterminates.
Thepurposeofthispaperistounderstandtheconnectionbetweenmaternityleave
policiesandbreastfeedingduration,specificallyexclusivebreastfeedingforthefirstsix
monthsofinfancy.Itisimportanttounderstandhowpublicpolicycanaffectthehealth
outcomesofindividuals,inthiscase,themotherandinfant.Althoughmanycountrieshave
adoptedtheWHObreastfeedingrecommendations,theirpoliciesmaynotbesupportiveof
exclusivebreastfeedingforsixmonths,demonstratingcontradictoryideology.Firstly,
maternitypolicieswillbeexaminedinCanada,Norway,Sweden,DenmarkandtheUnited
StatesofAmerica.Canadaisthecentralfocusofthisreview,andwillbecomparedin
relationtotheothercountriesmentioned.Iresearchedcountrieswiththe“best”maternity
leavepoliciesandthe“worst”policiesinordertounderstandhowmaternityleavepolicies
canaffectbreastfeeding.Iwantedtocomparebreastfeedingdatabetweenthesecountries
toseeiftherewasacorrelationbetweenmaternityleavepolicyandinfantbreastfeeding
rates.Althoughtherearemanyothercountriesthatcouldbeexamined,thesecountriesare
allconsideredsimilarinregardstoeconomy,governmentanddevelopment.TheUnited
StatesofAmericaistheonlydevelopednationoncountlessliststhatdescribethe“worst
maternityleavepoliciesintheworld”,whichiswhyitisbeingusedinthisreviewasthe
“worst”maternityleavepolicy.TheUSAislistedamongcountriesineconomical,political
andsociologicaldespair,suchasSwazilandandTunisia(McPhedran,2016).Itis
hypothesizedthatNorway,DenmarkandSwedenwillhavethehighestratesofexclusive
breastfeeding,astheyhavethe“best”maternityleavepolicies.
2.0MaternityLeavePolicies
CanadaMaternityLeavePolicy
CanadainfantbenefitsaredividedintotwocategoriesunderEmploymentInsurance
Act:MaternityBenefitsandParentalBenefits.MaternityBenefitsare“offeredtobiological
mothers…whocannotworkbecausetheyarepregnantorhaverecentlygivenbirth”.
ParentalBenefitsare“offeredtoparentswhoarecaringforanewbornornewlyadopted
childorchildren,”(GovernmentofCanada,2016).UnlikeScandinavianpolicy,thelengthof
timeoffisnotalteredifanindividualgivesbirthtomorethanonechild.Itisimportantto
notethatQuebechasitsownparentalinsuranceprogram,andisexcludedfromthe
GovernmentofCanadaforthesepurposes.
TheGovernmentofCanadaoutlinestheeligibilityforreceivingparentalbenefitsas
someonewhois:
• Employedinaninsurableemployment
• Meetsspecificcriteriaforreceivingemploymentinsuranceparentalbenefits
• Normalweeklyearningswillbereducedbymorethan40%
• Youhaveaccumulatedatleast600hoursofemploymentduringthe
qualifyingperiod
Ininsurableemployment,theemployerdeductsemploymentinsurancepremiumsfrom
individuals’salaries.Thisisonewaythatthegovernmenttaxesindividualsinordertohelp
payforthewelfareprogramssetinplacethroughoutthecountry.Forevery$100an
individualearns,$1.63isdeductedtoreachayearlyamountof$51,300.Thespecific
criteriaoutlinedbytheGovernmentdescribesthatparentsmustprovideproofof
pregnancyandthechild’sbirthinordertobeinsured.
Intotal,52weeksofemploymentinsurancearegivenundermaternityandparental
benefits.35oftheweeksareparentalbenefitsandmaybesplitbetweentwoparentswhile
theremaining17arematernallyallocated.
Thebasicrateforbenefitsis55%ofanindividual’saverageinsurableweeklyearnings,up
toamaximumof$51,300(upto$543perweek).
In2015,CanadaelecteditsfirstLiberalGovernmentinnineyears,ledbyJustin
Trudeau.Thegovernmentbudgetfor2017introducedthenotionofextendingparental
leaveto18months(72weeks)withthesamecoverageof55%ofsalary.Anotherlarge
benefitofthenewinsuranceismaternityinsurancewillbeabletobeclaimed12weeks
beforetheexpectedbirth,anincreasefromeightweeks.
The“BestMaternityLeavePoliciesintheWorld:Scandinavia-Denmark,SwedenandNorway
Scandinaviaisknownforitshighqualityoflife,welfareprogramsandthehightaxes
thatfundthesegovernmentprograms.Allthreecountriesplacedtop5inSavethe
Children’sMothers’IndexRankingofTop10BestPlacestobeaMother,withNorwaybeing
rankedasthenumberonecountryintheworld.Scandinavianpolicies,suchasgovernment
sponsoredcollegeeducation,paidparentalleaveanduniversalhealthcarearenoteworthy
programsthatreflectthecollectivevaluesofthecountryandhelpexplainwhythese
countriesareconsecutivelyvotedastopplacestoliveintheworld.Inthe1970sand
1980s,thesecountrieswereamongthefirsttodeveloppoliciesofpaidparentalleaveto
includeboththemotherandfather(Eydal,G.B.,Gíslason,I.V.,Rostgaard,T.,Brandth,B.,
Duvander,A.Z.,&Lammi-Taskula,J.,2015.)
Scandinaviancountriesraisealotofrevenuefromincometaxesbyusingaflatrate
incometaxsystem.InDenmark,thetopmarginaltaxrateof60%appliestoallindividuals
whomake1.2timestheaverageincomeinDenmark.InSwedenandNorthway,top
marginaltaxratesare56.9%and39%andapplytoallincomes1.5timesand1.6timesthe
averageincomes,respectively(TaxFoundation,2015).Thecountrieshavefurthertaxes,
includingValue-addedtaxes(VATs),andbusinessandcapitaltaxestocontributetothe
countries’GDPs(TaxFoundation,2015).
DanishMaternityLeavePolicy
Overall,therearethreetypesofleaverelatedtohavingachild:duringpregnancy,
maternityleaveandparentalleave(Rasmussen,N.2015).Thesethreetypesofleavetotal
52weeksofpaidparentalleave(GovernmentofDenmark).Themotherhastherightto
fourweeksofleavedirectlybeforetheplannedbirth,andthenafurther14weeksofleave
afterbirth.Duringthefirst14weeksafterbirth,thefatherorco-motherisentitledtotwo
weeksofleave.Theremaining32weeksfollowingcanbedividedbetweenmotherand
fatherorco-parent,andcanbeextendedbyanother14weeks.Ifparentsdecidedtoextend
the32jointweeks,theywillreceiveasmalleramountofparentalallowanceeachmonth.
Theamountofpaythatparentsareentitledtofromthegovernmentislessthanthefull
amountofsalary.However,itiscommonforprivatecompaniestohaveanemployee
agreementinwhichtheypayforfullsalaryforaperiodoftime.Theamountpaidbythe
governmentisreimbursedtothecompany,whichinturnpaysfortheparent’ssalary.
Theseagreementsaredeterminedbyemployer/employeeagreementsandthereforediffer
fromworkplacetoworkplace.
SwedishMaternityLeaveAct
Paidparentalleaveisforatotalof480days(69weeks)andcanbetakenatanytime
untilthechildreachestheageofeight(GovernmentofSweden,2017).Bothmothersand
fathersareentitledtosharetheleave,althoughoneparentmaytakeupto420days.Of
those,fathersareallotted90paidpaternitydaystohelppromotefather-infantbonding.
Theamountofmoneytowhichanindividualisentitledtodependsontheircircumstances.
Generally,individualswhohavebeenworkinginSwedenforover240daysareentitledto
80%oftheirsalaryfor390ofthedays,whiletheremaining90daysarepaidaflatrate.
Specificpoliciesareinplaceforsingleparents,low-incomeparentsandparentswhohave
notworked240days.Anotherpolicyinplaygivesparentsthelegalrighttoreducetheir
normalworkinghoursby25%untilthechildturnseight,althoughtheyareonlypaidfor
thetimetheywork.
NorwegianParentalBenefitPeriod
InNorway,motherscantakeupto49weeksoffworkwith100%oftheirpay,or
mayoptfor59weeksoffworkwith80%pay(GovernmentofNorway,2017).Similarto
Denmark,themotherhas3weeksreservedforherthatmustbeusedpriortotheinfant’s
duedate.Mother’smaybegintousetheparentalbenefitperiodupto12weeksbeforethe
duedate,andtheweekswillbesubtractedfromtheparentalsharedperiod.TheNorwegian
governmentclaimsthattotalparentbenefitpaidisgreaterifparentschoose100%
coveragefor49weeks.Parentsmayfollowupwithunpaidleave,howeverifitislonger
than14daysitmayaffectone’srightstosicknessbenefitandattendanceallowance
(GovernmentofNorway,2017).Intheeventofmultiplebirths,leaveisextendedbyfive
weeksperadditionalchildwith100%coverageandbysevenweeksperadditionalchildren
with80%coverage.Norwayallotstenweekstoeachparent,andtheremaining26or36
weeksisconsidereda“sharedperiod”betweenparents.Theentireperiodofparental
benefitdoesnothavetobeusedinonecontinuoustimeframe,andmaybetakeonapart-
timebasisuntilthechildisthreeyearsold.StatisticsNorway(2010)foundthattwooutof
threewomenoptforlongleaveat80%payandthreeoutoffivefatherstooksixormore
weeksofleave.
Overall,thesecountriesareapplaudedgloballyfortheirmaternityleavepolicies,
andmanycountriestrytomodeltheirpoliciesafterthesecountries.Itcannotbedenied
thatparentsofnewbornsaregivenfinancialcompensationfromthegovernmentthat
allowsthemtotakeoffextendedperiodsoftimetospendwiththeirnewborn.The
percentageofearningspaidforparentalleavein2013rangedfrom77.9%inSwedento
100%inDenmark(Eydal,G.B.etal.,2015).
NumberofWeeks Pay
Denmark 52 Basedonprivatecompanyagreements
Sweden 69 80%salary(withamaximum)forfirst390days
Flatrateforlate90days
Norway 49/59 100%payat49weeks*
80%payat59weeks*
*amountofpayhasamaximum
Table:ScandinavianParentalLeavePolicies
UnitedStatesofAmerica
TheUnitedStatesofAmericaistheonlydevelopedcountryintheworldtonothave
mandatorypaidmaternityleave(MaternityLeaveintheUnitedStates).Employersmayopt
topaytheiremployees,howeveritisnotmandatory.Someofthemajorcompaniesinthe
UnitedStates,suchasAmazon,opttohavearound10weeksmaternityleavefortheir
workers.Comparedtothematernityleavepolicieswehavejustexplainedabove,thisis
quotelow.Further,healthcareinthecountryissoexpensiveandinaccessiblethatmany
womenarenotprovidedthetoolstheyneedtobreastfeed,suchasabreastfeedingcoachor
home-visitnurse.
3.0BreastfeedingTrends
CanadaBreastfeedingTrends
Canadiantrendsseemtobeimproving,accordingtoStatisticsCanada.In2011-2012,
89%ofmothersbreastfedtheirbaby,with26%breastfeedingexclusivelyforsixmonthsor
more(Gionet,2013).Canada’sratewashigherthantheUnitedStates,77%,butlowerthan
thatofNorway,95%,andAustralia,92%(Gionet,2013).The2011-2012Canadianrates
increasedsignificantlycomparedtothe85%and17%,respectivelyrecorded,in2003.
Canada’soverallbreastfeedingrateishigh,althoughitwidelyvariesprovince-to-province,
from57%inNewfoundlandandLabradorto96%inBritishColumbiaandYukon(Gionet,
2013).AlthoughCanadiantrendschangedfrom2003to2011-2013,trendsamong
provincesdidnothavesignificantchanges.
Table.CanadaBreastfeeding.
2003 2011-2012
BreastfeedingInitiation 85% 89%
Exclusivebreastfeeding6months 17% 26%
TheWHO,HealthCanada,CanadianPaediatricSocietyandPublicHealthAgencyof
Canadaallrecommendexclusivebreastfeedingforaninfant’sfirstsixmonths(Gionet,
2013).WiththeGovernmentofCanadainsupportofthiseffort,publicpoliciesand
programsshouldreflectCanada’shealthrecommendations.Wecanseethatbreastfeeding
frequencyishighinthiscountry,butthedurationiswhereCanadaisfailing.Withonly26%
ofmothersmeetingnationalandinternationalpublicpolicystandardsofsixmonths
exclusivebreastfeeding,itwouldbereasonabletoexaminematernityleavepoliciesasa
potentialexplanationforthelackofcontinuation.Atlongerdurations,womenreportingthe
needtoreturntoworkastheleadingreasontostopbreastfeeding(Baker&Milligan,
2008).Ifwomenareforcedtoreturntoworkoutoffinancialandprofessionalnecessity,
theyaremorelikelytostopexclusivebreastfeeding.Clearly,thereisacontradiction
betweenpublichealthgoalsandlabourmarketpoliciesregardingjob-protectedleaves.
Further,manyworkplacesdonotprovidepaidbreaksforwomentobreastfeedor“pump”,
creatingagreaterbarriertoachievingPublicHealthstandards.
PotentialExplanationsforBreastfeedingTrends
Canadianmotherswhodonotbreastfeedtendtobeyounger,havelessformal
educationandaremorelikelytobesinglecomparedtomotherswhoinitiated
breastfeeding(Gionet,2013).TheaverageageofCanadianmothershasincreasedinthe
past10years,withwomenage30-34beingthelargestpercentageagegroupgivingbirthin
2011.Thisissignificantlydifferenttotheagegroupof25-29in2001,andcouldaccountfor
themarkedincreaseinbreastfeedingratesseenintherecentdecade.About77%of
motherswhoexclusivelybreastfeedforsixmonthswereaged30andolder,contributingto
theexplanationofbreastfeedingtrendspresentedabove(Gionet,2013).In2011-2012,
76%ofmotherswhoexclusivelybreastfedforsixmonthsormorehadpostsecondary
qualifications.Itcanbeinsinuatedthatofthis76%withpostsecondaryqualificationshave
jobswithmaternityleavebenefitsthatgoabovewhattheGovernmentofCanadaoffers.
Forawomantobequalifiedformaternityleave,shemusthave600hoursofpaid
employmentover12monthspriortothedateofclaim(Baker&Milligan,2008).Thismeans
thatsomeonewomenareunabletoclaimmaternityleaveandareleftunfundedbythe
government.
NorwegianBreastfeedingRates
Norway’sbreastfeedingstatisticscameasasurprise,andwarrantedfurther
explanationinthisreview.Norwaynearlyhasuniversalinitiationofbreastfeeding,with
approximately1%ofbabiesneverreceivingbreastmilk.Breastfeedingatsixmonthsis
highatabout80%,althoughexclusivebreastfeedingisapproximately7%(Statistics
Norway,2010).In2007astudysurveyed1,635infantsweresurveyedanditwasfound
thatratesofanybreastfeedingwere75%atsevenmonthsofage,63%atninemonthsand
46%attwelvemonthsofage(NorweiganHealthDirectorate,2009).
In2010,StatisticsNorway(Kristiansen,Lande,Overby,Andersen,2010)releaseda
studywithasampleof3,000NorwegianinfantswhowerebornfromApril17toMay8in
2006.92%oftheseinfantswerebreastfedexclusivelyatoneweekofage,although10%of
themwereintroducedtosolidfoodsbeforefourmonths.Atsixmonthsofage,82%of
infantswerebreastfedbutonly10%werebreastfedexclusively.Kristiansenetal.(2010),
foundanegativeassociationbetweenbreastfeedingat12monthsoldandforhavingthe
infantcaredforduringthedaybysomeoneotherthantheparents.Ifthiscountryis
consideredtohavethebestmaternityleavepolicyofanycountryintheworld,therehasto
beanotherexplanationforwhybreastfeedingratesaresolow.Theseresultsdonot
supportthehypothesisthatalongerandmorefinanciallysoundmaternityleavepolicywill
increaseacountry’sbreastfeedingrates.
TheNorwegianGovernmentpublishedanActionPlanforBetterNutrition2007-
2011,withoneofthegoalsforbetterhealthbeingthatinfantsbreastfeedinlinewith
internationalrecommendations.Thegovernmentsetforthaplantoincreasepercentagesof
infantsbeingexclusivelybreastfedatfour,sixandtwelvemonthsandpublishedobjectives
tomeetthesegoals.Oneoftheseobjectiveswasto“maintainestablishedmaternityleave
arrangementsforwomen…”UndertheWorkingEnvironmentAct,womancantaketwo
thirtyminutebreaksadaytobreastfeedherchild,orcanhavereducedworkhours,upto
anhouraday,althoughtheleaveisunpaid.TheActionPlandescribesexploringthe
possibilityofpaidbreastfeedingbreaksforwomenatwork,tocreategreateraccessibility
tothecontinuationofbreastfeedingoncereturningtowork.TheActionPlansGoals
include:
• Infantswhoareexclusivelybreastfedatfourmonthsofagetoincreasefrom44%to70%
• Percentageofinfantswhoareexclusivelybreastfedatsixmonthsofagetoincreasefrom
7%to20%
• Percentageofinfantsbreastfedat12monthsofagetoincreasefrom36%to50%
ThesegoalsdemonstratethehighvaluetheNorweiganGovernmentplaceson
breastfeedinginthefirst12monthsoflife.
ComparisonofBreastfeedingRatesBetweenCountries
2012-2014 BreastfeedingInitiation ExclusiveBreastfeeding6Months
Canada 89% 26%
Denmark - 17%
Norway 100% 10%
Sweden 94.5% 15.4%
UnitedStatesofAmerica 79.2% 18.8%
ImageSource:OECD
4.0Discussion
Basedontheliterature,statisticsandpoliciesexplainedabove,maternityleavedoes
impactthedurationofbreastfeeding.However,thereseemstobeotherfactorsthatare
moreinfluential,andthusourhypothesiswasprovenincorrect.Mother’sageandeducation
arestrongfactorsinwhetheramotherdecidestobreastfeedexclusivelyforsixmonths.
However,thiscouldindirectlyberelatedtothematernityleavethattheyreceivefromtheir
workbenefits,andwouldhavetobestudiedonacase-by-casebasis.Overall,allcountries,
withtheexceptionoftheUnitedStates,provideadequatematernityleave.Realistically,
CanadaisunabletoprovidethematernityleavethatScandinaviancountrieshave,asithas
todowiththedifferingofpoliticalideologyandcollectivevaluesofeachcountry.Prime
MinisterTrudeau’snewbudgetformaternalandchildhealthwillhelpmorewomentake
extendedperiodsoftimeoff.Thenextstepsthatshouldbetakenareprovidingpaidbreaks
inworkplacesforwomentobreastfeedandpumpbreastmilk.Thishasbeenstatedmany
timesasadeterrentforwomentocontinueexclusivelybreastfeedingoncetheyreturnto
work.Throughouttheliteraturesearchesdone,maternityleavewasnotseenasa
prominentinfluenceronwhetherachildisexclusivelybreastfedforsixmonths.However,
itwasfoundthatbasedonawoman’smaternityleavepolicy,theyhadanideaofhowlong
theyplannedonbreastfeedingforbeforethechildwasborn.StatisticsCanadastatesthe
mainreportedreason’sforstoppingbreastfeedingbeforesixmonthswere“notenough
breastmilk”(44%)and“difficultwithbreastfeedingtechnique”(18%).Thissuggeststhat
tangiblesupportformothers,suchaslactationconsultsandnursesshouldbelookedat
morethoroughlyasmeansofincreasingbreastfeedingratesinthecountry.
5.0ConclusionandCompetencies
Thepurposeofmycapstonewastogainabetterunderstandingofhowpublic
maternityleavepoliciescouldaffectbreastfeedingdurationofwomen.Tobetter
understandthis,countriesofsimilarstatusaroundtheworldwereexamined.Maternity
leavepolicyandbreastfeedingtrendswereexaminedineachcountrytogainabetter
understandingoftheinfluencepolicyhasonacountry’shealthoutcomes.Inconducting
thisresearch,IbelievethatIdevelopedfivekeycompetencies:
1. Comparetheorganization,structureandfunctionofhealthcareandpublichealth
systemsacrossnationalandinternationalsettings
2. Discussthemeansbywhichstructuralbias,socialinequitiesandracismundermine
healthandcreatechallengestoachievinghealthequityatorganizational,community
andsocietallevels
3. Assesspopulationneeds,assetsandcapacitiesthataffectcommunities’health
4. Advocateforprogramsandpolitical,socialandeconomicpoliciesthatwillimprove
healthindiversepopulations
5. Evaluatepoliciesfortheirimpactonpublichealthandhealthequity
Understandingeachcountry’smaternitypoliciescouldbeconfusing,andIoftenhad
tosearchmultiplesitesinordertoconcisely,andeffectivelydescribetheminthispaper.I
believethatthroughthis,Ihavedevelopedabetterunderstandingofhowtoanalyze
governmentalpolicies,whichIbelievewillbeanassetformeinthefuture.Further,
researchingbreastfeedingtrendscouldbedifficult,andittooktimetofindthedatathatI
neededtosupportmythesis.
AnunderlyingcompetencyIdevelopedwastheabilitytounderstandanddiscuss
socialinequitiesthatunderminehealth,creatingchallengesinachievinghealthequity.Most
literatureregardingbreastfeedingdurationhighlightedthefactthatolder,moreeducated
womenaremorelikelytobreastfeed.Manycompaniesprovidefurthermaternityleave
support,andinsomeinstances,liketheUSA,provideallofthesupport.Itcanbeassumed
thatmoreeducatedwomenwilllikelyhaveamorestable,higherpayingjobwithbetter
healthbenefits.Womenwithlesseducationwilllikelyhavelessmaternalsupport,needing
togobacktoworkearlierandthusstopbreastfeeding.Overall,moreeducatedwomenare
likelytobreastfeedforlongerformanyreasons,butoneislikelythattheyhavemore
maternityleavesupportthanonewhoisworkingalowerpayingjob.
PartofthisCapstonewasassessingpolicytoseeifwomenarereceivingallofthe
supporttheyneedinordertomeetthehealthstandardssetforthembytheirfederal
governmentsandtheWHO.Competenciesthree,fourandfivewerecomplementaryand
intertwining,andgavemeabetterunderstandingofpoliciesthathelporhinder
breastfeedinggoalsofacountry.Scandinaviancountriesdoanimpeccablejobproviding
thesupportwomenneedtotaketimeoffofwork.Ithasbeenshownthatproximityisa
majorfactorinbreastfeeding,thecloserthemotherbeingtothechild,themorelikelysheis
tobreastfeed.Bythesecountriesprovidingthefinancialsupportwomenneedtostayat
homelongerwiththeirchild,theyaredirectlyaffectingthedurationofbreastfeeding.The
USAisnotprovidinganysupportforwomenpostpartum,anditisreflectedintheirlow
breastfeedingrates.Somewomenmayreceivematernityleavebenefitsfromtheir
employer.Thegovernmenthasputwomenoflowersocioeconomicstatusandlower
educationinasituationwheretheyhavenochoicebuttoreturntoworkshortlyaftertheir
childisborn.Thisdecreasestheratesofbreastfeeding,butfrequencyandduration,andcan
havesomeserioushealthrepercussionssuchaslowerimmunologicalstrengthandstunted
growth.
Overall,maternityleavecaneffectbreastfeedingduration,howeveritdoesnotseem
tobethemostimportantfactor.Ensuringwomenareproperlyeducatedaboutthebenefits
ofbreastfeedingexclusively,providingtrainingandlactationsupportinhospitalandonce
theyreturntohome,andeducatingthefatheraswellareallstrategiesthatcouldbeusedto
increaseexclusivebreastfeedinginCanada.ThematernityleavepoliciesinCanadaseemto
beeffectiveandprovidewomenwithfinancialsupport.AlthoughScandinavianpoliciesare
forlongerdurationormorefinances,Canadiangovernmentandcitizenideologywould
makereachingsimilarcompensationnearlyimpossible.Canadaseemstobeincreasing
theirbreastfeedingrateswiththematernitypoliciesinplace,anditshouldcontinueto
increaseoverthenextfewyears.
References
1. Baker,M.,&Milligan,K.(2008).Maternalemployment,breastfeeding,andhealth:
Evidencefrommaternityleavemandates.Journalofhealtheconomics,27(4),871-
887.
2. Canada.(n.d.)RetrievedJuly20,2017,from
http://www.health.gov.au/internet/publications/publishing.nsf/Content/int-comp-
whocode-bf-init~int-comp-whocode-bf-init-ico~int-comp-whocode-bf-init-ico-
canada
3. CDCBreastfeedingReportCard(2014).RetrievedOctober27,2017,from
https://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf
4. EligibilityforParentalLeavePay.(n.d.).RetrievedOctober20,2017,from
https://www.humanservices.gov.au/individuals/enablers/eligibility-parental-
leave-pay
5. Eydal,G.B.,Gíslason,I.V.,Rostgaard,T.,Brandth,B.,Duvander,A.Z.,&Lammi-
Taskula,J.(2015).TrendsinparentalleaveintheNordiccountries:hastheforward
marchofgenderequalityhalted?.Community,Work&Family,18(2),167-181.
6. Gionet,L.(2013).BreastfeedingtrendsinCanada.Ottawa,Canada:StatisticsCanada.
7. Grøvslien,A.H.,&Grønn,M.(2009).Donormilkbankingandbreastfeedingin
Norway.JournalofHumanLactation,25(2),206-210.
8. HowMuchParentalLeavePaycanyouGet.(n.d.).RetrievedOctober20,2017,from
https://www.humanservices.gov.au/individuals/enablers/how-much-parental-
leave-pay-you-can-get
9. Kristiansen,A.L.,Lande,B.,Øverby,N.C.,&Andersen,L.F.(2010).Factors
associatedwithexclusivebreast-feedingandbreast-feedinginNorway.Publichealth
nutrition,13(12),2087-2096.
10. MaternityLeaveintheUnitedStates(n.d.)RetrievedOctober28,2017,from
https://en.wikipedia.org/wiki/Maternity_leave_in_the_United_States
11. MaternityLeavePoliciesEU(n.d.)RetrievedJuly17,2017,from
http://www.europarl.europa.eu/RegData/etudes/STUD/2015/509999/IPOL_STU(
2015)509999_EN.pdf
12. McPhedran,T.(2016,April11).Bestandworstmaternityleavepoliciesaroundthe
world.RetrievedOctober18,2017,fromhttp://www.ctvnews.ca/world/best-and-
worst-maternity-leave-policies-around-the-world-1.2854349
13. Naylor,A.J.(2001).Baby-friendlyhospitalinitiative.PediatricClinics,48(2),475-
483.
14. Norway,S.(2010).WomenandmeninNorway:whatthefiguressay.Retrieved
August,5,2015.
15. Norway(n.d.)RetrievedJuly15,2017,from
http://www.health.gov.au/internet/publications/publishing.nsf/Content/int-comp-
whocode-bf-init~int-comp-whocode-bf-init-ico~int-comp-whocode-bf-init-ico-
norway
16. OECDFamilyDatabase(n.d.)RetrievedOctober27,2017,from
https://www.oecd.org/els/family/43136964.pdf
17. Parentalbeneftit-www.nav.no.(n.d.)RetrievedSeptember10,2017,from
https://www.nav.no/en/Home/Benefits+and+services/Relatert+informasjon/pare
ntal-benefit#chapter-3
18. ParentalleavewhenyouworkinDenmark(n.d.)RetrievedAugust5,2017,from
http://www.oresunddirekt.se/in-english/in-english/family-parenting-in-
denmark/parental-leave-when-you-work-in-denmark
19. Pomerleau,Kyle.(2015,10June).HowScandinavianCountriesPayforTheir
GovernmentSpending.Retrieved:2017,4June.https://taxfoundation.org/how-
scandinavian-countries-pay-their-government-spending/
20. Puzic,S.(2017,March23).CanadaIntroduced18-monthParentalLeave,butWhat’s
theCatch?Retrievedfrom:http://www.ctvnews.ca/politics/canada-introduces-18-
month-parental-leave-but-what-s-the-catch-1.3337772
21. Rasmussen,N.(2015,6May).WorkinginDenmark:TakingParentalLeave.
Retrieved:2017,4June.https://www.thelocal.dk/20150506/working-in-denmark-
maternity-and-parental-leave
22. SavetheChildren.(2012).Nutritioninthefirst1,000days:StateoftheWorld's
Mothers2012.
23. StatisticsonBreastfeeding(2014).RetrievedOctober27,2017,from
https://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/20333/2016-9-
20.pdf
24. Turck,D.,&ComitédenutritiondelaSociétéfrançaisedepédiatrie.(2005).Breast
feeding:healthbenefitsforchildandmother.Archivesdepédiatrie:organeofficielde
laSociétefrançaisedepédiatrie,12,S145.
25. WomenatWork,Trends2016ExecutiveSummary(2016).RetrievedSeptember6,
2017,fromhttp://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/---
publ/documents/publication/wcms_457086.pdf
26. WorktestforParentalLeavePay.(n.d.).RetrievedOctober20,2017,from
https://www.humanservices.gov.au/individuals/enablers/work-test-parental-
leave-pay
27. WorldHealthOrganization,&UNICEF.(2003).Globalstrategyforinfantandyoung
childfeeding.WorldHealthOrganization.
28. 10thingsthatmakeSwedenfamily-friendly.(2017,March10).RetrievedSeptember
7,2017,fromhttps://sweden.se/society/10-things-that-make-sweden-family-
friendly/
29.