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MATERNITY
BENEFIT
PROVISIONS
for employed women
WOMEN’S BUREAU BULLETIN 272 • I960

UNITED STATES DEPARTMENT OF LABOR

James P. Mitchell, Secretary

WOMEN’S BUREAU
Mrs. Alice K. Leopold, Director

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MATERNITY
BENEFIT
PROVISIONS
for employed women
WOMEN’S BUREAU BULLETIN 272 . 1960

UNITED STATES DEPARTMENT OF LABOR
James P. Mitchell, Secretary
WOMEN’S BUREAU
Mrs. Alice K. Leopold, Director

U.S| GOVERNMENT PRINTING OFFICE, WASHINGTON : 1960

For sale by the Superintendent of Documents, U.S. Government Printing Office
Washington 25, D.C. - Price 25 cents

FOREWORD
In these days, when one woman in three contributes to the national
economy through her employment, and more than half of all women
workers are married, the provision of maternity benefits for employed
women is a matter of vital importance.
The present survey of existing provisions in the United States, both
voluntary and legislative, supersedes an earlier bulletin (No. 240)
published by the Labor Department’s Women’s Bureau in 1952. A
major legislative advance was made in 1959 when Congress enacted
a law providing that the Federal Government shall participate in the
cost of health insurance (including maternity benefits) for its em
ployees and their families.
For employees in private industry, maternity benefits are provided
chiefly through voluntary health and insurance plans. These have
made great progress since 1952, both in the number of employees
covered and in the scope of benefits provided. Because these plans
depend on the initiative of private citizens—employers, employees,
medical personnel, and commercial insurance companies—there are
wide variations in the type and amount of benefits provided, and some
workers are not covered by any plan. The large majority of women
in the United States who need maternity care, however, are covered
by at least some of the programs described here.
This report was prepared and written by Sylva S. Beyer, under the
general direction of Stella P. Manor, Chief of the Division of Program
Planning, Analysis, and Reports in the Women’s Bureau of the United
States Department of Labor.
Grateful acknowledgment is given to the many specialists in other
Government agencies who provided basic materials and offered valua
ble suggestions.

Alice K. Leopold,

Assistant to the Secretary of Labor
and Director, Women’s Bureau.
in

Contents
Pase

I. The Background
Growth of maternity benefit plans in the United States_________
Number of women workers eligible for maternity care__________
Beneficiaries of maternity care plans
II. Voluntary benefit plans
Types of maternity benefits for employees____________________
Maternity leave
Compensation during leave
Medical and surgical care
Types of insurance plans
Blue Cross
Blue shield
Independent plans
III. Union-management plans
10
Maternity accident and sickness benefits
Qualifying period
Amount of accident and sickness benefits___________________
Duration of benefits
12
Comparison of plans studied in 1958 and 1955_____
Other maternity benefits provided (1955)
Types of benefits
13
Qualifying period
13
Hospital benefits for maternity care
14
Maternity surgical benefits
18
Maternity medical benefits
19
General lump-sum allowance toward maternity care__________
IV. Legislation and regulation in the United States__________________
Federal legislation and regulations
21
Federal income tax deduction
21
Railroad Unemployment Insurance Act
22
Maternity leave for Federal civilian employees______________
Maternity care for Federal civilian employees_______________
Maternity care for women in the Armed Forces_____________
Maternity care for dependents of men in the Armed Forces____
State laws and regulations
State laws prohibiting employment
State temporary disability insurance laws.......................
State provisions for their own employees___________________
State laws disqualifying unemployed pregnant women for unem
ployment insurance benefits
38
Local community provisions for their own employees___________
Maternity leave
38
Maternity care
39
Federal-State-Local provisions for health and maternity protection
as a public service
40
Public general health services
41
Public maternal health services
42

1
1

2
3
4
4
4
5
6
6
6
7
7
10
11
11
12

19
21

24
27
30
31
32
32
32
34

Page

V. International standards formaternity protection------------------------The International LaborOrganization Convention--------------------Maternity protection in other countries---------------------------------Types of systems
47
Coverage
47
Source of funds
4S
Cash sickness benefits----------- --------------------------------------Medical care benefits----------------------------------------------------Qualifying conditions----------------------------------------------------Administration
50

45
45
46

48
49
49

I
THE BACKGROUND
Growth of Maternity Benefit Plans
in the United States
Millions of women in the United States are eligible for maternity
benefits through health and insurance programs provided under volun
tary plans or, in some cases, through legislative action. These benefits
may take the form of cash payments to meet part or all of the expense
of obstetrical care; or they may provide medical and hospital services.
For women workers, they may also include maternity leave provisions
and cash payments to compensate in part for loss of wages during
disability.
“Voluntary” plans are those originated and maintained by the vol
untary action of private individuals or groups. They include a great
variety of job-related prepayment or insurance plans and health pro
grams that provide maternity care for women workers.
The cost of these programs may be paid entirely by the employer,
shared by employer and employees, or, in some cases, may be paid en
tirely by the employees. Whether or not she is covered by a job-related
plan, a woman worker or her family may enroll in a plan not related
to employment; or may purchase commercial insurance against loss of
wages and the cost of medical care. In addition, maternity leave may
be the subject of specific union-management contract clauses (as dis
tinguished from provisions in union-management negotiated health
plans). In companies where no plan is in effect and no union contract
is in operation, provisions for maternity leave and pay during leave
may be established by formal or informal company personnel policy.
The phenomenal growth of voluntary programs since World War II
is an outstanding characteristic of health protection (including ma
ternity protection) in the United States. About two-thirds of all
workers are protected by employee health benefit plans of some type.
Maternity benefits are provided by 90 percent of existing plans that
were negotiated between unions and management, and by an unknown
percentage of other job-related plans.
The trend in the United States toward voluntary programs is in
sharp contrast to the trend in many other countries which has been

Maternity Benefit, Provisions

chiefly in the direction of legislated social insurance or health and
maternity programs, either for groups of employed persons or as a
public service for citizens in general (see chapter Y). In the United
States, also, some groups of women workers are covered by legislative
or regulatory maternity provisions (see chapter IV). These groups
include women workers in six States and Puerto Rico; women in the
railroad industry; and (after July 1, 1960, on a voluntary basis)
women employed by Federal agencies. Many women, whether em
ployed or not, are eligible for maternity benefits as wives of men
employed by Government agencies or men in the Armed Forces.

Number of Women Workers
Eligible for Maternity Care
Over 90 percent of all women in the United States marry at some
time in their lives. About 35 percent of all women 14 years of age
and over—but only about 30 percent of married women living with
their husbands—were in the work force in 1958.
Because of the great preponderance of married women in the popu
lation, however, more than half of all women workers are married.
In March 1958, according to estimates of the Census Bureau, 11.8 mil
lion out of a total of 22 million women in the work force were married
and lived with their husbands. Of these married women, 4.2 million
were 45 years of age or over. This left 7.6 million women workers in
the age groups (14 through 44 years) when most women have their
children. In addition, 1.2 million women workers (all ages) were
married to men who were temporarily absent for service in the Armed
Forces or for other reasons. Between March 1958 and October 1959,
the number of women in the work force increased from 22 million to
23y2 million. At a conservative estimate, therefore, there were then
some 9 million women workers for whom maternity care was poten
tially important. From 93 to 95 percent of the women workers are
employed; the remainder are unemployed, but actively seeking work.
In any one year, the percentage of pregnancies among employed
women is relatively small. According to various studies made during
and after World War II, about 4 percent of employed women need
maternity care in a given year.1 It is possible that the percentage has* 4
1 A Women’s Bureau field survey of 43 firms in 1950 found that the number of women
who had left their jobs in the preceding year, giving pregnancy as their reason, averaged
4 percent. A large commercial insurance company estimated that about 4 percent of the
employed women insured with them under health insurance plans that included maternity
benefits received such benefits during the preceding year. Among women qualified to re
ceive maternity benefits under the Railroad Unemployment Insurance Act (see p. 22), the
incidence ranged from 3 percent in 1947-48 to 5 percent in 1950-57.

for Employed Women

risen slightly in recent years, perhaps to 4±/2 or 5 percent.2 This
means that there may be as many as a million maternity cases among
employed women in a year’s time, or one for every nine married women
workers under 45 years of age.
In general, however, women who work tend to have smaller families
than women who do not work. This is because many women drop out
of the work force when their first—or perhaps their second—baby is
born. Of the women with children under 6 years of age, only one in
five was in the work force in 1958, compared with two in five of the
women whose children were 6 to 17 years of age. The decision to
return to work is a matter of choice, made by the woman and her fam
ily on the basis of family income, individual preference, local job
opportunities, and various other factors. As a result, the women in
the work force are likely to be those who have few children or no
children.

Beneficiaries of Maternity Care Plans
In 1957, some form of health insurance was held by 67 percent of all
women in the United States, according to the Health Insurance In
stitute.3 This figure agrees closely with that of the Social Security
Administration of the Department of Health, Education, and Welfare,
for 1956,4 which estimated that 70 percent of all women 14 through 64
years of age had health insurance of some sort. At that time, twofifths of all insured women were in the work force.
Many job-related plans provide benefits for workers’ dependents as
well as for the workers themselves. It may happen, therefore, that a
wife who is not employed or who, though employed is not covered by
such a plan, is eligible for maternity benefits by virtue of her husband’s
coverage at his place of employment. Her benefits as wife are usually
less in amount than those of covered workers, and of course they do
not include payments to compensate for income loss.1
1 Census estimates Indicate a rise of 31 percent from 1950 to 1957 in the number of
children ever born per 1,000 women workers, 15 through 44 years of age, who were or
had been married. This is greater than the Increase (18 percent) among women not
in the work force.
*A Profile of the Health Insurance Pullic, published by Health Insurance Institute
438 Madison Aye., New York, N.Y., 1959. P. 7.
* See Agnes W. Brewster, Division of Program Eesearch, Social Security Administra
tion, U.S. Department of Health, Education, and Welfare, I. Health Insurance Coverage
by Age and Sex, September 1956, Eesearch and Statistics Note No. 13, 1958; and II.
Characteristics of the Population with Hospitalization Insurance, September 1956, Ee
search and Statistics Note No. 14, 1958.

537054-60-

-2

II
VOLUNTARY BENEFIT PLANS
Types of Maternity Benefits for Employees
Maternity benefits made available to groups of women workers
through, voluntary plans are of several types: Maternity leave; pay
ments to compensate for wages lost (known as accident and sickness
benefits) ; payments for obstetric care; and the provision of medical
and hospital services. A plan may provide for one or more of these
benefits.
Voluntary plans, as distinct from legislative programs, include
plans negotiated between unions and management; commercial in
surance plans; plans operated by associations of hospitals or physi
cians; and cooperative plans operated by the members.
Maternity Leave

Maternity leave actually involves several things: (a) a relatively
short leave period, (b) an extended leave period, and (c) job secu
rity. Job security, too, needs to be considered under more than one
heading: (1) security against immediate dismissal because of preg
nancy; (2) security against dismissal during leave—i.e., assurance of
reemployment; (3) assurance of the same or an equivalent job—i.e.,
retention of seniority; and (4) accumulation of seniority for a limited
period, or throughout the whole leave period.
In practice, provisions for maternity leave are many and varied.
They may, as already noted, be spelled out in a negotiated or nonnegotiated employee health plan; in clauses of union-management
contracts other than health plan contracts; in a company’s formal
personnel policy; or they may be informal, tailored to the employee’s
need and the company’s requirements. Union contract maternity
leave clauses are found in 28 percent of union contracts.5 A contract
clause may state, for example, what plant official the employee is to
notify, under what circumstances leave will be granted and for how
long, whether reemployment is guaranteed, whether and how long
seniority will remain in force, or whether seniority will accumulate.
5 Collective Bargaining Negotiations and Contracts, Vol. 2, Contract Clause Finder,
62: 241—245, Washington, D.C. Bureau of National Affairs, Inc., loose leaf, March 21,
1958.

for Employed Women

The National Industrial Conference Board recently analyzed the
maternity leave provisions of 112 firms (11 unorganized, 101 under
union contract) .6 About half the firms specified the maximum time
during which the employee may continue to work—generally up to
the fifth or sixth month of pregnancy. About a fourth also stipu
lated a definite period before the employee could return to work,
usually not sooner than the second or third month after delivery.
Duration of leave of absence (without pay) ranged up to 2 years,
with only 1 company allowing less than 3 months. Over one-third
of the companies granted 6 months; one-fourth, 12 months. About
one-half allowed an extension of the original leave period. Threefourths of the companies provided “for some degree of seniority pro
tection,” but only one-fourth guaranteed reemployment in the same
or a similar job. An earlier study by the National Industrial Con
ference Board covered personnel practices, including maternity leave,
in over 400 companies.7 Almost three-fourths of these companies
granted maternity leave without pay to workers paid on an hourly
basis (production workers) and almost one-half, to certain salaried
workers. At that time, quite a number of firms required pregnant
employees to resign.
Compensation During Leave

Payments to compensate in part for wages lost because of disability
are known as “accident and sickness benefits” or “temporary cash
disability payments.” These payments are almost always less than
full wages—usually a given percent of wages, or scaled according
to wage brackets, although they may also be set according to occupa
tional group or scaled to length of service.
With few exceptions, accident and sickness benefits are the same
for women as for men. Most often, and increasingly, the amount of
the benefit is the same for maternity cases as for other types of dis
abilities; but almost always the benefit is available for a shorter
period for maternity disabilities than for other disabilities.
Accident and sickness benefits are provided under many health
and insurance plans and programs. Frequently, however, an em
ployer provides these benefits under a “sick leave plan,” separately
from any health and welfare insurance plan which may be in force.
The employer generally finances the sick leave plan through operating
funds set aside for the purpose, usually on a self-insured basis. Em
ployers without a formal plan may pay cash maternity disability
“National Industrial Conference Board, Inc., Management Record, July-Aug. 1959,
Vol. XXI, Nos. 7-8, “Maternity Leaves of Absence,” pp. 232-234, 260-263.
7 Personnel Practices in Factory and Office, National Industrial Conference Board, Inc.,
247 Park Aye., New York, N.Y. Studies In Personnel Policy, No. 145. 1954. Pp. 29 and 80.

Maternity Benefit Provisions

benefits on an individual basis. Employees themselves sometimes
purchase commercial insurance for such benefits.
The accident and sickness benefits for maternity disabilities through
union-management plans are discussed under “Beneficiaries of Mater
nity Care Plans,” page 3.
Medical and Surgical Care

Maternity care is often included in the medical and surgical care
of insurance purchased by individuals, families, or groups of indi
viduals or families. The group may be made up of fellow employees,
members of a community cooperative association, members of a union,
of a professional association, or of a variety of other associations.
A majority of workers have protection under some form of employee
benefit plan or program, the cost of which is most often paid for or
shared by the employer. Some persons are covered by more than one
plan or form of insurance.
All insurance plans and programs for medical care protection have
this in common: They are prepaid; that is, payments are made before
the expense of medical care is incurred. And all are insurance in
the sense that they provide against a contingency and spread the
financial risk.

Types of Insurance Plans
There are basically two types of insurance: (1) commercial indi
vidual and group insurance that provides cash indemnity benefits;
and (2) service plans that provide, not cash, but the medical care
itself. Service plans again may be divided into (a) Blue Cross and
Blue Shield plans, operated by associations of hospitals and of phy
sicians respectively, and (b) independent plans which are not asso
ciated with the other types of plans or with each other. Insurance
company payments represented 47 percent of the total hospital, sur
gical, and medical benefits paid in 1957; Blue Cross-Blue Shield
accounted for 47 percent; and independent plans for the remaining
6 percent.8
Blue Cross

Blue Cross is a nonprofit association providing hospital benefits
through voluntary prepayment plans. In 1959, it had 79 plans operat
ing in the United States through which 56 million Americans in 48
’Health Insurance Council, Twelfth Annual Survey, The Extent of Voluntary Health
Insurance Coverage in the United States as of December 31, 1957. New York, N.Y., August
1958.

or Employed Women

States and. the District of Columbia were protected for hospital care.
Some plans served complete States; some, metropolitan areas.
To earn the right to use the Blue Cross symbol a plan must comply
with Standards of the American Hospital Association. In addition,
most plans are supervised by some State agency, usually the depart
ment of insurance, and in most States must comply with statutory
requirements specifically applicable to such plans.
1 ypically, the hospital service benefits offered include care in semi
private rooms for varying periods (depending on the subscription
charges paid), and a full range of hospital services.
Subscription rates vary from area to area, depending on the com
prehensiveness of the services offered, the local cost of the services,
and claims experience in the area.
Blue Shield

Generally, Blue Shield plans provide for surgical, including ob
stetrical, care; many also provide for home or office calls.
About 79 percent of persons covered by Blue Cross (in 1959) were
also covered by Blue Shield. The two associations have grown up
side by side; they work closely together and the administration
frequently is in Blue Cross hands.
The 67 plans in the United States which were members (when
this study was made) of the National Association of Blue Shield
Medical Care Plans cover more than 42 million persons. Most plans
are statewide, some citywide. The largest had over 5 million
enrollees, the smallest about 10,000. Participating in the plans were
120,000 doctors.
Fifty-three of the plans were service plans under which doctors
agree to accept a stipulated sum in full payment for their services if
the member’s or family’s income did not exceed a specified annual
amount.
All plans are required to meet overall standards of care.
Independent Plans

Independent plans show wide dissimilarities in the scope of the
benefits they provide their membership. Some independent plans
include hospitalization among their benefits; others, only hospital
benefits; some do not provide this benefit at all. The same is
true with respect to surgical services, medical care in and out of the
hospital, and out-patient diagnostic benefits.
The 1957 Survey of Independent Plans showed an enrollment of
close to 9 million persons in independent plans in 1956.

Maternity Benefit Provisions

The Labor Health Institute of St. Louis9 is an example of a com
prehensive independent plan. It provides hospitalization; medical
and surgical care in the hospital; medical, diagnostic, and preventive
services in the clinic; medical care in the home; visiting nurse serv
ices; drugs at cost; ambulance service; and so forth. Institute serv
ices, which include full maternity care, are available to employed
persons covered by collective bargaining contracts with industrial
companies; dependents of workers; and other members of the
community. The employer pays the full cost of coverage for his
employees.
At the other end of the scale are small hospital associations that
provide only cash indemnity benefits for a limited number of days
in the hospital. A number of these plans are designed to round out
the medical benefits already available to their membership through
group insurance or Blue Cross-Blue Shield; these plans may there
fore omit hospitalization and/or surgical expense insurance and pro
vide, instead, such items as outpatient physicians’ services, diagnostic
services, physicians’ visits to the home, and drugs.
About two-fifths of the enrollees in independent plans receive some
benefits, if not all, through group-practice arrangements. An exam
ple of such plans is the Group Health Association of the District of
Columbia. Organized late in the 1930’s by Federal employees, the
plan now admits other members from within the greater metropolitan
area. Complete obstetrical services are provided. The member pays
the first $125 of the maternity hospital bill, but prenatal and post
partum medical visits are covered by the monthly dues. Nominal
charges are made for laboratory examinations and diagnostic tests.
Other examples of group-practice plans are the Health Insurance
Plan of Greater New York (see page 37), and the Kaiser Founda
tion Health Plan. The Kaiser Plan provides medical care and hos
pitalization to over half a million persons in the West Coast States.
A charge of $60 is made for complete medical care for mother and
child during confinement. In cases of interrupted pregnancy, the
charge is no more than $40.
Membership in group-practice plans most commonly occurs
through participating groups organized chiefly on a union or com
pany basis. Dependents are eligible for coverage. Benefits vary.
The following benefits are provided for employees covered by pro
grams reported on by the Bureau of Labor Statistics in 1958:10 In
0 Franz Goldman, M.D. and Evarts A. Graham, M.D., The Quality of Medical Care Pro
vided at the Labor Health Institute, St. Louis, Missouri, Labor Health Institute, St. Louis,
Mo., 1954. Also, St. Louis Labor Health Institute Handbook of Rules and Regulations,
Jan. 1, 1958.
10 U.S. Department of Labor, Bureau of Labor Statistics, Bull. No. 1236, Digest of One
Hundred Selected Health and Insurance Plans Under Collective Bargaining, Early 1958,
Washington, D.C., 1958.

for^Employed Women

hospital care by physicians, including surgeons and specialists;
doctor’s care at the office, including consultations and treatment by
specialists; follow-up calls by doctors (with a $2 charge for first
home visit) and visiting nurses; unlimited emergency services; full
hospital care and services, including private rooms and private-duty
nursing when needed.
An example of a wholly employer-financed plan is that of the
Undicott Johnson Corporation.11 Complete services, including ma
ternity care, are offered for employees and their family dependents on
a group-practice basis. Hospitalization, at a community hospital, is
fully covered. Physicians’ care is available at the clinic operated by
the plan, at home, or in the hospital. All the medical specialties are
represented, including obstetrics and gynecology.
A number of unions operate their own plans. The United Mine
Workers’ Welfare and Retirement Fund, for example, maintained
through employer contributions, provides services for mining families
in a number of States. The fund operates 10 hospitals with out
patient clinics and, in addition, has made arrangements with a number
of group-practice clinics owned or operated by physicians.
A number of self-insuring union trust funds purchase some of the
benefits provided their membership from other independent plans.
Several in New York City, for example, self-insure their hospitaliza
tion benefits but secure their surgical and medical coverage through a
contract with the Health Insurance Plan of Greater New York.11
11 Federal Security Agency, Public Health Service, Medical Care Programs in Industry,
reprinted from the Industrial Hygiene Newsletter, official publication of the Division of
Industrial Hygiene, U.S. Public Health Service, 1949.

UNION-MANAGEMENT PLANS
Particularly characteristic of the American mind-set are the vol
untary health and insurance plans negotiated between unions and
management, most of which include maternity benefits. Only active
workers are eligible for some of the benefits (such as accident and sick
ness benefits) provided by these plans; and for some other types of
benefits, dependent wives of working men are eligible. Because of
their special interest to the woman worker, the plans affecting her are
given here in more detail than those covering dependent wives. In
formation on all the types and amounts of benefits provided is avail
able from Bureau of Labor Statistics bulletins covering unionmanagement plans in operation in 1955 and 1958.12

Maternity Accident and Sickness Benefits
Cash benefits for disabilities resulting from pregnancy are provided
for women workers under many health and insurance plans negotiated
between unions and management.
Of the plans studied in 1958, 232 provided accident and sickness
benefits and 75 percent of these included accident and sickness bene
fits for disabilities resulting from pregnancy. Of the plans studied in
1955, 239 provided accident and sickness benefits, but only 60 percent
of these included maternity benefits. Accident and sickness benefits
were provided under most of these plans through group insurance
M “Analysis of Health and Insurance Plans Under Collective Bargaining, Late 1935,”
Bureau of Labor Statistics Bulletin 1221 (Nov. 1957) ; and “Health and Insurance Plans
Under Collective Bargaining—Accident and Sickness Benefits, Fall 1958," Bureau of
Labor Statistics Bulletin 1250 (June 1959). The 1955 study includes information on
various types of maternity benefits available for both working women and dependent wives;
the 1958 study covers maternity accident and sickness benefits available only to active
workers—Including women.
Results of the latest Bureau of Labor Statistics studies of maternity benefit plans under
collective bargaining agreements—those in effect in 1959—were not available when this
Women's Bureau bulletin was being prepared, but are being published by the Bureau of
Labor Statistics during 1960. Analysis of maternity hospital benefits for both working
women and dependent wives are covered in “Health and Insurance Plans Under Collective
Bargaining: Hospital Benefits, Early 1959” Bureau of Labor Statistics Bulletin 1274,
1960. Further study results to be published by the BL8 in 1960 will provide information
on maternity surgical and medical benefits under collective bargaining agreements in effect
during the late Bummer of 1959.

for Employed Women

policies, although some depended on self-insurance by the employer.
The employer paid the full cost of financing the plans in 59 percent of
the plans in 1958, compared with 57 percent in 1955.
Qualifying Period

In addition to the period required for a new employee to become
insured (which in nearly all the plans was 4 months or less), a wait
ing period was required in the majority of plans before an employed
woman was qualified to draw maternity benefits. As shown in the
following summary, fewer plans made maternity benefits available
immediately in 1958 than in 1955:
Year
1958

Plans providing maternity benefits 168

1955

166

For all insured women (benefits immediatelyavailable)______
For women whose pregnancy commences while insured_______
For women who have been insured for a definite period (usually
9 months) 45

53
66

Amount of Accident and Sickness Benefits

Most of the plans (162 in 1958) provided for weekly cash benefits.
Of these, all but one (where benefits were based on employee’s length
of service) provided either a uniform (flat) weekly benefit or a
weekly benefit scaled to earnings. The flat benefits ranged from $9
to $55 a week in the plans studied in 1958; the median amount being
$35. The benefits scaled to earnings, for women earning $57.70 a
week (equivalent to $3,000 a year), ranged from $10 to $48 a week.
The median was 60 percent of earnings—$35 a week at the $3,000
level. The following tabulation shows the number of plans of each
type providing weekly benefits of specified amounts in 1958 and also
in 1955:
Number of plans providing—
Amount of weekly maternity benefit for worsen earning $8,000 a year

1958

Total

Under $20_____
$20 exactly_____
$20.01 to $24.99_______
$25 exactly
$25.01 to $29.99-_
$30 exactly
__
$30.01 to $34.99_$35 exactly
_
$35.01 to $39.99__________
$40 exactly____
$40.01 to $44.99 ______
$45 and over ..
537054—60-------3

Graduated
amount

Flat amount
1955

4
2

1
1

1958

6
6

4
7

2
2
12

4
7

5
5
3
31

18
9
4

2
12
1

1955

16
14
7
13
6

Maternity Benefit Provisions

Only two of these plans providing weekly benefits paid women a
smaller amount for pregnancy disabilities than for other types of
disability; one paid $5 less and the other $6 less, per week. (A few
accident and sickness plans paid lower benefits to women than men
for disabilities of any type. There were 11 of these in 1958, out of
a total of 230 plans; and 13 in 1955. Information is not available
to show whether any of these plans included maternity benefits.)
That the general trend in the amount of maternity accident and
sickness benefits is upward is indicated by the tabulation below:
Percent of •plans paying—
Flat amount

Graduated
amount

Amount of maternity benefit

1958

1955

1958

1955

$25 and over__ _ _ —
-------$30 and over---------- -------------- ------------ „
..
$45 and over
- - — ---------

92
82
26

83
76
5

96
77
4

66
0

Duration of Benefits

In 1958 as in 1955, the predominant maximum period for which
maternity accident and sickness benefits were payable was 6 weeks.
Of the 162 plans providing maternity benefits in 1958, only 1 had a
maximum duration period as long as that for nonmaternity disabili
ties—26 weeks under this particular plan. A comparison of the dura
tion of 1955 and of 1958 benefit follows:
Duration of maternity benefit

Number of plans
1958
1955

All plans 162
4 weeks----------------------------------------------------------------6 weeks 158
8 weeks----------------------------------------------------------------13 weeks
26 weeks
1

166
1
2

1
159
4
2

Comparison of Plans Studied in 1958 and 1955

Of the plans with cash accident and sickness benefits, a slightly
larger proportion in 1958, than in 1955, provided these benefits for
disabilities resulting from pregnancy. In plans requiring an ad
ditional qualifying period for pregnancy or maternity benefits, the
benefits were more likely in 1958 than in 1955 to be available on the
basis “if pregnancy commences while worker is insured.” This pro
vision covers the contingency of disabilities arising from an
interrupted pregnancy.
On the whole, the maternity benefits provided were somewhat more
liberal in 1958 than in 1955. This does not necessarily mean, however,
that the benefits were increased as much as the costs of medical care
increased during the 3-year period.

for Employed Women

Other Maternity Benefits Provided (1955)
The 1955 report on 300 health and insurance plans negotiated be
tween unions and management (see footnote 12) includes extensive
information on various types of maternity benefits available through
these plans, in addition to the cash accident and sickness benefits
discussed in the previous section. Maternity benefits of some kind
were available for women employees in 90 percent of the plans and
for the wives of men employees in 88 percent of the plans.
Types of Benefits

Under some plans, a general lump sum allowance was provided as
the entire maternity benefit. Generally, however, coverage was in the
form of specific allowances or services—that is, hospitalization, sur
gical (obstetrical), and medical benefits; and the weekly accident and
sickness benefits to compensate for wages lost, which have already been
discussed in some detail.
The following tabulation shows the number of plans providing
specific types of benefits for women employees and for wives of men
employees:
'Number of plans
covering—
,
.. _
..
__
Maternity benefits available

Wives of
Women
men
employees employees

Hospital-----------------------------------------------------------------Surgical -----------------------------------------------------------------Medical
General lump sumallowance 30
Weekly accident andsickness 166

239
233

230
210

14
34
0

For both women workers and wives of men employees, the single
maternity benefit most frequently provided was hospitalization, fol
lowed closely by surgical benefits.
The most frequently provided combination of benefits was: For
women workers, weekly cash accident and sickness payments, hos
pitalization and surgical benefits; for wives as dependents, hospitaliza
tion and surgical benefits.
Qualifying Period

Many plans required a qualifying period—beyond any waiting
period necessary to become eligible for insurance—before maternity
benefits became available.
The extent to which a qualifying period was required for women
employees under plans providing maternity hospital, surgical, medi
cal, and lump sum allowance is shown in table 1. In some cases, these
benefits became available to workers immediately on being insured,

Maternity Benefit Provisions

but under the majority of plans, a qualifying period (usually 9
months) was required.
Table 1.

Availability of Specified Maternity Benefits for Women Employees, 1955
[Based on 300 health and insurance plans]

Plan

Plans providing benefit___ .
For all insured women1
For women whose pregnancy commences while inFor women -who have been
insured for a definite period:
8 months
9 months__
10 months..
12 months .
Other periods
.

Weekly
accident
and
sickness

Hospital

Surgical

Medical

Lump sum
allowance

166

239

233

10
88

37
3
1

18
5
4

8
11
6

5
3

1
1

1 Benefits immediately available.

Similar provisions existed for wives of men employees, with an even
higher proportion of plans requiring a qualifying period of 9 months
or longer for hospital benefits.13
Hospital Benefits for Maternity Care

More than two-thirds of the 239 plans with hospital benefits for
maternity provided cash benefits for women employees; about onefourth provided service benefits; a few provided both cash and service
benefits.
Cash flam.-—A flat amount (e.g., $100) for all expenses in the
hospital was provided in nearly half the 16G cash plans covering
workers for this benefit.
Separate allowances for daily room and board charges and for
hospital extras or ancillary services were provided under more than
two-fifths of these cash plans (less than one-fifth in the case of
dependent wives).
A maximum daily allowance for room and board, with an overall
maximum for all maternity hospital expenses, was provided by the
remaining plans.
M Benefits for wives of men employees are not discussed further in this bulletin. Detail
on them can be found in Bureau of Labor Statistics Bulletin 1221, “Analysis of Health
and Insurance Plans Under Collective Bargaining, Late 1955,” and in BLS Bulletin 1274,
“Health and Insurance Plans Under Collective Bargaining: Hospital Benefits, Early 1959.”

for Employed Women

Service 'plans.—Under service plans, women employees were assured
specified service benefits rather than allowances toward the cost of
benefits. Under a few plans they had to pay an initial maternity
charge (e.g., the first $60 of all hospital, surgical, and medical
expenses incurred); thereafter, full service benefits were provided.
Duration.—Plans, other than those which provided a flat amount
applicable to total hospital costs, stipulated the number of days avail
able to women employees for maternity hospital benefits. (See table
2.) In two-thirds of these 149 plans, the maximum benefit period
provided was shorter than for nonmaternity cases. Generally, the
service types of plans stipulated longer benefit periods than did the
cash types.
Only three plans stipulated less than 8 days as the maximum for
hospital benefits. Two-fifths of the plans stipulated a 14-day
maximum. Over a fourth provided for longer stays. Four plans
provided extended coverage periods at reduced allowances.
Table 2.—Maximum Duration of Maternity Hospital Benefits for Women Employees
by Type of Plan, 1955
[Based on 300 health and insurance plans]
Number of plans
Maximum duration of full-benefit period

All plans

Type of benefit
Cash

Service

Plans providing hospital benefits_______

239

173

Plans stipulating maximum duration.
Under 8 days_______________
8 days_____________________
10 days____________________
11-13 days_________________
14 days____________________
15-69 days_________________
70 days_____________ ______
71-119 days________________
120 days___________________
Over 120 days______________
Duration not specified___________

149
3
8
35
2
59
5
10
2
21
4
90

83
2
3
12
2
57
4
1
2

66
1
5
23
2
1
9
21
4

Hospital Daily Room and Board Maternity Benefits

Under Service Plans.—Under virtually all of the plans providing
services, both workers and dependents were eligible for semiprivate
accommodations—generally described as rooms having two beds or
as having two and not more than four beds. If the patient occupied
a private room, she was responsible for the difference in cost.
Under Cash Plans.—Ninety-four plans provided a fixed daily cash
allowance for women employees toward the cost of hospital room

Maternity Benefit Provisions

and board. Any charge in excess of this amount was paid for by
the insured.
Only 10 of these plans provided a lesser daily cash allowance for
maternity than for other cases. The average amount provided was
$11.17 a day. The most frequently provided daily allowances were
in the ranges $10 to $10.99 and $12 to $12.99.
The total maximum room and board allowance (the daily cash
allowance times the maximum number of days) ranged from under
$100 to more than $250 in 72 cash plans covering women employees.
Just under three-fourths of these cash plans provided total maximums ranging from $100 to $175:
Plans
Total maximum room and
--------------------hoard allowance
Number Percent
All cash plans specifying maximum------------------------------------- 72
100
Under $100
$100 to $124.99 17
$125 to $149.99 23
$150 to $174.99 13
$175 to $199.99
$200 to $224.99
$225 to $249.99
$250 and over 3

3
2
3

11
24
32
18
4
3
4
4

Maternity Hospital-Extra Allowances

Hospital “extra” or ancillary maternity services include use of oper
ating and delivery rooms, supplies (e.g., bandages, anesthetic mate
rials), prescribed laboratory examinations, and specified drugs and
medications. Not all health and insurance plans provided for these
services; and for 79 plans covering women employees the value of extra
services could not be computed because these plans provided a flat
lump sum covering room and board and extra services. However, 160
plans made specific provision for hospital charges other than for room
and board.
The various methods used in providing these benefits were the same
for maternity and nonmaternity cases.
Cash plans provided for one of the following:
(1) Payment of charges up to a fixed maximum.
(2) Payment of the full cost of specified services.
(3) Payment of the difference between the total hospital charges for
room and board and the maximum specified under the plans.
(4) Reimbursement in full of charges up to a certain level, and of
75 percent of the charges in excess of this level.
The great majority of these cash plans provided for methods (1) and
(2); only about a tenth provided for method (3); and only 4 plans for
method (4).

for Employed Women

Service plans typically listed those benefits for which cost was
covered (in full or in part), and those excluded. Virtually all plans
provided the same services for maternity cases as for nonmaternity
cases, except that some plans added nursery care for the newborn
infant.
The methods used by all the plans to specify allowances for hospital
extras were as follows:
Plans
Extra hospital benefit allowance

Number

All plans providing allowance 160

Percent

100

Allowance for expense incurred :
Up to a fixed amount 65
Up to a fixed amount with additional reimbursement on a
percentage basis
4
Up to a difference between room and board charges and
a fixed amount_____
Other
Benefit provided on a service basis for entire benefit period..

41
3
19
4
68

12
3

The amounts allowed under cash plans providing full reimburse
ment up to a fixed level ranged from less than $50 to over $275. More
than half the plans allowed less than $125. The amounts most fre
quently provided ranged from $100 up to (but not including) $125.
Maximum amount

Plans
Number Percent

All plans providing reimbursement of hospital extras
up to a fixed amount 65
Under $50
$50 to $74.99
$75 to $99.99 10
$100 to $124.9915
$125 to $149.99
$150 to $174.99
$175 to $199.99
$200 to $224.99
$225 to $249.99
$250 to $274.99
$275 and over 3

100
6
6

9
9
15

8
6
1
6
3
1

23
12
9
2

9
5
2
5

Lump Sum Allowance for Maternity Hospital Care

Frequently plans provided, as the total hospital cash benefit, a flat,
lump sum which could be applied to any part of the hospital bill
for room and board and special services. This approach was used
in 79 plans covering women employees. The amounts ranged from
$50 to $175; about three-fourths of the plans provided between $75
and $125.

Maternity Benefit Provisions

Plana
Amount

Number Percent

All plans providing a flat, lump-sum for hospitalization------------- 79
$50 to $74.99
$75 to $99.99 29
$100 to $124.99 31
$125 to $149.99
$150 to $174.99
$175 and over 2

100
10
37
39

8
6

4
3

Maternity Surgical Benefits

Surgical benefits for maternity cases were provided under 233 plans
covering women employees. Benefits were in the form of a cash al
lowance under the overwhelming majority of plans. Only 11 plans
made service benefits available.
Under all plans, the benefit was the same as that provided in non
maternity cases. However, of 40 cash plans which had an income
limitation provision, 12 did not extend this provision to maternity
cases.14
Amount of Surgical Benefits

Under Cash Plans.—Under cash surgical plans, the amount avail
able for “normal delivery” usually was greater than for a miscarriage
or abortion but less than for a caesarean section or ectopic pregnancy.
The “normal delivery” allowance ranged from $50 to $175. The most
frequent amounts, provided by nearly two-thirds of the plans, were
$50 and $75. The amounts provided by all cash plans were as follows:
Plana
Allowance for normal delivery

Number Percent

All plans providing a cash benefit 222
Under $50
$50
$50.01 to $59.99
$60
$60.01 to $74.99
$75
$75.01 to $99.99
$100
$100.01 to $124.99
$125
Other________________________________________ ____

100
2
68

1
25
18
72
20
5
4
6

1
31
0)
11
8

32
9
2
2
3
(a)

1 Less than 1 percent.
11 Under 40 plans utilizing Bine Shield, participating doctors agreed to accept the
scheduled surgical or obstetrical allowance as full payment of their services unless the
worker’s income exceeded a specified amount; 12 plans did not apply this agreement to
maternity cases.

for Employed Women

Under Service Plans.—Service plans provided the full cost of sur
gical care, with this exception: Under a few such plans, workers had
to pay ail initial maternity charge (e.g., the first $60 of all hospital,
surgical, and medical charges incurred), but thereafter full service
benefits were provided.
Maternity Medical Benefits

Only 16 plans provided medical benefits for pregnant women em
ployees, i.e., provided for doctor’s visits other than those of the doctor
performing the surgical procedures.
Service Medical Benefits were provided by 12 plans. The majority
of these plans made the benefits available regardless of where they
were provided—at home, doctor’s office, health center, or hospital.
Two, however, provided medical care only in the hospital; and one,
only in the medical center.
The Jp cash medical plans, unlike the majority of service plans,
provided benefits only in the hospital, or only in the doctor’s office.
Two plans provided the same in-hospital medical benefit specified
for nonmaternity cases; the others provided special allowances
differing from those available in nonmaternity cases.
Benefit provided for treatment

All plans----------------------------------------------------------------------------In
In
In
In
In

hospital only
5
hospital, doctor’s office, home, and health center____
hospital and health center
1-1
health center only
1
doctor’s office only
11-

All Cash Service
plans plans plans

3
2
8-8
_

General Lump Sum Allowance Toward Maternity Care

A specified sum of money, or general lump-sum allowance, was
provided women employees under 30 plans.
Under 22 of these plans, this lump sum was provided in lieu of all
other benefits. The remaining 8 plans allowed a lump sum in addi
tion to one other benefit, e.g., accident and sickness benefit or hospital
benefit.
As with the separate benefits, a waiting period was usually specified
(see table 1).
The lump-sum provided ranged from $50 to $175. The amount
most commonly specified was $150, as shown in the summary on the
following page.
537054—60-

Maternity Benefit Provisions

Humber of plana
with general lump
sum provided—

Amount of lump sum

All plans providing lump sum_______
$50
$75
$100

$125
$130
$150
$175

All
plans

30
4

In
addition
As only
to
maternity another
benefit
benefit

84 * 6

6
6

4
4
2
4
2

11
10
8
2

1-1

IV
LEGISLATION AND REGULATION IN
THE UNITED STATES
The United States has more legislation that provides maternity
protection for women workers than is generally realized. Wellknown laws are the Federal Railroad Unemployment Insurance Act
providing weekly cash maternity benefits to women in the railroad
industry; the Rhode Island Cash Sickness Compensation Act pro
viding weekly cash maternity benefits to women workers in that State;
and the laws of six States and Puerto Rico prohibiting employment
for specified periods before and after childbirth—in Puerto Rico
with half-pay.
Less familiar are laws and regulations making protection available
to many thousands of other women workers. Included in these pro
visions are income tax deductions for sick pay received during illness
in pregnancy; leave with pay for over half a million Federal civilian
women employees; and maternity medical care for women in the
armed services, in several Federal civilian agencies, and, after July
1,1960, in all Federal civilian agencies.
Included also are provisions for women workers who benefit in
directly, i.e., not through their own connections with a job but as
dependents. Such provisions apply to 98,000 employed wives of
men in the armed services, to the working wives of men in certain
Federal civilian agencies, and—after July 1, 1960—to the wives of
all men in the Federal civilian Government who elect family coverage.
Still other women who benefit, also, not directly as workers but
as “medically needy” when they must give up their jobs because of
pregnancy, are thousands of beneficiaries of Federal, State, and local
provisions for maternity medical care.
More detailed information regarding the above laws and regula
tions, as well as experience under them, follows.

Federal Legislation and Regulations
Federal Income Tax Deduction

Applicable to all women workers whose employment entitles them
to sick pay is a provision of the Federal income tax law allowing a

Maternity Benefit Provisions

deduction from taxable income for sick pay received while a worker
is absent because of illness during pregnancy. Pay received for
periods of absence due solely to pregnancy is not deductible; but if
the absence is due to illness during pregnancy, part or all of the sick
pay received is deductible, whether the illness was the result of
pregnancy or of some other cause. There is a waiting period of 1
wTeek for which sick pay is not deductible, unless the employee is
hospitalized; if she is hospitalized even for a day, sick pay for the
entire period of her absence from work is deductible. No more than
$100 a week is deductible, however, even if a larger amount of sick
pay is received.
Railroad Unemployment Insurance Act15

The Railroad Unemployment Insurance Act provides for unemploy
ment, sickness, and special maternity weekly cash benefits. The basic
formula by which the amounts of benefits are determined is the same
for all three types of benefits.
The Act has been amended several times, most lately on May 19,
1959, effective immediately.16 The main purpose of amendments after
1946 has been to raise benefits so that they would keep pace with earn
ings, and to adjust the financing of the program to the cost experience.
Under the 1959 Amendment, a woman must have earned at least $500
of railroad wages in a base year (calendar year) in order to qualify
for maternity benefits in the benefit year, which begins the following
July 1. If her earnings were at least $500 in 1958, she is qualified in
the period July 1,1959-June 30,1960.
Her daily benefit rate will be determined in one of two ways, which
ever will provide the higher rate, though in neither case may it exceed
$10.20. Her rate will either be:
(a) Sixty percent of her daily rate of pay on her last railroad job
in the base year; or
(b) Based on the following schedule:
“ 52 Stat. 1094. As originally enacted In 1938, effective July 1, 1939, the law pro
vided for the payment of benefits only to unemployed railroad workers who were “avail
able for work.” In 1946, effective July 1, 1947, the Act was amended (Public Law 572,
79th Cong., 2d sess., 1946) to provide weekly cash benefits for railroad workers who are
unable to work because of sickness; also provided are special maternity benefits to women
railroad workers.
18 June 23, 1948 : 62 Stat. 576-578; Oct. 30, 1951: 65 Stat. 691; May 15, 1952; 66 Stat.
73 ; Aug. 31, 1954 : 68 Stat. 1041; Aug. 12, 1955 : 69 Stat. 716; May 19, 1959 : Public Law
86-28, 86th Cong., 1st sess., (H.K. 5610), 1959.

for Employed Women
Employee’s creditable base-year earnings

§500 to §699.99____________________________________
§700 to $999.99_________________________________
§1,000 to §1,299.99_____________________________
$1,300 to $1,599.99_______________________ I_______
$1,600 to §1,899.99__________________________ ~~__ ~~~
$1,900 to $2,199.99_________________________________
$2,200 to $2,499.99_________________________________
$2,500 to $2,799.99_______________________ ~~____ "__
§2,800 to $3,099.99_________________________________
$3,100 to $3,499.99______________________~__________
$3,500 to $3,999.99____________________________
$4,000 and over___________

23
Daily
benefit rate

___ $4.50
----- 5.00
___ 5.50
____

6.00

___
___
___

6.50
7.00
7.50

____

8.00

___
___
___

8.50
9.00
9.50

------10.20

The new rates are retroactive to July 1,1958.
There is no waiting period for maternity benefits. To receive bene
fits, the claimant must file pertinent information, including statements
from a doctor on the expected and on the actual date of birth of her
child.
Benefits are payable for a total of 116 days, or approximately 1614
weeks. They may begin 57 days (about 8 weeks) before the expected
delivery date, but in no case may the claimant be paid for more than
84 days before actual childbirth. If the full 84 days before the date
of delivery are paid, clays paid after delivery may not exceed 31.
_ Since the first 14 days of the maternity period and the 14 days
immediately after the birth of the child are paid for at V/2 times
the daily rate, the total maximum benefit available is equal to 130
times the daily allowance. Total benefits available therefore range
from $485, payable to women with earnings between $500 and $699.99
in the base year, to $1,326 to women who have earned $4,000 or more.
During the 11 years the 1946 Amendment establishing sickness and
maternity benefits has been operative,17 the number of women railroad
workers who have received maternity benefits has fluctuated in a
relatively small range centering around 4,000. In the 1957-58 benefit
year they numbered 3,900, and they then represented about 4 percent
of all qualified women.
Women are only a small proportion of all railroad workers—6
percent in 1956, or 97,800 out of a total of 1,627,900. The majority of
these women (two-thirds in 1955) are office workers, and the great
majority of maternity beneficiaries are office workers—in 1957, nine
out of ten.
17 Information In this section on the operation of the maternity benefit provisions of the
Railroad Unemployment Insurance Act are from : (1) Railroad Retirement Board, The
Monthly Review, Feb. 1959; and (2) Railroad Retirement Board, Annual Report 1958 for
the Fiscal Year Ended June 30, 1958.

Maternity Benefit Provisions

The occupations of the 3,900 women who were beneficiaries in the
1957-58 benefit year were:
Number
of
employees

Occupation

Office employees:
Executives, supervisors, and professionals--------------------------------- 100
Station agents and. telegraphers---------------------------------------------100
Clerks and other office employees------------------------------------------- 3, 400
All other employees 300

The great majority of beneficiaries that year were under age 35
and were divided evenly between women 25 to 34 years old and those
under age 25, as the following grouping shows:
Age group

dumber

Under 251.700
25-34 1,
TOO
35-44
400
45 and over
100

The average duration of benefits, that is, the average number of days
benefits were paid per beneficiary, have ranged from 102 to 113 (109 in
1957-58); and the average total amount of benefit has risen from $456
in 1947-48 to $963 in 1957-58. Benefits in 1957-58 were distributed as
follows:
Maternity beneficiaries
Amount of benefit

Percent

Number

100

3, 900

Total
Less than $400.
$400 to $499-__
$500 to $599___
$600 to $699-__
$700 to $799__
$800 to $899__
$900 to $999__
$1,000 to $1,099.
$1,100 to $1,105.

1
2

100
200
100
200

300
800
1,400
800

4
2

5
7
20

■

38
21

1 Fewer than 50.

Eighty-one percent of the pregnancy claims were not terminated
until completion of the 116 days’ limitation period.
Maternity Leave for Federal Civilian Employees

Though Federal law does not refer to maternity leave as such for
Government civilian employees, Public Law 233 does make paid sick
leave available to them. Sick leave accrues at the rate of one-half day
for each full biweekly pay period and may be accumulated without
limit. A regulation of the Civil Service Commission, which adminis
ters this law, then permits such sick leave to be used as maternity

for Employed Women

leave.18 In the interest of achieving some degree of uniformity in ap
plying the regulation, the Commission’s Interagency Advisory Group,
composed of the personnel Directors of all Federal agencies, developed
nonmandatory Guides for Granting Maternity Leave. The Guide’s
recommendations may be summarized as follows:
All absences on maternity leave should be medically certified.
Leave approved for reasons related to pregnancy and confinement may be
charged to any combination of sick leave, annual leave, and leave without pay.*10
The usual period of maternity leave authorized is approximately 14 weeks:
6 weeks before the expected date of delivery and 8 weeks after the actual date
of delivery. These leave periods or an extension thereof should, when the
request for them is medically certified, be charged to available sick leave. In
those instances in which the request is not medically certified, or in which sick
leave is or becomes exhausted, the charge should be to available annual leave;
and when that is exhausted, to leave without pay.
Employees who plan to return to work may be granted leave without pay
beyond a medically certified period.
As a general rule, absence due solely to the employee’s responsibility for the
care of her child should not be charged to sick leave.
Request for sick leave not yet accrued to be advanced for reasons of
pregnancy should usually be denied.

Individual agencies may apply the foregoing recommendations
narrowly or liberally. Granting 14 weeks of maternity leave is not
mandatory. If granted to an employee with few years of service,
but without the privilege of advanced sick leave, a considerable
portion of the leave would probably be without pay.
On the other hand, if an employee who has accumulated sufficient
sick leave and annual leave is permitted to use them and is advanced,
sick leave, she may be on maternity leave 3 months or more with pay
throughout the whole period. If in addition, she is granted leave
without pay, she could be absent from her job for a still longer period.
In any case, provided no rule of the employing agency has been in
fringed, women granted maternity leave have job security and may at
the end of their leave return to the jobs they held.
19U.S. Civil Service Commission, Federal Personnel Manual, Chapter L-l, “Regula
tions,” sec. 30.401; Appendix C to Chapter L.
10 Under Title II of Public Law 233, 82d Congress, annual leave accrues to Government
employees at the rate of 13 days each year during the first 3 years of employment, 20 days
during the 4th through the 15th year, and 26 days thereafter; but no more than 30 days’
annual leave may be carried over from one year to the next, unless more than 30 had been
accumulated before the end of 1952. (Actually annual leave accrues by biweekly pay
periods; hence, there may be similar slight variations in the number of hours of leave that
accrue annually. Also, the leave-pattern is somewhat different for overseas civilian per
sonnel recruited In the United States.) Sick leave is accrued as noted above. In cases
of “serious disability or ailments and when required by the exigencies of the situation,” up
to 30 days of sick leave may be advanced an employee before he or she has actually
earned it.

Maternity Benefit Provisions

Agency Regulations

The separate agencies of Government have established their own
maternity leave regulations that conform strictly to the Federal law
on sick leave and to the Civil Service Commission regulation on the
use of sick leave for pregnancy and confinement but vary in degree of
conformity to the Guides for Granting Maternity Leave. Inasmuch
as the Department of Defense employs nearly half of all Federal
civilian women workers—not only in offices, but also in such military
installations as arsenals, shipyards, aircraft overhaul and repair
shops, etc.—its special regulations are of interest.
Within the Department of Defense, each of the three services—
Army, Navy, and Air Force—has set up regulations.
The Army has set up minimum provisions to be observed through
out the Army Establishment in granting leave for maternity reasons.20
Commanding officers may modify these provisions upward to meet
local conditions but may not reduce them. Although medical certifi
cation determines whether sick leave shall begin before or after the
period during which pregnant women should not be employed, nor
mally maternity leave is considered as beginning with the 36th week
of pregnancy. Tiro Army also provides for a part-time tour of duty
“where leave of absences is not appropriate, but, for reasons of preg
nancy, it is not possible to utilize an employee’s services on a full-time
basis.”
Certain Army maternity leave regulations are mandatory with re
spect to nontemporary employees who have completed their proba
tionary period and who contemplate return to work, but discretionary
with respect to other employees.
Navy21 regulations, in addition to providing for sick leave, annual
leave, and leave without pay, stipulate:
Pregnancy shall not unjustifiably jeopardize an employee’s job or seniority.
Ordinarily, the employee should cease work not later than 6 weeks before the
anticipated date of delivery.
Ordinarily, appointments will not be made during pregnancy. Commands of
activities may, however, exercise discretion in the matter.

Air Force 22 regulations relating to maternity leave include:
Normally, the period of absence for maternity reasons will be about 14 weeks;
6 weeks before the expected date of delivery and 8 weeks after delivery.

The initial authorization of absence for maternity leave will not exceed 6
months in any case. The total grant of leave will not exceed one year.
20 Department of the Army, Civilian Personnel Regulations.
“Leave,” CPR LI.4, pp.
23-24, Washington, D.C., April 1956. These regulations are current, 1959.
21 Navy Civilian Policy Instruction 115. 5-2. Oct. 25, 1957.
22 Air Force Manual, AF LI—3 TS 134. Mar. 31, 1959.

for Employed Women

For employees who have completed 10 months’ continuous service
prior to the expected date of delivery, provisions for leave are some
what more liberal than for other employees.
Maternity Care for Federal Civilian Employees

Seventy percent of Federal employees were protected in 1959 by
some type of health benefit plans, most if not all of which included
obstetrical benefits.23 Except in a few agencies, employees paid the
entire cost of prepayments or premiums. However, their employment
enables them to obtain this protection as group protection, at less cost
than if it were purchased individually.
Federal Employees Health Benefits Act of 1959

On September 28,1959, President Dwight D. Eisenhower signed the
Federal Employees Health Benefits Act of 1959, which made health
insurance, partly paid for by Government, available to over 2 million
Federal civilian employees and their dependents on a voluntary basis,
effective the first pay period after July 1, 1960. Over a fourth of the
employees are women.
Employees have free choice among health benefits plans in four
major categories, each of which provides obstetrical benefits:
(1) A Government-wide service benefit plan, such as is offered by
Blue Cross-Blue Shield;
(2) A Government-wide indemnity benefit plan, such as is offered
by commercial insurance companies;
23 On the West Coast, 70,000 Federal employees and their dependents are enrolled In
the nonprofit, group practice, prepayment Kaiser Foundation Health Plan, e.g., groups
at the Alameda Naval Air Station; San Francisco Naval and Mare Island Shipyards;
Hamilton, Travis, Norton, and March Air Force Bases ; Atomic Energy Commission, Public
Health Service, Internal Revenue Service, Veterans’ Administration and Veterans' Admin
istration hospitals, Federal Bureau of Investigation, and the Customs Service. Most Fed
eral employees in New York City are enrolled in the nonprofit, group-practice, prepayment
Health Insurance Plan of Greater New York for medical and surgical benefits and in the
nonprofit Blue Cross Plan for hospital benefits. In Washington, D.C., many Federal
employee groups have subscribed to the Blue Cross hospital and Blue Shield surgical
plans; others are members of the Group Health Association, a nonprofit, group-practice,
community cooperative plan.
Agents of the Federal Bureau of Investigation a decade ago formed the Special Agents
Mutual Benefit Association and bought health Insurance coverage from a commercial
carrier. The plan now includes clerical personnel of the FBI who elect this coverage.
There is no collection of premiums by employees except among clerical staff; the Mutual
Benefit Association has hired its own staff, established its own midtown office, and
premiums are collected through Individual billings. Obstetrical benefits for both FBI
employees and wives, according to an officer of the association, compare favorably with
those of Blue Cross and Blue Shield.
The National Federation of Post Office Clerks has a self-insured union plan operating
in 7,500 cities and towns across the country. It provides maternity cash Indemnity
hospital benefits for members and wives of members.

Maternity Benefit Provisions

(3) One of several employee organization plans, such as the health
plans of the National Association of Letter Carriers and the National
Federation of Post Office Clerks; and
(4) A comprehensive medical plan, which may be either a grouppractice prepayment plan (such as the Kaiser Foundation Health Plan
in California and the Group Health Association plan in Washington,
D.C.), or an individual-practice prepayment plan (such as the Group
Health Insurance Plan in New York).
The Government-wide service benefit plan and the Government-wide
indemnity benefit plan include two levels of benefits, between which
employees may choose. Thus, those already protected under plans of
the types described are able to continue health protection with the
Government meeting part of the cost.
The Civil Service Commission, which administers the program, has
authority to execute contracts with the Government-wide service
plan and indemnity plan carriers, and to make contracts or enter into
agreements regarding the other types of plans. Publication of the
benefits provided under the various plans is scheduled for May 1960.
Contracts are between the Commission and carriers for at least a
year and, unless either party gives notice of termination, are auto
matically renewable. However, premium rates may be readjusted
on the basis either of past experience or of adjustments in benefits.
The Government’s contribution to the subscription charge for each
enrolled employee is either 50 percent of the charge or an amount
prescribed by the Commission, whichever is less. The approximate
maximum biweekly amounts the Government can contribute are: $1.82
for a self-only enrollment; $4.42 for a family enrollment; and $2.60
for a family enrollment which includes a nondependent husband.
Further, law and regulations provide in varying degree for other
sharing of the cost of medical benefits, including obstetrical benefits,
in specific Federal agencies, as follows.
Foreign Service Personnel

The Foreign Service Act of 1946 provides for medical care of over
seas personnel (including 27,000 women) of the Departments of State
and Agriculture, International Cooperation Administration, and
United States Information Agency. Effective 1958, an amendment
provided for the inclusion of dependents. The Act is administered
by the Secretary of State. Under regulations of the Department
of State, obstetrical care except in the case of certain complications
is specifically excluded. However, obstetrical care may be obtained at

for Employed Women

United States Government hospital facilities, when these are available
in the area, at less cost than at most private facilities.
U.S. Public Health Service

Nurses and women physicians in the Commissioned Corps of the
Public Health Service and the wives of male physicians are eligible
for full maternity care at Government expense under the Medicare
Program that serves members of the Armed Forces.
The restrictions that govern members of the Armed Forces regard
ing marriage, pregnancy, and support of dependents, however, do
not apply in peace time to the commissioned nurses and women doctors
of the Public Health Service. On Presidential declaration at the
time of a national emergency, these officers become part of the Armed
Forces.
Tennessee Valley Authority24

TVA, a corporation of the United States and an independent Gov
ernment agency, has broad powers to fix the compensation of its
employees and negotiates matters affecting compensation and fringe
benefits with its employee organizations on the basis of practices
prevailing in the area.
A health program has been in effect at TVA since 1946. To make
it possible for employees in small work-units and isolated locations
to participate, and to decrease the administrative costs of the existing
voluntary collection system, payroll deductions were inaugurated in
1949. Since 1955 separate medical insurance plans have been nego
tiated for the salary employees, represented by a panel of five whitecollar unions, and for the trades and labor employees, represented
by the Tennessee Valley Trades and Labor Council composed of 15
craft unions.
Salary employees are covered by a basic plan, the cost of which
is borne 50-50 by the employee and TVA. The cost of major medi
cal coverage is borne by the employee alone.
Trades and labor employees are insured with a commercial carrier.
The TVA contribution is not a given percentage but is renegotiated
once a year on the basis of an area wage survey.
TVA employs over 1,400 women, and the two health benefits plans
provide obstetrical benefits for both workers and dependents. Under21 * *
21 Hearings before the Subcommittee on Insurance of the Committee on Post Office and
Civil Service on S.94. U.S. Stenate, 86th Cong., 1st sess., Apr. 15, 16, 21, 23, 28, 30,
1959. Washington, D.C., 1959, pp. 233-242 ; 36-37.

Maternity Benefit Provisions

the salary employees’ plan, the benefits are those of Blue Cross and
Blue Shield in Alabama, Kentucky, and Tennessee. The trades and
labor employees’ plan provides obstetrical benefits in a lump sum:
Normal delivery, $150; caesarean section, $200; miscarriage, $75.
Federal Deposit Insurance Corporation24 *

FDIC, also a corporation and independent Government agency,
meets its expenses from the earnings of the Corporation. Its insurance
plan is underwritten by Health Service, Inc., involves Blue Cross and
Blue Shield, and provides obstetrical care. FDIC pays the full cost
of the premiums for the employees. Under the family plan, the
employee pays the difference between individual coverage for the
employee and coverage for the family.
Maternity Care for Women in the Armed Forces'"

There are about 32,000 women in the Armed Forces of the United
States as members of the Army, Navy, Marine Corps, Air Force and
Coast Guard. While married women except for Reserves, and in most
cases women with dependents under 18 years of age, are not accepted
as recruits in the Armed Forces, they may marry when they have
completed their basic training. Half of the women in the Army Nurse
Corps, for instance, are married. Women who become pregnant,
however, are separated from the services.26
Women w’ho are pregnant at the time of separation from the Armed
Forces, whether separation was because of pregnancy or for another
reason, are eligible for maternity care at Government expense. This
care includes prenatal care; hospitalization; confinement; postnatal
care either in a hospital or as an outpatient for 6 weeks following
delivery; and care for newborn infants while the mother is a patient
in the medical treatment facility.
24 See footnote on p. 29.
22 See Department of the Army, Headquarters, Army Regulations, No. 601-124, “Per
sonnel Procurement,” January 1958 : No. 601-139, “Personnel Procurement,” July 1959 ;
No. 40-108, “Medical Service,” May 1959 ; No. 140-101, Army Reserve, October 1956 ;
and Department of the Navy, Manual of the Medical Department, U.S. Navy, Chapter
21—20, “Former Members.”
26 There may be exceptions. For example, women on overseas naval duty who become
pregnant are ordinarily returned to the continental United States by the first suitable
means of transportation for separation from the service; if, however, the woman’s or
child’s health would be endangered by such transportation, full medical care is provided
overseas until both she and her infant are fit to travel, are returned to the United States
and the mother separated from the service.

for Employed Women

Maternity Care for Dependents of Men in the Armed Forces31

Some 98,000 women workers (in 1958) had husbands who were in
the Armed Forces and absent from home.27
28 An indeterminable ad
ditional number of women workers are wives of servicemen who are
stationed where they can live at home. These wives may or may not
have maternity care benefits available to them in their own right as
workers. They have full maternity care available in Medicare by
virtue of their husbands’ service in the Army, Navy, Marine Corps,
Air Force, and Coast Guard.29
The Medicare program utilizes both military and civilian medical
facilities. The civilian facilities are made available through private
insurance carriers, Blue Cross, Blue Shield, and arrangements with
State Medical Societies. The maternity patient pays part of the hos
pital costs—a total of $25, or $1.75 per hospital day, whichever is
greater; or pays $15 if the child is delivered at home. The patient
also pays part or all the difference between the cost of a semiprivate
and private room, depending on whether a private room is prescribed
or simply a convenience. She also pays the first $100 plus 25 percent
of charges over $100 for private-duty nursing ordered by the physi
cian, and pays for such items as baby name wrist bands, photographs,
or footprints for identification. The Medicare program pays all other
costs.
There were 259,600 births under Medicare in fiscal 1958—95,200 in
Service hospitals, 164,400 in civilian hospitals. Maternity cases repre
sented over 55 percent of all Medicare cases whose care was completed
in that fiscal year. The average cost of 159,148 normal deliveries in
civilian facilities was $308 to the Government ($184 for physicians’
services, $124 for hospitalization) and $26 to the patient.30 The
average length of the hospital stay was 5.1 days.
27 See: Department of Defense-Department of Health, Education, and Welfare Joint
Directive for Implementation of the Dependents’ Medical Care Act (P.L. 569, 84th Cong.),
Reprint 6010.4 incorporating changes through Sept. 16, 1958, Washington, D.C. See also
First and Second Annual Reports Dependent’s Medical Care Program, prepared bv the staff
of the Office for Dependents’ Medical Care, Department of Defense, June 1, 1908 and June
1,1959 respectively.
28U-S. Department of Commerce, Bureau of the Census, Current Population Reports,
Labor Force, Series P-50, No. 87, Marital and Family Characteristics of Workers, March
1958. January 1959.
28 For history of events leading up to the Medicare program see The Army Almanac, Rev.
ed. Harrisburg, Pa., Stackpole, Jan. 1959.
30 The Second Annual Report, Dependents’ Medical Care Program, June 1, 1959, contains
“the first extensive data on the actual cost of hospitalized illness.”

Maternity Benefit Provisions

State Laws and Regulations
State Laws Prohibiting Employment

Six States have laws originally enacted 40 to 50 years ago that pro
hibit the employment of women for specified periods before and after
childbirth.
childbirth

Connecticut-.4 weeks---Massachusetts 4 weeks—
Missouri____ ____ ____________________ ______ 3 weeks--New York ___________________________________________
Vermont 2 weeks---------------------------------------------------------Washington:
In manufacturing, food processing and fresh fruit
and vegetable packing industries__________ 4 months-_
In laundry, dry cleaning and dye works
industry 4 weeks--------------------------------------------------

childbirth

4 weeks
4 weeks
3 weeks
4 weeks
4 weeks
6 weeks.

4 weeks.

Puerto Rico prohibits employment 4 weeks before and 4 weeks
after childbirth. Employers must also pay maternity benefits amount
ing to one-half of regular salary or wage during that period. An
extension of 4 weeks’ leave without compensation is allowed on
presentation of a medical certificate, and a woman’s job must be kept
open for her.
Slate Temporary Disability Insurance Laws31

Four States—California, New Jersey, New York, and Rhode Is
land—have provided for temporary disability insurance, or cash sick
ness compensation. Only in Rhode Island, however, are pregnancy
benefits an integral part of the disability insurance program. No
pregnancy benefits are paid in New Jersey; California provides such
benefits only to the extent that the disability exists more than 28 days
after the termination of 'pregnancy; and New York permits payment
only after the return to covered employment for at least two
consecutive weeks following termination of pregnancy.
The Rhode Island Law

The Rhode Island Cash Sickness Compensation Act (passed in
1942; effective April 1943) was the first compulsory system of compen
sation for wage loss due to nonwork connected disability to be enacted
in this country.
The original law made no reference to pregnancy. It was sometimes
contended, therefore, that claims based on pi’egnancy should have been
81 Information on State temporary disability insurance laws, particularly the Rhode
Island Cash Sickness Compensation Act, is from the following publications of the Bureau
of Employment Security, U.S. Department of Labor: (1) Rhode Island Disability Insur
ance Program, July 1954; (2) Significant Temporary Disability Insurance Data, 1957;
(3) Comparison of Temporary Disability Insurance Laws, December 1958. For Rhode
Island’s experience under its Cash Sickness Compensation Act, see especially (1).

for Employed Women

denied on the grounds that, medically speaking, pregnancy is not a
disease but a normal physiological condition. The temporary disa
bility insurance statutory definition of “sickness,” however, was not
a medical one. Section 2(13) of the original law defined sickness as
follows:
“(13) ‘Sickness.’ An individual shall be deemed to be sick in any
week in which, because of his physical or mental condition, he is un
able to perform any services for wages.” This provision has been
amended, but the italicized language has not been changed. The
agency interpretation and ruling that pregnancy is compensable as a
physical condition making the individual unable to work has, in effect,
been upheld by subsequent legislation placing limitations on payments
for pregnancy—limitations imposed primarily because pregnancy
benefits were the major single factor in benefit costs, threatening the
solvency of the Temporary Disability Insurance Fund.
The first specific restriction, added in 1916, reduced the period of
payments from a maximum of 20-plus weeks to a maximum of 15
weeks for an uncomplicated pregnancy. Those weeks, however, could
be drawn at any time during the pregnancy, provided that the woman
was not working. Under the uniform base-period and benefit-year
provisions in effect prior to 1950, wage credits might remain available
for a long time after the termination of employment.
Further, in the interest of maintaining the Temporary Disability
Insurance Fund on a self-sustaining basis, several changes were
effected in the law in 1950 and 1951. Maximum duration of the
benefit period for an uncomplicated pregnancy was decreased to 12
weeks; minimum qualifying wages were increased; and wage credits
were based on an individual base period and benefit year, substantially
shortening the length of time wage credits remain available after
termination of employment. Moreover, if there is evidence of with
drawal from the labor market, particularly before the pregnancy is
apparent, the woman is disqualified.
Some 4,900 claimants for maternity benefits—16 percent of all
claimants for disability benefits—had qualifying wage credits in
1951. Information on the number who actually received benefits, and
the amounts of those benefits, is not available.
From the beginning, the temporary disability insurance program
lias been administered in coordination with the unemployment insur
ance program. The present administrative agency is the Rhode
Island Department of Employment Security.
The temporary disability insurance law covers the same workers
as the unemployment insurance law—those of employers with one or

Maternity Benefit Provisions

more workers at any time. Excluded from compulsory coverage are
workers in domestic service, agriculture, Government and certain non
profit employments. State workers are included; local govern
ment and other excluded businesses may elect coverage. Qualifying
employment or wages are 20 weeks in which weekly earnings are at
least $20, or $1,200 earned in the course of the base year.
Duration of pregnancy claims is limited to 12 consecutive weeks,
to begin 6 weeks before expected childbirth and to end not more than
6 weeks following childbirth, except for unusual complications.
No waiting period is required in pregnancy claims. Medical cer
tification by a licensed physician is required for all initial claims,
which must be filed by mail with the disability insurance division in
Providence.
An important factor in the Rhode Island disability insurance pro
gram is the large proportion of women among the workers in that
State. In 1954 it was estimated that 40 percent of the workers cov
ered by the program were women. In June 1957, the State of Rhode
Island Employment Bulletin reported, “Although the number of
women workers in this State is at the lowest level in many months . . .
the statewide percentage of female help remains one of the highest
in the nation.”
State Provisions for Their Own Employees 32
Maternity Leave

Most of the States permit the use of annual and sick leave for
pregnancy, and leave without pay may also be granted. Practices
vary among States, and vary within States except where comprehen
sive civil service programs or merit rating systems covering most or
large segments of the employees have been established. By 1958, at
least 28 States (compared with 22 a decade ago) had such compre
hensive merit systems, either through provisions in their State consti
tutions or by acts of their legislatures. States which did not have such
comprehensive systems in operation covered at least those employees
engaged in employment security programs and programs financed in
part by Federal grants-in-aid.
Twenty-one of the 22 States with comprehensive merit systems pro
vide 12 to 15 days of annual leave after one year of employment. In
32 See The Book of the States for the years 1948-49 through 1958-59, Chicago. The
Council of State Governments, 1948 through 1958 ; “Section IV, Administrative Organiza
tion, 2. Personnel Systems;’’ William G. Torpey, Public Personnel Management, D. Van
Nostrand Co., Inc., New York, N.Y., 1953, p. 95 ; O. Glenn Stahl, Public Personnel Ad
ministration, New York, N.Y., Harper and Bros., 1956, pp. 406—408, p. 398 ; Norman J.
Powell, Personnel Administration in Government, Edgewood Cliff, N.J., Prentice-Hall, Inc.,
1956, pp. 314-316.

for Employed Women

18 States, including five which provide 10 days or less of annual leave,
allowances increase with length of service. Sick leave is usually
earned at the rate of 13 days a year and may be accumulated.
Most States do not in their laws refer specifically to maternity leave.
One State, New York, that does, provides:33
“1. Maternity Leave:
A pregnant employee bolding a position by permanent appointment shall be
granted a leave of absence without pay for a period of six months which may
be extended by the appointing authority up to one year.
The employee shall report to the appointing authority the existence of preg
nancy not later than the end of the fourth month.
The appointing authority may thereafter place the employee on leave at any
time when in its judgment, the interest of either the department or the employee
would be best served by such action.
The employee may be allowed to reduce the six month period of leave without
pay by the use of any or all earned credits.
A physician’s statement as to the fitness of the employee for the performance
of her duties may be required at any time before her leave commences, and may
be required prior to her return to duty.”

Maternity Care

The idea of Government as employer contributing to the cost of em
ployee group health insurance (which customarily covers maternity
care) is rapidly taking hold (see footnote 32). In late 1957, only 8
States, Hawaii, Guam, and the Virgin Islands, made no provision for
employee health insurance (see footnote 32). The remaining States
and Puerto Rico have made hospital insurance, or medical or surgical
insurance, or both, available to at least some group of their employees.
A number of jurisdictions have assumed the cost of deducting pre
miums from pay rolls.
Of the 28 States with general merit system coverage, one provides
for hospital insurance only, and 23 and Puerto Rico provide for both
hospital and medical or surgical insurance. Most interestingly,
four of these States (compared with only one State two years previ
ously) pay all or part of the cost of both types of coverage; Puerto
Rico, of hospital coverage (see footnote 32).
One of the most recent State-supported health insurance programs
for State employees to go into effect is that of New York, on December
5, 1957.34 The program provides what is known as the statewide
plan but also offers employees in certain down-state counties the op
33 McKinney's Consolidated Laws of New York, Annotated, Book 9, Civil Service Law,
“Attendance Rules for employees in New York State Departments and Institutions, as
amended to August 5, 1959/’ Rule 3. Leaves without pay, p. 488.
34 State of New York, Laws of 1956, Chap. 461.

Maternity Benefit^Provisions

tion of two other plans in which many were already enrolled—the
Health Insurance Plan of Greater New York (HIP) and Group
Health, Inc. (GUI) .36
Maternity Care for New York State Employees

1. The statewide flan.—For this plan, contracts were made with
Blue Cross for hospital benefits, with Blue Shield for surgical and in
hospital medical benefits, and with a commercial insurance company
for major medical expense benefits. (Blue Cross, as a matter of fact,
also provides the hospital benefits under the two optional plans.) The
maternity benefits provided under the statewide plan are as follows:
Hospitalization.—The maximum basic allowances are:
Routine delivery-----------------------------------------------------------------------$75.00
Caesarean section-------------------------------------------------------------------- 87 • 50
Ectopic pregnancy-----------------------------------------------------------------Miscarriage ----------------------------------------------------- --------------------- 25.00

In obstetrical cases other than those mentioned above, and where severe
medical or surgical complications occur, hospitalization up to 120 days
is available.
Surgical and In-Hospital Medical Care—The maximum basic
allowances are the same in amount as those listed above for hospitaliza
tion. That is, the total available for hospitalization and for surgical
and in-hospital medical care in the case of a routine delivery is $150,
in the case of a caesarean section, $175, etc. In-hospital medical care
of the newborn is not provided.
An employee or dependent wife selects her own doctor. If he has
entered into an agreement with Blue Shield, he will accept the schedule
of allowances as full payment, provided the individual patient’s in
come is not more than $4,000, or the individual’s and his dependent’s
income is not more than $6,000. If incomes are higher, or if the doctor
has not entered into an agreement with Blue Shield, charges may be
greater and the patient is responsible for the difference.
Major Medical Expense Care.—In the case of severe medical or
surgical complications arising out of a pregnancy, major medical
expense benefits are available after Blue Cross-Blue Shield benefits
have been exhausted. The patient pays an initial $50 “deductible”;
the plan then pays 80 percent of the remaining expenses, but not more
than $7,500 in any one calendar year or $15,000 in a lifetime. The
* For detail of these plana see : State of New York Department of Labor, Industrial
Bulletin, May 1959, pp. 12-19; U.S. Department of Health, Education and Welfare,
Public Health Service, Public Health Reports April 1959, pp 341-347; Health Insurance
for Employees of Local Subdivisions in New York State, booklet published for use of
affected employees.

for Employed Women

benefits provided include hospitalization, surgery, private duty
nursing, X-rays, pharmaceuticals, blood transfusions, etc.
2. The optional Gill flan
Hospitalization.—The benefits are the same as those provided
under the statewide plan.
Surgical and Medical Care.—Benefits include full prenatal care,
delivery, and postpartum care of mother and child. Care is provided
in the physician’s office, the hospital, or the patient’s home.
A patient chooses her own “family doctor.” If he is a partici
pating physician—one who has entered into agreement with GHI—
he accepts the GHI schedule of allowances for medical and surgical
care in the hospital, regardless of the patient’s income, provided the
patient uses semiprivate or ward accommodations. The doctor also
accepts as full payment the GHI schedule of allowances for maternity
care rendered in his office or the patient’s home. Nonparticipating
physicians may charge additional amounts, and the patient is respon
sible for the difference. The following payments for medical and
surgical care in the hospital are made to any doctor:
Normal delivery $125
Caesarean section 200
Ectopic pregnancy 175
Miscarriage
75

Examples of other payments are: first office visit, $4.00; subse
quent visits, $3.00; home visits, $5.00.
3. The optional HIP plan.—Hospitalization benefits under the
Health Insurance Plan of Greater New York are the same as those
provided under the statewide plan. Medical and surgical care are
provided through 32 medical groups consisting of family doctors and
specialists. The enrollee first chooses one of the HIP medical groups
serving the area in which she lives and then chooses one of the family
doctors in the medical group as her personal physician. Care is
given at home, at doctor’s offices, at medical group centers, and in
hospitals. There is no limit to the number of doctors’ visits nor to
the amount of medical care provided, including general health check
ups, laboratory tests, visiting (but not private-duty) nurse services,
and private ambulance transportation. There is no exchange of
money between patient and doctor.
Under the statewide plan, an employee pays half the premium for
his or her own protection and 65 percent of the premium for depend
ents’ protection; the State pays the rest. (For the contract year
April 1, 1959-March 31, 1960, individual coverage costs the employee
$3.08 a month; family coverage, $9.46.) Coverage costs more under

Maternity Benefit Provisions

GHI and HIP and, since the State’s contribution is the same under
these plans as under the statewide plan, the employee’s cost is
necessarily somewhat higher under the two options.
At the end of 1958, premiums were being paid for 84,000 employees
and their dependents, or a total of over 200,000 persons. When later
employees of the State’s “contract” colleges were included, 2,600 more
people were added, plus their dependents.
State Laws Disqualifying Unemployed Pregnant Women For
Unemployment Insurance Benefits

The District of Columbia and 35 States (14 more than in 1949)
have special statutory provisions that either disqualify an unemployed
pregnant woman for unemployment insurance benefits or consider her
unavailable for employment.36 In restriction of benefit rights, there
is no distinction between the two types of provisions.
Disqualification is for a definite period in some States, ranging from
4 weeks before and 4 weeks after childbirth to 4 months before and
2 months after childbirth. In other States the period is indefinite,
e.g., “duration of unemployment due to pregnancy,” or until reem
ployed for a specified period or at specified wages.

Local Community Provisions for Their Own Employees
Maternity Leave

Information on maternity leave provisions in local government
units was obtained only for teachers.37
As long as a decade ago, national educators found, “In recent years
the difficulty of obtaining qualified teaching personnel has led a num
ber of local school systems to abandon rulings against the employment
of married women as regular teachers. These school systems are,
therefore, finding it necessary to establish definite policies with re
spect to maternity leave.”
30 As of October 10, 1959. See U.S. Department of Labor, Bureau of Employment
Security, Comparison of State Unemployment Insurance Laws as of January 1, 1958,
Washington, D.C., 1958, and Supplements thereto. The 15 States that have no legislative
provisions of this type are: Alabama, Arizona, California, Florida, Georgia, Iowa, Ken
tucky, New Jersey, New Mexico, New York, Khode Island, South Carolina, Texas, Virginia,
and Wyoming.
37 National Education Association of the United States, Special Memo: Teacher Per
sonnel Practice, Urban School Districts, 1055-56, Washington, D.C., The National Edu
cation Association, 1956. American Association of School Administrators and Research
Division of the National Education Association, Educational Research Service Circular
No. 6, 1948: Maternity-Leave Provisions in 157 School Systems in Cities over 50,000 in
Population, Washington, D.C., August 1948.

for Employed Women

Among teachers, as among all employed women, the number who
are married has continued to increase. Over two-thirds of urban
school districts in 1956 (as compared with 5 percent in 1941) gave no
preference in hiring to single women over married women teachers.
Women who married in service continued in service on the same basis
as single women in 97 percent of these school districts (as compared
with 75 percent prior to 1951).
Two-thirds of the urban school districts in 1956 granted maternity
leave. The size of the community had a direct bearing on maternity
leave policy. The proportion of districts granting such leave ranged
from all in large urban cities down to 61 percent in the smallest com
munities reporting.
Actual leave provisions, investigated earlier in cities of over 30,000
population, varied considerably. Only about three-fourths of the
school systems had definite policies regarding leave before childbirth,
and about the same proportion had definite provisions on leave after
the child was born.
Provisions for leave before childbirth ranged from “immediately
upon becoming aware of pregnancy,” to 7 months. Eighty percent
of the school systems agreed on 4 to 6 months, most often 5 months.
Several school systems allowed a teacher to return after the birth
of her child on a physician’s advice or at her own discretion. Among
the systems that set definite time periods, 7 weeks was the earliest
date at which return was permitted: more than half required that the
child must be at least a year old; some, 3 years old.
About half the systems reported that if an employee’s former posi
tion were not open upon her return, she would be placed at the level
for which she qualified as soon as a suitable vacancy occurred.
Maternity Care

The idea of government as employer contributing to employee
health insurance has been taking hold, particularly among municipali
ties. (See footnote 32.) Both New York City and San Francisco
have comprehensive programs for their employees, that for San Fran
cisco being compulsory. The New York City (HIP) includes person
nel in the public school system.
A 1958 amendment to the law establishing New York’s statewide
plan for health insurance of State employees permitted local gov
ernment subdivisions also to participate. By February 1, 1959, 24
local government applications had been approved. Other States also
make health insurance available to local governments.

Maternity Benefit Provisions

In certain areas, particularly in the West, local government units
have made other provisions for their employees. In California, for
instance, various cities and counties in the Bay Area have provided
their employees a choice of the Kaiser Foundation Health plan or
an optional plan.38
Elsewhere cities and towns have banded together to provide pro
tection for their employees at rates more favorable than would be
available on an individual city basis: In Oregon, where there are
only three cities with a population of 25,000 or over, the League of
Oregon Cities established an insurance trust and in September 1958
inaugurated a group insurance program.39 The plan includes medical,
surgical, hospital, and major medical expense insurance. Benefits for
maternity care, provided only under two-person and family
agreements, are:
Hospital

Doctor

Normal delivery $75-------------------------------------------------------------Caesarean section $75-----------------------------------------------------------Ectopic pregnancy Regular
service benefits

$50
150
150

Benefits are available immediately in the event of an ectopic preg
nancy, otherwise after 9 months’ enrollment under the plan.
The total monthly premium rate is $5.60 for employees, plus an
additional $7.65 for the first dependent or $11.65 for two or more
dependents. The League requires the employing city to pay all or
a substantial share of the premium for the employee’s coverage. In
the spring of 1959, the plan covered 279 employees in 10 cities, all but
one of which paid the full premium for their employees’ coverage;
in the tenth, the employees worked on the city’s railroad and the con
tribution, by union agreement, varied between employees.
Similar group insurance arrangements are known to have been
made by the Municipal Leagues of Arkansas, Colorado, Idaho, Ken
tucky, Louisiana, and Utah.

Federal-State-Local Provisions for Health and Maternity
Protection as a Public Service
We have seen the range of laws and regulations that provide mater
nity cash benefits in lieu of wages, or maternity medical care, or both
«* Health Insurance Program for Federal Employees: Hearings before Subcommittee on
Insurance of the Committee on Post Office and Civil Service, United States Senate, 86th
Cong., 1st Seas., on S. 94. April 15, 16, 21, 23, 28, and 30, 1959, pp. 208-210.
» Joseph Zisman, The Employee Benefit Plan of the League of Oregon Cities, Research
and Statistics Note No. 11-1959. U.S. Department of Health, Education, and Welfare,
Social Security Administration, Division of Program Research, April 23, 1959.

for Employed Women

for many women workers in their status as workers or as wives of
workers.
However, Federal, State and local governments also provide health
services including maternal health protection on a large scale for
women workers as a service to the pvMic. These provisions include
(1) measures for the general public health, (2) measures for the
general maternal health, and (3) direct maternal medical care.
Recipients of direct Federal, State and local maternity medical care
include the needy (those on public relief rolls) and the medically
needy (those who can manage to meet daily expenses but not the high
cost of medical care) .40 Facilities providing such services frequently
classify patients as full-pay, part-pay, or indigent, depending on in
come and family size. Costs to the medically needy are often scaled
to family income.
Included among women who are or become medically needy are
Aveekly wage workers in plants which have not elected to be covered
by a health insurance plan. Many are day workers in homes to whom
industrial health and insurance plans are not accessible. They in
clude agricultural workers and many part-time workers. While
these women could participate in voluntary health insurance plans,
they usually have no maternity protection, either in the form of partcompensation for wages lost or against the costs of medical care,
other than that provided by government.
Public General Health Services

The last 30 years have seen a very great expansion in Federal, State,
and local provisions for the public health. These have both been
brought about by, and have helped bring about, our rising standard of
living, improved standards of sanitation, the conquest and control
of epidemics and disease, the high caliber of our medical care, the
introduction of antibiotics and other “miracle” drugs, and increased
and better hospital and related facilities.
These measures have greatly heightened the healthfulness of our
environment and the level of the Nation’s health, and with them the
level of maternal health. The United States, instead of having one
40 S<ee Bernhard J. Stern, Medical Services by Government: Local, State and Federal,
New York, The Commonwealth Fund, 1946; Milton Terris, “Medical Care for the Needy
and Medically Needy,” in The Annals of the American Academy of Political and Social
Sciences,” Vol. 273, Jan. 1951.

Maternity Benefit Provisions

of the highest maternal mortality rates, as it did 30 years ago, now has
one of the very lowest.41
On the Federal level, the Public Health Service is the agency
charged with responsibilities for protecting and improving the health
of the Nation’s people.42 In fiscal 1958 the Service expended
$613,720,000 (including $174 million in aid to States) to conduct and
support research and training, to provide medical and hospital serv
ices, to aid in the development of hospitals and community health
services, to prevent and control disease, etc.
Public Maternal Health Services

Specific responsibilities for maternal and child health are lodged,
on the Federal level, in the Children’s Bureau of the U.S. Department
of Health, Education, and Welfare.43 Included in these responsibil
ities is administration—under title Y, part 1, of the Social Security
Act—of grants to State health agencies for extending and improving
maternal and child health services. Services for which State agencies
use these funds include maternity medical clinics and maternity nurs
ing services for prenatal and postnatal care of mothers; also hospital
in-patient maternity service, dental treatment for pregnant women,
and the inspection and licensing of hospital maternity services. Ma
ternal and child health services also include well-child conferences for
infants and children, child health nursing service, and immunization
programs. Not all these services are provided in all States, however,
as the accompanying table shows.
41 Information was available for 26 countries In 1929-31: Australia, Belgium, Canada,
Ceylon, Chile, Denmark, England and Wales, Estonia, France, Germany, Hungary, North
ern Ireland, Irish Free State, Italy, Japan, Mexico, Netherlands, New Zealand (excluding
Maoris), Norway, Palestine, Scotland, Sweden, Switzerland, Union of South Africa
(Europeans), United States, Uruguay; of these, only Ceylon and Chile had a higher
maternal mortality rate (deaths per 1,000 live births) than the United States. Jacob
Yerushalmy, “Infant and Maternal Mortality in the Modern World,” in The Annals of the
American Academy of Political and Social Sciences, Jan. 1945, pages 134-141. Data for
1957 from U.S. Department of Health, Education, and Welfare, Children’s Bureau.
Health Information Foundation, Progress in Health Services, “Advances in Maternal
Health,” Vol. VII, No. 9, Nov. 1958.
42 For pertinent legislation, see U.S. Government Organization Manual, 1958—59, Wash
ington, D.C. For activities of Public Health Service, see U.S. Department of Health,
Education and Welfare, 1958 Annual Report, Washington 2i5, D.C., pp. 83-151.
43 For pertinent legislation, see U.S. Government Organization Manual, 1958—59, Wash
ington 25, D.C. For activities of the Children’s Bureau, see U.S. Department of Health,
Education, and Welfare, 1958 Annual Report, pp. 53-69.

for Employed Women

Type of service

Maternity medical clinic service
35
Maternity nursing service
53
Dental treatment during pregnancy
12
Hospital in-patient care
13

43
Number of
States
providing
service

Number of
mothers
receiving
service

240,630
446,843
3,583
39,562

Source: Maternal and Child Health Services, 1957. Children’s Bureau, U.S. Depart
ment of Health, Education, and Welfare, Statistical Series No. 53. 1959.

Expenditures for the maternal and child health services program,
1956-57, were $64.6 million—with $15.7 million contributed by the
Federal Government, and $48.9 million in matching funds by State
and local governments.44 In 1958, the Federal appropriation was
raised from $16.5 million to $21.5 million. These funds are used to
extend and improve health services for mothers and children. No
cash payments are made to individuals under this program.
Other Children’s Bureau responsibilities for maternal care—the
costs of which are included in overall Children’s Bureau expendi
tures—include medical consultation service to State agencies; a
clearing-house of research; and publications on prenatal care which
are of inestimable value to women everywhere.
Every State makes special provisions for the health of mothers and
children, as do most cities.45 Federal grants-in-aid to State agencies
are allocated to local units; the ultimate application of medical care
services is local.
Local facilities are, however, also operated by Federal or State
agencies. Examples are the U.S. Public Health Service’s operation
of Freedmen’s hospital, where a record 3,227 births took place in 1958
without a single maternal death; the Service’s provisions for Indian
mothers;46 and its recently launched 5-year study of 40,000 pregnant
women and their children in which the National Institutes of Health
and 16 medical centers throughout the country are cooperating.
On the State level, almost all States provide, or subsidize local
agencies to provide, direct maternity clinic services. At least half the
States provide hospital delivery services; some provide home delivery
services. State university hospitals are used to furnish much of the
clinical and hospital care.
44 U.S. Department of Health, Education, and Welfare, Social Security Bulletin, Annual
Statistical Supplement, 1957, p. 13.
46 U.S. Department of Health, Education, and Welfare, Distribution of Health Services
in the Structure of State Government, 1950, Washington, 25 D.C., 1954, p. 209.
46 U.S. Department of Health, Education, and Welfare, 1958 Annual Report, pp. Ill,

Maternity BenefitIProvisions

The practice of midwifery continues in some States because of the
inability of many patients to afford physicians’ services; in others
because of an inadequate number of physicians in the area; and occa
sionally as a preferred traditional practice.47 Another important
State function, therefore, in addition to licensure of hospitals and
other maternal medical facilities, is licensure of midwives.
« Distribution of Health Services in the Structure of State Ctovernment, 1950, pp. 217,
220.

In 1950, the number of midwives was steadily decreasing. A new trend is Indicated
by increased training and employment of nurse midwives, stimulated by a steady increase
in the annual number of births and no commensurate increase in the number of physicians.
Training programs, for which only registered nurses may qualify, usually run from 8
months to 1 year, and stress the clinical side of obstetrics—examination, history taking,
management of labor and delivery, and recognition of complications. Before 1953 there
were only three schools of nurse midwifery in the United States. In 1953 Johns Hopkins
became the first university teaching center in the United States to undertake nurse
midwife training, since then Columbia, Vale, and New York State University have insti
tuted nurse midwife curricula and other medical centers are making plans for them.
“Today nurse midwives are employed directly by hospitals, clinics, and individual
physicians.” Public Health Economics, Vol. 16, No. 8, Aug. 1959, pp. 390—392.

V
INTERNATIONAL STANDARDS FOR
MATERNITY PROTECTION
For perspective on the picture of maternity benefits for women
workers in the United States, it is useful to consider international
standards in the same field. In the United States, the approach has
been chiefly through voluntary health and insurance plans of various
types. Although limited groups of workers (including railroad work
ers, Government employees, and, in two States, employees of private
industry) are covered by legislative provisions, comprehensive cov
erage of all women workers through national legislation has not been
sought.
In most other countries, by contrast, the approach is primarily
legislative and administrative. A total of 59 countries (including
the United States) had established some kind of maternity insurance
or related program by 1958, usually as an integral part of health
insurance programs. This was twice the number of countries report
ing such provisions in 1940. The pattern for most of the maternity
protection programs is set by the Maternity Protection Convention
of the International Labor Organization.

The International Labor Organization Convention
The Maternity Protection Convention and accompanying Resolu
tion 48 adopted in 1952 by the International Labor Organization was
a revision of an earlier Convention, adopted at the first session of the
ILO in 1919. Prior to 1951, the Convention had been ratified by 18
countries.
The revised Convention is broader in scope and carries more ex
tensive provisions than the earlier one. It applies to women in indus
trial and commercial undertakings and also in nonindustrial and
agricultural occupations, and includes women wage earners working
at home. The provisions require that an employed woman shall have
“ Convention No. 103 concerning maternity protection (revised 1952) and Recoinmendation No. 95 concerning maternity protection.

Maternity Benefit Provisions

maternity leave for at least 12 weeks at the time of her confinement.
At least 6 weeks of this period shall follow the birth of her child.
During this maternity leave, she shall be entitled to cash and medical
benefits provided as a matter of right by social insurance or public
funds. She shall also be given time off from work to nurse her child
without any loss of wages. It shall be unlawful for the employer to
discharge her during her leave.
The Recommendation, which supplements the Convention, proposes
that the period of maternity leave should be lengthened to 14 weeks
when a woman’s health makes such an extension desirable. It also
suggests that the maternity benefit should be as high as the woman’s
earnings, that nursing breaks should total an hour and a half daily,
that seniority rights should be preserved during maternity leave, and
that pregnant and nursing women should be prohibited from work
which is prejudicial to health and from working overtime or at night.
The ILO Convention came into force in 1953 on ratification of the
required number of countries.49 Each country that has ratified the
Convention must report annually on progress made toward putting
the standards into effect. In addition, countries belonging to the
ILO that have not ratified the Convention may be requested at in
tervals to file special reports on laws and practices in relation to tire
standards established by the Convention.
The influence of the ILO Convention is undoubtedly much greater
than the number of ratifications would imply. By 1959, the minimum
period of maternity leave for women workers had been set at 12 weeks
(the ILO standard) in 30 countries, and the discharge of a woman
worker during maternity had been forbidden in 40 countries.

Maternity Protection in Other Countries
Maternity protection provisions are included in a report on social
security systems in 59 countries in 1958, published by the Social Se
curity Administration of the United States Department of Health,
Education, and Welfare.50 The following summary is based on that
report.
« By June 1959, Convention No. 103 had been ratified by seven countries : Byelorussia,
Cuba, Hungary, Ukraine, Uruguay, Union of Soviet Socialist Republics, and Yugoslavia.
00 Social Security Programs Throughout the World—1958. Washington, D.C., 1959.
The 59 countries included are: Albania, Argentina, Australia, Austria, Belgium, Bolivia,
Brazil, Bulgaria, Burma, Canada, Chile, China (Nationalist), China (Communist),
Colombia, Costa Rica, Cuba, Czechoslovakia, Denmark, Dominican Republic, Ecuador,
El Salvador, France, Germany (West), Germany (East), Greece, Guatemala, Honduras,
Hungary, Iceland, India, Iran, Iraq, Ireland, Israel, Italy, Japan, Libya, Luxembourg,
Mexico, Netherlands, New Zealand, Nicaragua Norway, Panama, Paraguay, Peru, Philip
pines, Poland, Portugal, Rumania, Spain, Sweden, Switzerland, Turkey, Union of Soviet
Socialist Republics, United Kingdom, United States of America, Venezuela, Yugoslavia.

for Employed Women

Types of Systems

The great majority of the national programs reported are social
insurance programs, under which both cash benefits and medical serv
ices are provided. These programs are financed in considerable meas
ure from special insurance contributions paid by employees, employ
ers, or both, and eligibility for benefits and services is normally linked
to payment of contributions or coverage in insured employment dur
ing a specified minimum period. Eligibility for medical services as
well as cash benefits under most of these programs is contingent upon
coverage under social insurance.
A somewhat different arrangement prevails in about a sixth of the
countries. In these, only cash benefits for maternity are provided
through social insurance. Medical services, in contrast, are furnished
by the government under a separate program to all residents, rather
than only to social insurance contributors. These programs, under
which a variety of medical services are furnished, in effect as a publ ic
service by the government, are in some countries referred to as a na
tional health service. A few countries provide cash benefits for wage
loss, but no medical-care services.
Coverage

The risks of income loss from maternity exist mainly for persons
working for the account of another. They are present to a much lesser
degree for self-employed persons working for their own account. The
coverage of nearly all of the cash benefit programs is limited to em
ployees in general, or to particular classes of employees. Some of the
newer systems apply only to employees of larger firms in industry,
commerce, and related branches. A few countries also exclude higher
paid salaried employees.
The provision of health and maternity benefits in some countries is
organized around membership in various types of mutual sickness
clubs, societies, or funds. Membership in such societies is usually
made compulsory for specified categories of employees. Members’
contributions are paid to the societies, which also receive government
subsidies and sometimes employer contributions as well. The societies
in turn provide benefits at levels which may not be below certain
statutory minimum standards.
Nearly a fifth of the countries are introducing their health and
maternity insurance systems gradually. Typically, benefits are first
provided in the capital city and perhaps certain other centers, and are
then gradually extended to other urban or rural areas. The pace of
the extension is usually controlled by the rapidity with which new

Maternity Benefit Provisions

clinics and hospitals can be financed and erected in different regions,
for the furnishing of medical benefits.
Source of Funds

In the large number of countries relying on social insurance, the
usual methods of financing this insurance are used also in the financing
of their health and maternity insurance programs. That is, a fixed
percentage of earnings is generally payable as a contribution by em
ployers and employees. These contributions go into a central fund
from which all benefits, including both cash and medical benefits, are
financed.
A majority of these countries also provide for some type of govern
ment contribution or subsidy to the social insurance system, so that
tripartite financing is numerically the most common arrangement.
There are, however, various other combinations of revenue sources.
Some countries use only employee and employer contributions. In
others, particularly where benefits are provided through mutual sick
ness societies, only employees and the government participate in the
financing. In contrast, certain countries rely on employer contribu
tions exclusively.
In most countries where medical care is provided to all residents,
by means of some type of national health service, the government
usually pays all or the greater part of the cost of this service.
A number of countries place a ceiling on the amount of earnings
on which an individual worker must pay contributions.
Cash Sickness Benefits

Cash sickness payments are paid under all but four of the pro
grams when women are prevented from working owing to pregnancy.
Four other programs provide only maternity but not other types of
cash sickness benefits. Under more than a third of the programs,
maternity cash sickness benefits are at a higher rate than other types
of cash sickness benefits, and under a third of the programs, they
are the same. The rates at which maternity benefits are paid are
almost always something less than full wages, although under about
a fifth of the programs they are 100 percent of wages. Most often
benefits range between 50 and 75 percent of wages.
Duration of benefits, however—that is, the number of weeks during
which benefits are payable—is almost always shorter in the case of
maternity cash sickness benefits than in the case of other types of
cash sickness benefits. For maternity benefits, the most common pro
vision is 12 weeks; for other sickness benefits, 26 weeks.

for Employed Women

To obtain maternity benefits, a woman must abstain from paid
work during the period that benefits are received, must suffer an actual
loss of wages, and usually must take advantage of the prenatal and
postnatal care provided by the system.
Medical Care Benefits

Most foreign social security programs that provide cash sickness
benefits provide medical benefits as well. It is possible in general to
distinguish three main patterns. Under one general method, insured
patients pay the bills of doctors, hospitals, druggists, and so forth,
themselves, and then later receive reimbursement from the social in
surance system. Under a second method, the social insurance system
pays the doctors and hospitals directly. The third general method,
used in some countries, is for the social insurance system to acquire
its own dispensaries, clinics, and hospitals, as well as its own medical
staff, and to provide services directly to the insured population it
covers.
Where medical benefits are provided in the form of reimbursement
for bills paid by the patient, or in the form of direct payments to
doctors and hospitals, the payment by the social insurance system
may cover the whole cost or only a part of the cost, e.g., 75 percent,
with the patient bearing the remaining part of the cost. Where medi
cal services are provided directly by the social insurance system or as
a public service, patients are sometimes required to pay a fixed fee
per visit or prescription, in addition.
Nearly all the programs that provide medical benefits for sickness
also provide prenatal care to working women covered by the insurance
system as well as obstetrical and postnatal care. The obstetrical care
may in some cases be limited to that furnished by a midwife, although
care by a doctor is usually available if required. In addition, care
in a maternity home or hospital is usually furnished where necessary,
as well as essential medicines.
Qualifying Conditions

Nearly all health and maternity insurance programs require that
claimants for cash benefits, in addition to being incapacitated, must
have completed some kind of a minimum qualifying period of con
tribution or insured employment. The length of the qualifying pe
riod for cash maternity benefits is usually somewhat longer than for
other cash benefits, ranging up to 10 months or more.
As regards medical care benefits, the qualifying period is also most
commonly longer for maternity than for other types of disability

Maternity Benefit Provisions

benefits. There is, of course, no qualifying period required under
those programs which furnish medical care as a public service.
Administration

The largest number of countries provide for the administration
of health and maternity insurance programs by some type of selfgoverning semi-autonomous institution, under government supervi
sion. Some of these institutions own and operate their own medical
facilities, through which at least a part of the medical benefits pro
vided under the program concerned are furnished.
In some countries, responsibility for most of the detailed admin
istration of the program is placed in the hands of a large number of
local or occupational sickness funds or societies, which workers are
required to join. These bodies collect contributions from their mem
bers, pay cash benefits, and also arrange for the furnishing of medical
care to their members, often through contracts with doctors and per
haps hospitals in the region. These smaller funds in a number of
countries are affiliated in turn with larger federations, which may
carry on various coordinating activities at the national level.
Health and maternity insurance programs in most of the remaining
countries are administered by government departments. Such admin
istration is often linked with that of other types of social security
benefits, the entire range of benefits being administered as a single
integrated program.

Full text of Maternity Benefit Provisions for Employed Women : Women's Bureau Bulletin, No. 272

FRASER