Maternity leave extension in HK lowers postnatal depression rate by 22 percent

Paid maternity leave extension to 14 weeks in Hong Kong led to a 22 percent reduction in the rate of probable postnatal depression, researchers from the University of Hong Kong (HKU) and the National University of Singapore (NUS) have reported.

The Employment (Amendment) Bill 2020, which took effect in Hong Kong on 11 December 2020, extended statutory paid maternity leave from 10 weeks to 14 weeks to meet the International Labour Organization standard of ≥14 weeks. “In 2021, maternity leave of ≥14 weeks was in place in 120 countries, including China [14 weeks], Japan [14 weeks], Singapore [16 weeks], the UK and Canada [approximately 52 weeks for both],” noted the researchers. [www.labour.gov.hk/eng/faq/cap57h_whole.htm; www.ilo.org/publications/maternity-protection]

According to a meta-analysis, the prevalence of postnatal depression in Hong Kong was 30 percent, which was markedly higher than prevalence rates observed globally (18 percent), in China (14 percent), and in Singapore (3 percent). [Front Psychiatry 2018;8:248]To assess the maternal mental health implications of the policy change in Hong Kong, the researchers recruited 1,414 women who gave birth (mean age, 32 years) before (August to December 2020) or after (December 2020 to July 2022) the policy implementation. Most respondents were primiparous (74.6 percent) and 42.0 percent worked in highly skilled occupations. [Health Aff (Millwood) 2024;43:707-716]

Of note, the maternity leave extension policy was associated with a 22 percent decrease in the rate of probable postnatal depression (40.2 vs 31.5 percent [pre- vs post-policy]; p=0.008), as measured by Edinburgh Postnatal Depression Scale scores of ≥10. Additionally, there was a 33 percent decrease in the impact of postpartum emotional well-being on the respondents’ ability to care for their babies (49.2 vs 32.8 percent [pre- vs post-policy]; p<0.001).

Policy implementation led to an immediate 54 percent increase in mothers taking leave of ≥14 weeks and delaying their return to work. Extending paid maternity leave was also associated with reduced emotional burden, allowing new mothers more time to recover from birth and form bonds with their babies without work-related concerns.

“Even a modest change in policy – an additional 4 weeks of paid leave – was associated with significant mental health benefits,” commented Dr Jian-chao Quan of the School of Public Health, HKU.

Retaining women in the workforce is a key strategy to address labour shortage, and female labour-force participation is highest, at >80 percent, among women of child-bearing age. Importantly, the paid maternity leave extension policy was not associated with more mothers leaving the workforce (7.9 vs 4.9 percent [pre- vs post-policy]; p=0.06), and may support the retention of highly skilled female workers.

“As part of family-friendly initiatives, the Singapore Prime Minster announced plans for an additional 10 weeks of shared parental leave entirely paid by the government, bringing total paid leave to 7.5 months by 2026,” added Dr Ellie Bostwick Andres of Duke-NUS Medical School, Singapore.

“Policymakers must weigh the cost of additional paid leave [funded publicly or privately] alongside the economic gains from increased retention of a younger workforce with improved mental health [and likely higher productivity] and encouraging higher birth rates,” commented the researchers. “Additional support should be considered to reduce disparities for the most vulnerable: unskilled workers.”