[JM Test Article 3] Expanded benefits for unwed mothers a welcome change, experts say

Earlier this month, Singapore’s Minister for Social and Family Development Tan Chuan-Jin announced that unwed mothers are entitled to 16 weeks of maternity leave from early 2017 and access to a Child Development Account (CDA) from late 2016, funds from which can be used for healthcare expenses, just like married mothers.

Previously, unwed mothers were only entitled to 8 weeks of employer-sponsored maternity leave and were ineligible for government-sponsored cash matching schemes. A CDA is matched by the government for contributions up to S$6,000.

Experts called the announcement good news, saying the benefits offered extra support to mothers and children during the clinically crucial time surrounding birth.

“It’s long in coming,” said Dr. Carol Balhetchet, a clinical psychologist and senior director of Youth Services at Singapore Children’s Society. “You need the luxury of time for the mother to focus on nurturing and nothing else – breastfeeding, resting, and being there for the child for the first few months.”

Research bears out the potential clinical benefits of the new policy.

A recent study showed that increasing government-backed paid maternity leave was associated with 7.9 fewer infant deaths (95 percent confidence interval [CI], 3.7-12.0), 2.9 fewer neonatal deaths (95 percent CI, -0.2-6.0), and 4.4 fewer post neonatal deaths (95 percent CI, 0.9-8.0) per 1,000 live births in low- and middle-income countries. [PLoS Med 13;doi:10.1371/joumal.pmed.1001985]

Increased maternity leave also improves vaccination rates in infants and facilitates breastfeeding, which organizations like the American Academy of Pediatrics and the World Health Organization recommend exclusively for 6 months. [Soc Sci Med 140;doi:10.10161i.socscimed.2015.07.008; N Engl J Med  362:299-305; BMJ 311:481-485; Lancet 355:451-455]

If the mother is able, breastfeeding may be most important for providing passive immunity for infants, who are vulnerable to infection, via maternal antibodies and other secretory factors.

Nursing guidelines from Singapore’s Ministry of Health on managing breastfeeding detail further benefits for babies, including preventing ear infections and showing links to positive outcomes for children in respiratory infections and long-term cognitive and intellectual development.

And motherhood has a protective effect on women’s health with some studies citing decreased risks of breast cancer. [Am J Epidemiol 2000;152:950-964]

The hub from which these benefits web out, however, lies in the bonding period, which an unwed mother may not have if she has to return to work, if she has to abandon breastfeeding, or which may be tainted with stress if she lacks emotional, physical, or financial support from a partner or extended family, which ultimately leads to poorer health outcomes for mothers and children.

In addition, the mother may need to recover from vaginal delivery or episiotomy or caesarean wounds following birth while babies may suffer jaundice or other poor health conditions. Both mother and baby require a number of postnatal checkups and learning to care for and feed the baby takes time.

“If you think of it from a societal point of view, it is only humane that unwed mums also get the benefit of maternity leave and to CDA,” said Professor Anne Goh of the Department of Paediatrics at KK Women’s and Children’s Hospital. “The child still needs to be taken care of and [the new policies do] help to make it possible for the mother to do so better.”

There are variations in single and unwed mothers across socioeconomic strata, and not all unwed mothers will struggle, noted Dr. Christopher Ng, an obstetrician and gynaecologist at the GynaeMD Women's & Rejuvenation Clinic. The new policy would likely be most beneficial for single mothers without family or social support who may be less financially well off and for whom going back to work soon after delivery may not be their choice.

 “For those extra months, they can remain employed with a guaranteed salary but with more time to bond with the baby,” he said.

In fact, Balhetchet said that, in addition to a percentage of teen or accidental pregnancies, many mothers who have children outside of marriage are in their 20s and 30s and want children but don’t necessarily want to be married to the father. They have their children knowing they won’t be able to access the same benefits as their married counterparts.

“They’re a little bit more liberal... it’s more stronger willed women who want to do that,” she said.

Unwed mothers still don’t have total parity with their married peers. They do not receive a Baby Bonus cash gift, parenthood tax rebates, and cannot buy an HDB flat until they are 35 similar to singles.

These women also face significant social stigma, particularly when their community firmly or exclusively endorses a traditional family structure with children born to a wedded mother and father.

More can be done to provide equal support for unwed mothers, Balhetchet said, but expanding the available benefits is a start.

“No matter what happens, the child is here and women may be stuck in a situation where they’re on their own,” she said.