Impacts of Paid Family Leave on Perinatal Health: A Nationwide Quasi-Experimental Study.

Abstract

The United States remains the only high-income nation without a national paid family leave (PFL) policy. It also has persistently high maternal and infant mortality rates. Understanding PFL impacts on perinatal health is critical. We determined the impact of state PFL policies on perinatal health, with additional focus on socioeconomic disparities. We analyzed live singleton births using 2016 to 2022 birth certificate data (N = 11 452 411). We conducted a quasi-experimental analysis using heterogeneity-robust differences in differences, comparing pre-post trends in a comprehensive set of perinatal outcomes in jurisdictions with (Connecticut; Washington, DC; Massachusetts; New York; and Washington) and non-South states without PFL. Analyses were additionally stratified by maternal race and ethnicity, education, insurance, and Special Supplemental Nutrition Program for Women, Infants, and Children participation and adjusted for individual- and state-level time-varying covariates. Hypertensive disorders of pregnancy risk decreased by 13% following PFL implementation, as did excess gestational weight gain. PFL implementation was associated with modest increases in small for gestational age (0.290 percentage points [pp]; 95% CI, -0.300 to -0.102), preterm birth (0.590 pp; 95% CI, 0.465-0.715), and lower mean birthweight (-5.205 g; 95% CI, -7.096 to -3.314). Socioeconomically disadvantaged subgroups saw higher risks of adverse birth outcomes but improved maternal outcomes. This study adds to prior research that found that PFL is associated with improvements in parental health and breastfeeding in the United States. Our findings suggest that state PFL policies had mixed impacts on perinatal health; further investigation of policy parameters and mechanisms is warranted.