Leave policy after stillbirth in LMICs: how much are we thinking about bereaved mothers? A scoping review

INTRODUCTION: Low-income and-middle-income countries (LMICs) contribute to the maximum burden of stillbirth globally, which affects parents in various tangible and intangible ways, emphasising the need for having a provision of parental leave to recover from the physical and mental/emotional drain. In response to this, we conducted a scoping review with the objective of identifying provision of leave within maternity benefit policies after stillbirth in LMICs.

METHODOLOGY: The study is conducted in accordance with Joanna Briggs Institute guidelines, using the population, concept and context framework to define the research questions. The International Labour Organization (ILO) global care policy portal and documents from selected international United Nations (UN) organisations were reviewed to assess the inclusion of stillbirth within maternity leave policies. Additionally, country-specific maternity leave policies were retrieved from official government sources for LMICs. Fuerther, databases including PubMed, Web of Science, Scopus and ProQuest were searched for studies from LMICs to identify literature with recommendations around leave policy. Study selection and data extraction were conducted by two independent reviewers with arbitration by a third reviewer.

RESULTS: This study noted a stark difference in the leave policy; although all 49 LMICs included in the review had a national maternity leave policy, 67.3% did not align with ILO's Convention number 183. In contrast, only 10 countries (<20%) have provision of leave after stillbirth. Notably, even among the 10 countries with specific provisions for stillbirth, the average duration of leave after stillbirth was 50.1 days, compared with an average of 107.7 days following a live birth in the same countries. The review also found substantial variation in how stillbirth was defined across policy documents. Furthermore, documents of selected UN organisations revealed a detailed provision of leave post stillbirth for childbearing (12 weeks) and for non-childbearing (2 weeks) women. Further, we could not identify literature with recommendations around leave policy among publications about stillbirth in LMICs.

CONCLUSION: Leave grant showed stark disparity. Ignoring the need for physical rest may have long-term health implications. Organisations should have a provision to support women having a stillbirth. Having a provision for flexible leave options allows women to decide when they are emotionally and physically ready to return, rather than forcing a one-size-fits-all solution.