Amy Raub

Breastfeeding policy: a globally comparative analysis.

OBJECTIVE To explore the extent to which national policies guaranteeing breastfeeding breaks to working women may facilitate breastfeeding. METHODS An analysis was conducted of the number of countries that guarantee breastfeeding breaks, the daily number of hours guaranteed, and the duration of guarantees. To obtain current, detailed information on national policies, original legislation as well as secondary sources on 182 of the 193 Member States of the United Nations were examined. Regression analyses were conducted to test the association between national policy and rates of exclusive breastfeeding while controlling for national income level, level of urbanization, female percentage of the labour force and female literacy rate. FINDINGS Breastfeeding breaks with pay are guaranteed in 130 countries (71%) and unpaid breaks are guaranteed in seven (4%). No policy on breastfeeding breaks exists in 45 countries (25%). In multivariate models, the guarantee of paid breastfeeding breaks for at least 6 months was associated with an increase of 8.86 percentage points in the rate of exclusive breastfeeding (P < 0.05). CONCLUSION A greater percentage of women practise exclusive breastfeeding in countries where laws guarantee breastfeeding breaks at work. If these findings are confirmed in longitudinal studies, health outcomes could be improved by passing legislation on breastfeeding breaks in countries that do not yet ensure the right to breastfeed.

Creating and Using New Data Sources to Analyze the Relationship Between Social Policy and Global Health: The Case of Maternal Leave

Objectives. Operating at a societal level, public policy is often one of our best approaches to addressing social determinants of health (SDH). Yet, limited data availability has constrained past research on how national social policy choices affect health outcomes. We developed a new data infrastructure to illustrate how globally comparative data on labor policy might be used to examine the impact of social policy on health. Methods. We used multivariate ordinary least squares regression models to examine the relationship between the duration of paid maternal leave and neonatal, infant, and child mortality rates in 141 countries when controlling for overall resources available to meet basic needs measured by per capita gross domestic product, total and government health expenditures, female literacy, and basic health care and public health provision. Results. An increase of 10 full-time-equivalent weeks of paid maternal leave was associated with a 10% lower neonatal and infant mortality rate (p≤0.001) and a 9% lower rate of mortality in children younger than 5 years of age (p≤0.001). Paid maternal leave is associated with significantly lower neonatal, infant, and child mortality in non-Organisation for Economic Co-operation and Development (OECD) countries and OECD countries. Conclusions. This preliminary study, using newly available worldwide policy data, demonstrates the potential strength of using globally comparative data to examine SDH. Further data development to make multilevel modeling of the impact of labor conditions possible and to broaden which social policies can be examined is a critical next step.

Constitutional rights to health, public health and medical care: The status of health protections in 191 countries

United Nations (UN) member states have universally recognised the right to health in international agreements, but protection of this right at the national level remains incomplete. This article examines the level and scope of constitutional protection of specific rights to public health and medical care, as well as the broad right to health. We analysed health rights in the constitutions of 191 UN countries in 2007 and 2011. We examined how rights protections varied across the year of constitutional adoption; national income group and region; and for vulnerable groups within each country. A minority of the countries guaranteed the rights to public health (14%), medical care (38%) and overall health (36%) in their constitutions in 2011. Free medical care was constitutionally protected in 9% of the countries. Thirteen per cent of the constitutions guaranteed childrens right to health or medical care, 6% did so for persons with disabilities and 5% for each of the elderly and the socio-economically disadvantaged. Valuable next steps include regular monitoring of the national protection of health rights recognised in international agreements, analyses of the impact of health rights on health outcomes and longitudinal multi-level studies to assess whether specific formulations of the rights have greater impact.

Facilitating Working Mothers’ Ability to Breastfeed Global Trends in Guaranteeing Breastfeeding Breaks at Work, 1995-2014

Background: Mothers who work away from home tend to stop breastfeeding earlier than their nonworking counterparts due to workplace barriers. Barriers to breastfeeding discriminate against women and may lead to inequities in children’s health outcomes. Guaranteeing paid breastfeeding breaks at work is 1 mechanism that can improve mothers’ opportunity to breastfeed in the workplace. Objective: This study aimed to assess the trends in the share of countries guaranteeing breastfeeding breaks in the workplace and paid maternal leave that lasts until the infant is 6 months old (the World Health Organization recommended duration for exclusive breastfeeding), between 1995 and 2014. Methods: Legislation and secondary source data were collected and reviewed for 193 United Nations member states. Legislation was analyzed for content on breastfeeding breaks and maternal leave guarantees. Results: Fifty-one countries (26.7%) in 2014 did not guarantee breastfeeding breaks in any form and 4 countries provided only unpaid breaks or breaks that did not cover the first 6 months of life; since 1995, around 15 countries (10.2%) legislated for such a policy. In 2014, out of 55 countries that did not guarantee paid breastfeeding breaks for the first 6 months after birth, 7 countries guaranteed paid maternal leave for the same duration; 48 countries (25.1%) provided neither paid maternal leave nor paid breastfeeding breaks. Conclusion: Progress in the number of countries guaranteeing breastfeeding breaks at work is modest. Adopting measures to facilitate breastfeeding at work can be a critical opportunity for countries to increase breastfeeding rates among the growing number of women in the labor force.

Where do Women Stand? New Evidence on the Presence and Absence of Gender Equality in the World's Constitutions

In countries around the world, constitutional protections of womens rights have provided a legal foundation to combat discriminatory laws, customs, and actions and a catalyst for advances in gender equality. This article draws on newly available data from 191 countries to analyze womens constitutional rights across the spheres of general equality and nondiscrimination, political participation, social and economic rights, family life, and customary and religious law. We examined how gender-specific and universal protections differed according to a constitutions year of adoption and last amendment, and identified regional patterns that persisted across all decades. Women were explicitly guaranteed general equality or nondiscrimination in 81% of constitutions, some aspect of political equality in 32%, marital equality in 27%, some aspect of work equality in 26%, and equal educational rights in 9% of constitutions. Protection of womens rights increased substantially between 1980 and 2011. As of June 2011, however, no constitution in the Middle East and North Africa guaranteed gender-specific protection in education, work, or marriage, and there were no guarantees of marital equality in South Asian constitutions. Of the constitutions that protected some aspect of gender equality, 5% stated that customary or religious laws could prevail over constitutional provisions.

Assessing Compliance with the crc: Indicators of Law and Policy in 191 Countries

Currently, the report-based monitoring system of the crc provides a wealth of qualitative information about country performance, but not in a form that is frequently updated, easily analysable and comparable across countries and over time. To date, a broad range of quantitatively comparable indicators of laws and policies relevant to the crc have not been widely available. Through the world Policy Analysis Center, we have collected and analysed primary legislative texts, international reports and other sources to create such indicators for all States Parties. In this article, we draw on this new data set to propose a complementary approach to monitoring progress on crc obligations using quantitatively analysable indicators of law and policy, and operationalise a sample set of indicators to demonstrate the feasibility and utility of this approach in assessing country action on children’s rights and compliance with the crc.

The association of minimum wage change on child nutritional status in LMICs: A quasi-experimental multi-country study*

ABSTRACT There is recognition that social protection policies such as raising the minimum wage can favourably impact health, but little evidence links minimum wage increases to child health outcomes. We used multi-year data (2003–2012) on national minimum wages linked to individual-level data from the Demographic and Health Surveys (DHS) from 23 low- and middle-income countries (LMICs) that had least two DHS surveys to establish pre- and post-observation periods. Over a pre- and post-interval ranging from 4 to 8 years, we examined minimum wage growth and four nutritional status outcomes among children under 5 years: stunting, wasting, underweight, and anthropometric failure. Using a differences-in-differences framework with country and time-fixed effects, a 10% increase in minimum wage growth over time was associated with a 0.5 percentage point decline in stunting (−0.054, 95% CI (−0.084,−0.025)), and a 0.3 percentage point decline in failure (−0.031, 95% CI (−0.057,−0.005)). We did not observe statistically significant associations between minimum wage growth and underweight or wasting. We found similar results for the poorest households working in non-agricultural and non-professional jobs, where minimum wage growth may have the most leverage. Modest increases in minimum wage over a 4- to 8-year period might be effective in reducing child undernutrition in LMICs.

Paid Parental leave policies for single-parent households: an examination of legislative approaches in 34 OECD countries

ABSTRACT Many studies have examined the availability of paid parental leave for the general population, but few have looked specifically at whether leave policies meet the needs of single parents. Across OECD countries, 17% of children on average live in single-parent households. Depending on policy framing, parental leave benefits may not meet the needs of parents and children in single-parent families. This study provides the first comprehensive examination of paid parental leave policies in 34 OECD member countries as they pertain to single-mother and single-father households. Using original legislation and administrative sources, we created a new database to examine the total duration of paid leave available to parents in single- and two-parent households after the birth or adoption of a child. Our findings indicate that single mothers receive shorter durations of paid leave compared to two-parent families in 22 countries after the birth of a child; for fathers, this number rises to 29. Single adoptive mothers and fathers receive shorter durations of leave than two-parent households in 17 countries each. We discuss the potential origins of these discrepancies and policy approaches to providing single parents with adequate paid leave while continuing to incentivize dual uptake in two-parent households.

Child Marriage Laws around the World: Minimum Marriage Age, Legal Exceptions, and Gender Disparities

ABSTRACT The marriage of children below 18 is widely recognized in international human rights agreements as a discriminatory global practice that hinders the development and well-being of hundreds of millions of girls. Using a new global policy database, we analyze national legislation regarding minimum marriage age, exceptions permitting marriage at earlier ages, and gender disparities in laws. While our longitudinal data indicate improvements in frequencies of countries with legal provisions that prohibit marriage below the age of 18, important gaps remain in eliminating legal exceptions and gender discrimination.

Do constitutions guarantee equal rights across socioeconomic status? A half century of change in the world’s constitutions

For those disadvantaged by bias and barriers based on socioeconomic status (SES), constitutions can provide a defense against discrimination and a foundation for greater equality in social, economic, and political life. In light of the near-global commitment to a multi-dimensional poverty reduction agenda and the increased inclusion of marginalized groups in constitution-drafting processes, this article examines how 193 constitutions address SES and how this has changed over time. The majority of constitutions guarantee equal access to primary education across SES (59%) and prohibit discrimination on this basis (58%). Fewer guarantee access to healthcare (20%), equal rights in employment (15%), eligibility for legislative office (4%), and voting rights (4%) across SES. Constitutions adopted after 1990 are considerably more likely to protect equal rights across SES than older ones. However, 25% of constitutions – including 17% of those adopted since 1990 – restrict political participation based on socioeconomic characteristics.