A research team from the School of Public Health and the School of Nursing, LKS Faculty of Medicine at the University of Hong Kong (HKUMed), Duke-NUS Medical School (Singapore), and the University of British Columbia (Canada) found that extending Hong Kong’s statutory paid maternity leave from 10 to 14 weeks in 2020 led to a significant improvement in maternal mental health. The study revealed a 22% decrease in postnatal depressive symptoms among mothers and a 33% reduction in mothers reporting that baby care interfered with their emotional well-being. The findings were published in the healthcare journal Health Affairs [link to the publication].

Background

Hong Kong’s Employment (Amendment) Ordinance 2020 extended statutory paid maternity leave from 10 to 14 weeks to meet international standards. International Labour Organisation (ILO) standards recommend a minimum of 14 weeks of paid maternity leave. In 2021, the duration of maternity leave was at least 14 weeks in 120 countries (Korea: just 13 weeks; Mainland China/Japan: 14 weeks; Singapore: 16 weeks; the United Kingdom/ Canada: about 52 weeks).

Currently, only 52% of women in Hong Kong participate in the workforce, compared with 64% of men. Retaining female employees can thus help address the labour shortage. Women of child-bearing age (25–34 years old) have the highest workforce participation rate (80%), making them the most likely to benefit from the minimum 14-week maternity leave policy.

Postnatal depression is a common and serious mental disorder affecting mothers up to 12 months after childbirth. About 30% of new mothers in Hong Kong experience postnatal depression, significantly higher than the global average of 18% (14% in Mainland China and just 3% in Singapore). The leave-extension policy could have important implications for public health, including improved maternal mental and physical health and higher breastfeeding rates.

Research findings and significance

The research team recruited 1,414 eligible mothers who gave birth before (August 2020 to December 2020) and after (December 2020 to July 2022) the policy implementation. Participants had a mean age of 32 and worked mostly in skilled occupations.

The study found that 33% of respondents had probable postnatal depression and required a health assessment. The policy was associated with a 22% decrease in mothers experiencing postnatal depressive symptoms (40.2% pre-policy versus 31.5% post-policy). There was also a 33% drop in the number of mothers who reported that their baby care during the first two months after birth had been affected by their negative emotional well-being.

According to Dr Quan Jianchao, Clinical Assistant Professor in the School of Public Health, HKUMed, the extension did not lead to more mothers exiting the workforce. The new policy thus supports the retention of highly skilled and educated female workers.

‘Even a modest change in policy – an additional four weeks of paid leave – was associated with significant mental health benefits,’ said Dr Quan. ‘Despite significant improvements after the policy extension, maternal mental health in Hong Kong remains concerning. One-third of the participants in our sample had probable postnatal depression, while other estimates have put the figure at 16% to 30% of Hong Kong mothers, depending on the timing of the assessment. All these estimates are high compared to other Asian and Western societies.’

Neighbouring governments are increasing funding for paid parental leave as part of family-friendly initiatives. ‘On 18 August 2024, the Singaporean Prime Minister announced plans for an additional 10 weeks entirely paid by the government, bringing total paid leave to 30 weeks (7.5 months) by 2026,’ said Dr Ellie Bostwick Andres, one of the principal investigators, and a Senior Research Fellow in the Lien Centre for Palliative Care at Duke-NUS Medical School in Singapore.

About the research team

The research was jointly led by Dr Quan Jianchao, Clinical Assistant Professor in the School of Public Health, HKUMed; and Dr Ellie Bostwick Andres, a Senior Research Fellow in the Lien Centre for Palliative Care at Duke-NUS Medical School in Singapore. Other research team members included Professor Marie Tarrant, Dean of the Faculty of Health and Social Development, School of Nursing, the University of British Columbia, Canada; Dr Sofie Yung Shuk-fei, Clinical Assistant Professor of Practice, Department of Obstetrics and Gynaecology, School of Clinical Medicine, HKUMed; and Professor Kris Lok Yuet-wan, Assistant Professor, School of Nursing, HKUMed.

Acknowledgements

This research was supported by the Health and Medical Research Fund of the Health Bureau, the Government of the Hong Kong Special Administrative Region.

About the School of Public Health, HKUMed

The School of Public Health, HKUMed has a long and distinguished history in public health education and high-impact research. With world-leading research on infectious diseases, as well as on non-communicable diseases of both local and global importance, the School has made a significant contribution through its research and advocacy to improve the health of populations and individuals, both locally and globally. The School is a leading research and teaching hub in public health on influenza and other emerging viruses, control of non-communicable and infectious diseases, tobacco control, air pollution, psycho-oncology, behavioural sciences, exercise science, life-course epidemiology, population mental health, health economics, and health services planning and management. This work has informed international, national and local public health policies.