The effect of prenatal maternity leave on short and long-term child outcomes

A realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes

BACKGROUND

Child and maternal health, a key marker of overall health system performance, is a policy priority area by the World Health Organization and the United Nations, including the Sustainable Development Goals. Previous realist work has linked child and maternal health outcomes to globalization, political tradition, and the welfare state. It is important to explore the role of other key policy-related factors. This paper presents a realist synthesis, categorising policy instruments according to the established NATO model, to develop an explanatory model of how policy instruments impact child and maternal health outcomes.

METHODS

A systematic literature search was conducted to identify studies assessing the relationships between policy instruments and child and maternal health outcomes. Data were analysed using a realist framework. The first stage of the realist analysis process was to generate micro-theoretical initial programme theories for use in the theory adjudication process. Proposed theories were then adjudicated iteratively to produce a set of final programme theories.

FINDINGS

From a total of 43,415 unique records, 632 records proceeded to full-text screening and 138 papers were included in the review. Evidence from 132 studies was available to address this research question. Studies were published from 1995 to 2021; 76% assessed a single country, and 81% analysed data at the ecological level. Eighty-eight initial candidate programme theories were generated. Following theory adjudication, five final programme theories were supported. According to the NATO model, these were related to treasure, organisation, authority-treasure, and treasure-organisation instrument types.

CONCLUSIONS

This paper presents a realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes from a large, systematically identified international body of evidence. Five final programme theories were supported, showing how policy instruments play an important yet context-dependent role in influencing child and maternal health outcomes.

Time of leaving work pregnancy results during COVID-19 pandemic. The MOACC-19 cohort from Spain

BACKGROUND

COVID-19 pandemic has changed the way pregnancies have been controlled as well as working conditions. In countries with paid leave of work, leaving earlier has been a relevant measure for controlling the pandemic. No study has been published on factors associated with earlier leaving work in pregnancy and the consequences it could have on pregnancy outcomes.

OBJECTIVE

We aimed to identify woman and pregnancy characteristics associated with leaving work earlier and its consequences on pregnancy results.

METHOD

A cohort study was carried out in Cantabria, Northern Spain, including 760 women who were pregnant in 2020 and were working at the beginning of their pregnancy. Data on pregnancy characteristics and results were obtained from medical records and gestational age at leaving work was self-reported. In a logistic regression analysis, leaving work before 26th week of pregnancy was the main effect variable.

RESULTS

Several factors were associated with lower probability of leaving work before 26th week, including university studies (OR = 0.49, 95% CI: 0.36, 0.68), having presential work (OR = 0.57, 95% CI: 0.40, 0.81), women born in non-European countries (OR = 0.55, 95% CI: 0.30, 1.01) and non-smokers (OR for smokers = 1.79, 95% CI: 1.12, 2.87). Neither type of delivery, gestational age at delivery nor other pregnancy results were associated with the gestational age of leaving work.

CONCLUSION

Several pregnancy and women characteristics were associated with leaving work earlier in the COVID-19 pandemic, although it was not associated with any pregnancy outcome.

Maternity leave and children's health outcomes in the long-term

This paper assesses the impact of the length of maternity leave on children's health outcomes in the long-run. My quasi-experimental design evaluates an expansion in maternity leave coverage from two to six months, which occurred in the Federal Republic of Germany in 1979. The expansion came into effect after a sharp cutoff date and significantly increased the time working mothers stayed at home with their newborns during the first six months after childbirth. Using this cutoff date as a source of exogenous variation, I exploit German hospital registry data, which contains detailed information on the universe of inpatients' diagnoses from 1995-2014. By tracking the health of treated and control children from age 16 up to age 35, this study provides new insights into the trajectory of health differentials over the life-cycle. I find that the legislative change generated positive long-term health effects: My intention-to-treat estimates show that children born after the implementation of the reform experience fewer hospital admissions and are less likely to be diagnosed with mental and behavioral disorders.

Womb at work: The missing impact of maternal employment on newborn health

Parental leave policies across the globe have become much more generous than they used to be. This is also true for prenatal maternal leave. While this may be costly in the short run, little is known about the effect of maternal employment during pregnancy on newborn health. In this paper, I exploit three sharp policy changes on the duration of paid parental leave in Austria that strongly affected the share of mothers who work up to the 32nd week of pregnancy. I use administrative data from Austria on the working history of women linked to the full Austrian birth register and coupled with a regression discontinuity framework to identify the effect of prenatal employment on their offspring. Maternal employment during pregnancy with the second child reacts strongly to these policy changes. The share of employed mothers sharply declined in 1990 by 19.1 percentage points, increased in 1996 by 6.9 percentage points and declined again by 6.4 percentage points in 2000. None of these changes in prenatal employment translated into effects on newborn health measured via birth weight, gestational length, and Apgar scores. This result holds true for mothers of different socioeconomic backgrounds and across industries. The effect is precisely estimated, which suggests that prenatal employment prior to the 32nd week of pregnancy does not causally affect the fetus for measures visible at birth.