Impact of paternity leave on maternal postpartum recovery and mental health: policy frameworks in India and Kerala

INTRODUCTION

The postnatal phase is vital to the maternity care continuum, yet it is frequently overlooked or undervalued by women, their families, and healthcare providers. This stage often receives disproportionately fewer resources compared to the antenatal and intrapartum periods.¹ Typically defined as the first six weeks following childbirth, this period is marked by significant hormonal changes, the shrinking of the uterus, the initiation of breastfeeding, and the resolution of pregnancy-related physiological changes.² The foundation for the health and well-being of both mother and child is established during the weeks after birth.³

Parental leave policies are evolving worldwide, leading to a reassessment of their diverse effects on both parents and children.⁴ Traditionally, maternity leave has been the primary focus, but there is growing acknowledgment of the significant role fathers play in early childcare, calls for a deeper exploration of paternity leave and its impact on maternal recovery.⁵ Paternity leave, which refers to the period of paid or unpaid leave available to fathers after the birth or adoption of a child, is believed to offer more than just opportunities for paternal bonding; it may also enhance maternal physical and mental health.⁶ Fathers’ presence and involvement, made possible by paternity leave, can help reduce the burdens and stress typically experienced by mothers during the postpartum period, leading to a more comprehensive and smooth recovery.

METHODS

This review compiled relevant literature and policy documents that were written in English. An in-depth search was executed across PubMed, Scopus, Web of Science, and Google Scholar, covering the years 2004 to 2025 to include the latest research and policy progress. Main search terms used were “paternity leave,” “postnatal care,” “maternal recovery,” and “parental leave policies”. Additional searches were performed using geographic terms such as “India” and “Kerala” in conjunction with the primary search terms. Official policy documents, government notifications, and legislative proposals, such as the paternity benefit bill, from India and international entities were examined to provide insights into legislative and policy frameworks.

GLOBAL CONTEXT OF PATERNITY LEAVE

Paternity leave policies differ globally, reflecting a range of cultural norms, economic situations, and government priorities concerning family support and gender equality. Traditionally, parental leave has mainly focused on mothers, but there is a growing global acknowledgment of the crucial role fathers play in early childcare and supporting maternal recovery. This change is evident as more countries are introducing or enhancing paternity leave benefits.⁷

Nordic countries, including Denmark, Finland, Iceland, Norway, and Sweden, are renowned for their progressive parental leave policies that promote gender equality and shared parenting. Historically, maternity leave was more extensive, but over time, paternity leave featuring initiatives like “daddy days” and “father quotas” has emerged as a crucial policy to encourage fathers’ active participation in raising children.⁸ In Sweden, parents are granted a total of 480 days of leave for each child. Out of these, 390 days are based on earnings, while the remaining 90 days are provided at a minimum flat rate. Each parent is allocated 180 days of leave (90 days each, known as the ‘daddy months’), and the rest of the days can be divided between the parents as they choose.⁹ Iceland exemplifies this forward-thinking strategy, having extended its policy in 2021 to offer a full year of paid leave. This leave is equally divided, granting each parent six months, with 4.5 months of each parent’s leave being non-transferable to encourage fathers’ participation.¹⁰ These initiatives are designed to support mothers, promote gender equality in childcare responsibilities, and strengthen the bond between fathers and their children.

Conversely, certain nations, such as the United States, do not have a nationwide policy for paid paternity leave, instead leaving it up to individual states or employers to offer these benefits.¹¹ This difference underscores the varying degrees of dedication to supporting fathers in their caregiving responsibilities. Nonetheless, even in areas with less comprehensive policies, there is an increasing push towards advocating for and establishing more fair parental leave options.

POSTNATAL CARE AND MATERNAL RECOVERY

This phase, generally spanning six to eight weeks, lays the foundation for the enduring health and well-being of both the mother and her newborn.³ The terms “postpartum” and “postnatal” are often used interchangeably, with “postpartum” typically addressing maternal concerns and “postnatal” focusing on the infant.¹² Nonetheless, there are differences among organizations and countries regarding the length and schedule of standard maternal care after childbirth, which can range from six weeks to a year, involving two to six healthcare visits.¹³

The primary complications during this period, such as severe haemorrhage, infections, hypertension, and unsafe abortions, contribute significantly to maternal mortality.¹⁴ Providing high-quality, continuous care during this time is crucial for reducing maternal deaths.¹⁵

Most deaths of mothers and babies happen within the first month of birth. Therefore, in order to enhance the mother’s and the newborns short-term and long-term health outcomes, good postpartum care is essential.¹⁶

IMPACT OF PATERNITY LEAVE ON MOTHER’S PHYSICAL AND MENTAL HEALTH

Paternity leave provides fathers to assist with childcare and household tasks during the vital postpartum period, reducing the physical strain on mothers as they recuperate. This reallocation of responsibilities helps lessen the musculoskeletal stress and fatigue associated with new born care, such as lifting the infant and dealing with disrupted sleep. Research indicates that when mothers have longer leave, there is a positive link to enhanced physical health after childbirth, underscoring the benefits of environments that support rest and recovery.¹⁷ A Norwegian study reveals that when fathers take extra paternity leave beyond the standard allocation, mothers experience a 5-10% decrease in sickness absence following childbirth. This serves as a reasonable indicator of enhanced physical health and recovery.¹⁸ The findings suggest that paternal leave indirectly benefits mothers’ physical well-being by lessening their need for medically certified leave, which is often necessitated by physical issues or exhaustion.

Paternity leave plays a crucial role in enhancing the success and longevity of breastfeeding by being the main source of support from fathers. Studies indicate that a mother’s confidence in her breastfeeding abilities, known as breastfeeding self-efficacy, is greatly and positively influenced by the active and positive support she receives from her partner during the postpartum period. This support includes emotional encouragement and practical help with childcare and household responsibilities.¹⁹ Breastfeeding significantly reduces the maternal risk of developing breast cancer, type 2 diabetes, and cardiovascular disease through extended lactation, highlighting an important indirect link between paternity leave and long-term maternal physical health advantages.

Mothers generally experienced better mental health with more generous parental leave policies, particularly regarding the length of leave and whether it was paid or unpaid. Longer leave durations were typically linked to a decreased risk of poor maternal mental health, such as depressive symptoms, psychological distress, and burnout, along with reduced use of mental health services. This indicates that having sufficient time away from work, along with financial stability, enables mothers to concentrate on their recovery and bonding with their newborn without the stress of having to return to work immediately.²⁰

A father’s presence and engagement soon after a child is born as vital protective elements against postpartum depression and stress in mothers. When fathers are involved, it correlates with reduced maternal pain, anxiety, and fatigue during childbirth. After the baby arrives, the father’s active participation is associated with a decrease in the mother’s burden of childcare and household duties, leading to better maternal mental health.²¹ This observation is consistent with broader findings that early paternal engagement is associated with improved maternal mental health up to one year postpartum (Figure 1).¹⁷

THE EVOLVING ROLE OF FATHER’S IN CHILD CARE

Traditionally, fathers were primarily seen as providers, with caregiving and raising children falling mainly to mothers. This conventional division casting fathers as “breadwinners” and mothers as the main nurturers and caregivers, was deeply ingrained in societal norms and family structures.²² However, recent societal shifts, including evolving gender roles, shifts in the labour market, and new family policies, have led to a redefinition of fatherhood, expanding the father’s role to include more active participation in caregiving. Today, father involvement is understood as a complex concept that includes several aspects: interaction (direct participation in activities with the child), accessibility (being available both physically and emotionally), and responsibility (taking charge of the child’s care and well-being).²² Increased father involvement is not just about the amount of time spent but also the quality of interactions, focusing on emotional support, nurturing, and cognitive development.²² The unique contributions fathers make to child development. Fathers often engage in physical, stimulating play, such as rough-and-tumble activities, which help children develop risk-taking abilities, self-regulation, and social skills in ways that differ from maternal caregiving styles. This dynamic, sometimes referred to as the “father-child activation relationship,” complements the mother-child attachment relationship, enriching the developmental context through which children learn to navigate and adapt to their environments.²³

The father’s role also influences the family environment and child adjustment. For example, when fathers engage more in play, it often leads to better coparenting support, whereas involvement in caregiving tasks may sometimes encounter ambivalence or resistance within the coparenting framework, indicating complex family negotiations regarding parenting roles.²⁴ Cultural and relational factors significantly affect how fathers engage with their children. Maternal gatekeeping, where mothers may consciously or unconsciously control fathers’ involvement in childcare, plays a significant role in determining the level of father participation. Mothers’ perceptions of the father’s role can either encourage or limit the father’s investment in his identity and caregiving activities.²² Increasingly, research has recognized the significance of father-infant bonding and paternal leave as ways to boost father participation. Although the link between the length of paternal leave and bonding is complex, longer paternity leave generally promotes greater involvement in childcare, which can enhance father-child relationships and positively impact family well-being.²⁵

The traditional view of fathers as mainly financial providers, disconnected from the everyday aspects of child raising, is experiencing a significant shift. This change is driven by evolving socioeconomic conditions, changing gender roles, and increasing research that underscores the importance of fathers in child development. Today’s fathers are more frequently seen as active contributors to nurturing, educating, and emotionally supporting their children, expanding beyond the conventional role of a financial provider.²⁶ Fathers are now participating in activities that foster children’s development, preparing them for social interactions and employment in an increasingly complex world.²⁷ Modern fathers are involved in guidance and hands-on care, although cultural norms often still Favor mothers as the primary caregivers.²⁸ The rise in paternal involvement requires a deeper understanding of the various factors that influence fatherhood, including cultural expectations, economic conditions, and historical contexts, to fully appreciate the role of fathers.²⁶

PATERNITY LEAVE POLICIES IN INDIA AND KERALA

National policies and legislation in India

The Department of Personnel and Training (DoPT) oversees paternity leave for Union government employees through the central civil services (leave) rules, 1972, and office memoranda (OMS). Male employees of the central government who have fewer than two living children are eligible for this and a 15-day paid paternity leave is available, which can be taken either before or within six months following the birth of a child. The leave is fully paid and considered as duty, without affecting other leave balances. Typically granted when adopting a child under one year old, as specified in Oms and it is approved by the appropriate authority; usually available to probationary employees.²⁹

Paternity benefit bill, 2019

The introduction of the paternity benefit bill, 2019, by Ms. S. Jothimani, M.P., in the Lok Sabha marked a notable advancement towards a more inclusive framework for paternity leave. Although this bill is still in the proposal stage and has not been enacted into law, it offers valuable insights into the potential future of paternity leave policies in India. The bill seeks to regulate the employment of men in various sectors, including factories, mines, plantations, and establishments with ten or more employees, as well as self-employed individuals and those in the unorganized sector, for periods before and after they become fathers.

Duration and eligibility

It grants men the right to paternity benefits at the rate of their average daily wage for the duration of their actual absence. To qualify, a man must have worked for at least 80 days in the 12 months leading up to the expected delivery date. The maximum period for paternity benefits is proposed to be 15 weeks, with no more than seven weeks before the expected delivery date. Importantly, the benefit can be utilized up to three months after the delivery date. The bill also extends these provisions to fathers who legally adopt a child under three months old or the legal husband of a commissioning mother.³⁰

Work-from-home provision

A progressive aspect of the bill is the provision for ‘work from home’ if the nature of the work permits and if mutually agreed upon by the employer and employee after availing paternity benefits.³⁰

Parental benefit scheme and creche facilities

The bill proposes the creation of a parental benefit scheme and a dedicated fund, with contributions from employees, employers, and the central government. Additionally, it mandates creche facilities in establishments with 50 or more employees, allowing fathers four visits a day to the creche.³⁰

Protection against dismissal

The bill includes measures to protect employees from being discharged or dismissed during paternity leave, emphasizing a commitment to job security during this period.³⁰

While the paternity benefit bill, 2019, has not yet become law, its comprehensive nature reflects a growing awareness and legislative intent to extend paternity leave benefits beyond the government sector, addressing issues of duration, eligibility, and support infrastructure.

KERALA STATE FRAMEWORK FOR PATERNITY LEAVE

Kerala Service Rules

According to Kerala Service Rules, Part I, Rule 102B, male employees of the state government are entitled to 10 days of paternity leave. This leave is generally to be taken within three months following the birth of a child and is restricted to those with up to two living children. It is granted as a separate category of leave and is considered as duty for all purposes in line with KSR. This applies to regular state government employees, with the approval process, required documentation (such as a birth certificate or medical evidence), and the possibility of combining it with other types of leave being regulated by KSR and departmental circulars issued by the Finance Department.³¹

Paternity leave in the private sector

In India, there is no consistent legislation governing paternity leave, leading to notable differences between the private and government sectors. Some multinational companies and forward-thinking Indian businesses have established relatively generous policies. For example, IKEA offers six months of paid paternity leave, which also applies to adoptive and single parents. Zomato stands out for implementing a 26-week leave policy that includes same-sex couples, marking one of the first such inclusive initiatives in India. Similarly, Novartis provides 26 weeks, while companies like Amazon, Starbucks, and Microsoft offer shorter durations ranging from six to twelve weeks. In sharp contrast, the Indian IT giant Infosys grants only five days, highlighting the disparity among private employers. This variation highlights two main issues. Firstly, the availability of such leave is determined by organizational discretion rather than legislative consistency, resulting in unequal access to parental rights for employees. Secondly, these differences perpetuate gendered stereotypes, as extended parental leave is often reserved for mothers, while fathers in many private companies receive only brief, symbolic leaves. This situation undermines the broader societal goal of promoting caregiving as a shared responsibility between parents.³²

KEY FINDINGS AND RECOMMENDATIONS

Paternity leave plays a vital role in enhancing postnatal care and aiding maternal recovery. Research indicates that when fathers have access to substantial and practical leave and actually take it, mothers benefit from reduced separation anxiety, extended breastfeeding periods, and longer, better-supported maternity leave-all of which are crucial for physical recovery and mental health.³³ Additionally, when fathers utilize their leave, it helps shift gender norms towards more equality, although merely providing information does not alter attitudes.³⁴ However, leave policies are not a cure-all: short, poorly paid, or stigmatized leave results in low or unequal participation; cultures of overwork can hinder the transition back to work; and in some cases, paid family leave can have limited or even negative long-term effects on mothers’ employment if not accompanied by additional support.³⁵ Implementing paternity leave policies that offer adequate wage replacement, ensure job security, and foster a supportive workplace culture, along with providing postnatal and breastfeeding assistance, is essential for transforming entitlements into better outcomes for mothers and their babies. This is especially significant in India, where initiating breastfeeding within the first hour after birth is advised to shield newborns from infections, lower mortality rates, and help prevent malnutrition, such as wasting.^36,37

Barriers within organizations and sectors hinder fathers from taking leave and negatively impact caregivers. Stigma, vague policies, and fear of losing status discourage clinicians and trainees from taking parental leave. Men frequently opt for short leave periods, even when they wish for more time, due to cultural norms and the need for self-advocacy.^38,39

Implement a statutory, paid, and job-secured paternity (or gender-neutral parental) leave policy that spans all industries. Begin by offering 2-4 weeks of fully compensated, job-secured leave for fathers or secondary caregivers, with a strategic plan for future extension; explicitly incorporate provisions for adoption and surrogacy. Combine this with anti-retaliation measures and assured job reinstatement to encourage participation and improve maternal health outcomes.^37,40

CONCLUSION

This review illustrates that paternity leave plays a crucial role in shaping maternal health by aiding physical recovery and supporting mental well-being during the postpartum period. Current research synthesis shows that when fathers are actively involved, it eases the physical burden on mothers, reduces the chances of postpartum depression, and improves breastfeeding success. The importance of paternity leave in supporting maternal postpartum health is emphasized in this review, transforming its perception from a simple workplace perk to a critical, evidence-based postnatal health strategy. The review also identifies significant legal gaps in various government sectors in India and Kerala, as well as in the unregulated private sector, this review emphasizes the urgent requirement for statutory, fully paid, and job-secured paternity leave across all employment sectors to ensure fair maternal health outcomes.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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