The magazine of the UW School of Public Health

Download full issue PDF. Spring/Summer 2016
Volume 33, Number 1

Inside this issue


Early Childhood Lasts a Lifetime

Stephen Bezruchka, Senior Lecturer for UW's Global Health and Health Services departments, shares his opinion on the need for paid parental leave to help level inequities in early life.

Opinion By Stephen Bezruchka

Addressing our hardest health challenges at their core means recognizing that health’s “core” is a person’s earliest stage of development—as a zygote or first cell. This first cell divides 42 times to produce a newborn. Five more cycles of cell division produce an adult.

During this earliest period of life—called the first thousand days—roughly half of our health as adults is programmed. In my courses, I have students introduce themselves by talking about conditions their mother bore them in while in utero, their birth weight, and how much time a parent spent with them in their early years.

Commonly, I hear stories such as “my mother was working at a stressful, low-paying job until she went into labor and I arrived at a low birth weight. Then she had to go back to work two weeks later, and I was raised by others.”

Such circumstances lead to issues down the line, such as chronic diseases as an adult.

The harsh truth is that Americans die younger than inhabitants of similarly rich countries. For adult mortality (the chances of dying between age 15 and 60), we are on a par with Sri Lankan girls or Tunisian boys.

One major reason for our poor health is economic inequality, which causes families to struggle to get by during a child’s early years. Every country with a population exceeding a million guarantees paid time off of work for new mothers, except the US and Papua New Guinea. Sweden offers a full year of paid leave, Hungary two years, and even Uganda offers three months. The US has a Family Medical Leave Act which grants certain employees up to four months of leave without pay. Only 11 percent of eligible women who have a baby are able to take this leave. The rest can’t afford it.

We have the highest infant mortality rates among all nations and are among the highest rates of prematurity, low birth weight, and compromised infant development. We are one of eight nations worldwide that have seen increases in maternal mortality in the last decade. We get what we pay for.

The Washington Physicians for Social Responsibility have attempted to gauge public attitude towards having a paid parental leave program in Washington State. We conducted on-the-street interviews in a variety of neighborhoods. All individuals supported the idea of a policy with substantial time and income support. Most didn’t have concrete ideas for how to fund such a policy, but when asked if they would support a payroll tax, there was almost uniform agreement.

For comparison, we interviewed individuals from Victoria and Vancouver, British Columbia, and the results were strikingly different. Canada has a yearlong paid leave policy at 60 percent of a person’s salary, with an employer often contributing more. Even though the policy is paid from taxes, the people without children who we talked to felt it was fair that they paid into the process even though it did not directly benefit them. It was a part of being Canadian, namely to take care of everybody, and they felt the government was there to serve everyone.

In 2007, Washington State passed a paid maternity leave act granting five weeks at a very low weekly rate of pay. It was never funded and was added to a scrap heap of legislation that will never see action. This year, another similar bill failed to receive a hearing in the fiscal process. Nationwide, only three other states have functioning paid leave policies, all with short duration and low compensation.

Paid parental leave policies have demonstrated benefits, including lower rates of infant and child mortality, low birth weight, and prematurity. Breastfeeding is more successful and father-child bonding is stronger. Children grow up to have fewer teen babies and more college education. When women return to work, they, and the economies in which they reside, are more productive. In short, there are no downsides.

Why don’t we have such win-win policies? One belief is that paying for leave might incentivize women to have more babies (though there is no evidence to support this). Another belief is that families should save up for taking time off to parent. Finally, a third attitude is that it would be bad for business to hold a position for a returning employee.

How much time should be given to parent? I suggest 39 weeks split between the mother and father with the mother taking 26 weeks to support exclusive breastfeeding for six months, the World Health Organization’s recommendation. The pay scale should be based upon the individual’s salary up to a reasonable limit, and for those without a job, adequate financial support should come from the state.

What will it take to accomplish this? Public will. Public health can foster this process by educating the public on great need, possible benefits, and lack of harm related to parental leave policies.

Washington Physicians for Social Responsibility is working on a strategic plan based on the qualitative research we have done, which will inform other chapters. We have passed a resolution on paid parental leave by working with the Washington Academy of Family Physicians and will try to involve decision makers in Olympia, Washington. Most of all, we will work to inform the public to get them to advocate for change.

As we go from zygote to zeitgeist, the first thousand days matter most for us and for society. Early life lasts a lifetime. Let’s begin with a funded statewide policy to support it. We might just get back to our standing as one of the world’s healthiest nations.

Stephen Bezruchka

Stephen Bezruchka is a Senior Lecturer for the University of Washington School of Public Health in the Departments of Global Health and Health Services. He has spent over 10 years in Nepal working in various health programs and teaching in remote regions.