The effect of paid maternity leave on early childhood growth in low-income and middle-income countries


Background: Despite recent improvements, low height-for-age, a key indicator of inadequate child nutrition, is an ongoing public health issue in low-income and middle-income countries. Paid maternity leave has the potential to improve child nutrition, but few studies have estimated its impact. Methods: We used data from 583 227 children younger than 5 years in 37 countries surveyed as part of the Demographic and Health Surveys (2000-2014) to compare the change in children’s height-for-age z score in five countries that increased their legislated duration of paid maternity leave (Uganda, Zambia, Zimbabwe, Bangladesh and Lesotho) relative to 32 other countries that did not. A quasiexperimental difference-in-difference design involving a linear regression of height-for-age z score on the number of weeks of legislated paid maternity leave was used. We included fixed effects for country and birth year to control for, respectively, fixed country characteristics and shared trends in height-for-age, and adjusted for time-varying covariates such as gross domestic product per capita and the female labour force participation rate. Results: The mean height-for-age z scores in the pretreatment period were -1.91 (SD=1.44) and -1.47 (SD=1.57) in countries that did and did not change their policies, respectively. The scores increased in treated and control countries over time. A 1-month increase in legislated paid maternity leave was associated with a decrease of 0.08(95% CI -0.20 to 0.04) in child height-for-age z score. Sensitivity analyses did not support a robust association between paid maternity leave policies and height-for-age z score. Conclusion: We found little evidence that recent changes in legislated paid maternity leave have been sufficient to affect child height-for-age z scores. The relatively short durations of leave, the potential for low coverage and the strong increasing trend in children’s growth may explain our findings. Future studies considering longer durations or combined interventions may reveal further insight to support policy.

BMJ Glob Health
Sam Harper
Sam Harper
Associate Professor of Epidemiology

My research interests include impact evaluation, reproducible research, and social epidemiology.