UCLA

Background: Diarrhea is the fourth-leading cause of death and second-leading infectious cause of death in children under five years of age. The global burden of morbidity and mortality due to severe diarrhea is concentrated primarily in South Asia and sub-Saharan Africa, where a significant percentage of the population resides in low-resource settings. This dissertation examines if more generous paid maternity leave policy is associated with improved breastfeeding practices and a lower risk of diarrhea in children under five years of age in low- and middle-income countries (LMICs).

Methods: We merged longitudinal data measuring national maternity leave policies with information on live births occurring between 1996 and 2014 in 40 LMICs that participated at least twice in the Demographic and Health Surveys (DHS) between 2000 and 2015. In the first two studies (Chapter 2–3), we used a difference-in-differences approach to compare relative changes in the prevalence of early initiation and exclusive breastfeeding, the duration of breastfeeding, as well as the proportion of children with bloody diarrhea across countries that lengthened their paid maternity leave policy between 1995 and 2013 to the countries that did not. In the third study (Chapter 4), we performed a causal mediation analysis that examined the possible mediating role of breastfeeding duration underlying the association between paid maternity leave policy and childhood diarrhea incidence.

Results: We found that a one-month increase in the legislated duration of paid maternity leave was associated with a 7.4 percentage-point (95% CI 3.2–11.7) increase in the prevalence of early initiation of breastfeeding, a 5.9 percentage-point (95% CI 2.0–9.8) increase in the prevalence of exclusive breastfeeding, a 2.2-month (95% CI 1.1–3.4) increase in breastfeeding duration, and a 39% (RR 0.61, 95% CI 0.44–0.84) reduction in the risk of bloody diarrhea. Breastfeeding for at least six and 12 months were found to mediate the effect of paid maternity leave policy on bloody diarrhea by 14% and 17%, respectively.

Conclusion: In conclusion, the results support our hypotheses that more generous paid maternity leave is associated with improved breastfeeding practices and a lower diarrhea incidence in children under five years of age, suggesting a potential instrument for facilitating early-life interventions to improve young children’s health outcomes in LMICs. From a policy planning perspective, further work is needed to examine the impact of paid maternity leave on other aspects of child health and whether there are shared effects across maternity leave and other policies. Further studies may also seek to examine whether the increase in breastfeeding duration is longer than the increase in maternity leave duration because of threshold effects. Specifically, future studies could examine whether a certain minimum length of leave is needed to encourage breastfeeding initiation and whether it is easier to continue breastfeeding while working once an infant has reached a certain age. Such research could contribute to developing better early-life interventions to ensure positive health outcomes for mothers and infants in LMICs.