Associations between sick leave during pregnancy and after childbirth and future labour force participation: a Dutch cohort study

OBJECTIVES: Women's labour force participation often declines after childbirth, but the role of sick leave during pregnancy and after childbirth in sustained employment remains unclear. This study examined: (1) the association between sick leave during pregnancy and/or within 2 years after childbirth and sustained labour force participation, (2) whether sick leave during pregnancy predicts sick leave within 2 years after childbirth, (3) demographic and employment-related factors associated with sick leave length and labour force participation. METHODS: Prospective cohort study including 261 171 women in the Netherlands who applied for maternity benefits in 2020 or 2021. A subset also received sick leave benefits during pregnancy or after childbirth. Logistic regression assessed associations between sick leave timing and sustained labour participation. General linear models examined determinants of the total length of sick leave during pregnancy and within 2 years after childbirth. RESULTS: Sick leave during pregnancy was associated with higher odds of sustained labour force participation (OR 1.20, 95% CI 1.17 to 1.23), whereas sick leave within 2 years after childbirth was associated with lower odds (OR 0.65, 95% CI 0.62 to 0.67). Sick leave during pregnancy strongly predicted sick leave within 2 years after childbirth (OR 3.63, 95% CI 3.53 to 3.74). Employment sector, contract type, residential area and age were associated with sick leave length and labour participation. CONCLUSION: Sick leave within 2 years after childbirth was associated with reduced sustained labour force participation, whereas sick leave during pregnancy was not negatively associated. Employment characteristics were strongly associated with both sick leave patterns and sustained labour force participation.