Mali's Maternity Protection

In 2008, Mali became the first African country to ratify the ILO Maternity Protection Convention 2000 (Convention No. 183), which stipulates a minimum of 14 weeks of maternity leave. In Mali, 100% paid maternity leave benefits are equivalent to earnings from the most recent salary and are granted for privately and publicly-insured women. In addition, nursing mothers are granted one-hour breaks for nursing per day for a total of 15 months. Mali is one of only four countries in Africa that has ratified the ILO Maternity Protection Convention and furthermore, is one of the few countries where the maternity benefits come from the government (from the National Social Insurance Institute – INPS). Overall, Mali’s legislation represents a step in the right direction. From 2012 to 2015, Mali’s exclusive breastfeeding rates increased by 16.7% (20.4% and 37.1%, respectively), suggesting the strengthening of the breastfeeding environment through the adoption of key activities, including the ILO Maternity Protection Convention 2000, are making substantial changes in breastfeeding outcomes in Mali. While legislation is not the sole cause of increasing exclusive breastfeeding rates, the laws help formally-employed mothers take maternity leave subsequently allowing them the opportunity to exclusively breastfeeding. Furthermore, the legislation provides protections for women to continue breastfeeding their babies by offering nursing breaks. Mali’s adoption of the ILO Maternity Protection Convention 2000 is an example of a country moving forward with scaling up breastfeeding policies to protect, promote, and support breastfeeding.

Main Components

Paid maternity leave and birth leave for fathers is mandated under article 41 of the Employment Act (3,4):

• Maternity benefit: 100% of the insured mother's last earnings is paid for six weeks before and eight weeks after the expected childbirth; may be extended for up to three weeks if there are complications arising from childbirth.
• Birth leave: 100% of the father's last daily earnings is paid for any three days in the first 15 days after childbirth.
• Both are paid through the National Social Insurance Institute (INPS in Mali).

Maternity Benefits are reported by the INPS (5):

• Salaried women or legally married spouse to an employed worker may receive maternity benefits on the condition that they give birth in a medical facility and subject the infant to monthly medical inspections. This is in order to increase the medical surveillance of the infant in its first years of life. Maternity benefits are prescribed 15 months after childbirth or 3 months after the child’s first birthday. The monthly rate of the maternity benefits is equal to one-tenth of the flat-rate monthly salary used as a basis for calculating family benefits. Payable in three fractions, the monthly amount of the maternity allowance is 2,060 CFA francs ($3.89 USD) and the total amount of maternity benefits is 16,380 CFA francs ($30.96 USD).

The ILO has a summary report of protection and rights of pregnant women at work (10):

• Under Law No. 92-020 and the Maternity Protection Convention 2000, it is prohibited to employ women, pregnant women, and children in occupations which go beyond their strengths, are dangerous, or by their nature and conditions are likely to offend their “moral standards”. Women and children must have a resting period of at least twelve consecutive hours. Night work in the industry is prohibited.
• Decree No. 96-178 detailed all work prohibited to women, including pregnant women which includes dealing with certain materials such as lead or sulfur products, insecticides, and more.

Under Law No. 92-020 and the Maternity Protection Convention 2000, during the 15-month period from childbirth, the mother has the right to rest in order to breastfeed her child in the workplace. The total resting time shall not exceed
one hour per day. The rest time cannot result in a decrease of the salary.

Evidence of Implementation Strategy

There is a lack of evidence on the implementation of the Maternity Protection Convention and the Employment Laws
that stipulate maternity leave/benefits in Mali. The WBTi 2015 assessment report on Mali praises the 14-week maternity leave granted for both private and publicly employed women (6). However, women in the informal sector do not have this same protection (6) leading to 90% plus of African women not covered by these maternity benefits (7). In addition, the WBTi cites a lack of legislation that stipulates designated breastfeeding spaces in the workplace as a
shortcoming, as well as the fact that the hour break for nursing may not be adequate for truly successful exclusive breastfeeding (6).

The US-based Center for Reproductive Rights in partnership with the Association des Juristes Maliennes in Mali developed a report in 2003 regarding the rights of Malian women in pregnancy and childbirth (11). In their report, they praise the Malian government’s respect for pregnant women’s right of healthcare, reflected in the national labor code that stipulates the 14-week maternity leave (11). They also praise the one-hour nursing break mandated by law and the restrictions on arduous labor for pregnant women (11).

In 2015, 37.1% of infants under 6 months were exclusively breastfed, a large increase from a mere 12% in 1996 and a substantial increase from 20.4% reported in 2012 (6,12,13). The median duration of breastfeeding in Mali is longer than most countries at 23.5 months (6). The laws may help formally-employed mothers to take maternity leave and allow the opportunity to breastfeed, and furthermore, when they return to work, continue to breastfeed their babies with nursing breaks.

Cost and Cost-Effectiveness

Mali’s gross national income per capita, equivalent to the average annual salary, is $770 USD per year according to the World Bank, placing it among the poorest countries in the world (13). Assuming 10% of the total population of women (~9 million total women) are formally employed (900,000 women formally employed) and assuming all of these women receive their maternity leave based on this average annual salary, the most money the Malian National Social Insurance Institute (INPS) would expect to contribute is $187 million USD. This is a high estimate. The budget for INPS for 2018 was announced as 159 billion FCFA ($300 million USD) (14). This budget can fully cover all of these women, but clearly does not as this budget serves other social welfare programs, as well as technical, administrative, and capital expenditures (14). The INPS expenditure budget was up 8% from 2017 (14).

Perceptions and Experiences of Interested People

The ILO praises Mali for being one of the few African countries that offers maternity leave, and the US-based Center for Reproductive Rights in partnership with the Association des Juristes Maliennes in Mali likewise commended the
legislation. However, the ILO still says much progress must be made in Africa, particularly making maternity leave/benefits universal with inclusive eligibility criteria that would include women working in the informal sector
(7). Furthermore, they state that labor inspection is imperative to ensure non-discrimination against women and men with familial responsibilities (7).

Benefits and Potential Damages and Risks

• There is a risk that if the funding obligation falls on employers rather than the government, women will not receive their full maternity leave/benefits. Proper monitoring and violation-reporting system should be in place to ensure full funding by employers. There is also a risk that under a government with limited resources that maternity leave/benefits will not be fully funded as stipulated in legislation.
• As evidenced in Mali, there is a risk that even with paid maternity leave, breastfeeding rates may not increase due to cultural traditions. It may be most effective then, in addition to maternity leave, to use funds and technical resources for health workers training and promotional activities.
• The benefits inadopting the Maternal Protection Convention 2000 include attracting the interest and efforts of national organizations to improve the health and nutrition of women and infants. Adopting the Convention into its legislation is often a key step to taking action to improve breastfeeding rates.

Scaling Up Considerations

• A country must have the financial resources to fund maternal and paternal paid leave for all its citizens. Mali has stipulated 14-weeks paid maternity leave and 3 days of paternity leave for its formally-employed population, paid for by the National Social Insurance Institute. Countries adopting paid maternity leave will need to consider the sources of funding - government, employers, or a combination of the two.
• Monitoring businesses to ensure they comply with the maternity leave legislation for their employees is crucial. Public awareness of maternity leave legislation would help this monitoring and enforcement, as employees could self-report violations. These activities would also need to be funded.

Barriers to Implement

• The lack of a monitoring system to ensure women are receiving their full paid maternity leave/benefits, their nursing breaks and are working under proper conditions. A violations reporting system would help to reduce this barrier.
• Financial resources to fund maternal and paternal paid leave for all its workers, particularly if it is paid through the national social insurance system.
• A lack of knowledge of the legislation that stipulates women’s rights to paid maternity leave/benefits is a barrier for women to assume their rights and take paid leave.

Equity Considerations

The current maternity leave and maternity benefit legislation in Mali does not extend to the informal sector, where a majority of women work (6,7). Thus, approximately less than 10% of women are accessing these benefits, leaving out
a huge proportion of the population that is more likely to be poor and unable to access healthcare.

References:

1. International Labor Organization. (2017). Ratifications for Mali.
2. International Labor Organization. (1992). Act No. 90-020 on the Labor Code.
3. Social Security Administration. (2015). Social Security Programs Throughout the World: Mali.
4. The World Bank. (2013). SABER Country Report: Mali.
5. Institut National de Prevoyance Sociale. (2017). Les Allocations de Maternité (Maternity Benefits).
6. World Breastfeeding Trends Initiative. (2015). Country Report: Mali.
7. International Labor Organization. (2015). “Five Things You Should Know About Maternity Protection in Africa.”
8. Krinniger, T. “African Women Struggle for Paid Maternity Leave.” Deutsche Welle. (2016).
9. Arsenault, M. “Mali: Promoting Exclusive Breastfeeding in ‘baby-friendly’ Maternities.” UNICEF. (2008)
10. International Labor Organization. (2014). Mali.
11. Center for Reproductive Rights and the Association des Juristes Maliennes. (2003). Claiming Our Rights: Surviving Pregnancy and Childbirth in Mali.
12. Gupta, A. et al. (2013). “How Can Global Rates of Exclusive Breastfeeding for the First 6 Months be Enhanced?” ICAN: Infant, Child, and Adolescent Nutrition, 5(3).
13. UNICEF. (2013). Information by Country: Mali.
14. The World Bank. (2018). Country: Mali.
15. Niarela. (2018). “INPS: Le Budget de 2018 équilibre en recettes a 172,763,120,701 FCFA et en dépenses a 158,990,448,849 FCFA.”

Could it work?

There is some evidence that the changes in maternity leave had a positive impact on breastfeeding rates in Mali. The leave is a right for women working in the formal sector which means that just a small proportion of women (less than 10% of African women are formally employed) have the benefit. There is not enough data to show what the potential impact could be if all women received paid maternity leave for the full 14 weeks. This intervention is flexible and need to be adaptable to each country context.

Will it work?

This is dependent on the political will to prioritize maternity leave and the resources allocated. Paid maternity is funded by through the Mali social insurance system but this is one of many funding options. Certainly the costs associated with this intervention are a potential barrier and equity among working women in formal and informal sectors need to be considered.

Is it worth it?

Evidence shows that maternity leave has a
positive impact on breastfeeding outcomes in addition to many other benefits
for mother and babies well-being.