Question

Prior to 1970, maternity was usually treated differently from other medical expenses, either excluded entirely from coverage or subject to a flat lump-sum cash (indemnity) benefit. Why? During the 1970s, 23 states mandated that treatment related to pregnancy be covered the same as any other type of treatment, and in 1978, such coverage became uniform throughout the United States. Would mandated maternity benefits make working in a salaried position more or less attractive to women? Would it make women of childbearing age more or less attractive as employees? Would it increase or decrease the number of births performed by cesarean section? Whom do you think bore the expense of implementing this mandate? (For a discussion of these issues see Jonathan Gruber, “The Incidence of Mandated Maternity Benefits,” American Economic Review 84, no. 3 (1994): 622–641.

Answer 1

The foundation of the NHS in 1948 marked a turning point in the history of maternity services and sparked renewed interest in maternal health. Women and children were perhaps its greatest beneficiaries, having gained least from the pre-war health insurance schemes. Maternal mortality had risen in England and Wales between 1900 and 1937 (to over 40 deaths per 10,000 births), although infant mortality had been steadily declining (from nearly 170 deaths per 1,000 live births in 1900 to under 35 deaths per 1,000 by 1948). After 1948, both rates continued to fall and are now negligible in England and Wales.

Despite these improved outcomes for mothers and babies, there was never any clear, universally agreed vision for maternity care. Between 1948 and 1974 the maternity services reflected the tripartite system of the NHS with responsibility for maternal care divided between hospital services, General Practitioners (GPs), and local authority health services which ran public health services such as maternal clinics.

The 1956 report of the Guillebaud inquiry into the cost of the NHS identified a 'state of confusion' in maternity services and recommended a thorough review. The Earl of Cranbrook was appointed in April of that year by Anthony Eden's government to chair a committee of investigation, resulting in the 1959 Report of the Maternity Services Committee (the Cranbrook report). This set a target for 70 percent of all births to take place in hospital. Given correct selection for hospital or home confinement, the committee felt that the remaining 30 percent of mothers could safely give birth at home. However the medical community continued to debate this, as more pregnancies were being classified as 'high-risk' through new obstetric knowledge and methods.

In 1967 the Maternity and Midwifery Advisory Committee was asked to consider the future of the maternity services. The resulting report, named after the committee chair, consultant obstetrician John Peel, recommended 100 per cent hospital deliveries with medical and midwifery care provided by consultants, GPs and midwives working as teams. The report implied that hospital birth was safest, though it was criticised for a lack of evidence to support this and for a lack of consultation with women about their needs and experiences. The Peel report contributed to the dramatic shift from home to hospital birth over the following decade. Before the Second World War, most women had given birth at home, with hospital births only becoming a majority during the war. From 1954 to 1960, the proportion of hospital deliveries in England and Wales increased only slightly, but between 1963 and 1972 the rate rose from 68.2 percent to 91.4 percent, and from 1975 onwards, it never fell below 95 percent.

It's a fact that a mother who is given a longer maternity leave will be more likely to return to her job after the birth of a baby and more likely to continue to be a productive and value-added worker after returning. It's easy to say that her employer could just replace her with a man and be done with it, but it's not necessarily true. For starters, women now make up a larger proportion of college graduates than men and women, even women of child-bearing age, still do make important and at this point necessary contributions to the work place. Not hiring women is simply not an option and smart employers know this. 2) Generous parental and maternity leave policies in the context of broader cushy benefits packages are often dangled as carrots to potential employees by the elite firms and companies who wish to draw the best talent to their firm. Google, Wall Street banks and many, many others are now in a race to offer the most competitive benefits packages (to include maternity leave) in order to attract and retain the best people. Where does this leave unskilled or even medium skilled workers? Well, it leaves them without a leg to stand on, unfortunately, as many of those women will fall victim to the trap that Hall details. But for graduate degree holders and those in the professional classes, the picture isn't as simple as Hall paints it. But if you're working at McDonalds, you're probably better off quitting and going on welfare post-baby. But of course that's costing us all a pretty penny, too.

A third of managers would rather employ a man in his 20s or 30s over a woman of the same age for fear of maternity leave, according to a new study. A survey of 500 managers by law firm Slater & Gordon showed that more than 40% admitted they are generally wary of hiring a woman of childbearing age, while a similar number would be wary of hiring a woman who has already had a child or hiring a mother for a senior role.

A quarter said they would rather hire a man to get around issues of maternity leave and child care when a woman does return to work, with 44% saying the financial costs to their business because of maternity leave are a significant concern.

The maternal mortality rate in the United States has climbed in the past two decades to 14 deaths per 100,000 live births. That’s considerably higher than the rate in other wealthy countries such as Germany, Canada, and the United Kingdom, according to the World Bank. The infant mortality rate in the United States is also grim; it stands at about six deaths per 1,000 live births, double the rate of countries like such as Japan, Finland, Portugal, and the Czech Republic, according to the Centers for Disease Control and Prevention.

Mandates, however, are financed by a benefits tax; if employees value the benefit that they are receiving, then the deadweight loss from financing that benefit will be lower than from tax financing. In the limit, with full valuation of the benefit by employees, wages will fall to offset the cost of the benefit to the employer, and there will be no efficiency cost. In fact, recent research has suggested that the increased costs of one workplace mandate, workers compensation, were largely shifted to wages with little effect on employment