Candidate number: 13086887

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Maternal employment and children’s health and wellbeing

Introduction

During the mid-twentieth century, the model that guided disease research focused
mainly on the analysis of adult risk factor or adult lfestyle as the main influence for
health outcomes, but in the late 1980s David Barker introduced the Fetal origins of
Adult hypothesis Disease (FOAD) that was a catalyst for the revival of life course
perspective in disease research.1 The FOAD states the hypothesis that the first years
of life have a great impact on the risk of developing diseases during adulthood and for
example, low birth weight, which is associated with poor fetal development and
nutrition, is linked to coronary diseases hypertension and obesity.2

From the 1990s, more epidemiological studies that took the life-course perspective
began to be carried out and since then, in parallel, several life courses conceptual
models in chronic disease epidemiology have been developed, which are not
excluding and can operate simultaneously.3 One of them considers that chronic
diseases during adulthood are biologically programmed during critical or sensitive
periods of prenatal growth and development and the first years of life. Another model
hypothesizes that chronic adult diseases occur due to cumulative exposure during life
to damaging physical and social environments. These risk factors are usually grouped
because many of them are associated with the socieconmic postition, 4 which
underlines the importance of the environments in which the individual lives, in
shaping their health experience.5

The lifecourse framework therefore takes into account how the biological, behavioral
and psychosocial processes throughout the person's life and how they influence their
health, but consider that the exposure that occurs during the prenatal and early
childhood period are core elements in the life-course perspective.6

In the period of early childhood, which extends from the prenatal period to 8 years of
age, basic skills are developed that are the basis for optimal development during those
years and adulthood. This time is considered the most important in terms of
development3, therefore, the characteristics of the environment where they grow is
very important for their development.7

One of the main element of the framework that proposes the The Commission on
Social Determinants of Health of the World Health Organization in its report “Early
Child Development: A Powerful Equalizer”8 for understanding the contexts that
influence on child developmnet, it is the family, which is the main mediator of
experiences for the child. The family is the one which provides the social and
economic resources that include occupational status, income, and living conditions.
The difference in resources in the family is one of the elements that most influences
the health and well-being of children in different societies.8
Within social and economic resources, employment, in addition to status and social
networks, provides resources to a family; poverty deprivation and family
unemployment are associated with worse child health. 9 Therefore, family employment
will improve child health by increasing household income. Also employment, and in
this case the mother's employment status will be taken into account, can influence
aspects of the child's development such as cognitive and social, and also in obesity
and overweigth that may also have health influence adult child.10

Socio economic conditions, employment and child development

The socio-economic status of a children family influences their health and the health
risks to which they will be exposed. 11 Exposures harmful to the health of individuals
are socially determined an the responses of a person before these risks are also
affected by their social and economic experience. In addition, exposures during
critical or sensitive periods of development can be especially harmful if they influence
functions or structures that shape the long term health.11

Kuh D and Ben-Shlomo in the chapter Socioeconomic Pathways between Childhood

and Adult Health from his book A Life Course Approach to Chronic Disease
Epidemiology12, explain three of the main explanatory pathways on how aspects of
childhood socieeconomic context affect adult health in the future. First, the parents'
socieconmic postition influences the socioeconomic positionof adulthood with the
influence it has on access to resources, especially educational ones. In adulthood, the
socioeconomic position will also influence the type of risks to which the individual
will be exposed. Second, the socieconomic environment affects exposures that in turn
affect biological processes that are associated with some aspects of development, and
third, the socio-economic environment forms behaviors that have long-term effects on
disease risk, and operate independently, cumulatively or interactively with future
exposures of risks.13

Maternal work and children health

As it has been already said, one of the elements that conforms the socioeconomic
position is the occupation or employment. In the case of children, the work of
parents will affect their access to resources, education, housing, social networks
and health resources. Employment improves household income, and therefore
health-related behaviors such as taking better and healthier meals, or joining
sport clubs. 14 But on the other hand it can limit the time for child care, or it may
make it is necessary to make child care arrangements, with family or friends, that
can be stressful for parents or children. The child care can deal benefits or
damages depending on the quality it has. The mother's time and well-being
depends a lot on her working hours, if she is a lone mother or if she has a
partner, the salary she has, etc. Therefore, there is a possibility that maternal
employment may have adverse effects on the health and well-being of the child. 14

If in the social debate and in the recent scientific literature more focus is placed
on the study of mother employment and its influence on the health of the child,
than on that of the father it is because the father's work status has not changed
so much in recent decades and normally, it has been more common for them to
work full time away from home. Historically, it has also been the mother who has
been primarily concerned with child care and feeding of the child. 14

The rate of maternal employment in developed countries has increased sharply since
the 1970s. More and more mothers return to work after the birth of their children. As
Davie et al.15 points out, about half of the mothers of children born in the National
Child Development Study (NCDS) of the 1958 cohort had not returned to a paid job
when the child was 7 years old. And for the births in the new 21st century, in the UK,
about 49% of mothers have returned work when the child is 9 months old.16

Current public policies in the UK support parental employment to address child

poverty. This means, especially in low-income families, that both parents go to the
labor market and there is also support for lone families to access employment. But the
effects that these circumstances may have on child health are unknown, and questions
arise, such as at what age mothers should enter the labor market so that this is not a
detrimental aspect for the health of the child.17

There is a consensus based on the evidence that work is associated with better health
for men. For women, the number of studies is more limited, although the effects
found are usually neutral or beneficial.17

Especially for women there is the social pressure of having to satisfactorily combine
the role of mother and worker, which can lead to guilt situations and anxiety for them.
A child will not benefit if his mother is depressed or anxious for this reason, but it is
not a good outcome if he suffers from social isolation derived from full time
domesticity.14

All these conflicting aspects of mother employment require a good body of evidence
to guide public policy and social debate towards a state that is beneficial for both
mother health and well being and that of the child.

Evidence on maternal employment and children health and well-being

Since the perspective of the life course in epidemiology has been revitalized, there
have been new longitudinal studies and exisiting cohort studies have been used to
investigate the exposures that exist throughout the lives of individuals and analyze
health outcomes and disease risks.

Such data sets have also allowed us to analyze the influence of mother employment
on child health and well being.

MacMunn et. al in their study on the relationship between maternal employment and
child socioemotional behavior in the UK they used data from the UK Millennium
Cohort Study. The study aimed to investigate whether children whose mothers
worked outside the home were more likely to have adverse partner emotional
behavior than children with mothers who were at home full-time, independent of
mental health, maternal education or economic position at age five, if the effects the
employment of the mother and child socio-emotional behavior were cumulative or
more sensitive during the first year of life, and if there was a socio-emotional effect
behavior at the age of 5 years depending on the different types of parental work
arrangement The results of this study are that they found no evidence of the negative
effects of maternal employment on the soci-emotional behavior at the age of 5 in
families of two-parents. But there is significant gender differences and there is a
positive effect of mother employment on socioeconomic behavior in girls. And the
most positive parental work arrangement for boys and girls was that both parents were
present in both the house and were employed, regardless of the maternal educational
attainment and household income.18
`
Other studies on the socio-emotional child behavior found some evidence of a
sensitive period during the first years of life regarding maternal employment 14. But
other studies have found that there is no relationship between maternal employment
and socieconomic behavior, or that there is a relationship between both variables
depending on family structure: there are greater behavioral difficulties among children
of lone mothers but not with children of married mothers.19

Gregg and Washbrook used data from the ALSPAC, the Avon Longitudinal Study of
Parents and Children of the Bristol Area, a cohort study of 12,000 births, to
investigate the effects that maternal employment can have on the child's cognitive and
behavioral development. According to this study, full-time maternal employment in
the first year has slight negative effects on the child's results, but the part-time job or
work after the first 18 months of life has no adverse consequences. This study also
explores the mechanisms that unite maternal employment and social development and
found that several factors minimize the effect of the participation of mothers in the
labor market on their children: Fathers are normally more involved in child care when
mothers return to work soon, and this is beneficial for the child's development.
Negative effects are also more evident when mothers depend on outside help (a friend
or relative) for child care, and moreover, children would be protected from the
negative effect and could have better cognitive results if they had child-care at a
center-based provider that if the child were at home with a mother who does not
work.17

Mindlin M, Jenkins R, Law C. did a systematic review on maternal employment and

indicators of child health in in pre-school children in OECD countries. They wanted
to determine if maternal employment was associated with two indicators of family
health behavior; this is childhood vaccination uptake, and childhood overweight and
obesity. The results indicated that vaccination uptake levels were the same for
children with employed and unemployed mothers, and as for child overweigth, the
prevalence was higher in children with employed mothers.20

Verropoulou G, Joshi H in their study Multilevel analysis of British mothers born in

1958 examined four dimension of child developmnet -math score, reading
recognition, external behavioral adjustment (nonagression) and internal bahavioural
adjusting (nonanxiety) - and found some relationship between maternal employment
and child development but only during the first year of life, in only one of the
dimensions of development they were studying (reading recognition), and especially
concentrated in women with low educational level.14

Gregg et al. 21, Davie et al. 15, and Belsky et al. 22

have in common that conducted
several studies that found in their studies that the effect of maternal employment in
child development is relatively small and the three of them also found that the child´s
reading is the moste sensitive to the status of mothers employment.

Regarding the risk overweight and obesity in the early years, SS Hawkins, TJ Cole &
C Law from the The Millennium Cohort Study Child Health Group, wanted to study
whether changing patterns of family life, after the increase of the mother in the labor
market are contributing to an increase on the prevalence of childhood obesity. For this
purpose they studied the relationship between maternal and partner employment and
overweight in children aged three years and concluded that there is no evidence of
association between childhood overweight and the partner's hours of work. What they
did find is that the duration (hours) of the mothers' employment is associated with less
access for children to healthy meals or physical activity.23

Conclusions

What can be perceived from the different longitudinal studies analyzed is that in
general the effects of maternal employment on children's health and well being are not
strong and that they differ according to other variables such as household income or
hours worked during the day. When there is a delay in development or there are
negative aspects in the children health, this could be compensated with, for example,
other positive aspects of the mother's employment such as income or certain child
care arrangements.

Public policies that promote parental employment should take into account the effect
that these policies have on the health and wellbeing of all family members, and
aspects that can mitigate the negative effects of access to the parents' labor market.
Take into account the composition of families, the quality of employment, enhance
and facilitate access to healthy meals, physical activity, and informal and formal
childcare for all families regardless of income.

In addition, the cumulative nature of some exposures during the period of childhood
urges to design public policies that also take into account the life course perspective
and that establish itineraries of health promotion in a coordinated and continuous way
during life-time.

Finally, there is a need for family conicliation policies from a gender perspective that
involve both men and women in the tasks of raising children and that make possible
the professional development of family members.
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