Earlier this year, a Google employee released a memo titled “I’m Not Returning to Google After Maternity Leave and Here is Why,” alleging that Google had been a hotbed of pregnancy discrimination [1a]. Such internal criticism about motherhood bias in Silicon Valley is hardly new; it took a complaint by Sheryl Sandberg, a former vice president at Google, for the company to finally implement closer parking for pregnant women, implying that women lower in the corporate ladder had felt powerless to voice their concerns [1b]. Such phenomena are symptomatic of the difficulties that new parents, and especially mothers, face not just in the corporate world but in the American workforce at large.

Across the globe, women who have children face economic consequences that endure for the rest of their lives. In Denmark, a country praised for its efforts to ease the financial burden of raising children, women’s earnings still fall 30% relative to men’s in the first year after childbirth; by the end of the next twenty years, women make 18.5% less than men and have 10% lower workforce participation rates than men [2]. In the United States, where the gap in earnings between men and women is already 5% higher, mothers are six times less likely than childless women to be recommended for hire [3a]. Moreover, there is a double standard: while fathers are considered more dedicated to their jobs and more deserving of higher wages than are childless men, mothers are viewed as less committed, requiring higher standards for punctuality and meriting reduced pay.  Such a hostile work environment is likely related to how female labor participation has actually decreased 3% in the past twenty years and is likely connected to the precipitous decline of total fertility rates in the US  from replacement levels of 2.11 in 2007 to 1.73 in 2019 even as the nation recovered from the Great Recession, a crisis that will curtail future economic growth [3b].

The United States’ lack of any substantial maternity or paternity leave is no doubt part of the problem; although the International Labour Organization (ILO) recommends at the very minimum 14 weeks of maternity leave, the United States is the only country in the OECD, an organization of high-income, developed nations, to lack any sort of paid parental leave policy (the US does let new parents take up to a laughable twelve weeks of unpaid leave but, to add insult to injury, only at companies of 50 employees or more) [4]. By remedying this glaring omission, the United States would not just achieve a moral victory, but also an economic one. Recent studies have ascribed 29% of the difference between women’s labor force participation rate between the US and other OECD countries to policies like paid maternal leave and part-time work entitlements [5]. Paternity leave, too is part of the solution: key to Sweden’s highest-in-the-EU female employment levels is three months of paternity leave paid at 90% of earnings. Before the take-it-or-leave-it policy was implemented, fewer than 10% of Swedish men took advantage of the policy; afterward, men had an incentive to take it, allowing them to assume responsibility for a greater share of the invaluable unpaid work (i.e. childcare) that economists ignore that typically falls on women.

Still, as much as a failure to protect new parents hinders economic growth, a lack of protection for new mothers costs lives. From 2000 to 2014, US maternal deaths actually increased, the causes of which are extensive. It is true that the mean age of primigravidae has increased 1.4 years from 2000 to 2014 in part due to increased reliance on reproductive technologies as well as increased educational attainment. Moreover, a disproportionate amount of births in the United States (against the recommendation of the World Health Organization) are Caesarian sections and result from unplanned pregnancies, both of which present an increased risk for birth complications [6] [7]. Nonetheless, a macroscopic perspective reveals something not altogether shocking but particularly alarming: most afflicted women are black, from rural areas, low-income, or uninsured (or insured with Medicaid) [8] [9]. For these women, it is no surprise that prenatal and postnatal check-ups are a distant luxury, a predicament that hinders physicians’ ability to diagnose potentially life-threatening (yet easily preventable) conditions like hypertension, cardiomyopathy, and pre-eclampsia.

What is a surprise, however, is that infant mortality rates have actually decreased (though are still high as 23,000 infants die each year in the US). So why is that? Part of it is a lack of interest in women’s reproductive health; most interventions focus on the child’s health, rather than the mother’s, as only 6% of federal Title V money dedicated for public health efforts for mothers and children goes to mothers [10]. Secondly, many just don’t believe women’s perception of pain; the gastric pain associated with preeclampsia is often misdiagnosed as symptomatic of heartburn [10]. Even when quantitative data demonstrate sky-rocketing blood pressure, low platelet count, hemolysis (red-blood-cell breakdown), and elevated liver enzymes, all characteristic of a severe variant of preeclampsia called HELP, medical error related to the overworking of OB-GYNs (24-hour shifts are the norm) and personal biases can cause patient death [11]. The problem, therefore cannot be pinpointed to be a specific source or group; it is as much a public, systematic failure in which women are often considered melodramatic as it is a mirror to the workaholic obsession of this nation.

More public support is definitely needed, and through investigational reports like this, I hope to inform the reader of the necessity that our government and private sector take action immediately to develop nationwide procedures to respond to cases of maternal death. When women as prominent as tennis player Serena Williams, whose repeated fears about blood clots were ignored until it was almost too late to treat her pulmonary embolism, are suffering, the issue extends to all sectors of our society. It is not exclusively a black-person problem or a rural-Alabaman problem; it is a human problem. Addressing the underlying factors that predispose American women (a corporate culture that penalizes mothers economically and a healthcare system that makes large swathes of the population susceptible to worsened outcomes) requires that healthcare workers and outsiders together work together, demonstrating that medicine exists beyond a textbook in the everyday struggles of people who live within warped societies.

[1a] https://www.vice.com/en_us/article/mbmqxq/heres-the-memo-currently-going-viral-at-google

[1b] economist.com/business/2019/04/20/the-subtle-ways-that-discrimination-works

[2] https://www.nber.org/papers/w24219.pdf

[3a] http://gap.hks.harvard.edu/getting-job-there-motherhood-penalty

[3b] https://www.pewresearch.org/fact-tank/2019/05/22/u-s-fertility-rate-explained/

[4]http://www.ilo.org/global/about-the-ilo/newsroom/news/WCMS_008009/lang–en/index.htm

[5] https://www.nber.org/papers/w18702.pdf

[6] https://www.cdc.gov/nchs/products/databriefs/db232.htm

[7] https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_06.pdf

[8] https://www.ncbi.nlm.nih.gov/books/NBK221019/

[9] https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/

[10] https://www.npr.org/2017/05/12/527806002/focus-on-infants-during-childbirth-leaves-u-s-moms-in-danger

[11] https://www.preeclampsia.org/health-information/hellp-syndrome