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.

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