The Impact of Paid Family Leave in the United States on Birth Outcomes and Mortality in the First Year of Life

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Neonatology Update

Paid parental leave has been tied to improvements in many pediatric health outcomes including breastfeeding, preterm birth, low birth weight and infant mortality. However, most of the existing literature has come from international studies looking mainly at European countries. In 2004, California was the first state to pass paid family leave legislation in the United States. More than 10 years later, its effect on birth outcomes and risk of mortality in the first year of life is not known. Given the increasing number of states passing similar legislation and ongoing national discussions about optimal parental leave programs, it is crucial to better understand how such policies impact health outcomes in the U.S. specifically.

In our study, we evaluated the effect of the passage of paid family leave legislation in California on statewide rates of preterm birth, low birthweight, post-neonatal mortality (i.e., within the first 28 days) and overall infant mortality (within the first year). Using a quasi-experimental study design to compare the rates of these outcomes in California before and after implementation of the 2004 policy with rates in two states without paid family leave policies, we found that post-neonatal mortality rates decreased by 12% in California after 2004, after adjusting for maternal and neonatal factors. We also found that there were no differences in the policy’s effect by race/ethnicity or insurance status except for increased odds of low birthweight among privately insured women in California after 2004.

Our study thus found evidence that paid family leave policies are associated with reduced post-neonatal mortality in the U.S. Given that California has not seen any adverse effects on labor or economic-related outcomes to date, recent federal legislation expanding paid family leave policies nationally should be explored as a strategy to improve infant health across the country.

Montoya-Williams D, Passarella, M Lorch SA. The Impact of Paid Family Leave in the United States on Birth Outcomes and Mortality in the First Year of Life. Health Serv Res. [Published online ahead of print April 5, 2020].

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