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STATE COLLEGE LIBRARY

MATERNITY
PROTECTION
of

EMPLOYED

WOMEN
Women’s Bureau
Bulletin No. 240

U. S. DEPARTMENT OF LABOR
MAURICE J. TOBIN, Secretary

Women’s Bureau
FRIEDA S. MILLER, Director

Washington : 1952




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MATERNITY PROTECTION
of
EMPLOYED WOMEN

Jvfcs G*

Bulletin of the Womens Bureau, No. 240

UNITED STATES DEPARTMENT OF LABOR




MAURICE J. TOBIN, Secretary

Womens Bureau
FRIEDA S. MILLER* Director

Washington : 1952

For sale by the Superintendent of Documents, U. S. Government Printing Office
Washington 25, D. C. - Price 20 cents




LETTER OF TRANSMITTAL
United States Department op Labor,
Women’s Bureau,

Washington, March 31, 1952.
Sir: I have the honor to transmit a report on maternity protection
of employed women. The 10,000,000 married women workers repre­
sent more than half of all women workers in the national labor force.
Their protection before and after childbirth involves not only their
status as workers and their standard of living as citizens, but the
health and well-being of themselves and their families and thus the
national health in years to come.
Part I of the present report deals with legislative and other provi­
sions in the United States. Its preparation involved a field study of
practices in 43 firms by representatives of the Women’s Bureau.
Part II contains an analysis of the ILO Maternity Convention of
1919, a proposed revision of which is on the agenda for consideration at
the 1952 session of the International Labor Conference in Geneva;
also a brief review of national legislation for maternity protection in
ratifying and nonratifying countries.
The field study was made and the report written by Ethel Erickson,
head of the Branch of Field Research, and Hazel Hansen in the
Bureau’s Division of Research, directed by Mary N. Hilton.
Respectfully submitted.
Frieda S. Miller, Director.
Hon. Maurice J. Tobin,
Secretary oj Labor.




hi




CONTENTS
Introduction______ ____________________________________________________________

Page
1

Summary________________________

2

I. Maternity Protection in the United States_____________
Federal legislation and regulations
Federal legislation for railroad employees___________________
Regulations for Federal employees
State legislation and regulations
Laws prohibiting employment of women before and after child­
birth■
Unemployment insurance laws.___________________________
Disability insurance laws
Provisions for State civil service employees_________________
Employer and union sponsorship
11
Types of maternity protection found in 43 firms_________________
Scope, administration, and financing
13
Cash benefits
15
Hospital benefits
15
Obstetrical benefits
20
Comprehensive medical care plans
22
Maternity leave________________________________________
Working conditions for pregnant women
30
Experience of 831 claimants for maternity benefits_______________
The claimants
32
The benefits
33
38
Need for further study
Part II. Maternity Protection Legislation in Foreign CountriesInternational Labor Organization Maternity Protection Convention..
National legislation in nonratifying member countries____________
Proposed Revision of ILO Maternity Convention_______________
Maternity Protection (Agriculture) Recommendation_____________
Statements on selected countries
43

5
5
5
6
6

Part




References

v

7
7
8
10

13

24
32

39

39

41
42
43
47

Maternity Protection of
Employed Women
INTRODUCTION
Maternity protection of employed women in the United States has
taken on increased significance with the increasing proportion of mar­
ried women in the labor force. More than one-half of the women in the
labor force are married. Women not in the labor force comprise the
largest reserve labor pool for emergency employment, and nearly threefourths of these are married. With the high marriage rate 'prevail­
ing at the present time, the birth rate may be expected to continue at
a high level for years, and problems relating to the employment of
pregnant women and maternity benefits will be of concern to employ­
ers, unions, and organizations interested in the welfare of employed
women.
Visitors from other countries ask, time and again, why the United
States, almost alone among the industrial countries of the world, has
no Federal law providing for a national system of maternity protec­
tion of its women workers.
Because of the interest in this subject, the Women’s Bureau recently
prepared an annotated bibliography of selected references dealing
with maternity protection.1 The present report outlines the legisla­
tion for maternity protection of employed women in the United States
and foreign countries; discusses the development of less formal plans
and standards in the United States, where there is little in the way of
legislation; and presents findings of a field study by the Women’s
Bureau from employers, unions, and insurance companies on mater­
nity benefits, maternity leave, and other special considerations for
pregnant employees.
The Women’s Bureau field study includes 43 firms having maternity
benefits. Of these firms, 30 are manufacturing and 13 are nonmanu­
facturing. Products of the manufacturing plants are textiles, hosiery,
hats, shoes, chemicals, pharmaceuticals, soaps, canned foods, candy,
photo-engraving, publishing, radios, electrical and metal goods. The
i V. S. Department of Labor. Women’s Bureau. Bibliography on Maternity Protection. September
1951. Mimeo D-2. 53 pp. + alphabetical index.




1

2

MATERNITY PROTECTION OF EMPLOYED WOMEN

13 nonmanufacturing firms include retail stores, hotels, restaurants,
banks, an insurance company, a public utility, and a union office.
The number of employees covered by the maternity protection and
benefit plans in these companies varies from less than 100 to more
than 80,000. The proportions of women range from 5 to 75 percent
of the total employment. In about one-half of the firms, women
comprised more than 40 percent of the employees. The number of
married women was not available in most companies, but most of the
manufacturing plants reporting estimated that at least one-half were
married; a few reported as many as two-thirds. In 7 nonmanufac­
turing firms, the proportion of married women varied from approxi­
mately 20 percent in an insurance company to over 60 percent in
restaurants.
About two-thirds of the 43 plants had collective bargaining systems.
Representatives of the firms and also, in many instances, representa­
tives of the unions were interviewed as to the policies relating to the
employment of pregnant women, maternity benefits provided, num­
ber of women leaving because of pregnancy, and number returning to
work after childbirth. The claim and benefit records of individual
women, wherever available, were obtained to learn about the actual
experiences of employed women as claimants for maternity benefits.
SUMMARY
Legislation for Maternity Protection in Foreign Countries

There are few countries where maternity protection has not been the
subject of general national legislation.
An international standard on maternity protection for women work­
ers in industrial and commercial undertakings was adopted by the
International Labor Organization at its first session in 1919. It was
the third convention adopted by the ILO. Since then 18 European
and Latin American countries have ratified the Maternity Protection
Convention and have enacted laws to carry out its directives. Most
of these countries ratified it before 1935. Many of the countries
that have not ratified, in Asia as well as in Europe and Latin America,
have adopted national legislation providing maternity protection
equaling some if not all of the requirements of the ILO Convention.
Most of the countries with maternity protection legislation include
maternity benefits for employees under their compulsory social
insurance systems.
Legislation for Maternity Protection in the United States

In the United States, the only national legislation giving industry­
wide benefits to pregnant employees is a 1946 amendment to the




INTKODTJCTION

3

Federal Railroad Unemployment Insurance Act that provides insur­
ance for sickness and specifically includes pregnancy and maternity
disabilities.
Rhode Island is the only one of the four States with sickness
compensation laws that allows benefits for disabilities attributable to
pregnancy.
Six States and Puerto Rico have legislation that prohibits employers
from “knowingly’' employing pregnant women for specified periods
before and/or after childbirth. Only the Territory of Puerto Rico
provides for weekly cash benefits, the provision being 8 weeks for
pregnant employees in any office, commercial or industrial establish­
ment, or in public utilities.
In almost one-half of the States, pregnancy disqualifies a woman for
unemployment insurance.
Maternity Protection in the United States through Employer and Union
Sponsorship

Maternity protection in the United States for employed women has
been achieved chiefly through industrial plans sponsored by employers
and organized labor rather than through legislation.
Maternity leaves of absence are provided in many union contracts
and, also, often are included in the personnel policies of unorganized
establishments. The maternity leave period is usually 1 year, with
job security and seniority retained for the leave period.
Industrial health-insurance plans have been growing in number and
an increasing number of these are including maternity benefits in
their coverage. Less than one-fourth of the 43 firms included in the
Women’s Bureau study have had maternity-benefit provisions for
more than 10 years, and more than one-fourth have had them for less
than 5 years. Some insurance plans still specifically exclude mater­
nity benefits, but the majority in woman-employing industries have
some provision for this type of benefit.
Maternity benefits include weekly cash benefits to compensate for
some of the income loss during pregnancy, hospitalization, and sur­
gical (obstetrical) benefits.
Weekly cash benefits for pregnancy in most plans are for 6 weeks
and the amounts paid are usually related to earnings. Weekly pay­
ments of from $22 to $26 are common.
Hospitalization is the most commonly provided benefit. Surgical
benefits for obstetrical costs are provided by most of the plans. All
the plans in the Women’s Bureau study had hospitalization, and all
but 3 of the 43 had obstetrical benefits.
Two main types of health-insurance plans are generally followed for
hospitalization and obstetrical benefits. One type pays cash allow997117—52------ 2




4

MATERNITY PROTECTION OF EMPLOYED WOMEN

ances for specified services directly to the worker on presentation of
hospital bills and obstetrical charges. Commercial insurance com­
panies are the principal carriers for this type of benefit. The other
type provides a specified service rather than direct money payment.
Blue Cross for hospitalization and Blue Shield for medical care are the
chief agencies administering the second type. Although in most cases
the indemnity allowances for maternity do not cover the total hospi­
tal and doctor bills, they do pay a substantial part of the costs, onehalf or more in most instances. Complete medical care and hospital­
ization for maternity as well as for other disabilities are provided by
a small proportion of the plans.
There is a waiting period of at least 9 months under most plans
before an employee is eligible for maternity benefits.
Special Provisions for Working Conditions for Pregnant Women

Formal policies for adjusting hours of work, rest periods, and changes
in job duties are rarely found. Most employers, if possible, are
willing to make adjustment in working conditions on an individual
basis. Since the annual incidence of pregnancy in the total group of
employed women is relatively low, 30 to 40 per 1,000 women, the
actual number of cases affecting employment in most plants is small
and if special arrangements in working conditions are needed, they
are handled as individual cases. Women are rarely dismissed for
pregnancy, but are expected to leave at a reasonable time depending
on their physical condition, the demands of their job, and sometimes
their dealings with customers.
Experience of Claimants for Maternity Benefits

The maternity benefit claims of approximately 800 employed women
were analyzed by the Women’s Bureau. The median age of the
women collecting maternity benefits was 26. The average period of
leaving employment before childbirth was 17 weeks or about 4 months.
The number of women who had returned to their jobs within a year
was small and of those returning, most returned within 6 months after
confinement.
Weekly cash benefits, almost always for 6 weeks, were received by
70 percent of the claimants. The average amount totaled $134.
Hospital benefits for delivery were received by 90 percent of the
group. The period of hospitalization was usually a week or less.
Obstetrical benefits were received by approximately 65 percent or
two-thirds of the claimants. Approximately 90 percent covered
normal deliveries; the other 10 percent covered miscarriages and
complicated deliveries, such as caesarean, requiring surgery.




Part I
MATERNITY PROTECTION IN THE UNITED STATES
Federal Legislation and Regulations

Maternity protection for employed women has been promoted
through general national legislation by most of the industrial coun­
tries except the United States. The international standard adopted
in 1919 by the International Labor Organization has served as a
directive for much of the legislation even though the Convention as
such has not been ratified by many of the leading industrial nations.
The ILO Convention prohibits the employment of women for 6 weeks
after childbirth; provides for 6 weeks leave before childbirth if re­
quested and accompanied by medical certification of date of con­
finement; provides for cash benefits, medical care, and supplementary
benefits; and affords some degree of protection against dismissal during
extended leave of absence for maternity. The provisions of the ILO
Maternity Convention and its implementation through legislation in
foreign countries are discussed in part II of this report.
Federal Legislation for Railroad Employees

The only Federal legislation in the United States that provides
maternity protection for employed women on an industry-wide
basis is the law providing temporary disability insurance for railroad
employees.
Weekly cash maternity and sickness benefits are provided rail­
road employees under the Federal Railroad Unemployment Insurance
Act by amendments enacted in 1946 that became effective in July
1947.2 Benefits and administrative costs are financed from the em­
ployer tax payable under the act.
Women represent only about 5 percent of an approximate 1,500,000
employees in Class I Steam Railways, occupational distribution of
women being limited chiefly to those in “white collar” groups. Ap­
proximately 4,000 women railroad workers yearly have received ma­
ternity benefits since 1947, the number of beneficiaries having increased
from 28 per 1,000 in 1947-48 to 35 per 1,000 in 1949- 50. Of women
receiving maternity benefits since 1947, approximately 88 percent
were clerks and other office employees.
! Public Law No. 572, 79tb Cotig., 2d sess., 1946.




5

6

MATERNITY PROTECTION OF EMPLOYED WOMEN

A woman railroad employee who has earned $150 or more in rail­
road work during the previous base year (beginning on July 1), and
who submits a statement from her physician which shows expected
date of childbirth, is eligible for benefits. The “maternity period” is
supposed to begin 57 days or about 8 weeks before the expected de­
livery date and continues for 116 days or approximately 16K weeks.
Daily benefit rates are based on a schedule related to annual earn­
ings and range from $1.75 to $5. As 1K times the daily rate is paid
for the first 14 days of the maternity period and for the 14 days im­
mediately after the birth of the child, the total maximum benefit
available is equal to 130 times the daily allowance. The maximum
benefit for employees earning $2,500 or more a year is $650. Average
total benefit received in 1949- 50 was $540 and average weekly benefit,
$33.75. Average compensable duration in 1949-50 was 112 days.
Duration of the benefit period is considerably longer than that pro­
vided for weekly cash benefits in any of the establishments included
in the present Women’s Bureau survey.
Regulations for Federal Employees

Federal employees do not have any special maternity leave or bene­
fits. However, employees whose employment is regulated by provi­
sions in the Federal Personnel Manual of the Civil Service Commission
may use accumulated sick and annual leave as maternity leave and
may return to the jobs held by them prior to taking leave. Employ­
ees may also, under specified conditions and upon Bureau authoriza­
tion, be granted advance sick leave of 30 days (i. e., 6 calendar weeks,
which assures employees with a 5-day workweek the equivalent of
the international standard). Whether or not an additional period of
leave-without-pay status is also granted is dependent upon policy
established in the particular agency concerned.
Provisions concerning employment of pregnant women in military
installations and activities are detailed in national regulations of
each department, but modification may be made by local officers.
War Department regulations prohibit employment after the thirtysecond week of pregnancy; Navy Department, for a period beginning
not later than 6 weeks before expected date of delivery.
State Legislation and Regulations

State legislation and regulation in the United States giving assistance
to women who are employed and who become pregnant is very limited.
Existing laws and regulations are concerned chiefly with the employ­
ment of women before and after childbirth; with unemployment com­
pensation or insurance; and with State disability insurance. Some
States, also, have arrangements concerning pregnant civil service
employees under State Civil Service systems.




MATERNITY PROTECTION IN THE UNITED STATES

7

Laws Prohibiting Employment of Women Before and After Childbirth

Minimum standards recommending that women not work for 6
weeks before and for 2 months after delivery, jointly recommended by
the Children’s Bureau and the Women’s Bureau as early as 1942,
are not recognized by any of the States in their laws regulating em­
ployment of women. The six States having laws prohibiting the em­
ployment of women before and after childbirth originally enacted
them 30 to 40 years ago and, as shown below, none meets the recom­
mended minimum standards for both prenatal and postnatal leave:
childbirth

Connecticut------------------------------------------------------Massachusetts---------------------------------------------------Missouri----------------------------------------------------------New York--------------------------------------------------------Vermont----------------------------------------------------------Washington:
In manufacturing, food processing, and fresh fruit and
vegetable packing industries----------------------------In laundry, dry cleaning and dye works industries___

childbirth

4 weeks
4 weeks
3 weeks

4 weeks
4 weeks

----------2 weeks

4 weeks
4 weeks

4 months
4 weeks

6 weeks

3 weeks

4 weeks

None of the State laws provides for compensation during the en­
forced absence, and none contains a reemployment provision.
Of the United States territories, neither Alaska nor Hawaii has
such laws, but Puerto Rico prohibits employment 4 weeks before and
4 weeks after childbirth, and employers must pay maternity benefits
amounting to one-half of regular salary or wage during that period.
An extension of 4 weeks’ leave wdthout compensation is allowed on
presentation of a medical certificate, and position must be kept open
for worker.
Unemployment Insurance Laws

State unemployment insurance or employment security laws con­
cern pregnancy only as to length of time during which an unemployed
pregnant employee may not receive compensation. Under laws as
summarized 3 after the regular legislative sessions of 1949, 21 States,
Alaska, and Hawaii have special provisions for disqualification for
unemployment due to pregnancy. Eleven of these disqualify a preg­
nant employee and 12 describe her as unavailable, but in restriction
of benefit rights there is no distinction between the two.
The most common definite restriction in benefits is for a 4 months’
period with variations in the prenatal and postnatal periods. Pour
jurisdictions that have a 4 months’ period deny unemployment
8 IT. S. Department of Labor, Bureau of Employment Security. “Comparison of State Unemployment
Insurance Laws as of September 1949.” Washington, D. C., Government Printing Office, 1949. 113 pp.




8

MATERNITY PROTECTION OF EMPLOYED WOMEN

benefits for 2 months before and 2 months after childbirth; two deny
benefits for 12 weeks before and 4 weeks after. Two other States
specifically deny benefits for 6 months, another for 17 weeks, and in
the others the period of restriction is for 1, 2, or 3 months or for an
indefinite duration.
Disability Insurance Laws

Disability insurance or cash sickness compensation on a State-wide
basis has been provided for by four States—Rhode Island, New York,
New Jersey, and California—but only Rhode Island includes benefits
for disabilities attributable to pregnancy.
Rhode Island’s Cash Sickness Compensation Act, the first such
State law, was passed during 1942, but did not originally specify
payment of benefits during pregnancy. Under its provisions for
payment of benefits to eligible individuals as compensation for wage
losses due to inability to work caused by sickness, however, claims
for pregnancy were also being paid for the maximum number of 26
weeks. Definite inclusion of benefits for disabilities due to or com­
plicated by pregnancy was made later by administrative decision.
In 1946 the legislature limited pregnancy benefits to 15 weekly pay­
ments.
The Rhode^Island [Cash^ Sickness Compensation Act covers the
same group of workers as does the Unemployment Compensation Act—
those in commercial and industrial undertakings having four or more
employees. Self-employed, agricultural and railroad workers, those
in domestic service and those in government and other nonprofit­
making enterprises are excluded.
It is financed by a 1-percent employee tax, which is a part of the
employee contribution that was formerly devoted exclusively to un­
employment benefits.
As pregnancy claims are the major single cost factor in the Rhode
Island program, a few facts on the number of claims and cost of
benefits are detailed in this study.
Claims for pregnancy in the year ending April 1950 totaled 8,402
and represent 40 percent of total claims paid to women. They
represent almost 23 percent of all claims paid in 1949-50. Because
the law “lacks clarity as to the extent to which a claimant must be
actively in the labor market at the onset of disability” many women
claimed benefits who were not regularly employed (some voluntarily
and some because of labor market conditions) when they became
pregnant.
Pregnant women tended to claim benefits for a longer period than
any other claimants except those with severe disabilities such as cancer




MATERNITY PROTECTION IN THE UNITED STATES

9

and tuberculosis. Average compensable duration was 10.1 weeks in
1949-50 as compared to 6.5 weeks for all other causes. Forty-two
percent of the pregnancy claims were not terminated until the com­
pletion of the 15 weeks’ limitation period.
Daily benefit rates for those who claimed pregnancy benefits in 1950
were somewhat lower than the average rate of other female claimants
because of lower than average base year earnings and less regular
employment. Base benefit rates ranged from $10 to $25 a week, but
only 44.4 percent of pregnancy cases qualified for $25 as compared
with 52.8 percent for all female claimants. Average benefit rate for
pregnancy claimants was $21.01 weekly, for other women claimants
$21.68, and for all claimants other than for pregnancy $22.95. Because
of the longer average compensable duration of pregnancy, however,
the average amount collected per case was $215 as compared to $146
for all other cases.
Payments for pregnancy are estimated to have been 16.8 percent of
all payments for claims during the year ending April 1944, the first
year of payments, and approximately 30 percent of total payments in
the years 1947 through April 1950. They represented one-half of all
payments made to women claimants in 1950.
After consideration of medical opinions and recommendations made
in the interest of employees and of suggestions by the Rhode Island
Department of Employment Security to reduce the costs of pregnancy
compensation in the interest of maintaining the Cash Sickness Fund
on a self-sustaining basis, several changes were effected in 1950 and
1951. Duration of benefit period for pregnancy was decreased from
15 to 12 weeks, minimum employment credit requirement was in­
creased from $100 to $300, and credits were based on an individual
benefit year instead of on a fixed benefit year. Under present oper­
ation, payments are based on extent of employment during the 4
quarters immediately preceding employee’s leaving employment.
Benefits are paid for a maximum 12 weeks’ period, 6 weeks before and
6 weeks after delivery. Claimant must file a statement signed by
her doctor approximately 8 weeks before anticipated delivery.
The costly experience of Rhode Island probably led to the specific
exclusion of pregnancy benefits from the cash sickness compensation
plans of other States. States differ as to their specific provisions for
the treatment of pregnancy claims. In California payment is not
allowed for disability lasting less than 4 weeks after termination of
pregnancy. New Jersey does not pay for any period of disability due
to pregnancy, miscarriage, or abortion. New York makes such pay­
ments after an individual has worked in covered employment at least
two consecutive weeks after termination of the pregnancy.




10

MATERNITY PROTECTION OF EMPLOYED WOMEN

Study of Rhode Island’s experience will probably be used as a guide
for inclusion or exclusion of pregnancy in future legislation. That
there is interest in working out satisfactory State plans for providing
some type of benefit for employed women who become pregnant is
indicated to some extent by the inclusion of such benefits in 1951
proposals for disability insurance in several of the States.
In the Women’s Bureau field study of maternity protection, infor­
mation was received from several firms in New York and New Jersey
that no longer paid weekly cash benefits during an absence due to
pregnancy. Health insurance policies which included payment of
pregnancy benefits were canceled when the firms obligated themselves
for the contributions required to meet the State program, and no
other arrangements were made for coverage of weekly cash benefits
for pregnancy.
Provisions for State Civil Service Employees

Laws and regulations of most of the States do not include specific
provisions for maternity protection of civil service employees, and as
with other employing units, practice varies considerably from State
to State.
In States replying to a questionnaire of the Women’s Bureau in
1948, no State reported providing maternity leave with pay. Leave
without pay was granted usually by administrative regulation or by
practice. Most of the States permitted use of sick leave allowance
for absence due to pregnancy. One State, however, specified in legis­
lation that “Sick leave with pay is not granted for illness due to
pregnancy.”
Information from a number of States did not specify duration of
maternity leave; others mentioned 3 months, 6 months, or 1 year,
and one State restricted leave to not more than 12 months in 5
years.
Civil service regulations of New York set forth the following detailed
statement: “Existence of pregnancy must be reported in writing to
the head of the department not later than the fourth month and
employment shall be discontinued when, in his judgment, further
service would be detrimental to health. In such circumstances,
maternity leave of 6 months’ duration without pay may be granted.
This may be extended by the appointing office to a total not exceed­
ing 11 months without pay. The employee may be permitted to
reduce such leave without pay by the use of any or all earned credits.
A doctor’s certificate may be required at the time leave is requested
and prior to return to duty.”




MATERNITY PROTECTION IN THE UNITED STATES

11

Employer and Union Sponsorship

Management and unions in the United States have been increas­
ingly concerned during the last decade with welfare plans, and have
either individually or jointly sponsored the increase of fringe benefits
such as pensions, life and health insurance. Health insurance and
other benefits were given instead of rate increases during World War
II, since wage stabilization controlled and limited wage increases.
The trend of increased fringe benefits has continued in the postwar
period. Plans initiated by management often have been made a part
of union agreements and benefits revised and increased through col­
lective bargaining. In many instances health insurance plans have
been expanded to provide maternity benefits not only for employees
but also for wives.
A Bureau of Labor Statistics’ survey in 1950 stated that practically
every major union in the country has negotiated, to some extent,
pension or health and welfare programs.*
4
Welfare plans on an industry-wide basis are still the exception, but
national organizations are providing assistance to local groups in set­
ting up their plans and are promoting standardization of benefits.
The Amalgamated Clothing Workers, the American Federation of
Hosiery Workers, the International Ladies Garment Workers Union,
the Textile Workers Union of America, and the United Hatters, Cap
and Millinery Workers—organizations with high proportions of women
workers—all sponsor plans of health insurance and through these have
made some provision for maternity benefits. Local groups such as
the affiliates of the hotel and restaurant union negotiate and admin­
ister plans of a multi-employer type for their membership. The
United Steelworkers of America and also the United Automobile and
Aircraft Workers, CIO, have health-insurance plans with Nation­
wide coverage providing maternity benefits. The inclusion of mater­
nity benefits in the last two organizations is of special significance to
women because of the influx of women into the metal-working indus­
tries during war and defense periods.
A study by the New York Department of Labor of union and unionmanagement administered health insurance plans, January 1951,
includes an analysis of maternity benefits.5 Of the 304 plans report­
ing on maternity benefits, 171 reported maternity benefits for depend­
ent wives and 161 for women members. Although most of the plans
4U. S. Department of Labor, Bureau of Labor Statistics. Summary Report, Employer Benefit Plans
under Collective Bargaining, December 1950.
4 New York Department of Labor, Division of Research and Statistics. Union and Union-management
Administered Health Insurance Plans in New York State. January 1951. Mimeo. 59 pp.

997117-52-




12

MATERNITY PROTECTION OF EMPLOYED WOMEN

giving benefits to wives give them also to women members, there
were 143 plans that did not include maternity benefits, primarily in
unions where there are no or very few women members, such as the
building trades organizations and teamsters’ union.
The maternity benefits afforded by the 161 plans for women mem­
bers in the New York study varied in types of services and amounts
allowed. Weekly cash benefits, usually for a 6-week period, were
provided by 94 plans. By far the greater part (77) of the 94 that gave
cash benefits, also had provision for hospitalization and obstetrical
benefits. Hospitalization was the most common benefit and was pro­
vided for by 132 plans. About one-half of the plans for hospitalization
were Blue Cross and most of the others provided cash reimbursement
on a fixed maximum allowance for periods of 10 to 14 days. Obstet­
rical benefits were afforded in 116 plans with the benefits tending to
follow a pattern of $25 for miscarriage, $50 for normal delivery, and
$100 for caesarean and ectopic complications. A flat cash allowance
of from $25 to $75 towards maternity expenses was made by 16 organ­
izations. General medical care during or after pregnancy was not
usually reported under maternity benefits.
Maternity benefits negotiated by collective bargaining in some of
the leading woman-employing industries are indicated as follows:
1. The American Federation of Hosiery Workers (Independent)
since 1943 has had an industry-wide health insurance plan for organ­
ized workers in the full-fashioned hosiery branch of their industry.
Maternity benefits were included from the start and provide weekly
cash benefits based on 60 percent of average earnings for 6 weeks, a
maximum of $7 a day re-imbursement for hospitalization for a maxi­
mum of 12 days, and an allowance of $15 for delivery room charges.
2. The Amalgamated Clothing Workers (CIO) has a Nation-wide
welfare plan for most branches of the industry. It includes weekly
cash, hospital and surgical benefits for nonoccupational disabilities,
but for maternity provides only obstetrical benefits of from $25 to
$100.

3. The International Ladies Garment Workers Union (AFL) has a
national policy for establishing health and welfare funds and health
centers with local autonomy in the administration and services.
Most of the membership is covered by health and welfare benefits.
However, less than 1 percent of the total disbursements from local
funds have been for maternity benefits. Maternity benefits, when
paid, usually consist of a $50 cash allowance, but most locals do not
include such protection. In the New York study of union health
insurance plans, 25 locals and joint boards were reported for the
International Ladies Garment Workers; 14 did not have maternity




MATERNITY PROTECTION IN THE. UNITED STATES

13

benefits; 11 gave flat grants—8 of $50, and 3 of $25. Health centers
established by the union do not usually have prenatal clinics or any
special services for pregnant members.
4. The Textile Workers of America (CIO) has been encouraging the
inclusion of health insurance plans in all contracts of the union, and its
international office reported that almost 90 percent of its membership
is covered by insurance plans financed by the employer. There is no
fixed plan of benefits. Benefits are bargained for on local or area
levels. Union representatives estimated that more than three-fourths
of their women members have maternity coverage. Usually there are
weekly cash benefits for 6 weeks, hospital benefits with maximum daily
allowances of from $3.50 to $9 for a maximum of 2 weeks, and maxi­
mum obstetrical allowances of $50 for normal delivery, $25 for mis­
carriages, and $100 and $150 for caesarean and ectopic deliveries.
The international office employs an insurance director and gives
assistance to locals in establishing their health insurance plans and
setting standards for benefits and administration.
5. The New York Hotel Trades Council (AFL), representing 10 locals
of hotel service workers, upholsterers, firemen, operating engineers,
painters, telephone operators and office employees, and the Hotel
Association of New York City, representing approximately 175 union
contract hotels, have negotiated an insurance plan and health program
for all workers covered by collective bargaining. Maternity benefits
for women employees include: weekly cash benefits for 6 weeks, Blue
Cross hospitalization, prenatal and postnatal care at the health center,
and free obstetrical care for delivery. All services are free to the
employee, being financed by a payroll tax on member hotels.
In addition to the provision of maternity benefits, many unions
have negotiated for maternity leave, job security, and retention of
seniority for workers absent for pregnancy and childbirth.
Types of Maternity Protection Found in 43 Firms
Scope, Administration, and Financing

The maternity benefit pattern for industrial health insurance is
usually threefold: (1) weekly cash benefits to compensate for time
lost from work, (2) hospitalization, and (3) surgical benefits for ob­
stetrical care. In most industrial health insurance plans, medical
care for maternity is limited to obstetrical service at the time of child­
birth but some plans offering comprehensive medical service include
prenatal care during pregnancy and postnatal care of the mother and
child. Some plans offering general medical care for health disabili­
ties definitely exclude maternity.




14

MATERNITY PROTECTION OF EMPLOYED WOMEN

The types of benefits provided by the 43 plans included in the
Women’s Bureau study are:
Number
Benefits provided

Weekly cash, hospital, obstetrical, and medical---------------Weekly cash, hospital, and obstetrical--------------------------Weekly cash and hospital-----------------------------------------Hospital, obstetrical, and medical-------------------------------Hospital and obstetrical-------------------------------------------Hospital only---------------------------------------------------------

of firms

2
26
2
1
11

1

All 43 plans provided hospitalization, 40 provided obstetrical bene­
fits, 30 provided weekly cash benefits, and 3 offered general.medical
care during pregnancy and after childbirth.
These findings agree closely with those of the 161 plans providing
maternity benefits which were analyzed by the New York State
Department of Labor (see p. 12).
Management generally assumes the responsibility for enrolling em­
ployees in health insurance plans, making payments to the insurance
carrier, and handling all routine details in connection with group poli­
cies. In handling and processing claims for benefits, the participa­
tion of management varies materially. Some firms handle the pro­
cessing of claims and collection of cash benefits for their employees
while others take no responsibility for handling individual claims.
Where there is a service plan for hospitalization and obstetrical serv­
ices, such as Blue Cross and Blue Shield, cash claims for hospitaliza­
tion and obstetrical benefits are eliminated. Services are claimed
merely by presentation of membership cards, thus simplifying admin­
istration for both management and the claimant. The administration
of many plans on a national or local basis is handled by the union or
by the union and management jointly. Seven of the 43 plans included
in the Women’s Bureau’s maternity protection study were adminis­
tered primarily by unions.
Employer participation in payment of insurance premiums or cost
of other health plans is generally accepted. Employers either paid
all or contributed to the cost of the maternity benefits in all the 43
plans in the Women’s Bureau study.
Health insurance is substantially more expensive for women than
for men. Insurance companies estimate that, without maternity
benefits, the disability rate for compensable illness is about 50 percent
higher for women than men. In plans with 6 weeks’ pregnancy bene­
fits, twice as much is paid in benefits to women as to men; the cost of
health insurance where large numbers of women are employed is
much higher than for the same number of men. Where maternity
benefits are included, the difference is even greater.
In industries that employ women predominantly, such as the needle
trades and retail stores,^weekly cash benefits especially are less fre­




MATERNITY PROTECTION IN THE UNITED STATES

15

quently provided for pregnancy than in industries that have a low
proportion of women, such as the metal trades (for instance, steel),
the automobile, and aircraft industries. In hospitalization plans
such as Blue Cross, an employee must be enrolled under a family
contract to be eligible for maternity protection.
Cash Benefits

Weekly cash benefits for periods of disability due to maternity are
sponsored by employers or jointly by employers and unions, except
as legislated for in Rhode Island and the railroad industry. They are
usually part of a health insurance plan carried with a private insurance
company. These cash benefits provide partial compensation for time
lost and give some measure of financial aid or security during periods
of disability. The scale of payments is the same as for other dis­
abilities, but the length of time for which they are paid is shorter. Six
weeks is the customary maximum for maternity benefits while for other
nonoccupational disabilities there tends to be a maximum of 13 weeks
under private insurance plans.
Almost three-fourths of the firms that were included in the Women’s
Bureau study provide weekly cash benefits. The payments may be
a flat amount, a given percentage of wages or salaries, or scaled ac­
cording to wage and salary brackets. Benefits are almost always less
than average earnings. The cash benefits range from $9 to $50 a
week, but most of them are from $20 to $30. With the upward trend
of wage levels in recent years, benefits scaled to earnings tend to be
higher and more desirable than flat rates.
One plan provides two benefit periods that apply to maternity. A
cash benefit for 6 weeks through a joint contributory insurance plan
is paid when the woman leaves for pregnancy and a second period of
6 weeks of full pay is paid by the employer at the time of childbirth to
employees having a full year’s service at the time of leaving. Some
companies continue to pay salaried workers leaving for maternity on
an informal or individual basis for limited periods.
Private insurance companies were the risk carriers for 26 of the 30
companies that had weekly cash benefits; 3 were self-insured; and 1
paid benefits through a mutual benefit association. The cost of pro­
viding cash benefits was assumed by the employer in 19 of the 30
companies and in the other 11 was financed by joint contributions of
employees and employer.
Hospital Benefits

Hospitalization for childbirth has been described as “perhaps the
most dramatic evidence of the relationship between hospital use and
public health. . , . Thirty-seven percent of all the babies born in




16

MATERNITY PROTECTION OF EMPLOYED WOMEN

1935, were born in hospitals; in 1949, when there were over a million
more babies born than in 1935, about 87 percent were born in hos­
pitals.” Preliminary data indicate that in 1951 the number of live
births exceeded the previous record of 3,818,000 in 1947.
Hospital benefits for childbirth in the United States provide insur­
ance for beneficiaries against cost of board and room, of general nurs­
ing care during confinement, and of hospital “ extras” or special hospital
fees. Use of the delivery room and frequently use of the nursery for
the child are included in maternity care provided. Protection is by
cash payment of an insurance carrier either to the individual or to the
hospital of a specified amount for hospitalization; or by coverage on a
service basis of hospital care, usually in semiprivate accommodations;
and occasionally by unlimited hospital care under a comprehensive
plan.
Hospital benefits are available under voluntary group health insur­
ance plans including (1) nonprofit plans such as Blue Cross, (2) poli­
cies of commercial insurance companies, and (3) plans of independent
organizations such as self-insured plans of industry and labor unions.
In the United States, 75 million persons at the end of 1950 had some
form of insurance covering hospital care. However, the extent to
which hospitalization for maternity is afforded is not reported.
In the Bureau’s recent study, hospitalization benefit for maternity
was available to women employees in all of the 43 establishments
visited. In 26, hospitalization was available through Blue Cross and
in 16, through private insurance companies. One firm provided com­
plete medical and obstetrical care in a hospital and in associated clinics.
Employees may or may not be required to contribute toward cost
of the premium of health insurance plans. Employers, however, have
been contributing to an increasing extent. In the Bureau study, the
hospitalization benefit for maternity was paid for by the employer
alone in 21 establishments, by joint contributions of the employer and
employees in 17, and entirely by the employees in 5. In 11 establish­
ments where the insurance carrier was a private company and in 9
having Blue Cross, the employer paid all; in the other establishment
hospitalization was included in the comprehensive medical care plan
financed entirely by the employer. In all plans where the worker
paid full hospitalization premium, Blue Cross was the carrier.
Blue Cross.—Blue Cross, which originated in 1932, has pioneered
in providing hospitalization for maternity cases. Today it is the
leading single insurance carrier of such benefits for employees. It is
a nonprofit agency operating on an area basis and affiliating with a
National Blue Cross Commission. Approximately 85 area plans cover
47 States, including the District of Columbia and Puerto Rico.




MATERNITY PROTECTION IN THE UNITED STATES

17

Basically, enrollment in Blue Cross is by subscribers and their fami­
lies through groups formed at places of employment or through exist­
ing associations. By the end of 1950, it afforded hospital protection
to approximately 37% million enrollees and dependents, representing
approximately one-half of the estimated total of 75 millions having
some insurance against hospital costs.
Maternity benefits are available, with few exceptions, only to those
enrolled under a husband-and-wife or family contract; in approxi­
mately two-thirds of the Blue Cross plans they are available only
under the latter. Frequently in group participation, employers pay
for single coverage, and the employee pays the difference in cost of a
family contract that gives maternity coverage.
The waiting period required by Blue Cross plans before maternity
hospitalization benefit may be received varies from 8 to 12 months,
the most common period being 10 months. However, a number of
plans have introduced waivers of waiting periods if a certain percent­
age of enrollment in an establishment is obtained and if the employer
contributes toward the cost. Usually, waiver is granted to groups
of 25 or more employees in which enrollment in the plan is 75 percent
and in which there is employer contribution.
Blue Cross reported that as of July 1950, an estimated 12.2 percent
of the participants in reporting plans were enrolled in employer
contribution groups as compared to 7.6 percent of participants in
December 1946. It was estimated that the employer paid about
one-half of the premium in cases where he participated. In the 26
establishments visited by the Bureau in which Blue Cross was the
carrier for hospitalization benefit, 6 had only employee contribution,
9 had only employer, and 11 had joint contribution toward premium.
Included in the latter 11 were some in which general hospitalization
coverage was paid by the employer but in which the additional cost
for maternity coverage was paid by the employee.
Generally a special limit is placed on the number of days for which
care will be provided for maternity cases or a maximum limit is placed
on the benefits to be received. For normal delivery the hospital
stay specified is often 10 days, but it may vary from 7 to 12 days.
Accommodation offered is in a ward or semiprivate room. Maximum
dollar benefits for maternity hospitalization ranged from $50 to $80
for normal deliveries.
The large majority of the Blue Cross plans provide ordinary
nursery care for the newborn child during the mother’s confinement.
Comparison of the regular Blue Cross group plans of New York City,
Philadelphia, and Newark—three cities visited by the Bureau in its
1951 study—furnished information on similarities and variations in
maternity hospitalization benefit provisions in adjacent areas.




18

MATERNITY PROTECTION OP EMPLOYED WOMEN

In all three cities, maternity benefits are available only under a
family contract.8 Length of waiting period is 10 months in all of
New York State, except where a waiver is granted; in Philadelphia it is
12 months; and in New Jersey it is specified as 240 days after joint
enrollment for husband and wife. Maximum length of maternity
hospitalization is 10 days in New York and Philadelphia and 8 days
in New Jersey. Total maximum paid in New York is $80, in Phila­
delphia $75, and in New Jersey $124. Philadelphia allows an addi­
tional $4 per day toward nursery charges sometimes necessary for the
newborn child after the mother’s discharge from the hospital. Care
of child during mother’s stay in the hospital and use of delivery room
are specified as being included in the maximum allowances of both
Philadelphia and New Jersey. For care involving caesarean sections,
ectopic pregnancies, or premature terminations of pregnancy not
resulting in childbirth, Philadelphia does not allow additional time, but
New York provides regular hospitalization benefits for a maximum
of 21 days.
Variations similar to these exist among plans within States or in
other adjacent areas because plans have developed autonomously out
of local community needs. Within an area, however, maternity
benefits are the same. Greater uniformity of benefits in general is
recognized by the Blue Cross as being desirable, but a standard or
national contract for all areas, proposed in 1947, was adopted by very
few plans.
Possibilities for more uniformity in Blue Cross plans affecting em­
ployed workers in Nation-wide industries are demonstrated, however,
by 1950-51 contracts in the national steel and automobile industries.
Uniform benefits at uniform rates are provided by agreement with
employers having employees in 40 or more States. Provision for
maternity benefits in the steelworkers’ (CIO) contract includes hos­
pitalization on a full service basis for a period not exceeding 10 days
for any one pregnancy. Benefits are not available until expiration
of a 9 months’ period after enrollment for those not employed by the
company on the effective date of the program. Financing is jointcontributory, one-half of the cost being paid by the company and
one-half by insured employees.
Increasing interest by companies in insuring under such national
contracts paved the way for establishment at about the same time of a
new Blue Cross function in New York City known as Health Services,
Inc., created for the purpose of giving assistance in working out the
problems entailed in providing a company with industry-wide health
coverage.
• In Philadelphia, benefits are available under husband-wife plan, but at aamc cost as for family contract.




MATERNITY PROTECTION IN THE UNITED STATES

19

Problems in connection with continuance of insurance protection
when workers are laid off or change location have been met to some
extent by many of the Blue Cross area plans. It is now generally
possible to transfer from one area to another with no new waiting
period required for eligibility for maternity benefits. In the last few
years, reciprocity of service benefits as well as reciprocity of enroll­
ment has been introduced in many of the plans; under the arrangement
with an Inter-Plan Service Benefit Bank, subscribers needing hospital
care when away from their homes receive benefits of the plan with
which they are enrolled.
Private Insurance Companies.—Group health insurance under
private insurance companies has developed during the past two
decades and coverage for maternity benefits has developed chiefly in
the past decade. More than three-fourths of the firms in the Women’s
Bureau survey did not have maternity benefits 10 years ago.
Insurance companies by the end of 1950 were estimated as carriers
of insurance covering approximately 34 million of the 75 million
persons in the United States having some form of insurance for hos­
pital care. Twenty million had group policies. In 1949 maternity
protection was included in 93 percent of group insurance hospitaliza­
tion certificates covering employees. Insurance companies provided
the hospitalization benefits for maternity cases in 16 of the 43 estab­
lishments visited in the Bureau study.
Almost all private insurance policies now limit the amount payable
for maternity coverage to a specific amount in money or to a specific
number of days, whereas 3 years ago many companies were experi­
menting with the idea of carrying maternity without a specific limit.
The two most common plans of maternity coverage provide either a
maximum 14-day period for room and board plus an allowance for
extras, or an over-all amount equal to 10 times the daily hospital
benefit.
Type of benefit provided for employees in 14 of the 16 establish­
ments in the Bureau study that were insured by private companies
included a maximum number of days’ care at a stated amount, and
usually an additional sum for incidental special hospital fees such as
delivery room, care of the infant, and medicine. Range in number of
days provided was from 6 to 14, most common being 14 days. Range
in daily amounts paid was from $5 to $10, about two-thirds of the
plans paying $7 or more. Total maximum hospitalization benefit,
including allowance for extras, ranged from $50 to $228.
Less standardization of maternity benefits exists among policies of
various insurance companies and among companies within a city
serviced by the same insurance company than among Blue Cross
9&7117—51-------- i




20

MATERNITY PROTECTION OF EMPLOYED WOMEN

plans. Maternity hospital benefit is a part of a composite “package”
of insurance provided by the employer or purchased under a joint
arrangement by the employer and employees. Extent of benefit
depends, among other factors, upon amount employer has contracted
to pay for all types of employee insurance benefit; extent of his interest
in a particular item such as maternity coverage; and level of local
hospital costs. In four firms in the Bureau study that were serviced
by the same insurance company, four different plans of coverage were
provided. One plan, financed by the employer, provided 14 days of
benefit at $5 and special hospital fees of $50. A second employerfinanced plan provided 14 days at $8 with special fees of $40. A
third, financed equally by employer and employees, specified maximum
14 days’ hospitalization at $7 with $35 for extras, and a fourth, twothirds financed by employer contribution, provided $10 a day with a
maximum of $100 for board and room and extra services.
Insurance agents report they are selling an increasing number of
policies with daily benefits of $9 and $10.
Potential maximum total benefits available under commercial
insurance coverage in the Bureau survey were higher than under
Blue Cross, but as maximum length of stay allowed under insurance
plans seems to be longer than the average length of confinement,
actual amount received during a maternity hospitalization period
may be considerably less than the maximum allowed.
Average claim for duration of hospital expense during maternity has
been found to be less than 14 days. Average claim durations in 1945
of maternity hospitalization experience (of employees and of depend­
ents) of a typical company was 9 days, although range of duration
for 77.5 percent of the employees was from 8 to 14 days. Average
duration for hospitalization found in the 1951 Bureau study was 6 days.
Three-fourths of the employees claimed benefit for 7 days or less.
Payments of benefits by private insurance companies are usually
made directly to the individual. However, insurance companies
during the last few years, through their Health Insurance Council,
have developed plans by which the insured person may assign the
collection of benefits directly to a hospital. The hospital accepts
such assignments of benefits in place of cash deposit. This offers
some of the advantages of the Blue Cross hospital admission plan.
Obstetrical Benefits

Benefits for obstetrical care are a part of the surgical care schedule
and in most insurance plans are limited to payments or credits for
delivery or miscarriage. Insurance for payment of doctors’ fees is
not nearly as common as for hospitalization. While 75 million per­
sons in 1950 were protected by hospital insurance, 48 million of them,
approximately two-thirds as many, had insurance against cost of




MATERNITY PROTECTION IN THE UNITED STATES

21

physicians’ services.7 Obstetrical benefits, like hospitalization for
maternity, are among the newer developments in group insurance and
before 1940 were rarely included in health insurance plans.
Commercial insurance companies and medically sponsored plans
such as Blue Shield are the common carriers of surgical care plans.
Private insurance companies carry most of the surgical coverage and
though benefits for obstetrics are optional, 94 percent of the group
certificates of women employees in force in 1950 were reported as
providing for maternity care. Nonprofit plans such as Blue Shield
have developed rapidly in the last decade and are second among the
carriers of group surgical expense, and provision is made in all plans
of this type for maternity benefits under family contracts.
All but 3 of the 43 plans for maternity protection included in the
Women’s Bureau study had provisions for obstetrical benefits. Of
the 40 plans, 21 were insured with commercial companies; 15 were
subscribers to nonprofit plans—Blue Shield and Group Health Insur­
ance—for the firms visited; 3 offered obstetrical services including
prenatal and postnatal care in comprehensive medical care plans; and
1 gave an obstetrical allowance through a mutual benefit plan.
Obstetrical benefits are usually provided in the form of cash pay­
ments for specified services. The maximum amounts allowed on a
cash indemnity basis in the firms visited varied considerably. The
most common maximum schedule for obstetrical payments was: $50
for normal delivery, $25 for miscarriage, and $100 for caesarean or
other surgery. The preceding was the pattern for 11 of the 21 plans
carrying insurance with a commercial company; 9 provided more
generous benefits and 1 had a lower schedule. For the 21 plans, the
range in maximum benefits was from $30 to $100 for normal delivery,
$12.50 to $70 for miscarriage, and $50 to $200 for complicated deliveries.
In general, benefits in contracts written in the last few years are more
generous than earlier ones. Maternity or pregnancy benefits for
both obstetrical and hospitalization benefits under most insurance
company policies are payable if childbirth occurs within 9 months
of the termination of employment and the payment of premiums.
An average waiting period of 9 months after the effective date of
insurance is usually required for obstetrical benefits as well as for
hospitalization.
The benefit patterns for 12 Blue Shield plans included in the
maternity study of the Women’s Bureau for the three areas represented
were:
Obstetrical service
Pennsylvania
New York New Jersey

Normal delivery.-. _____ ___ ...
Miscarriage
..
Caesarean, ectopic, operative
...

$60
25
100

$75
50-75
125

$125
75
225

’ Report of Committee on Labor and Public Welfare, U. S. Senate Report No. 359, Part I, p. 40.




22

MATERNITY PROTECTION OF EMPLOYED WOMEN

Two plans insured with Group Health Insurance, a nonprofit plan
similar to Blue Shield serving the New York area, offered the stand­
ard benefits of this organization, $70 for normal delivery, $50 for
miscarriage, and $100 for caesarean or operative delivery; the third
company in this group offered double these amounts through pay­
ment of higher premiums and enrollment in a special plan.
Commercial insurance companies, in some areas, have agreements
with physicians to accept the specified allowances as full payment
from lower-income subscribers while from persons with incomes
above the plan’s income limits, the doctors are permitted to charge
additional fees. Payment is most often made directly to the policy­
holder, but assignment of the benefit directly to the physician may
be arranged. Such plans, sponsored by State medical societies,
have been developed in Wisconsin, Rhode Island, Tennessee, and
Maine. The family income limit in 1950 was $3,600 in the first
three States and $3,000 in Maine.
Blue Shield is a nonprofit organization and operates under different
names in different areas, such as United Medical Services in New
York and Medical Service Association in Pennsylvania. Blue
Shield was incorporated in March 1946 by nine medical care groups
and by November 1950 it included 71 plans. Member plans are
sponsored either directly by a medical association or are officially
approved by such a group, and with the exception of a very few plans
write only surgical-medical insurance. Most plans are coordinated
with Blue Cross and recruit their membership largely from such
accounts, adding surgical coverage to hospitalization.
A typical nonprofit Blue Shield surgical plan in 1949 offered full
service surgical benefits to subscribers and their families with in­
comes below $3,100 and for single persons with income below $2,050.
It was estimated that from one-fourth to one-third of the Blue Shield
members receive service benefits and the rest receive cash payments
for surgical services. Increasing interest in developing partial or full
service coverage for subscribers with incomes above the present
limits was reported.
Comprehensive Medical Care Plans

In addition to group health insurance plans carried by insurance
companies and nonprofit organizations such as Blue Cross and Blue
Shield, a large number of local and independent group plans, more
than 250, covering about 4,000,000 persons, have been organized
throughout the country. Sponsors of these plans include medical
societies, community-wide groups, cooperative or consumer groups,
and industrial groups such as unions, other employee groups, and
employers. Services offered vary in the range of benefits provided




MATERNITY PROTECTION IN THE UNITED STATES

23

but usually include more comprehensive medical care such as
physicians’ services in the home and office, clinical, laboratory, and
sometimes nursing and dental services. Information is not available
as to the extent to which maternity benefits are provided by these
plans; some definitely exclude maternity benefits while others offer
complete prenatal, delivery, and postnatal care of the mother and
child.
In the Women’s Bureau survey, three comprehensive medical care
plans with maternity benefits were included, one employer sponsored,
one employer-employee, and one accepting group memberships on a
community-wide basis.
The employer financed and sponsored plan offers complete medical
care to approximately 18,000 employees and about 32,000 dependents
in a manufacturing enterprise. For maternity, an employee or wife
of an employee receives prenatal, delivery, and postnatal medical
services for herself and child at clinics, home, or hospital. A local
hospital, endowed by this manufacturing firm, has a modern and
well-equipped maternity wing, and it was reported that over 300
women employees of this company and many more wives of employees
had been afforded maternity care during 1950.
The New York Hotel Trades Council and Hotel Association plan
in New York City has a comprehensive medical care plan for hotel
employees covered by union agreement. In addition to its insurance
and hospital program it operates a health center where a wide range
of free medical services are offered. Prenatal and postnatal services
are offered at the Health Center and also the services of staff physicians
for delivery and maternity care in hospitals. Hospitalization is pro­
vided through Blue Cross. (See p. 13.)
The Health Insurance Plan of Greater New York provides medical
care on a group enrollment basis for employed persons and their
dependents. Comprehensive medical care is available to approxi­
mately 275,000 subscribers. General medical care is available in
homes, physicians’ offices, 30 medical care centers, and 2 group
practice units in hospitals. Under HIP all women enrolled, whether
married or single, whether on the “employee-only” or the family
contract are entitled to obstetrical service without restrictions of any
kind. There is no waiting period under HIP coverage. Complete
prenatal and postnatal care is given and in cases of complications
diagnostic aid is available without additional charge. All HIP sub­
scribers are expected to carry hospital insurance under a separate
contract. For employees of divisions of New York City enrolled in
this plan, there is a joint contract with Blue Cross and one collection
for medical and hospitalization coverage is made by HIP. The
contract of HIP for municipal employees of New York City includes




24

MATERNITY PROTECTION OF EMPLOYED WOMEN

the personnel in the public school system and in many of the depart­
ments in which large numbers of women clerks are employed. In the
Women’s Bureau study one of the companies visited had HIP coverage
for medical care, Blue Cross for hospitalization, and in addition
provided weekly cash benefits.
Maternity Leave

A minimum of 6 weeks’ maternity leave before delivery and at least
2 months’ leave of absence after delivery is recommended, with a
reasonable extension of leave allowed beyond the 2 months following
delivery if needed for the physical welfare of the mother.
Maternity leave is primarily the right or privilege to take a volun­
tary leave of absence for maternity and maintain job security and
seniority. However, it is sometimes used to set the time limits during
which an employee is prohibited from working before and after
childbirth and the conditions under which employment may continue
during pregnancy.
It is generally recognized that employment in occupations involving
lifting, balancing, continued standing, contact with poisonous sub­
stances, or heavy work of any kind should be avoided during pregnancy.
Further research is needed to determine the effect of employment in
general on the health of pregnant women and on their infants. In
deciding whether or not to discontinue work sooner, therefore, or
when to return to work after childbirth, a woman should follow the
advice of her physician.
When she does leave she should have some assurance of job security
for return to her former job or a comparable one within a reasonable
period after childbirth. If there is no provision or definite policy
covering maternity leave, separation from the job for pregnancy con­
stitutes termination and return to work is on a reemployment basis;
the worker then has no assurance that she will have a job to return to
or that her seniority will be protected.
Maternity leave protects a woman against discharge or loss of
seniority rights and protects her reinstatement rights after childbirth.
Leaves of absence for illness or other justifiable reasons are allowed by
most employers and maternity leave often is assumed to come under
general leave policies without any special provision. However, if the
general leave period is short, maternity leave in effect may be pre­
cluded because of its longer duration. Special leave policies for
maternity, therefore, are often spelled out when the numbers or the
proportions of women are high and sometimes include additional
provisions to safeguard the expectant mother’s welfare.




MATERNITY PROTECTION IN THE UNITED STATES

25

About three-fourths of the manufacturing firms and one-half of the
nonmanufacturing firms included in the Women’s Bureau field study
had leave policies that gave some measure of job security for maternity
leave. The duration of leave—the total time allowed before and
after childbirth—varied from 6 months to indefinite periods of more
than a year, with the most usual time being 1 year in both manufactur­
ing and nonmanufacturing establishments.
Granting of formal leave of absence implies that accumulated
seniority will be retained. In every firm visited in the Women’s
Bureau study that allowed maternity leave, seniority credited at the
time of leave was retained or frozen during the leave period; and a few
other firms that did not grant formal leave recognized past seniority
if the worker was reinstated. About one-half of the firms allowed an
accrual of service while on maternity leave, the time accrued varying
from 1 month to 1 year. Accrual of service credit up to a year was the
most common provision. At the expiration of leave after maternity,
a physician’s statement of the employee’s fitness to resume her job is
customary.
Policies prohibiting the employment of pregnant women for specified
periods before and after childbirth, even where they exist, are admin­
istered on a flexible basis depending on the duties of the job and the
needs of the employee. None of the firms included in the field study
considered pregnancy a cause for immediate dismissal. Prenatal
periods during which employment was prohibited were more common
than postnatal prohibitions. Sixteen of the 43 firms included reported
that they either required or expected pregnant employees to leave at
specified periods of their pregnancy. Of these, eight required women
to leave their jobs in the fourth or fifth month of pregnancy or earlier;
seven allowed them to work to the end of the sixth or seventh month;
and one required manufacturing workers to leave in the fifth month
and office workers in the seventh.
In the one firm that expected the women to leave by the end of the
third month, most of the women operated metal-working machines
such as punch presses and stood continuously while working, so it was
felt that the work was too strenuous and somewhat hazardous for
pregnant women. The possibilities of transferring operatives in this
firm to more sedentary jobs were considered slight, and, except in
special “need” cases, a change in job duties was not considered.
Representatives of a number of firms stated that they let the women
decide for themselves how long they should stay on the job and that
the women took care of it satisfactorily for all parties concerned. A
publishing house reported that women were expected to leave “when
their condition becomes noticeable.”




26

MATERNITY PROTECTION OF EMPLOYED WOMEN

The following is a statement of policy from a company which sets
definite prenatal time limits on employment:
Pregnancy.—“Length of time employee permitted to work—It has been
our policy to permit an employee who is pregnant, to continue to work until
she is 6 months pregnant, unless she is physically unable or unless she volun­
tarily terminates her employment before 6 months.
“Reason for time limit—This 6 months’ limit has been set by our plant
physicians and is for the protection of the employee and the company. The
plant physicians have extended this time in very special cases to permit
employees to qualify for certain benefits. However, the extended time ha°
been limited to 1 week or 2 weeks.”

Since only a small proportion of the women leaving for pregnancy
return within a year after childbirth, most of the firms do not have
any policy as to the postnatal period during which employment is
prohibited. Of the 43 firms included only 7, all of which were manu­
facturing firms, reported on specified postnatal leave, and the periods
ranged from 1 month to approximately 8 months. In the latter
case, maternity leave was required to begin not later than the end of
the fifth month of pregnancy and to continue for a year. Two or
three months after childbirth were minimum time limits for return
to work.
General leave clauses are included in many more union agreements
than are special maternity leave provisions. The Bureau of National
Affairs in its analysis of union contracts reports that about four-fifths
of the agreements contain leave of absence clauses. A little less than
one-sixth of the contracts (chiefly manufacturing) provide maternity
leave. About one-half of the union firms included in the Women’s
Bureau study—these were all woman-employing industries—had
negotiated definite maternity leave clauses. The provisions included
in maternity leave clauses vary greatly. Some merely provide that
leave will be granted for pregnancy. Others set forth eligibility
requirements for leave and reinstatement, over-all time limits, pre­
natal and postnatal time periods, the retention and accrual of seniority,
and some provide standards for safeguarding the welfare and working
conditions of pregnant employees.
The following five excerpts from union agreements illustrate differ­
ent types of maternity clauses:
“Leave of absence, without loss of seniority, for appropriate periods,
subject to extension upon reasonable request, will be granted to employees
in case of illness, pregnancy, or injury.”
“A female employee with 10 months or more of continuous company
service shall be granted a leave of absence upon presentation of a certificate
from her physician denoting pregnancy.”
“Female employees who may become pregnant shall be allowed a leave of
absence for a minimum period of six (6) months and a maximum period of
one (1) year. The leave of absence of any such female employee shall com­
mence within 3 to 6 months after she becomes aware of her pregnant condi­




MATERNITY PROTECTION IN THE UNITED STATES

27

tion and shall end within 3 to 6 months after the date of childbirth. The
first 6 months of any such absence from service shall not be deducted in
determining the total length of service with respect to seniority.”
‘‘Maternity leave provisions.—Employees with 60 days or more days of
service since last date of employment or reemployment are entitled to mater­
nity leave under the following conditions: (1) The employee will be re­
quired to report to the plant physician as soon as she becomes aware of her
condition; (2) she will be required to leave her work on or before the end of
the fifth month; (3) a minimum absence of 9 months is required in all mater­
nity cases; (4) at the expiration of 9 months’ absence, the employee must
notify the personnel office that she is ready to assume her work, or furnish
medical evidence that her health would not permit her to return to work
immediately; (5) failure to report at the expiration of the 9 months’ period
is equivalent to resignation and is subject to conditions governing resigna­
tions; (6) it will be necessary for the employee to be examined by the plant
physician before she is allowed to return to work; (7) when the employee
returns to work, full seniority will be given. During the employee’s absence
or leave her life, surgical, and hospitalization insurance will be continued in
full force by the company and the employee will be entitled to disability and
surgical benefits if insured for 9 months at time placed on leave—in accordance
with the provisions of the policy with the . . . Insurance Company.”
“The following provisions shall apply to employees who become pregnant:
Whenever an employee shall become pregnant, she shall furnish the company
with a certificate from her physician stating the approximate date of delivery,
the nature of the work she may do, and the length of time she may continue to
work. Thereafter, upon the request of the company she shall furnish an
additional certificate containing like information every 30-45 days. She
shall be permitted to continue to work, in suitable employment, in accordance
with her physician’s recommendation and she shall be allowed to work until
2 months before the expected date of delivery, if her physician certifies that
she is able to continue working. She shall not be employed on the midnight
shift; nor more than 8 hours a day nor more than 48 hours a week; nor at
any work requiring heavy lifting, or continuous standing or moving about,
or other work listed as hazardous for pregnant women by the Children’s
Bureau and the Women’s Bureau of the U. S. Department of Labor; and she
shall be allowed a 15-minute rest period during each half of the work shift.
Whenever she is required to interrupt her employment upon the advice of her
physician she shall be immediatley granted a leave of absence until she is
able to return to work. Upon presentation by her of a certificate from her
physician that she may return to work, she shall be so returned, and her
seniority shall accumulate during the period of such leave of absence. She
may return to work after delivery upon the presentation of a certificate from
her physician that she is able to work Upon her return she shall be placed
in suitable employment in accordance with the recommendation of her phy­
sician. Upon the expiration of a period of 2 months after delivery, the com­
pany shall have the right to require a physician’s certificate in support of her
request for a continuation of her leave of absence, at intervals of not less
than thirty (30) days. It is understood that these clauses applying to em­
ployees who become pregnant shall not be construed to deny or restrict,
but shall be deemed to enlarge, any rights (including rights involving leaves
of absence or light employment) to which they may be entitled under any
other provisions of this contract.”

Women representatives of the AFL and CIO organizations met in
the Women’s Bureau in 1944 and proposed the following standards
for maternity leave:
(1) Pregnancy not grounds for dismissal.
(2) Transfer to other duties on physician’s written statement.

997117—52--------5




28

MATERNITY PROTECTION OF EMPLOYED WOMEN

(3) Granting of maternity leave of not less than 6 weeks before
delivery and 2 months after delivery, with additional leave
up to 1 year on presentation of doctor’s certificate.
(4) Accumulation of seniority for the first 3% months and reten­
tion thereafter of full seniority until 1 year from date of
leaving.
(5) Charging to maternity leave, at employee’s written request,
of all unused sick and vacation leave, and payment of com­
pensation accordingly.
(6) Return to former job or one of comparable pay.
Percent oj women workers on maternity leave.—Numbers were not
available on the exact incidence of maternity among employed women,
but it was estimated by 1 of the large commercial insurance companies
that under health insurance plans including maternity benefits, about
40 women employees out of 1,000, or 4 percent, received benefits during
the course of a year. Under the railroad sickness compensation law,
the average was 35 women per thousand or 3% percent in 1949.
Of the 43 firms included in the Women’s Bureau field survey, 32
were able to supply information on the number of women that had
given pregnancy as their reason for leaving their jobs during the
preceding year. The median was 4 percent, or 40 per thousand, agree­
ing with the estimate given by the commercial insurance company.
One-fourth (8) of the firms reported only 2 percent. One-third re­
ported more than 5 percent.
Women currently on maternity leave were reported on by 31 of the
43 firms and more than one-half of these either had no women on
maternity leave or less than 2 percent.
Percent oj women returning from maternity leave.-—Reports of the
firms and the individual records of women receiving maternity
benefits indicated that the majority of women receiving maternity
leave do not return to their jobs, at least to the same firm, before the
expiration of their leave period. Records for 1950 of the number of
women leaving for pregnancy and the number of women returning
after maternity leave were available for 29 of the firms visited. For
the 29 firms the number leaving was 6 times as great as the number
returning after childbirth. A larger proportion of women employed
in manufacturing returned than in nonmanufacturing industries such
as insurance, banking, retail trade, hotels, and restaurants. In a
few of the manufacturing plants included in the study the proportion
of women returning was 30 percent or slightly over; in others it was less
than 3 percent. In the six nonmanufacturing plants providing in­
formation on the numbers leaving and returning, the number leaving
because of pregnancy was about eight times as great as the number
returning after childbirth.




MATERNITY PROTECTION IN THE UNITED STATES

29

Maternity leave for teachers.—With the increasing number of married
women teachers, a policy for maternity leave faces school boards and
teachers’ organizations. The National Education Association, in
a study of teacher personnel administration for the school year 1950­
51 in public schools throughout the United States, asked the following
question: “If your teaching staff includes married women, is leave of
absence given for maternity?” The findings were as follows:

Size of city

Total
500,000 or over ____ _ _
100,000 to 500,000
30,000 to 100,000 __________
10,000 to 30,000
5,000 to 10,000
2,500 to 5,000

Maternity leave—
Number of
school systems
reporting
Provided for Not provided
for

1, 606

16
78
235
341
393
543

807

Percent
providing

799

50

66

1
12

140
169
188
229

95
172
205
314

94
85
60
50
48
42

15

In cities of more than 100,000 population, maternity leave was
granted by approximately 90 percent of the public school systems.
In the smaller cities leave policies of any kind are less common.
Often in small school systems, teaching contracts are on a year to
year basis and teachers have little security of tenure.
A study of the Research Division of the National Education As­
sociation on maternity leave in 1948 showed that the duration of leave
and provisions for job security varied materially. Of those that set
up definite periods for prenatal leave, a large majority required that
teachers leave before the sixth month of pregnancy. A few expected
their employees to leave as soon as they became aware of their preg­
nancy. Periods of postnatal leave varied from 7 weeks to 3 years
after childbirth. The most usual provision was a minimum absence
of 1 year for maternity. Some school systems allow reinstatement
only at the beginning of the school year or semester, so minimum
time allowance may actually be considerably longer than the specified
period.
About one-half of the systems reported that if an employee’s former
position is not open upon her return, she will be placed at the level for
which she is qualified as soon as there is a suitable vacancy. Only a
few reports gave any indication of payment being made for any part
of the leave period.




30

MATERNITY PROTECTION OF EMPLOYED WOMEN

Working Conditions for Pregnant Women

In her book, “Women in Industry; Their Health and Efficiency,”
Dr. Anna M. Baetjer concisely points out some of the factors that
must be considered in the employment of women during pregnancy.
She states:
It is obvious that pregnancy places a definite limit on the ability of women
to do physical work, since a pregnant woman fatigues more readily, has
poorer balance, may be adversely affected by industrial poisons, and is unable
to respond normally to the physiological demands of strenuous physical work.
Pregnant women should not be employed on work requiring heavy labor,
constant bending or stretching, irregular shifts, long hours, night work, a
constant posture, good balance, or exposure to harmful chemical substances.
There is, however, no reason why a pregnant woman should not be allowed
to continue certain types of work if her physical condition is satisfactory, if
the conditions of work are properly controlled, and if the industrial physician
supervises her placement.

Many supervisors interviewed by Women’s Bureau agents consider
it a good policy to encourage women to report their pregnancy in the
early stages so that special consideration may be given them. The
incidence of pregnancy per 100 employed women only averages 3 or 4
annually, so some adjustments in duties or assignments for these are
minor problems handled on an individual basis. The special con­
siderations given may be more than compensated for in the retention
of the services of an experienced employee for several months.
Most of the firms do not have hard and fast policies as to working
conditions, job transfers, hours of work, and rest periods for pregnant
workers. A supervisor or an industrial nurse may authorize an extra
rest period if needed. Assignments to lighter physical work if the job
has appreciable physical strains or for rotation from standing to
sitting jobs are possible in many factories. In large retail establish­
ments, a pregnant saleswoman might be transferred to light stock or
light clerical work, such as telephone sales. Part-time work schedules
for pregnant employees in retail trade and restaurants oftentimes can
be arranged to meet the needs of pregnant workers and also those of
the employer.
Changes in working conditions are commonly made on an individual
basis with consultation as necessary with the industrial nurse and the
medical department. Company doctors may be asked to advise on
suitability of jobs and working conditions for the pregnant.
Employers do not usually offer any medical services or advice to
pregnant employees through plant medical departments, as it is gener­
ally felt that this should be left exclusively to personal physicians.
One company included in the study had a complete medical care plan
and prenatal and postnatal medical services that were available at the
plant clinic, located near the factory plant. In other plans offering




MATERNITY PROTECTION IN THE, UNITED STATES

31

complete medical services these were available at health centers or
clinics serving the community.
Some firms require certification of physical fitness to work from the
pregnant employee’s own physician, but this is usually only for
employment extending into the last months of pregnancy. On return
to work at the expiration of maternity leave, employees frequently are
required to bring a statement from their own physician of physical
fitness for reinstatement and also to have the approval of the com­
pany’s medical department.
The Women’s Bureau and the Children’s Bureau, consulting with
union and medical representatives during World War II, made the
following general recommendations for working conditions for pregnant
women: 8
Pregnant women should not be employed on a shift including the hours
between 12 midnight and 6 a. m. Pregnant women should not be employed
more than 8 hours a day nor more than 48 hours per week, and it is desirable
that, their hours of work be limited to not more than 40 hours per week.
Every woman, especially a pregnant woman, should have at least two 10minute rest periods during her work shift, for which adequate facilities for
resting and an opportunity for securing nourishing food should be provided.
It is not considered desirable for pregnant women to be employed in the
following types of occupation, and they should, if possible, be transferred to
lighter and more sedentary work:
(a) Occupations that involve heavy lifting or other heavy work.
(b) Occupations involving continuous standing and moving about.
Pregnant women should not be employed in the following types of work
during any period of pregnancy, but should be transferred to less hazardous
types of work.
(a) Occupations that require a good sense of,bodily balance, such as work
performed on scaffolds or stepladders and occupations in which the
accident risk is characterized by accidents causing severe injury, such
as operation of punch presses, power-driven woodworking machines,
or other machines having a point-of-operation hazard.
(b) Occupations involving exposure to toxic substances considered to be
extrahazardous during pregnancy, such as:
Aniline.
Nitrobenzol and other nitro compounds
Benzol and toluol.
of benzol and its homologs.
Carbon disulphide.
Phosphorus.
Carbon monoxide.
Radioactive substances and X-rays.
'
Chlorinated hydrocarbons.
Turpentine.
Lead and its compounds.
Other toxic substances that exert an
Mercury and its compounds.
injurious effect upon the bloodforming organs, thej liver, or the
kidneys.
Because these substances may exert a harmful influence upon the course of
pregnancy, may lead to its premature termination, or may injure the fetus,
the maintenance of air concentrations within the so-called maximum per­
missible limits of State codes, is not, in itself, sufficient assurance of a safe
working condition for the pregnant woman. Pregnant women should be
transferred from workrooms in which any of these substances are used or
produced in any significant quantity.
8 U. S. Department of Labor, Women's Bureau and Children’s Bureau. Standards for Maternity Care
and Employment of Mothers in Industry, July 1942.




32

MATERNITY PROTECTION OF EMPLOYED WOMEN

Experience of 831 Claimants for Maternity Benefits

To learn about the women who are the recipients of maternity ben­
efits, the Women’s Bureau in 1951 obtained data from firms visited
or their insurance carriers, covering the time lost for maternity, the
actual benefits received, the jobs in the firms, and ages for about 800
women who had received maternity benefits during the preceding year.
Since maternity benefits are only one segment of health insurance
programs and since often little effort is made to keep records that can
be readily identified and related to maternity claimants, it was difficult
to obtain complete coverage of maternity cases for a year from all of
the firms visited. Sometimes records of benefits are kept only by the
insurance company and the employing firm has no information on the
benefits actually collected. In other cases, the records were available
only in the union office administering the health insurance plan and
data were not kept in such a manner that the utilization of benefits
for maternity could be separated readily. Also, where hospitalization
and surgical benefits offered are on a service basis, neither the employer
nor the unions usually had any detailed information on the value of
benefits collected.
However, it was possible to obtain a complete coverage or a repre­
sentative sample of maternity claims from some of the firms visited
and to supplement this by records from insurance companies and
union offices. Altogether records for 831 women claimants of mater­
nity benefits for childbirth or miscarriage in about 200 firms and
organizations were collected. Of the 831 women claimants, 784 re­
ceived benefits for childbirth and 47 for miscarriage (see p. 37). More
than 90 percent of deliveries were reported as normal. The women
claimants were employees of manufacturing firms, retail trade, banks,
insurance companies, union offices, and hotel and restaurant industries.
The Claimants

The ages of the women workers at the time of childbirth ranged from
16 to 46 with a median age of 26. Most of the women were in their
twenties. Only about one-fourth were over 30. The clerical group
for whom records were available tended to be even younger than the
other groups. Saleswomen and restaurant workers tended to be a
bit older, with a higher proportion over 30. Only 8 percent of the
women were over 35.
Being for the most part a young group, it is to be expected that the
work histories available for most of the women would be short.
Almost one-half of those reporting on time with the firm had been
employed less than 5 years and only about 10 percent had as much
as 10 years’ seniority.




MATERNITY PROTECTION IN THE UNITED STATES

33

The Children’s Bureau and Women’s Bureau have recommended
maternity leave of at least 6 weeks before and of 2 months after child­
birth. Most of the women left their jobs during the second 3 months
of pregnancy. Seventeen weeks or about 4 months before childbirth
was the average time of leaving. The average time of leaving work
was 16 weeks before delivery for production workers, 18 weeks for
clerical workers, 20 weeks for sales, and 21 weeks for restaurant workers.
Approximately 20 percent left in the first 3 months, 50 percent in the
second 3 months, and 30 percent in the last 3 months of pregnancy.
Of those continuing to work in the last 3 months, about one-half—15
percent of the total—continued to work during the eighth and ninth
months of pregnancy. Four production workers had worked up to
the last day of their pregnancy. On the whole, clerical and service
workers tended to leave earlier than factory workers. While about
one-third of the production workers had continued employment dur­
ing the last 3 months of pregnancy, about one-fifth of the clerical and
one-sixth of the restaurant and store workers had worked as long
as this.
Records of the date of returning to work were available for only a
small group. Less than 10 percent of the women whose maternity
claim records for the year 1950 were obtained were reported as having
returned at the time of the study—IVTay 1951. Of the 67 reporting
on dates of return to work, 4 women (less than one-tenth) had returned
as soon as 6 weeks after childbirth. A little more than one-third had
returned within 3 months, and by the end of 6 months by far the
greater part—almost four-fifths of those returning—were back at
work.
The total time lost from work—prenatal and postnatal absence
combined was ascertained for those for whom the date of return was
available. The time-span ranged from 6 weeks to 67 weeks. The
average time lost was 32 weeks or about 8 months. Two-thirds of
the women lost 6 months or more and about two-fifths lost 9 months
and more. Of those who had returned, less than one-tenth had been
away from their jobs as long as a full year.
The Benefits

Maternity benefits included weekly cash payments as partial com­
pensation for lost earnings, and cash payments or prepaid service for
hospitalization and obstetrical care. Sometimes full medical care
(prenatal, delivery, and postnatal) was included. Maternity benefits
in some firms were limited to one of the listed services; in others they
comprised a complete service of weekly cash, hospitalization, and
obstetrical benefits; and in one, comprehensive medical care was in­
cluded. The records from this firm have been included with those




34

MATERNITY PROTECTION OF EMPLOYED WOMEN

tabulated under hospitalization and obstetrical benefits. The types
of benefits and the distribution of the women receiving them were:
Benefits

Percent of
women

Total...................... .................... ...................................

100

Weekly cash benefit, hospitalization, and obstetrical---------Weekly cash and hospitalization
25
Weekly cash and obstetrical--------------------------------------Weekly cash benefit only------------------------------------------Hospitalization and obstetrical-----------------------------------Hospitalization only or obstetrical only--------------------------

37
1
8

28
1

Weekly cash benefits—Weekly cash benefits were collected by 70
percent of the women and in most cases they were coupled with other
benefits. When only one type of benefit was provided, the weekly
cash benefit was the most common single provision. This benefit
gives the woman actual cash that makes up for some of the wages she
loses during pregnancy. Practically all the women receiving cash
benefits collected the full lump sum for 6 weeks, the customary period
for maternity cash benefits. Only four received less. The average
(median) cash benefit in lieu of wages for the women was $134, or the
equivalent of little over $22 a week for 6 weeks. The maximum cash
benefit was slightly over $300 and the minimum a little under $50.
Almost two-thirds of the women received from $100 to $175 as a lump
sum and about one-tenth received $200 or more. Clerical workers
and salespeople received somewhat larger amounts than the factory
workers, while the service workers in restaurants received considerably
less.
Hospitalization.—Hospital benefits were received by 90 percent of
the women. About two-thirds of the women received cash reimburse­
ment for hospital expenses from group policies carried with commercial
insurance companies. A small proportion of these received a flat cash
allowance such as $60 or $80 to apply on their hospital bills. Most of
those protected by commercial company policies were paid hospital
benefits on a fixed maximum scale of from $5 to $9.50 daily for a
limited period, and usually received an additional allowance for extra
charges for delivery room, laboratory fees, and other special services.
The most usual allowance for board, room, and care was $7 a day.
The period of hospitalization for childbirth was a week or less for ap­
proximately three-fourths of the women reporting. The hospital
stays were:




MATERNITY PROTECTION IN THE UNITED STATES
Days in hospital

35

Percent

Less than 5 days
5 days.------ --------------------------6 days------- ----------------------------7 days-----------------------------------------------------------------8 days-------- ------------------------9 and 10 days________________________
More than 10 days

10
20
22

22
15
8
3

The total amounts paid under commercial insurance contracts for
room, board, care, and extra charges showed a wide range of from $10
to $240, but almost three-fourths of the women received amounts
falling in the brackets from $40 to $90. The average cash reimburse­
ment for hospital charges was $66.25.
Hospital charges were obtained for 146 women who were covered by
commercial insurance policies. The extent to which the amounts
received met the costs for maternity hospitalization is indicated in the
following:
id
.
, ,
,
Percent of hospital bill reimbursed

Total women reporting
Less than 20 percent
20, under 30 percent
30, under 40 percent
40, under 50 percent
50, under 60 percent
60, under 70 percent
70, under 80 percent
80, under 90 percent
90 percent and over

Number of
women

146

ofbill___________________
ofbill___________________
ofbill___________________
ofbill
32
ofbill
45
ofbill___________________
ofbill___________________
ofbill___________________
3

Percent of
women

100.0
2
10
17

27
7
3

1.4
6.8
n,6

21.9
30.8
18.5
4,s
2.1
2. 1

Almost 60 percent of the women received amounts for hospitaliza­
tion that covered 50 percent or more of their hospital bills.
Individual claimant records were obtained for 128 women receiving
hospital service under Blue Cross coverage in two areas, Philadelphia
and New York City. In Philadelphia the women received hospital
services up to a maximum charge of $75 for normal delivery and in
New York City up to $80. In the case of caesarean or other deliveries
involving complications, more generous benefits were allowed.
Records of the actual charges made by hospitals and the payments
made by the Blue Cross to the hospitals were obtained for 44 mater­
nity cases in one Philadelphia company. Three-fourths, or 33 cases, had
been allowed $75 in services toward their hospital bills. This was the
maximum allowance for normal delivery. For 8 of the remaining 11
cases, the hospital bills were less than $75 and were fully covered.
The other 3 cases had involved complications in delivery and the
service allowances were: Full coverage of a bill of $123.20, $186.55
coverage of a bill of $212.55, and $218.10 coverage of a bill of $254.




36

MATERNITY PROTECTION OF EMPLOYED WOMEN

The following shows a summary of the payments and charges for
room, board, care, and incidental hospital expenses for the 44 cases
for which Blue Cross service payments were available:
Total charges for all services (44 cases)------------------------------- $4, 292. 50
Total Blue Cross payments to hospital-------------------------------- 3, 529. 05
Average total charge per case------------------------------------------97. 50
Average total Blue Cross payment per case-------------------------80. 20
Average hospital stay----------------------------------------- 6.2 days
Average daily charge for room and care of mother---------------------8.85
Average daily Blue Cross payment for room and care of mother.
8. 50
Average additional charge for extras per case---------------------------42.75
Average Blue Cross payments for extras per case----------------------26.95

The additional charges allowed cover such items as delivery room,
dressings, and nursery care of the infant.
The number of records on which Blue Cross hospital payments were
available was small but seemed representative in bearing out state­
ments made by representatives in firms that did not have the detailed
information on service payments.
Occasionally women employees are covered by Blue Cross through
family contracts carried by their husbands and may also collect
under cash reimbursement hospitalization plans at their own place
of employment.
Records were included from one firm that pays for complete medical
services for its employees. Women employees in case of pregnancy
after 6 months’ employment are eligible for prenatal medical care,
hospital and obstetrical services for delivery, postnatal care, and com­
plete medical care of the infant for 1 year. Medical care of the
mother continues for 1 year from date of leaving employment even
though she does not return to work.
Obstetrical or surgical benefits.-—Two-thirds of the women received
surgical benefits; that is, obstetrical allowances or services. These
benefits were provided by commercial insurance policies, group medi­
cal plans such as the Blue Shield, or by complete medical care
plans.
More than one-half of the obstetrical benefits reported were cash
allowances paid by commercial insurance companies. The most usual
payment for normal delivery was $75, paid to approximately 50 per­
cent of the women, and next was $50, paid to approximately 30
percent. More than 90 percent of the claims were for normal delivery,
and practically all the benefits paid by commercial insurance com­
panies ranged from $50 through $75. For caesarean and other
deliveries involving surgery, payments of $100 or more were usual.
For the group covered by Blue Shield and other group medical care
plans, records were not available on the costs or extent of the services




MATERNITY PROTECTION IN THE UNITED STATES

37

received. Under income limitation plans, some, undoubtedly, re­
ceived full compensation for obstetrical service. Others were en­
titled to service on an indemnity basis, and the customary benefits
in the plans included were allowances of $60 and $75 for normal
delivery and $100 and $125 for caesarean sections and ectopic
pregnancies.
Records available of amounts paid by the women for delivery fees
and the cash compensation received included only eight women. All
of these had paid $75 or more and none had received as much as $75.
Women covered by complete medical care in one large firm for
which records were available received unlimited obstetrical services
paid for entirely by the employer.
Combined benefits.-—When a worker receives weekly cash, hospital,
and obstetrical benefits, a substantial part of maternity costs are
covered. More than one-third, 286 of 784, received the combined
weekly, hospital, and obstetrical benefits. Total benefits were re­
ported in dollars for 199 and the range in benefits was from $160 to
$576 with an average $297. About one-half fell in the brackets from
$225 to $300, and for 10 percent, benefits totaled $400 or more.
Even when only one or two types of benefits were received, the
financial assistance is a material aid at a time when extra costs are
a drain on family resources.
Occasionally women fail to collect the benefits that are due them
either because of lack of information about their rights or in some
cases mere inertia in filing claims. Employees may fail to understand
and carry out their own obligations in instances where the plans are
financed by joint employer-worker contributions and do not arrange
to continue their payments after leaving for pregnancy.
Benefits jor miscarriage.—Six percent or 47 of the 831 women’s
records covered miscarriages. They have not been included in the
preceding discussion of benefits received by claimants. The time
lost for miscarriage varied from 1 to 36 weeks, with more than one-half
of those reporting on time lost returning to their jobs within 7 weeks.
The types of benefits received for miscarriage were:
Type of benefit

Total reporting

Number of
women

47

Weekly cash, hospital, andobstetrical___________________
Weekly cash and hospital
12
Weekly cash and obstetrical
Weekly cash only
Hospital and obstetrical___________
Hospital only
1




16
2
12
4

38

MATERNITY PROTECTION OF EMPLOYED WOMEN

The total weekly cash benefits received ranged from $11 to $230,
covering periods from 4 days to 6 weeks. About one-half of the
women receiving these benefits were paid for the full 6 weeks, the
usual maximum period for maternity benefits.
Blue Cross and full medical care plans provided hospitalization for
about one-third of the women with miscarriage claims. No infor­
mation was available on the extent of services provided to these
women. For the 19 women receiving cash reimbursement for hospital
expenses the amount showed a wide range from $5 to $134; five women
received between $30 and $40 and seven, between $70 and $80.
Nine women eligible for hospitalization had made no claims and
probably were not hospitalized.
Reimbursements for surgical benefits ranged from $25 to $50 and
the usual amount paid was $35.
Combined weekly, cash, hospital, and obstetrical benefits ranged
from $119 to $332, with the most common $270 to $275.
Need for Further Study

The Women’s Bureau study of maternity protection was concerned
only with some of the facets of the employment of pregnant women
such as legislation and regulations, personnel policies and practices
for maternity leave, and types of benefit plans sponsored by employers
and labor organizations that provide financial assistance and medical
care during pregnancy and childbirth. With the large numbers of
young married women that are employed, there is undoubtedly need
of study and research by appropriate agencies that would provide a
sound health basis for evaluating policies and standards for maternity
leave, working conditions, and medical benefits. A few questions on
which additional and current information for comparable groups of
employed women and other women would be helpful follow:
Does employment during pregnancy have any relation to medical
care problems during prenatal and postnatal periods and to more
complicated deliveries?
What is the incidence of miscarriage, premature deliveries, and
stillbirths among employed women as compared with other women
living on similar economic levels?
Does the nature or character of the work performed during preg­
nancy affect the development and well-being of the infant?
Is full-time employment harmful for the pregnant woman? Would
part-time work be more satisfactory for the woman and also for her
job performance?
Better record keeping by employers of pregnancy absences, duration
of maternity leave, date of childbirth or delivery, benefits paid,
special services given, and adjustments in working conditions are
needed for basic information.




Part II
MATERNITY PROTECTION LEGISLATION IN FOREIGN
COUNTRIES
International Labor Organization Maternity Protection Convention

The International Labor Organization, at its first session in 1919,
adopted a Maternity Protection Convention (No. 3). By the pro­
visions of the ILO Constitution member countries are obligated to
bring the provisions of adopted Conventions to the attention of the
appropriate authorities within whose competence the matter lies,
for the enactment of legislation or other action. This Maternity
Convention is to be considered for revision at the ILO Conference
meeting in 1952.
The Convention, ratified by 18 countries prior to 1951, concerns the
employment of women in industry and commerce before and after
childbirth and provides for the following:
Scope, Maternity Leave, Maternity Benefits, Nursing Facilities. “Article 3.
In any public or private industrial or commercial undertaking, or in any
branch thereof, other than an undertaking in which only members of the
same family are employed, a woman—
(a) Shall not be permitted to work during the 6 weeks following her
confinement.
(b) Shall have the right to leave her work if she produces a medical certifi­
cate stating that her confinement will probably take place within 6
weeks.
(c) Shall, while she is absent from her work in pursuance of paragraphs
(a) and (b), be paid benefits sufficient for the full and healthy mainte­
nance of herself and her child, provided either out of public funds or by
means of a system of insurance, the exact amount of which shall be
determined by the competent authority in each country, and as an
additional benefit shall be entitled to free attendance by a doctor or
certified midwife. No mistake of the medical adviser in estimating
the date of confinement shall preclude a woman from receiving these
benefits from the date of the medical certificate up to the date on
which the confinement actually takes place.
(d) Shall in any case, if she is nursing her child, be allowed half an hour
twice a day during her working hours for this purpose.
Protection of Employment—Job Security. “Article 4. Where a woman is
abisent from her work in accordance with paragraph (a) or (b) of Article 3
of this Convention, or remains absent from her work for a longer period as a
result of illness medically certified to arise out of pregnancy or confinement
and rendering her unfit for work, it shall not be lawful, until her absence shall
have exceeded a maximum period to be fixed by the competent authority in
each country, for her employer to give her notice of dismissal during such
absence, nor to give her notice of dismissal at such a time that the notice
would expire during such absence.”

Those provisions apply to women in the described employment
irrespective of age or nationality and whether married or unmarried.




39

40

MATERNITY PROTECTION OF EMPLOYED WOMEN

Ratifying countries.—All but 2 of the 18 countries ratifying did so
prior to 1935. Greece was the first country to ratify, and on June
13, 1921, when the second country, Eumania, registered its ratifica­
tion, the Convention became effective. Other European countries
that ratified included Bulgaria (1922), Spain (1923), Latvia (1926),
Yugoslavia (1927), Germany (1927), Luxemburg (1928), Hungary
(1928), and France (1950). Eight Latin-American countries ratified—
Chile (1925), Cuba (1928), Uruguay (1933), Colombia (1933), Argen­
tina (1933), Nicaragua (1934), Brazil (1934), and Venezuela (1944).
Thirteen of these ratifying countries are currently members of the
ILO9 and represent approximately one-fifth of the countries comprising
its membership.
Although complete agreement with the Convention has not been
effected in all of the ratifying countries, partly because of differing
national problems, considerable progress in the implementation of
national legislation on various aspects of the employment of pregnant
women has been made since the early years of the Convention.
With respect to maternity leave granted, differences exist in the
total duration of leave as well as in the extent of compulsory leave.
All 13 ratifying member countries provide maternity leave for em­
ployed women, but in three—Colombia, Greece, and Uruguay—leave
period is of 8 weeks’ duration instead of 12 weeks. Provisions in
some ratifying countries, however, require prenatal as well as post­
natal leave periods. In addition many go further than the Conven­
tion by protecting workers against dismissal for pregnancy.
In connection with payment of benefit, differences exist in connec­
tion with the financing of benefits received—compulsory social insur­
ance or compulsory employer obligation; requirements of employ­
ment or insurance coverage prior to eligibility for benefit; amount of
cash benefit; and extent of other benefits received for maternity. All
the ratifying countries, with the exception of Uruguay, provide cash
benefits and medical care for employees under a system of compulsory
social insurance. In some, the operation of the insurance laws has
not yet been extended to employees in the whole national territory;
and in some, payment of benefits for certain groups of employees is
made directly by the employers.
Cash benefits are received in lieu of wages by employees in all of
these countries. Approximately one-third of the ratifying countries
in 1951 gave allowances equal to the full wage; in others, the percent­
age of basic earnings paid ranged from one-third to two-thirds.
However, adequacy of cash benefits provided must be considered in
relation to the whole benefit program.
9 Does not include Germany (old), Latvia, Nicaragua, Rumania, and Spain.




MATERNITY PROTECTION LEGISLATION IN FOREIGN COUNTRIES

41

Medical assistance under national legislation is available in some
countries during all of the pregnancy period and after confinement.
Less use of hospital facilities is provided than in the United States.
Two countries have provisions for reducing cash benefits by 50 percent
in case of hospitalization. Supplementary benefits provided in
ratifying countries include layettes, nursing allowances in the form of
10 to 25 percent of basic earnings or a flat grant, and milk for children
not nursed by mothers. Some of the countries have supplementary
legislation designed to protect the health of pregnant employees, such
as prohibitions on employment in occupations involving the handling
of lead or lead compounds or alloys.
National Legislation in Nonratifying Member Countries

Many ILO members that have not ratified Convention No. 3 have
national legislation relating to maternity protection for employees.
The following list of member countries that had not ratified the
Maternity Convention by 1950 shows that most of them provide for
some maternity leave and for maternity benefits. Benefits are usually
provided under compulsory social insurance.
Maternity Protection Provided for Pregnant Employees Through
Legislation in ILO Member Countries That Had Not Ratified the
Maternity Convention by 1950 1
Country
Afghanistan_____ ___ _ .
Albania... .........................
Australia____ __
___
Austria_____ __
_____
Belgium... __
_______
Bolivia__________
_
Burma____ _
Canada *____ _ ______ _
Ceylon......................
China_______
Costa Rica__ _____ ____
Czechoslovakia. __ ______
Denmark.
_ _ _ _
Dominican Republic__ __
Ecuador.. ___ __
...
Egypt----------------- - _ ...
Ethiopia________
_
Finland___
_ _
___
Guatemala___ _______
Haiti_____
__ _
Iceland 4_________ ____
India_______
....
Iran
Iraq___________
__ __

Mater­ Cash
nity bene­
leave
fits

Med­
ical
care

Mater­ Cash Med­
nity bene­ ical
leave
fits
care

Country

x

_____

~x

x
X

x

x

x
x

(2)

x
x

*
X
X

X

X

Poland.........

_

"

_

x

x
x
x
x

■ _

X

x

■
X

x
X
X

X

x
x

x

! German Federal Republic, Indonesia, Viet-Nam have become members since March 1,1950, and Japan
rejoined in November 1951. (See p. 45.)
1 Optional.
1 Leave and benefit provisions for Canada and the United States are not provided for on a Nation-wide
basis and have been omitted from this table. Details for the United States are included in earlier sections
of the report.
* rtPla dt0r tlle introductl011 of compulsory national insurance covering sictness and maternity was being
ILO Committee on the Application of Conventions and Recommendations, Proposed Revision
of the Maternity Protection Convention, 1919, No. 3, G. B. 112, C. A. C. R„ D.5,112th Session, Geneva,
May-June 1950, pp. 19-27, and special tabulation of maternity benefits following page 60,




42

MATERNITY PROTECTION OF EMPLOYED WOMEN

In a few of the nonratifying countries maternity benefits are avail­
able under public service plans that provide out of public funds for
women residents.
Legislative provisions regulating the length of leave periods before
and after childbirth vary from 4 to 14 weeks in nonratifying countries.
Compulsory prenatal leave ranges from 8 days to 6 weeks and com­
pulsory postnatal leave from 2 to 8 weeks. Optional leave of 26
weeks is provided after 1 year’s continuous service with the same
employer in Sweden.
Extent of benefit provided also varies among the nonratifying coun­
tries. Amount of weekly cash benefit is usually a percentage of earn­
ings, rates varying from 25 percent of average basic earnings to 100
percent of basic earnings in the countries reporting.
Countries which did not report either compulsory leave or benefits
for pregnant employees include Afghanistan, Burma, Ceylon, China,
Ethiopa, Iceland, Israel, Lebanon, Liberia, Philippines, Syria, and
Thailand.
Proposed Revision of ILO Maternity Convention

Several of the member countries, realizing that in the course of
three decades since the adoption of the Maternity Convention there
have been changes in the economic and social conditions affecting
the employment of women, an increase in medical knowledge and
practice, and wide adoption of comprehensive systems of health insur­
ance, have recommended consideration of revision. Such considera­
tion is in keeping with the provision of the Convention that the
Governing Body of the ILO present to the General Conference, at
least once in 10 years, a report on the operation of this Convention.
Reports were scheduled for consideration at the 1952 Conference.
Some of the suggestions made by member countries for consideration
are noted here:
(1) More flexibility in coverage and leave that would make it
reasonably possible for a number of countries to conform.
(2) Broadening of coverage to include as far as possible all em­
ployed women, such as those in agriculture, and domestic
service.
(3) Review of length of leave in light of present-day medical
opinion including prenatal as well as postnatal.
(4) Possible changes in cash, medical, and supplementary benefit
provisions.
(5) Strengthening of job security and job seniority provisions.
(6) Safeguarding of health on the job, including restrictions on
employment involving hazardous activities and possible
transfer to other work.




MATERNITY PROTECTION LEGISLATION IN FOREIGN COUNTRIES

43

Maternity Protection (Agriculture) Recommendation

The General Conference of the ILO adopted Recommendation No.
12 in 1921, urging that each ILO Member take measures to insure to
women wage earners employed in agricultural undertakings protec­
tion before and after childbirth, similar to that provided by Convention
No. 3 for women employed in industry and commerce.
Statements on Selected Countries

A detailed discussion of maternity protection in foreign countries
will not be attempted in this bulletin, but brief statements of items
covered by national legislation in countries in different regions are
included here to indicate variations in coverage, leave, and benefits.
Latin-America. Seven Latin-American Member countries, includ­
ing some of the most industrialized, have ratified the Maternity Con­
vention. Nine of the ten Member countries that have not ratified
have implemented some of the provisions of the Convention with
legislation.
Terminology describing coverage varies, but most of the laws have
more general coverage than the “industrial and commercial under­
takings” of the Convention, such as “all employment” and “paid
employees.
Peru and Venezuela have special laws which apply only
to workers in agriculture. Application of protective legislation to
workers in this important industry was given special emphasis at a
1949 conference of the American States Members of the ILO, and is
an agenda item for the 1952 Conference.
Total length of leave provided varies from 5% weeks in Mexico to
14 weeks in Panama. Six of the nine nonratifying Latin-American
countries that prohibit employment of women during part of the
maternity period also report some national provision for cash benefits
during the enforced unemployment period.
Prior to a resolution adopted in 1939 by American States Members
of the ILO, payment of maternity benefits was considered a direct
obligation of employers in many of the Latin-American countries.
This resolution, however, provided that maternity allowances should
be paid by means of a social insurance plan or out of public funds.
All of the nonratifying member countries now have some coverage
under compulsory social insurance, but in some of the countries
employers are still responsible because the insurance system does not
yet extend throughout the whole country. In Costa Rica, Guate­
mala, and Panama, for instance, where the insurance system is being
put into operation by stages, employers pay most of the benefits. In
Peru there are separate insurance acts for wage earners of small means
and for salaried employees. In Chile, one of the ratifying countries,
the insurance plan for wage earners only pays benefits for 2 weeks




44

MATERNITY PROTECTION OF EMPLOYED WOMEN

before and 2 weeks after confinement, and the employer has to pay
for the balance of the leave period. He must also pay for extension
of leave for wage earners who have not worked long enough to get
social insurance benefits. Employers in Chile must also pay full
wages to salaried employees during the entire legal leave.
Most common weekly benefit in the nonratifying countries is 50
percent of basic earnings, and at least half of the Latin-American
countries provide prenatal and postnatal care as well as obstetrical
services at confinement.
Great Britain.—Maternity cash benefits for employed women in
Great Britain under a national health insurance scheme of 1911 and
medical care for pregnant women administered by local organizations
were substantially increased by the enactment in 1946 of the National
Insurance Act and the National Health Service Act.
Under the National Insurance Act, employed women receive a
maternity grant to help with the general expense of confinement and,
if they have qualified through employment for insurance in their own
right, they are eligible for a maternity allowance for 13 weeks, begin­
ning 6 weeks before confinement. Work during the benefit period is
prohibited; this has the effect of a statutory maternity leave provision.
Contributions under the National Insurance Act are made by the
insured, the employer, and the government. An employed married
woman may elect not to contribute as an employee, but to receive an
allowance instead as a dependent under her husband’s insurance.
As a dependent, she is eligible for a smaller weekly allowance for 4
weeks after confinement. Both insured persons and dependents
receive the same maternity grant.
Medical care for all pregnant women—whether employed or not—is
included in the general medical care provided under the National
Health Service Act. Prenatal and postnatal care and obstetrical
services of a midwife or doctor are provided through the local health
authorities, who supervise the work of Health Centers and administer
the Mid wives Acts of 1902-36.
New Zealand.—National legislation for employees in New Zealand
provides maternity leave. Leave legislation covers factories only and
provides a total of 6 weeks’ compulsory leave after confinement but
makes no provision for prenatal leave. No weekly cash benefits
are paid. Medical service during the prenatal period, obstetrical
service, and postnatal treatment are provided free to all residents as
part of the benefits offered under the Social Security Act of 1938.
Maternity hospital service in a public hospital or obstetrical nursing
at home is provided to residents for a 14-day period.




MATERNITY PROTECTION LEGISLATION IN FOREIGN COUNTRIES

45

India.—The first national legislation for maternity protection for
women workers in India was an act passed in 1941 providing mine
workers with 1 month’s optional leave before and 4 weeks’ compulsory
leave after confinement, and providing cash benefits for the 8-week
period.
For factory workers, total maternity leave provided varies from 4
to 12 weeks, according to differing legislation of various provinces;
five of the nine provinces provide 8 weeks (4 weeks’ optional and 4
weeks’ compulsory). Maternity leave is compulsory for plantation
workers in two provinces—in one province for 6 weeks, in the other
for 8.
A compulsory insurance act of April 1948 (not yet in operation)
provides that employees with low earnings, in factories of 20 or more
workers, would receive a daily flat maternity allowance. This allow­
ance is for a 12-week period, of which not more than 6 weeks may
precede confinement. In addition, the covered worker would receive
medical care.
Japan.—In Japan, maternity benefits for groups of women workers
have been provided under some type of social insurance system since
1927.
Compulsory coverage now extends to those in establishments of
five or more employees. Those not eligible for compulsory coverage
are eligible for voluntary coverage under a National Health Insurance
Plan. This is a system of community medical care plans, more or
less independent, but coordinated, supervised, and in part financed
by the national and prefectural governments.
Under compulsory insurance, benefits include a maternity allowance
to compensate for loss of wages—the rate of benefit is 60 percent of
earnings or 40 percent if hospitalized. Benefit is payable for 42 days
before and 42 days after confinement. This allowance is in addition
to obstetrical care in a hospital and a lump sum for delivery expense.
Since 1944, there have been no requirements such as length of
employment or length of insurance coverage, but benefits are payable
only if confinement takes place within 6 months after employee has
left covered employment. Financing of benefits is shared by the
employer, employee, and the government.
Scandinavian countries.—All three of the Scandinavian countries
had some maternity protection legislation prior to 1900. The pro­
visions for maternity leave and benefits vary considerably.
All three have compulsory postnatal leave and two have optional
prenatal leave. Denmark prohibits the employment of industrial
workers for 4 weeks after confinement. Norway has 6 weeks optional




46

MATERNITY PROTECTION OF EMPLOYED WOMEN

prenatal and 6 weeks compulsory postnatal leave. Sweden allows
optional prenatal leave of 2 weeks and has compulsory postnatal leave
of 6 weeks with optional postnatal leave of 6 months for employees
who have 1 year’s continuous service with the same employer.
Norway, under the amended health insurance act of 1930, has com­
pulsory cash maternity benefits for all wage earners below a specified
income level and voluntary insurance for other employees that pays
benefits for 12 weeks. Denmark, under a voluntary insurance act of
1933, as amended, provides cash maternity benefits of 80 percent of
wages for employed women for 14 days after confinement. No cash
benefits are paid for maternity by the insurance system or public
service act in Sweden.
In connection with obstetrical and medical services, Denmark
provides midwife’s assistance and medical care if necessary. Norway
provides care by midwife or payment for obstetrical services, including
care in maternity homes or hospitals. If an employee is hospitalized,
she does not receive cash benefits, but during her stay in the maternity
home or hospital, a family allowance is provided under social insurance.
The voluntary social insurance system in Sweden is to be replaced by
a Public Service Act entitling all residents to medical benefits, which
for maternity will include prenatal and postnatal health supervision
at health centers, attendance by midwife, and hospital treatment.




REFERENCES
The following titles are taken from the Women’s Bureau Bibliog­
raphy on Maternity Protection, a selected list of references arranged
according to subject and annotated.
American Hospital Association. Blue Cross Guide; a summary of group enroll­
ment benefits, rates and regulations of nonprofit Blue Cross hospital service
plans. Chicago, 111., the Commission, 1951. 130 pp.
Baehr, George, and Deardorff, Neva 11. Maternity Service under the Health
Insurance Plan of Greater New York. Address delivered before the Interna­
tional and Fourth American Congress on Obstetrics and Gynecology, May 17,
1950. 22 pp. Available from the Health Insurance Plan of Greater New
York, 425 Avenue of the Americas, New York 11, N. Y.
Baetjer, Anna Medora. Women in Industry; Their Health and Efficiency.
Philadelphia and London, W. B. Saunders Co., 1946. 344 pp.
Bambrick, James J., Jr., Special Clause for Pregnant Women. Conference Board
Management Record (National Industrial Conference Board) 12: 419-420 No­
vember 1950.
Brown, Winifred. A Service for Working Mothers; an Account of a Special
Factory Clinic. Industrial Welfare and Personnel Management (London)
25: 16-17 (January-February 1943).
Bureau of National Affairs. Collective Bargaining Negotiations and Contracts.
Part III—Contract Clause Finder. Washington, D. C., the Bureau. Loose
leaf.
Burnell, Max R. Gynecological and Obstetrical Problems of the Industrial
Physician. Industrial Medicine 13: 211-214 (March 1944).
-------- Health Maintenance Program for Women in Industry. Journal of
American Medical Association 124: 683-687 (Mar. 11, 1944).
Central Legislation for Maternity Protection for Women Workers in Mines
[India]. International Labor Review (ILO) 46: 604 (November 1942).
Complete Maternity Service. Planning, No. 244. London, Political and Eco­
nomic Planning. January 31, 1946. 31 pp. (Reprinted by New Republic.)
Dickason, Gladys. Women in Labor Unions. Annals of the American Academy
of Political and Social Science 251: 70-8 (May 1947).
Elkin, Jack M. The 1946 Amendments to the Railroad Retirement and Railroad
Unemployment Insurance Acts. Social Security Bulletin 9: 23-33, 49-50
(December 1946).
Frame, Dorothy F. Examining Women in Industry; Some Observations of a
Woman Physician. Industrial Medicine 12: 266-269 (May 1943).
Frankel, Lee K. Maternity Insurance. Reprint from N. Y. Medical Journal,
December 18, 1915. 28 pp.
Group Insurance and Maternity Benefits. Textile Bulletin, August 1950, p. 85.
Harris, Henry J. Maternity Benefit Systems in Certain Foreign Countries.
Children’s Bureau Publication No. 57. Washington, D. C., Government
Printing Office, 1919. 206 pp.
Held, Adolph. Health and Welfare Funds in the Needle Trades. Industrial
and Labor Relations Review 1:247-263 (January 1948).




47

48

MATERNITY PROTECTION OF EMPLOYED WOMEN

Hesseltine, H. Close, Chairman, Committee on the Health of Women in Industry
of the Section on Obstetrics and Gynecology. Preliminary Report of the Com­
mittee. Journal of the American Medical Association 121:799-802 (Mar.
13, 1943).
Hilbert, Hortense. Maternity Leaves in Public Health Nursing Agencies,
Public Health Nursing 34:602-608 (November 1942).
International Labor Office. Conditions of Employment of Agricultural Workers.
Third Item on the Agenda, Fourth Conference of the American States Members
of the ILO, Montevideo, April 1949. Geneva, the Office, 1949. 181 pp.
-------- Conventions and Recommendations, 1919-49. Geneva, the Office, 1949.
924 pp.
-------- Proposed Revision of the Maternity Protection Convention, 1919. (No.
3.) G. B. 112/C. A. C. R./D. S. Geneva, the Office, 1950. 72 pp.
-------- Report of the Director-General. First Item on the Agenda, Fourth
Conference of American States Members of the ILO, Montevideo, April 1949.
Geneva, the Office, 1949. 143 pp.
-------- Systems of Social Security—New Zealand. Geneva, the Office, 1949.
67 pp.
Maternity Benefits for Women Workers in 1947. Indian Labor Gazette (Delhi)
7:171-173 (September 1949).
Maternity Care for Women in the Steel Industry. Steel Labor, December
1949, p. 3.
Maternity Protection in Poland. International Labor Review (ILO) 58:784
(December 1948).
Maternity Protection in Yugoslavia. Industry and Labor (ILO) 2:448-449
(Dec. 1, 1949).
Mohr Jennie. Maternity Leave Clauses in Union Contracts. The Child
9:166-169 (May 1945). '
Mothers in Jobs. Planning, No. 254. London, Political and Economic Planning.
August 23, 1946. 15 pp. (Reprinted by New Republic.)
National Education Association, American Association of School Administrators
and Research Division. Maternity-leave Provisions in 157 School Systems in
Cities over 30,000 in Population. Educational Research Service Circular
No. 6. Washington, D. C., The Association, August 1948. 33 pp.
National Health Service Act, 1946. London, Eyre and Spottiswoode, 1947.
130 pp.
New Maternity Protection Act in Germany. International Labor Review (ILO)
46:598-601 (November 1942).
New Regulations for Greek Civil Servants. Industry and Labor (ILO) 3:274-275
(Apr. 1, 1950).
New York (State) Department of Labor, Division of Research and Statistics.
Studies in Disability Insurance. Special Bulletin 224. New York, N. Y., the
Division, 80 Centre St. 1949. 157 pp.
------------------Union and Union-Management Administered Health Insurance
Plans in New York State, January 1951. New York, N. Y., the Division,
1951. 59 pp.
Olsen, Caroline G. A Pregnancy Adjustment Plan for Women in Industry.
National Safety News 49: 32, 80-82 (February 1944).
O’Sullivan, J. V., and Bourne, L. D. Supervision of Pregnant Women in Factory
Employment. British Medical Journal (London), January 22, 1944, pp.
108-110.
Pakistan: New Act on Maternity Insurance. Bulletin of the International Social
Security Association (Geneva), May 1950, p. 34.




REFERENCES

49

Phelps, Edward Bunnell. New Statute for the Protection of Child-Bearing
Factory Workers and Means of Making it Effective. Albany, N. Y., J. B.
Lyon Co., 1913. 16 pp.
Pommerenke, Wesley T. Women in Industry from the Standpoint of the
Gynecologist. Industrial Medicine 12:512-514 (August 1943).
Protection of Working Mothers in Italy. Industry and Labor (ILO) 5:191-194
(Mar. 1, 1951).
Reed, Louis Schultz. Blue Cross and Medical Service Plans. Washington,
D. C., Federal Security Agency, U. S. Public Health Service, October 1947.
323 pp.
Research Council for Economic Security. State Cash Sickness Plans, 1949.
Chicago, 111., the Council, 1949. 11 pp.
Review of Cash Maternity Benefits. Ministry of Labor Gazette (London)
58:197 (June 1950).
Rhode Island Department of Employment Security. Preliminary Report on
Financing Cash Sickness Compensation in Rhode Island. Providence, R. I.,
the Department, 1951. 16 pp.
Right to Maternity Benefit in Argentina. International Labor Review (ILO)
58: 97-98 (July 1948.)
Sappington, Clarence Olds. Health Problems of Women in Industry. Pitts­
burgh, Pa., Industrial Hygiene Foundation, January 1944. 40 pp.
Sheppard, J. V. Health for the Working Girl. Hygeia 26: 250-252 (April
1948).
Silverman, Charlotte. Maternity Policies in Industry. The Child 8: 20-24
(August 1943).
Simsarian, Arax. Company Hospital and Surgical Plans. Conference Board
Management Record (National Industrial Conference Board) 11: 432-434,
463-464 (October 1949).
Sickness and Accident Benefits in Union Agreements, 1949. Monthly Labor
Review 70: 636-639 (June 1950).
Sickness and Maternity Benefits for Railroad Workers. Monthly Labor Review
65: 194-195 (August 1947).
Sinai, Nathan. Analysis of Rhode Island Cash Sickness Compensation, 1950.
Ann Arbor, Michigan, University of Michigan, School of Public Health, 1950.
35 pp.
-------- For the Disabled Sick, Disability Compensation. Research Series No. 5.
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[U. S.] Children’s Bureau. Maternity Policy for Industry. Children’s Bureau
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------— Congress, Senate Committee on Post Office and Civil Service. S. 198, A
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partment. Loose leaf,




50

MATERNITY PROTECTION OF EMPLOYED WOMEN

United States. Department of the Army. Policy of the War Department Con­
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---------------------------- Comparison of Temporary Disability Insurance Laws,
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view (ILO) 49:112 (January 1944).




0. S. GOVERNMENT PRINTING OFFICE: 1952