Does full time work affect childhood development?

Over the last generation, there have been an increasing number of working parents---a phenomenon that’s enabled more couples to be more financially comfortable, on the whole. But it’s come with the healthily and effectively raise children the way parents would like.

The last few decades have produced research on the effects of full time maternal employment on the behavior and achievement of children---but the conclusions of this research have been mixed, and largely reflected the prevailing ‘wisdom’ of the moment.

Understanding the perceptions of these effects, however, can tell us multitudes about the decisions that women are making today. In her seminar on “Stereotype Accuracy: Do College Women Miss the Mark when Estimating the Impact of Maternal Employment on Children’s Development?,” Professor Wendy Goldberg of UC Irvine discussed how college women frame the issue---and how accurate those stereotypes are.

She and her team found that most women overestimate the negative effects of motherhood on their children---i.e. they’d assume that working mothers would raise children with worse behavioral problems like aggression and depression, and that perform worse academically---and that women underestimate the positive effects: that having a working mother would provide a roll model as well as greater financial opportunities for her children, among others.

Accordingly, many mothers may seek to adjust their work lives accordingly, with part-time work or opting out entirely. The effect of this might be either a greater inclusion of mothers into the workforce, or a gender-segregation by jobs---particularly those who seek to advance after a break for childcare. Moreover, steady work reportedly offers the greatest mental and physical health benefits to women. Stereotypes regarding the negative effects of working mothers must thus be dispelled.

Of course, full time work is not a choice for many women and parents. Not all women have equal access to long-term, full time work, while women of disadvantaged economic backgrounds have even less flexibility. Thus more attention to paid parental leaves and subsidized childcare would help us get to a better place for all mothers, fathers, and children throughout society.

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Global Health Diplomacy

The Man: Scott Ratzan, MD Vice President, Global Health, Government Affairs & Policy for Johnson & Johnson

The Talk: Working Together on Health Literacy, Diplomacy and Innovative Health Communication to Advance Women’s Health

The Question: Health affairs as foreign affairs: how can we create a healthier world for women and girls? 

After hearing Dr. Ratzan at Davos, Harvard Kennedy School Academic Dean, Iris Bohnet, invited him to speak on campus -- I can see why. Ratzan spoke on achieving the MDG goals, using evidence to increase universal access to healthcare, incorporating technology into health education, and using health as a tool for foreign affairs. Not bad for a 60 minute presentation. 

Health as a common currency

Dr. Ratzan specifically focused on women and girls. He believes -- along with many others -- that if women and girls are given access to basic healthcare services, coupled with girls’ education, we can change the fabric of global inequalities. His position? Because health permeates all levels of society, altering this part of the equation affects all other variables. “Health is the common currency if what we’re trying to pursue is happiness,” says Dr. Ratzan. 

Much of what Dr. Ratzan discussed focused on achieving the MDG goals three and five: (3) Reducing child mortality, and (5) Improving maternal health. The highest rates of infant and maternal mortality are regional, but mainly clustered in six countries: India, Nigeria, Pakistan, Ethiopia, the Democratic Republic of Congo, and China. While some progress has been made in decreasing the under five mortality rate, attaining universal access to reproductive health would dramatically impact our ability to achieve these goals. “Short-term campaigns really don’t make the difference; you really need policy change. You need to have the advocacy for women and women in public policy to solve these problems.”

The catch-22, Dr. Ratzan says, is that, “Governments and people don’t want to invest unless they have evidence; but how do you have evidence unless you have investment?” He cited a well-known statistic that between 30 to 50 percent of Asia’s economic growth from 1965 to 1990 can be attributed to maternity and reproductive health programs; yet, we still find reasons to limit investment. 

Global health diplomacy: what is it? 

The WHO defines global health diplomacy as diplomacy that, “…brings together the disciplines of public health, international affairs, management, law and economics and focuses on negotiations that shape and manage the global policy environment for health. The relationship between health, foreign policy and trade is at the cutting edge of global health diplomacy.” 

Ratzan says it’s embedded in everything; from the U.S. Department of State to the Gates Foundation to the ivory towers of academia to the private sector, global health diplomacy engages all areas. While setting a global goal is important, getting there is much different. To bring these goals from ideas to practice, we need innovation. 

Mobile Technology

In April of this year, the New York Times ran a story about a woman in Nigeria who gave birth in an area without running water or electricity. What made this story so unusual? Cell phones lit the birth. In places where clean water is almost inaccessible, cell phone have deeper penetration. Dr. Ratzan called this the potential of mobile health. He then discussed a program called “Text4Baby” in a country with the following statistics:

• Annually, 500,000 babies are born prematurely
• Each year 28,000 die before their first birthday
• 89% of women between the ages of 18 - 49 have a mobile phone

What country is this? The United States of America. 

Text4Baby, founded by Johnson and Johnson, became a direct texting service out of this information. Although many factors influence these numbers -- access to health care, low income, poor health behaviors -- their research found that increasing knowledge around health, coupled with simple text reminders, could help mothers and children stay healthier. The program partnered with state and local government, along with cell phone carriers, to reach the lowest income mothers based on zip code. They plan to bring a service similar to this to Bangladesh and South Africa shortly. 

In closing

Personally, my favorite part of Ratzan’s presentation was the passion and conviction with which he spoke. Often cynicism and failure undermine our energies and ambitions, but Dr. Ratzan had a compassionate charisma that left the room feeling empowered. In essence, he brought it back to simple ways to achieve global health by utilizing existing technologies and innovative approaches. And all of this in the name of happiness.  

Melissa Sandgren is a MPP1 at the Harvard Kennedy School and a participant in WAPPP's From Harvard Square to the Oval Office program.

*Photo courtesy of http://globalhealth.illinois.edu/

It’s as simple as it is profound...

The Woman: Melanne Verveer, U.S. Ambassador-at-large for Global Women’s Issues

Last week I had the honor of hearing Ambassador Verveer speak to a crowded room of incredibly impressive women -- the capstone to three days of events, courtesy of the Women in Public Policy bi-annual board meeting. While this post will certainly fall short of the event, I will try and capture just a smidgeon of the essence from someone whose impact is as simple as it is profound: focus on women.  

Four Areas

Ambassador Verveer stressed four areas critical to elevating the status of women: 

1. Access to education
2. Economic participation
3. Access to basic health care
4. Political engagement

These four simple criteria provide both the foundation, as well as the strategies, to gauge and increase the status of women anywhere in the world. And, unfortunately, nowhere does parity on all four of these criteria exist. 

Why are these areas important? 

Education: When women and girls are educated, it provides a positive feedback loop that breaks the cycle of poverty. Girls marry later, have fewer children, raise healthier families, and are more likely to invest in their community. It has an exponential, and extensive, ripple effect that raises individuals and communities out of poverty. It is often colloquially referred to as The Girl Effect.

Economic participation: When women have access to economic opportunities, they reinvest 90 percent -- 90 percent -- into their families, communities, and countries. They raise the standard of living not just for themselves, but the world around them. They invest in the education of their children, the resources of their communities, and their household and financial assets. In places where banking sectors are slim or nonexistent, increased assets in the form of livestock or crops often serve as a necessary form of capital to protect against financial shocks, usually for medical emergencies. 

However, it goes beyond this; in countries where women are economically empowered, the entire countries’ GDP rises. Goldman Sachs calls it “Womenomics”. At a 2011 APEC summit, Secretary Clinton remarked that, “by increasing women’s participation in the economy and enhancing their efficiency and productivity, we can bring about a dramatic impact on the competitiveness and growth of our economies.” Ambassador Verveer also gave this staggering statistic: $46 billion is lost in economic growth from restricted job opportunities for women. The numbers seem to speak for themselves, but they are infrequently echoed.

Healthcare: In addition to economic inclusion, and especially in developing counties, having access to basic healthcare services is critical to ensuring equality. Women and girls are less likely to receive necessary immunizations or medical treatment, and limited financial resources are often extended only for boys. However, when women and girls have access to basic medical care, they are less likely to die in childbirth, more likely to see their children live past the age of five, and tend to raise healthier families. It provides another mechanism to break the cycle of poverty while simultaneously decreasing maternal and child mortality rates. 

Political participation: Political engagement is paramount. In countries where women are not allowed to receive inheritance or are denied property rights, they lack the legal and political rights to change these laws and policies. Even in the U.S., women represent less than 17 percent of Congress. Holding such a minimal amount of power prevents the dialogue and discourse from tackling issues impacting 50 percent of the population -- equal pay, preventative health care, and violence against women. Outside the U.S., and in newly minted countries, constitutions are being written without a single female voice. The inclusion and acceptance of women in the political process is essential to increasing their equality.

While these four areas are essential, they are not exhaustive. Ambassador Verveer discussed several other arenas where the role of women are paramount, yet often neglected. 

Women, Peace and Security

In December of last year, the U. S. State Department released the U.S. Action Plan on Women, Peace, and Security. The plan calls for women to be integrated into peace processes, conflict-prevention, transitional committees, and negotiating teams. Perhaps more importantly, it provides a bold declaration from the U.S. government that women are essential, perhaps even the crucial linchpin, to continued peace, stability and prosperity for countries. Personally, I like to believe the 2011 Nobel Peace Prize Laureates send a similar international message. 

Women are the canary

Ambassador Verveer said the State Department often views the role of women in a society as the canary. In regions where international security concerns are heightened, the role of women can speak volumes about the direction the country is headed. While the Ambassador did not mention specific situations, the metaphor easily translates: when the role of women is silenced or compromised, countries often find themselves headed towards instability.  

The importance of allies

Ambassador Verveer added an additional, often overlooked, component to the discussion - the importance of allies, specifically men, in securing the equality and inclusion of women. Allies are fundamental to encouraging this paradigm shift in women’s economic and political participation.  “Women’s issues are still perceived as ‘soft’. In reality, women’s issues are the hardest issues out there.” However, this asymmetry in power can be broken, especially when groups are familiar with the social, moral, and economic justifications of women's rights.  

Melissa Sandgren is a MPP1 at the Harvard Kennedy School and a participant in WAPPP's From Harvard Square to the Oval Office program.

*Photo cpyright World Economic Forum (www.weforum.org) / Photo Eric Miller emiller@iafrica.com

How to Transform a Global Health System

The Woman: Paula Johnson, Chief, Division of Women's Health, Brigham and Women's Hospital; Associate Professor of Medicine, Harvard Medical School

The Talk: Women's Health and Health System Reform: The Route to Transformational Development?

The Question: How do we transform a global health system that neglects gender?

As women continue to lag behind men in health and preventative care, the need for a health system transformation could not be greater. Yet, health access for women also requires recognition of the intricate relationship between politics, economics, education and current health systems. Fundamentally, the advancement of women hinges on improving their state of health and similarly, better outcomes for global health call for a gender-focused approach.

Women as mothers, individuals, and citizens

Dr. Johnson started her lecture with an overlooked angle to the question about improving health. As women, who are we and how do our multiple identities factor into global health? As mothers, Johnson says, women’s health needs will be neo-natal and maternal health services. As individuals, girls and women require reproductive and general health education catered to them. Women often act as family caregivers, providing “about 80 percent of the home health care”.

According to Johnson, health care systems must also treat women as citizens, who have risk for different kinds of diseases than men and who disproportionately bear the burden of disease. For example, women have a higher incidence of chronic diseases and a higher likelihood to suffer from anxiety and depression. Upper respiratory illness, often from exposure in kitchen spaces, also impacts more women around the world.

The roles of women and their distinctive health needs reinforce why health care changes must have targeted programs for women. The equity argument set aside, improving health circumstances for women can have a ripple effect. Johnson cites how Turkey and Sri Lanka developed female-focused health programs that may have resulted in higher national income, lower poverty rates, and increased global competitiveness.

Accountability in programs and public discourse

How do we create better health care access for women? Johnson answer: “data”. Policies such as the U.S. Affordable Care Act require a “mechanism to ensure that the policies do what they are supposed to do.” This means collecting data that is aggregated by gender and race, program monitoring with data analysis, and framing debate the about health policies with numbers.

Public discourse and political debate are key to reforms. Yet, at least for the United States, “Political divisions limit the conversation to abortion and contraception, making it extremely difficult to elevate other issues.” Johnson suggests “setting aside advocacy and the ideological arguments” for those based on numbered reasoning. She reminisced about a previous visit to the Kennedy School, where a debate on controversial topics in health took place. Ideology controlled, both sides were asked how they would improve women’s health.

Brooke Davis is a MPP1 at the Harvard Kennedy School and a State Department foreign affairs fellow.