Out of 87 in-depth interviews, 66 respondents were female (Table 1). The mothers, along with their partners, were equally distributed among the target characteristics as enumerated in Table 3. Among 12 interviewed employers, six were from manufacturing or merchandising workplaces, two were from business process outsourcing companies, and four were service-related employers. Among the 19 interviewed key informants, three were government legislators, ten were representatives from government agencies, and six were from non-government organizations.

Table 3 Characteristics of interviewed pregnant women, mothers of infants and their husbands/partners participating in in-depth interviews

Study results are presented by theme, based on the combined analysis of the findings of the desk review and the IDIs.

Maternity protection entitlements have improved to align more closely with international standards

Maternity protection policies in the Philippines are aligned with most of the standards set in ILO Convention 183 (Additional files 2 and 3). The issuance of the EMLL in 2019 increased paid maternity leave duration to 105 days from the previous 60 days for vaginal birth and 78 days for cesarean birth, bringing the legislation into alignment with ILO Convention No. 183, but not ILO Recommendation No. 191. The EMLL also provided an option of additional 30 days unpaid leave for all recipients and an additional 15 days of paid maternity leave for solo parents and allowed up to 7 days of leave credits from the mother’s 105 days maternity leave to be transferred to the child’s father (or an alternate caregiver in the case of absence or incapacity of the father), on top of the 7 days paternity leave credits for fathers. The Paternity Leave Act of 1996 granted 7-day fully paid paternity leave to all male married employees in private and public sectors for the first four births of their legitimate spouse [34].

The EMLL mandated mixed-source funding from social security and employers starting in 2019. ILO recommends that financing for paid maternity leave come from public or social security funds. However, the Philippines’ law required employers from the private sector to shoulder the salary differential if the mother’s salary credit from her contributions to the SSS fund is insufficient to cover 100% of her salary during maternity leave. The SSS is a government-run social insurance program in the Philippines catering to workers in the private sector and the informal sector.

The Labor Code of the Philippines states that acts of discrimination against women, such as receiving reduced compensation, are considered criminal acts [35]. EMLL also prohibits discrimination in employing women to avoid the provision of maternity entitlements.

Medical entitlements for mothers are also provided through the Philippine Health Insurance Corporation (PhilHealth) [36], the government-managed social health insurance program. Mothers who are active paying members of PhilHealth, regardless of SSS membership, are entitled to receive the following services free of charge at PhilHealth-accredited government facilities: prenatal and postnatal care, childbirth, and hospitalization. Hospital expenses related to childbirth in an accredited private facility are subsidized by PhilHealth. Mothers who are not PhilHealth members or have no qualifying contributions may be registered as sponsored members under point of care enrollment in government facilities. Those who do not qualify will need to pay an amount equivalent to one year premium or the total premium covering the missed and unpaid quarter/s of the calendar year to utilize the medical entitlements.

A timeline of the enacted maternity protection provisions is presented in Fig. 1 and Additional file 4.

Fig. 1

History of paid maternity leave provision in the Philippines 1974–2022 in relation to international recommendations

Not all working women can access maternity protection entitlements

Despite recent policy improvements, the ILO’s recommendation that maternity entitlements must cover the majority of working women has not been met. Maternity leave cash entitlements for private and informal sector workers were only granted to mothers enrolled in SSS with at least three-monthly contributions paid in the 12-month period preceding the semester of childbirth [16]. Membership in SSS is also not universal. There were 24 million privately employed and 12.8 million self-employed Filipino workers in 2020 [37]. SSS estimates that there are only 9.6 million privately employed and about 2.4 million self-employed and voluntary paying members as of May 2021 [38]. Among the female working age population, SSS coverage was estimated to be only 54% as of 2020 (SSS, personal communication). Female workers in the government sector, who were entitled to the same fully paid maternity leave, represented only 3% of the female working age population (CSC, personal communication).

Mothers under contract employment, such as independent contractors or freelance employees whose SSS contributions were not updated, were not eligible to receive maternity entitlements. Some respondents reported negotiating maternity leave duration that is less than the mandated 105 days and not receiving any cash payments during leave.

I am just new here, under Job Order, so I don’t have these. They only provided me 3 months [of maternity leave], but it does not have maternity pay. So, I didn’t have a salary [while on maternity leave]. (Mother, PIN 5028)

Interviews with female employees also revealed that some employers used short-term contracts to avoid provision of maternity entitlements to employees.

From what I heard in the factory, they don’t pay contributions for the benefits. Because I know in the factory, contracts end every 5–6 months, after which they will have to be renewed again. (Pregnant woman, PIN 4011)

Most respondents were not aware of how self-employed workers, such as street vendors and farmers, could access maternity entitlements. There was limited awareness of the SSS mechanism among interviewed self-employed parents. Those who had self-enrolled in SSS faced difficulty maintaining the monthly contributions.

I think it will only interfere to our daily needs if we will have to pay [SSS contributions]. (Mother, PIN 5012)

Most IDI respondents from the informal sector were more aware of and utilized PhilHealth medical entitlements for childbirth compared to maternity leave entitlements from social security programs.

Uptake of paternity leave entitlements are limited by marriage requirements and informal employment

Most fathers were not aware of their right to paternity leave and related entitlements. Among those who were aware, respondents mentioned barriers to accessing entitlements, including not being legally married, as required by the Paternity Leave Act; or working in the informal sector. One respondent also mentioned the type of employment of the mother as the reason for his ineligibility to receive paternity leave entitlements, a violation of the law since there is no such requirement.

In our delivery service company, we don’t have something like that [paternity leave entitlement], we were just like business partners with them, but we were not employed under them. (Father, PIN 6009)

I asked the HR (human resources) before, she said I can only avail paternity leave when my wife receives maternity leave. (Father, PIN 6010)

Despite awareness of the value of maternity protection, employers perceive disadvantages to policies

Employers, mothers, and fathers mentioned the following advantages of maternity entitlements: longer bonding time with their infants; increased time for mother to recuperate; and financial support. Only a few specifically mentioned increased time for breastfeeding as one of the benefits. Employers also mentioned benefits of maternity protection policies including increased employee morale; improved maternal and child health; good publicity to recruit and keep talented workers; and removal of the burden of choice between career or family.

It positively impacts the bonding between the mother and child. . we have what we called milestones that any mother would not want to miss with their child. (Employer, PIN 3007)

It will also help psychologically, since you have a sense of security. Mothers usually experience postpartum [depression] at this time. And it will help if they have period to rest. (Employer, PIN 3011)

By receiving these kind of [maternity] benefits, the employee would feel valued and cared by their company. I think they will give it back and do their work better as an appreciation to their company. (Employer, PIN 3012)

Some employers felt that having female employees go on maternity leave disrupts workplace operations and acknowledged the possibility of discrimination against women during hiring. Employers also perceived that non-parent workers who may receive additional workload while mothers are on maternity leave may feel upset, as they are unable to avail of such entitlements.

In my opinion, I think the non-parents will be upset since they are not entitled [to receive] these benefits. Also, there will be an added cost, aside from their paid leave. For the production operations, we still have to allot time for retraining and transition to work. This also includes planning and designing the work arrangement. (Employer, PIN 3019)

Actually, in a profit-oriented atmosphere, like in my workplace before, they request their temporary workers who were pregnant women to resign, since they will have to pay them for three months, and it is a liability. (Employer, PIN 3009)

There are policies in place that mandate workplace breastfeeding support

The Expanded Breastfeeding Promotion Act of 2009, which mandates the establishment of lactation rooms and implementation of lactation breaks in workplaces, is aligned with ILO recommendations. This policy requires that workplaces create a breastfeeding policy and prohibits marketing of breastmilk substitutes. Compliance with the Act is required to issue or renew business permits. Private and public workplaces may apply for a renewable exemption from establishing lactation rooms to DOLE and CSC, respectively [39, 40]. The criteria for exemption are different between the two agencies. DOLE, through Department Order No. 143, 2015, grants exemptions based on the presence of lactating and pregnant employees and presence of female guests in the premises during operating hours [39]. CSC, through the issuance of Memorandum Circular No. 12 series of 2015, considers the physical size of the agency, number of female employees, and average number of women visiting the workplaces [40].

Workplaces may apply for Mother-Baby Friendly Workplaces Certification, which are valid for two years, by complying with the requirements of the Expanded Breastfeeding Promotion Act of 2009 and fulfilling additional requirements set by the DOH; requirements include the provision of a manually operated breast pump, paper towels, and a covered trash can in the lactation rooms [41]. Review and assessment of applications is assigned to local government units (LGUs), while the onsite inspection and approval of certification is conducted by DOH Centers for Health Development (CHD). As an incentive, the cost incurred to comply with the Act would be deducted from taxable expenses. However, this was only effective within 6 months after approval of the law’s implementing rules and regulations (IRR) in 2011 [42]. There is no available information on workplaces that availed this tax incentive.

Implementation of workplace lactation support policies varies according to workplace and type of work

Some employers mentioned the presence of lactation rooms and refrigerators in their workplaces, while others referred breastfeeding mothers to clinics or unused or vacant rooms for breastfeeding and breastmilk expression.

Even if we don’t have a lactation room, we always make sure that they have a private room to do this. Usually, we have “lactation” signage. From our previous lactating mother, sometimes she doesn’t have time to lactate. So usually, she brings this signage and looks for a vacant room, and she will just post this signage. (Employer, Female, PIN 3006)

Based on enacted policies, local government units were encouraged to set up lactation spaces and programs for informal workplaces in partnership with the private sector. However, this is not widely implemented across all LGUs.

It will depend on the ordinance and the cooperation of the local government. Because these informal sector workers have no formal employers to talk to when they do not have these facilities [lactation spaces] for workers. (Programmer, Female, PIN 1021)

Employers have policies in place to complement national regulations. Some provide flexible working arrangements, free transportation services, additional cash assistance, free medical check-ups under the workplace’s health insurance package, and free childcare benefits.

Aside from maternity leave benefits, the company also gives childbirth assistance. I think it is PHP 1,000 to 2,000 (USD 20 to 40). (Employer, Female, PIN 3023)

Some workplace settings made breastmilk expression difficult due to workload and work schedule, with either nonexistent or inadequate break time. Output-based jobs with flexible working hours in the formal and informal sector also forces mothers to choose between earning more income and breastfeeding.

I think in this situation, cashiers have no break time unless their duty is finished. (Employer, Female, PIN 3010)

In that kind of work [production area], I think it is difficult to let down milk, because the mother does not have ample time to rest. (Employer, Male, PIN 3009)

Since the wages depend on product outputs, there is a possibility that the mother will opt for formula milk because of the hassle of extracting milk. (Employer, Female, PIN 3007)

Respondents also mentioned that maternity leave is not applicable for workers in the informal sector, making informal workers’ financial needs a contributing factor in their decisions to return to work early. Several informal work settings also had no suitable place for breastmilk expression and storage or were inappropriate environments for children.

Additional costs incurred by employers to establish and maintain lactation rooms, and to provide the cost differential from SSS claims was cited as a disadvantage, especially for small and medium enterprises. The mandatory establishment of lactation spaces was considered impractical by some key informants from the government and non-government organizations and employers due to the required investment and space limitations within some types of businesses. The small number of mothers who utilize the facility was also perceived as minimizing the impact of the investment.

Most of the employees here are already past their reproductive age, you will just waste that room which could be used for other purposes…. For example, the clinic is located on the first floor, but the lactating mother is located on the fourth floor. Of course, she will put the expressed milk in the refrigerator on the fourth floor. Let’s say in that quarter, she was the only lactating mother in the workplace. It is not wise to establish a lactation station on the fourth floor just for her (Local level policy maker, Female, PIN 1023).

Some employers do not support lactation at work

Some employers expressed unsupportive views toward breastfeeding and breastmilk expression at work. Employers and mothers recognized the difficulty in continuing breastfeeding once a mother returns to work, implying a lack of awareness of legal entitlements among mothers and a lack of knowledge and support for breastfeeding on the part of employers.

When a mother returns to work, they already perceive that breastfeeding is difficult in their work in the production area. They have to bring necessary materials such as containers and breast pumps which is inconvenient. They lack awareness on what would be the best for the baby. (Employer, Female, PIN 3028)

Some employers relied on the working mothers’ initiative and the accessibility of information from the internet rather than actively promoting and disseminating information related to maternity protection and workplace lactation support. One respondent equated maternity entitlements with merely compensation or receiving monetary support and did not seem to recognize that mothers need other workplace support during the maternity period.

There is no need for a very laborious information campaign, because as I’ve said this information is already available on the internet. So, we just tell them to sign the maternity benefits form. This is what is going to happen, this is the process, the date that you will be able to get it and all of that. Because what they expect really is when will they get the maternity benefits. (Employer, Female, PIN 3011)

Many mothers cannot balance between breastfeeding and work

There was a sense of acceptance among mothers that breastfeeding will stop once they return to work. Mothers working in a variety of different occupations mentioned the difficulty and inconvenience of expressing and storing breastmilk during work. Among women who took maternity leave, some breastfed only until the end of their leave.

Since I am working, I have no choice but to switch to infant formula. (Mother, bank teller, PIN 5004)

I am already practicing my child for infant formula, thus I already opted for mixed feeding. Because, after 3 months, I will return to my work. (Mother, supermarket employee, PIN 5003)

For mothers who need to work, it is usually difficult to pump and pump, then you will have to carry it, also there are uncontrolled times when you can express breastmilk. (Mother, part-time worker in government office, PIN 5007)

Systematic inter-agency enforcement and monitoring system not in place

Both SSS and PhilHealth record the number of maternity entitlement claims paid per year. DOLE has integrated the monitoring of maternity protection policy implementation, including monitoring of workplace lactation support, within its annual inspection for monitoring of workplaces in the private sector. DOLE recorded a high percentage (85 to 99%) of compliance among workplaces inspected from 2014 to 2020 [43]. However, less than 10% [43] of the estimated 1,500,506 private sector workplaces in the country [44] were inspected. Reasons for this low coverage include the insufficient number of inspectors to cover the high number of private sector workplaces and the reportedly lengthy labor inspection checklist requiring inputs from different types of professionals, possibly resulting in lower quality inspection. For the public sector, there is currently no established system for monitoring compliance.

The Department of the Interior and Local Government (DILG) issued a memorandum to guide the establishment of workplace lactation programs in local government offices, inclusion of workplace lactation programs for business registration, and private-public partnership in setting up and sustaining lactation management programs for the informal sector [45]. However, based on the result of this study, there is no established system to monitor implementation. Furthermore, the issuance does not mandate partnership of workplaces with local health offices for technical assistance on breastfeeding programs and development of educational materials.

There are no guidelines to monitor the implementation of and compliance with maternity protection policies. The roles and responsibilities of different government agencies have not been clarified. These indicate that there are gaps in understanding on how these agencies should contribute to monitoring and enforcement.

I am not aware of any monitoring guidelines developed for all levels as contemplated under Sect. 30, Rule VIII of the IRR. (Programmer, Female, PIN 1021)

While existing policies include provisions for the establishment of mechanisms for monitoring service utilization, the monitoring systems currently in place are limited in their capability to measure functionality and uptake of maternity protection entitlements.

Regional DOH-CHDs conducted stringent inspections but only among workplaces that applied for the Mother-Baby Friendly Workplaces Certification, which is voluntary. The setting up of inter-agency monitoring teams for all levels as mandated by law had not been done. There were recommendations for the integration of monitoring and enforcement activities in the mechanisms for monitoring other current programs of the DOLE and DOH.

Key informants from the government and non-government organizations agree on the need to increase breastfeeding promotion and support in workplaces

Policy makers mentioned the need for increased breastfeeding promotion activities among employers, fathers, and mothers to encourage breastfeeding and create more supportive work environments that encourage mothers to utilize their maternity entitlements. At present, employers comply with the mandate because it was included in the DOLE checklist but may not fully recognize the purpose and benefits of the policy. They also had insufficient knowledge to provide proper assistance to breastfeeding employees. One employer provided a care package that included diapers and breastmilk substitutes.

On top of their maternity benefits, we have a care package that was given for the babies first 6 months. So, there was a budget for milk and diapers that we provide for them. (Employer, Female, PIN 3011)

We conducted a survey, they have provided space for the breastfeeding station, but no advocacy activities are being conducted on the benefits of breastfeeding and how it will be done. The HR [human resource] personnel do not know how long the storage is and how the milk will be transported if they are far from work. We need to invest in teaching mothers how to do it [breastmilk expression and storage]. Do they need a cooler when transporting it? They want to breastfeed, but they do not know how to do it. (Civil society advocate, Female, PIN 1028)

We can contribute by ensuring that there are facilities in the workplace, but it is the personal decision of the mother, whether or not she will breastfeed because it is such a long process. I believe that people should be re-educated on the benefits of breastfeeding. (Programmer, Female, PIN 1021)

We need to have a supportive environment, not just the facility. They must view it in a positive way, as a way of life. We need to have that perspective and an accepting organization, wherein you can freely take a break because of your lactation duty. (Local level policy maker, Female, PIN 1023)