1
|
Chai Y, Nandi A, Heymann J. Is the impact of paid maternity leave policy on the prevalence of childhood diarrhoea mediated by breastfeeding duration? A causal mediation analysis using quasi-experimental evidence from 38 low-income and middle-income countries. BMJ Open 2024; 14:e071520. [PMID: 38216191 PMCID: PMC10806753 DOI: 10.1136/bmjopen-2022-071520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 09/28/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES Quasi-experimental evidence suggests that extending the duration of legislated paid maternity leave is associated with lower prevalence of childhood diarrhoea in low-income and middle-income countries (LMICs). This could be due to a variety of mechanisms. This study examines whether this effect is mediated by changes in breastfeeding duration. DESIGN AND SETTING Difference-in-difference approach and causal mediation analysis were used to perform secondary statistical analysis of cross-sectional data from Demographic and Health Surveys (DHSs) in 38 LMICs. PARTICIPANTS We merged longitudinal data on national maternity leave policies with information on childhood diarrhoea related to 639 153 live births between 1996 and 2014 in 38 LMICs that participated in the DHS at least twice between 1995 and 2015. PRIMARY OUTCOME MEASURE Our outcome was whether the child had bloody stools in the 2 weeks prior to the interview. This measure was used as an indicator of severe diarrhoea because the frequency of loose stools in breastfed infants can be difficult to distinguish from pathological diarrhoea based on survey data. RESULTS A 1-month increase in the legislated duration of paid maternity leave was associated with a 34% (risk ratio 0.66, 95% CI 0.47 to 0.91) reduction in the prevalence of bloody diarrhoea. Breast feeding for at least 6 months and 12 months mediated 10.6% and 7.4% of this effect, respectively. CONCLUSION Extending the duration of paid maternity leave appears to lower diarrhoea prevalence in children under 5 years of age in LMICs. This effect is slightly mediated by changes in breastfeeding duration.
Collapse
Affiliation(s)
- Yan Chai
- Department of Epidemiology, University of California, Los Angeles, California, USA
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jody Heymann
- Department of Epidemiology, University of California, Los Angeles, California, USA
- Department of Health Policy and Management, University of California, Los Angeles, California, USA
| |
Collapse
|
2
|
Arnautovic TI, Dammann CEL. The neonatal perspective of paid family medical leave (PFML). J Perinatol 2023; 43:1055-1058. [PMID: 35132148 DOI: 10.1038/s41372-021-01300-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/16/2021] [Accepted: 12/09/2021] [Indexed: 12/24/2022]
Abstract
Paid family medical leave (PFML) offers infants, parents, and society at large numerous health and economic benefits. It has been shown to improve neonatal and maternal outcomes, breastfeeding rates, familial relationships, and decrease gender inequalities in the workplace. Though the economic feasibility of PFML has been well established in many countries, the USA lacks a cohesive and comprehensive federal PFML policy. Neonatal healthcare providers play a critical role in impacting neonatal health and should actively advocate for the development and promotion of a federal PFML policy, particularly one that is inclusive of both mothers and fathers and is at least 12 weeks in duration.
Collapse
Affiliation(s)
- Tamara I Arnautovic
- Division of Newborn Medicine, Department of Pediatrics, Tufts Children's Hospital, Tufts University School of Medicine, Boston, MA, USA.
| | - Christiane E L Dammann
- Division of Newborn Medicine, Department of Pediatrics, Tufts Children's Hospital, Tufts University School of Medicine, Boston, MA, USA
| |
Collapse
|
3
|
Legister CS, Morgan SJ, Samora JB, Weiss JM, Caird MS, Miller DJ. Policies, Practices, and Attitudes Related to Parental Leave for Practicing Pediatric Orthopaedic Surgeons. J Pediatr Orthop 2023; 43:337-342. [PMID: 36827610 DOI: 10.1097/bpo.0000000000002360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Parental leave impacts family engagement, bonding, stress, and happiness. Because parental leave benefits are important to all surgeons regardless of sex, understanding parental leave practices in pediatric orthopaedic surgery is critical to promote equity within the profession and supporting balance in work and family life. The aim of this study was to survey pediatric orthopaedic surgeons about their knowledge of parental leave policies, attitudes towards parental leave, and their individual experiences taking leave. METHODS A 34-question anonymous survey was distributed to the Pediatric Orthopaedic Society of North America membership. Eligible respondents were attending pediatric orthopaedic surgeons practicing in the United States or Canada. The survey gathered information about employer parental leave policies, perceptions about and experiences with parental leave while practicing as a surgeon, and demographic information about respondents. RESULTS A total of 77 responses were completed and used for analysis. Most respondents were men (59.7%), <50 years old (67.5%), married (90.9%), and in urban communities (75.3%). A large majority were practicing in the United States (97.4%). Most respondents were unfamiliar with employer parental leave policies (maternity: 53.3%; paternity: 67.5%; and adoption: 85.7%). Those familiar with policies reported that employers offered 7 to 12 weeks for maternity leave (45.7%) and <1 week for paternity leave (50%) and adoption leave (45.5%). Most respondents believed 7 to 12 weeks should be offered for maternity leave (66.2%), 1 to 6 weeks for paternity leave (54.6%), and 7 to 12 weeks for adoption leave (46.8%). Many respondents reported taking 1 to 6 weeks of parental leave as a surgeon (53.3%) and that their colleagues were supportive of their parental leave (40.3%). CONCLUSIONS Most pediatric orthopaedic surgeons were unfamiliar with parental leave benefits provided by employers. Respondents who were familiar with these policies believed that more parental leave should be provided, especially for men who may feel social pressure to take less time for leave. Although respondents reported that their work environments were supportive, this study identified opportunities for improvement to support surgeons who wish to balance parental experiences with work responsibilities. LEVEL OF EVIDENCE Level V.
Collapse
Affiliation(s)
| | - Sara J Morgan
- Research Department
- Department of Rehabilitation Medicine
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Julie B Samora
- Orthopaedics, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer M Weiss
- Orthopaedics Department, Southern California Permanente Medical Group, Los Angeles, CA
| | - Michelle S Caird
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Daniel J Miller
- Department of Orthopaedics, Gillette Children's, St. Paul
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| |
Collapse
|
4
|
Whitney MD, Holbrook C, Alvarado L, Boyd S. Length of Maternity Leave Impact on Mental and Physical Health of Mothers and Infants, a Systematic Review and Meta-analysis. Matern Child Health J 2023:10.1007/s10995-022-03524-0. [PMID: 37043071 DOI: 10.1007/s10995-022-03524-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 04/13/2023]
Abstract
BACKGROUND Recent legislative decisions in the United States have encouraged discussion about national parental leave programs. Currently, over 47% of the United States workforce is female. However, the United States is the only nation of the 37 member countries in the Organization for Economic Co-Operation and Development (OECD) to have no national requirement for maternity leave. The first few months of a child's life are vital to their physical and mental development. Likewise, a gradual return to pre-partum functioning is important for a newly postpartum woman. While it has been shown that maternity leave positively impacts various measures of maternal and infant mental and physical health, we lack consensus on the optimal length of paid or unpaid maternity leave. Accordingly, we conducted a systematic review and meta-analysis to evaluate the optimal length of paid or unpaid maternity leave to encourage maternal and infant mental and physical health in the United States. METHODS A systematic review and meta-analysis were conducted to synthesize and critically evaluate the current research investigating the association between maternity leave and maternal and infant mental and physical health using the Preferred Reporting in Systematic Reviews and Meta-Analyses guidelines. Databases EMBASE, PsycInfo, and PubMed were searched using specific inclusion and exclusion criteria. Methodological Index for Non-Randomized Studies scale assessed the methodological quality of the included eligible studies. The magnitude of heterogeneity between-study was tested using The Cochrane χ2 test and the Moran's I2 statistic. Possible publication bias was assessed through the funnel plot and the Egger regression test. A p-value of < 0.10 will be considered as an indication for the existence of potential publication bias. All statistical analyses were carried out with Stata software version 15. RESULTS A total of 21 studies were analyzed. It was found that longer maternity leave may decrease rates of maternal mental and physical health complaints. It was also found that longer maternity leave leads to more positive mother-child interactions, decreased infant mortality, and longer periods of breastfeeding. CONCLUSION Maternity leave of 12 weeks or more confers the greatest benefit for mothers and their infants.
Collapse
Affiliation(s)
- Madeline Dixon Whitney
- Paul L Foster School of Medicine, El Paso, TX, USA.
- Department of Medical Education, Texas Tech Health Science Center El Paso, 5001 El Paso Drive, El Paso, TX, 79905, USA.
| | | | - Luis Alvarado
- Biostatistics and Epidemiology Consulting Laboratory, El Paso, TX, USA
| | - Sarah Boyd
- Texas Tech El Paso Department of Obstetrics and Gynecology, El Paso, TX, USA
| |
Collapse
|
5
|
Souza CBD, Melo DS, Relvas GRB, Venancio SI, Silva RPGVCD. Promotion, protection, and support of breastfeeding at work, and achieving sustainable development: a scoping review. CIENCIA & SAUDE COLETIVA 2023; 28:1059-1072. [PMID: 37042888 DOI: 10.1590/1413-81232023284.14242022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/28/2022] [Indexed: 04/13/2023] Open
Abstract
This article aims to map promotion, protection, and support strategies aimed at working women who breastfeed and their potential impact on achieving the Sustainable Development Goals (SDGs), in particular SDGs 5 (gender equality and women's empowerment) and 8 (decent work and economic growth). This study is a scoping review based on the Joanna Briggs Institute (JBI) framework, whose searches were performed in PubMed, Web of Science, Scopus, Social Science Research Network, and Open Knowledge Repository databases. This study's search obtained 576 publications, of which 33 were included in the study. The narrative synthesis was organized into three axes: 1) promotion; 2) protection, and 3) support for breastfeeding in the work context. Actions aimed at women who breastfeed at work have the potential to directly achieve SDGs 5 and 8, and indirectly achieve SDGs 1 and 10. Increased breastfeeding rates also help to achieve another four SDGs (2, 3, 4, 12). Actions aimed at working women who breastfeed can contribute directly and indirectly to the achievement of eight of the 17 SDGs, and should therefore be encouraged and reinforced.
Collapse
Affiliation(s)
- Carolina Belomo de Souza
- Departamento de Pediatria, Universidade Federal do Paraná. R. General Carneiro 181, 14º andar, Alto da Glória. 80060-900 Curitiba PR Brasil.
| | - Daiane Sousa Melo
- Faculdade de Saúde Pública, Universidade de São Paulo. São Paulo SP Brasil
| | - Gláubia Rocha Barbosa Relvas
- Escritório Regional de Saúde de Barra do Garças, Secretaria de Estado de Saúde de Mato Grosso. Barra do Garças MT Brasil
| | | | | |
Collapse
|
6
|
Lee LK, Miller KA, Chuersanga G, Melvin P, Zola J, Ward VL. Childbearing and Family Leave Policies for Physicians at US Children's Hospitals. J Pediatr 2022; 255:240-246. [PMID: 36528054 DOI: 10.1016/j.jpeds.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/13/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
The objective of this study was to examine the childbirth and parental leave policies for physicians at children's hospitals. We obtained institutional policies from 15 hospitals in 2021. The median duration of full salaried leave was 8 weeks (range, 2-12 weeks). Leave policies vary widely among US children's hospitals.
Collapse
Affiliation(s)
- Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston, MA.
| | - Kelsey A Miller
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Geeranan Chuersanga
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA
| | - Patrice Melvin
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA; Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston, MA
| | - Judith Zola
- Office of Human Resources, Boston Children's Hospital, Boston, MA
| | - Valerie L Ward
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA; Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston, MA; Department of Radiology, Boston Children's Hospital, Boston, MA; Department of Radiology, Harvard Medical School, Boston, MA
| |
Collapse
|
7
|
Awareness, Perceptions, Gaps, and Uptake of Maternity Protection among Formally Employed Women in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084772. [PMID: 35457636 PMCID: PMC9031189 DOI: 10.3390/ijerph19084772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/30/2022] [Accepted: 04/12/2022] [Indexed: 02/01/2023]
Abstract
Maternity protection is a normative fundamental human right that enables women to combine their productive and reproductive roles, including breastfeeding. The aim of this study is to examine the uptake of Vietnam's maternity protection policy in terms of entitlements and awareness, perceptions, and gaps in implementation through the lens of formally employed women. In this mixed methods study, we interviewed 494 formally employed female workers, among whom 107 were pregnant and 387 were mothers of infants and conducted in-depth interviews with a subset of these women (n = 39). Of the 494 women interviewed, 268 (54.3%) were working in blue-collar jobs and more than 90% were contributing to the public social insurance fund. Among the 387 mothers on paid maternity leave, 51 (13.2%) did not receive cash entitlements during their leave. Among the 182 mothers with infants aged 6-11 months, 30 (16.5%) returned to work before accruing 180 days of maternity leave. Of 121 women who had returned to work, 26 (21.5%) did not receive a one-hour paid break every day to express breastmilk, relax, or breastfeed, and 46 (38.0%) worked the same or more hours per day than before maternity leave. Although most women perceived maternity leave as beneficial for the child's health (92.5%), mother's health (91.5%), family (86.2%), and society (90.7%), fewer women perceived it as beneficial for their income (59.5%), career (46.4%), and employers (30.4%). Not all formally employed women were aware of their maternity protection rights: women were more likely to mention the six-month paid maternity leave (78.7%) and one-hour nursing break (62.3%) than the other nine entitlements (2.0-35.0%). In-depth interviews with pregnant women and mothers of infants supported findings from the quantitative survey. In conclusion, although Vietnam's maternity protection policy helps protect the rights of women and children, our study identified implementation gaps that limit its effectiveness. To ensure that all women and their families can fully benefit from maternity protection, there is a need to increase awareness of the full set of maternity entitlements, strengthen enforcement of existing policies, and expand entitlements to the informal sector.
Collapse
|
8
|
WEBSTER JESSICAL, PAUL DAVID, PURTLE JONATHAN, LOCKE ROBERT, GOLDSTEIN NEALD. State-Level Social and Economic Policies and Their Association With Perinatal and Infant Outcomes. Milbank Q 2022; 100:218-260. [PMID: 35128726 PMCID: PMC8932633 DOI: 10.1111/1468-0009.12548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Policy Points State-level social and economic policies that expand tax credits, increase paid parental leave, raise the minimum wage, and increase tobacco taxes have been demonstrated to reduce adverse perinatal and infant health outcomes. These findings can help prioritize evidence-based legislated policies to improve perinatal and infant outcomes in the United States. CONTEXT Rates of preterm birth and infant mortality are alarmingly high in the United States. Legislated efforts may directly or indirectly reduce adverse perinatal and infant outcomes through the enactment of certain economic and social policies. METHODS We conducted a narrative review to summarize the associations between perinatal and infant outcomes and four state-level US policies. We then used a latent profile analysis to create a social and economic policy profile for each state based on the observed policy indicators. FINDINGS Of 27 articles identified, nine focused on tax credits, eight on paid parental leave, four on minimum wages, and six on tobacco taxes. In all but three studies, these policies were associated with improved perinatal or infant outcomes. Thirty-three states had tax credit laws, most commonly the earned income tax credit (n = 28, 56%). Eighteen states had parental leave laws. Two states had minimum wage laws lower than the federal minimum; 14 were equal to the federal minimum; 29 were above the federal minimum; and 5 did not have a state law. The average state tobacco tax was $1.76 (standard deviation = $1.08). The latent profile analysis revealed three policy profiles, with the most expansive policies in Western and Northeastern US states, and the least expansive policies in the US South. CONCLUSIONS State-level social and economic policies have the potential to reduce adverse perinatal and infant health outcomes in the United States. Those states with the least expansive policies should therefore consider enacting these evidence-based policies, as they have shown a demonstratable benefit in other states.
Collapse
Affiliation(s)
| | - DAVID PAUL
- ChristianaCare, Department of PediatricsNewarkDE,Thomas Jefferson University Sidney Kimmel College of MedicinePhiladelphia
| | - JONATHAN PURTLE
- Drexel University Dornsife School of Public HealthPhiladelphia
| | - ROBERT LOCKE
- ChristianaCare, Department of PediatricsNewarkDE,Thomas Jefferson University Sidney Kimmel College of MedicinePhiladelphia
| | | |
Collapse
|
9
|
Chai Y, Ríos-Salas V, Stek P, Heymann J. Does Enhancing Paid Maternity Leave Policy Help Promote Gender Equality? Evidence from 31 Low- and Middle-Income Countries. GENDER ISSUES 2021; 39:335-367. [PMID: 35875727 PMCID: PMC9300538 DOI: 10.1007/s12147-021-09293-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 06/15/2023]
Abstract
Globally, women continue to have less economic decision-making power and face gender-unequal norms at work. Little is known about the impact of national public policies on norms surrounding equality. We examined the impact of extending paid maternity leave policy on decision making in the household and gender norms in the workplace, specifically whether women have sole or joint decision-making power with respect to large household purchases and whether women are perceived as having an equal right to jobs when jobs are scarce. We used difference-in-differences models to analyze the impact of increasing paid maternity leave on outcomes measured in the Demographic Health Surveys and World Values Surveys collected in 31 low- and middle-income countries. A one-month increase in the legislated duration of paid maternity leave increased the odds that women and their partners/spouses reported that women had more decision-making power by 40% (95% CI 1.14, 1.70) and 66% (95% CI 1.36, 2.03), respectively. A one-month increase in the legislated duration of paid maternity leave was associated with 41.5 percentage-point increase in the prevalence of individuals disagreeing with the statement that "when jobs are scarce, men should have more right to a job than women." More generous maternity leave increases gender equality in economic decision making in the household and improves gender norms related to work. Future studies should examine the impact of paternity leave and non-discrimination policy, as well as other large-scale policies aiming to improve gender equality at work and at home.
Collapse
Affiliation(s)
- Yan Chai
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, 621 Charles E. Young Drive South, Los Angeles, CA 90095 USA
| | - Vanessa Ríos-Salas
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, 621 Charles E. Young Drive South, Los Angeles, CA 90095 USA
| | - Pam Stek
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, 621 Charles E. Young Drive South, Los Angeles, CA 90095 USA
| | - Jody Heymann
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, 621 Charles E. Young Drive South, Los Angeles, CA 90095 USA
| |
Collapse
|
10
|
Diaz D, Freburg-Hoffmeister DL, Austin TM, Nyshadham S, Abramowicz S. Parental Policy in Oral and Maxillofacial Surgery Residency Programs Is Necessary but Not Available: A Cross-Sectional Survey of Oral and Maxillofacial Surgery Residents' Attitudes Toward Parental Leave. J Oral Maxillofac Surg 2021; 79:2404-2410. [PMID: 34547262 DOI: 10.1016/j.joms.2021.08.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Guidelines regarding parental leave in oral and maxillofacial surgery do not exist. This inconsistency may contribute to gender disparities and an increase in resident burnout. The purpose of this study was to examine perceptions and attitudes of oral and maxillofacial surgery residents toward parental leave. MATERIALS AND METHODS This was a cross-sectional study in which an anonymous 26-item questionnaire was electronically mailed to all current oral and maxillofacial surgery residents in the United States during August 2020. The survey consisted of 5 sections: 1) resident information, 2) residency program information, 3) parental policy information, 4) attitudes regarding parental leave, and 5) attitudes regarding early parenthood. RESULTS Surveys were sent to 860 oral and maxillofacial surgery residents; 220 completed the questionnaire (25.6%). Majority of respondents were male between the ages of 26 and 30. Half of the respondents did not know whether their oral and maxillofacial surgery program had a formal parental leave policy. Almost a third of residents reported that their program did not have a policy regarding parental leave. Only some programs had a policy regarding parental leave. Most programs allotted 2 days to 2 weeks for parental leave. Parenthood did not prevent pursuit of fellowship training. The majority of co-residents indicated that parenthood had a neutral impact on the performance of their colleagues. Lactation facilities and/or childcare services were not present in all programs. CONCLUSIONS Most oral and maxillofacial surgery residents support parental leave despite the lack of a formal policy in their residency program. Residents who had a child during residency received up to 2 weeks as parental leave. Residents felt that their programs were supportive of parental leave. Parenthood did not prevent the pursuit of fellowship training.
Collapse
Affiliation(s)
- Daili Diaz
- Resident, Department of Oral and Maxillofacial Surgery, University of Florida College of Dentistry, Gainesville, FL.
| | - Danielle L Freburg-Hoffmeister
- Clinical Assistant Professor, Residency Program Director, Department of Oral and Maxillofacial Surgery, University of Florida College of Dentistry, Gainesville, FL
| | - Thomas M Austin
- Associate Professor in Anesthesiology and Pediatrics, Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Soumya Nyshadham
- Assistant Professor in Anesthesiology and Pediatrics, Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Shelly Abramowicz
- Associate Professor in Surgery and Pediatrics, Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Emory University School of Medicine, Section Chief, Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
| |
Collapse
|
11
|
The Impact of Paid Maternity Leave on the Mental and Physical Health of Mothers and Children: A Review of the Literature and Policy Implications. Harv Rev Psychiatry 2021; 28:113-126. [PMID: 32134836 DOI: 10.1097/hrp.0000000000000246] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For decades, national paid maternity leave policies of 12 weeks or more have been established in every industrialized country except the United States. Despite women representing 47% of the current U.S. labor force, only 16% of all employed American workers have access to paid parental leave through their workplace. As many as 23% of employed mothers return to work within ten days of giving birth, because of their inability to pay living expenses without income. We reviewed recent studies on the possible effects of paid maternity leave on the mental and physical health of mothers and children. We found that paid maternity leave is associated with beneficial effects on (1) the mental health of mothers and children, including a decrease in postpartum maternal depression and intimate partner violence, and improved infant attachment and child development, (2) the physical health of mothers and children, including a decrease in infant mortality and in mother and infant rehospitalizations, and an increase in pediatric visit attendance and timely administration of infant immunizations, and (3) breastfeeding, with an increase in its initiation and duration. Given the substantial mental and physical health benefits associated with paid leave, as well as favorable results from studies on its economic impact, the United States is facing a clear, evidence-based mandate to create a national paid maternity leave policy. We recommend a national paid maternity leave policy of at least 12 weeks.
Collapse
|
12
|
Association Between Maternal Working Status and Unintentional Injuries Among 3 to 4-Month-Old Infants in Japan. Matern Child Health J 2021; 25:414-427. [PMID: 33411107 DOI: 10.1007/s10995-020-03083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Globally, unintentional injuries are one of the leading causes of infant death. Established risk factors for injuries during infancy include single parent households, socioeconomic disadvantage and maternal postpartum depression. We sought to examine whether maternal working status is associated with unintentional injury among infants in Japan. METHODS We used data from an original questionnaire targeting mothers who participated in a 3 or 4-month health check-up program in Aichi prefecture, Japan. Experience of any type of unintentional injury was used as the primary outcome, and we also examined the experience of "falls" and "near-drowning" as secondary outcomes. We conducted multivariable logistic regression analysis, adjusting for covariates. We also performed propensity score matching in order to balance covariates between paid employment and unpaid employment groups. RESULTS Among 6,465 valid responses (response rate, 67%), 9.8% of infants experienced unintentional injuries. After matching on propensity for maternal employment (based on 26 covariates), we found that infants of mothers in paid employment were 1.35 times (95% CI: 1.04-1.74) more likely to experience injures, including 1.60 times higher likelihood of falls (95% CI: 1.14-2.24). Near-drowning was not significantly associated with maternal employment. We also found that father's employment status was positively associated with risk of falls. CONCLUSION Both multivariable logistic analysis and propensity score matching analysis revealed that maternal paid employment status was associated with unintentional injuries among Japanese infants. To prevent infant injuries, comprehensive support for working families should be considered.
Collapse
|
13
|
Chai Y, Nandi A, Heymann J. Association of increased duration of legislated paid maternity leave with childhood diarrhoea prevalence in low-income and middle-income countries: difference-in-differences analysis. J Epidemiol Community Health 2020; 74:437-444. [PMID: 32111639 PMCID: PMC7307660 DOI: 10.1136/jech-2019-212127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 01/07/2020] [Accepted: 02/05/2020] [Indexed: 11/12/2022]
Abstract
Background Diarrhoea is the second-leading infectious cause of death in children younger than age 5 years. The global burden of severe diarrhoeal disease is concentrated in Africa and Southeast Asia, where a significant percentage of the population resides in low-resource settings. We aimed to quantitatively examine whether extending the duration of legislated paid maternity leave affected the prevalence of childhood diarrhoea in low-income and middle-income countries (LMICs). Methods We merged longitudinal data measuring national maternity leave policies with information on the prevalence of bloody diarrhoea related to 884 517 live births occurring between 1996 and 2014 in 40 LMICs that participated at least twice in the Demographic and Health Surveys between 2000 and 2015. We used a difference-in-differences approach to compare changes in the percentage of children with bloody diarrhoea across eight countries that lengthened their paid maternity leave policy between 1995 and 2013 to the 32 countries that did not. Results The prevalence of bloody diarrhoea in the past 2 weeks was 168 (SD=40) per 10 000 children under 5 years in countries that changed their policies and 136 (SD=15) in countries that did not. A 1-month increase in the legislated duration of paid maternity leave was associated with 61 fewer cases of bloody diarrhoea (95% CI −98.86 to −22.86) per 10 000 children under 5 years of age, representing a 36% relative reduction. Conclusion Extending the duration of paid maternity leave policy appears to reduce the prevalence of bloody diarrhoea in children under 5 years of age in LMICs.
Collapse
Affiliation(s)
- Yan Chai
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Arijit Nandi
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jody Heymann
- Department of Health Policy and Management, Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
| |
Collapse
|
14
|
Atabay E, Vincent I, Raub A, Heymann J, Nandi A. Data Resource Profile: PROSPERED Longitudinal Social Policy Databases. Int J Epidemiol 2019; 48:1743-1743g. [PMID: 31335956 DOI: 10.1093/ije/dyz153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Efe Atabay
- Institute for Health and Social Policy, McGill University, Montreal, QC, Canada
| | - Ilona Vincent
- Institute for Health and Social Policy, McGill University, Montreal, QC, Canada
| | - Amy Raub
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Jody Heymann
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Arijit Nandi
- Institute for Health and Social Policy, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| |
Collapse
|
15
|
ACOG Committee Opinion No. 733: Employment Considerations During Pregnancy and the Postpartum Period. Obstet Gynecol 2019; 131:e115-e123. [PMID: 29578986 DOI: 10.1097/aog.0000000000002589] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the United States, it is common for women, including mothers and pregnant women, to work outside the home. Working during pregnancy is generally safe. For those in high-risk occupations or with medically complicated pregnancies, work accommodations often can allow for continued safe employment. The major employment issues concerning pregnant women include pregnancy-related discrimination, work accommodations that allow continued employment, job-protected leave, and wage replacement while on leave. Workplace discrimination related to being pregnant and pregnancy-related harassment, including discrimination in the hiring process, is prohibited by federal and state law. There is no federal law guaranteeing comprehensive accommodations for pregnant and postpartum workers. Current federal and state laws provide protection for some pregnant women, but not others, because of eligibility requirements and state-by-state differences. By writing appropriate notes to employers, obstetrician-gynecologists and other obstetric care providers can be instrumental in obtaining accommodations for their patients who are able to continue working. Accommodations that allow a woman to keep working are the most reliable way to guarantee pay, benefits, and job protection. Obstetrician-gynecologists and other obstetric care providers also can assist pregnant women and their partners by providing them with information and resources that might help them better understand their employment rights. However, in cases for which potential job discrimination has occurred, accommodations are denied, extended medical leave is necessary, or when other complex employment questions arise, legal assistance should be obtained.
Collapse
|
16
|
Siregar AYM, Pitriyan P, Walters D, Brown M, Phan LTH, Mathisen R. The financing need for expanded maternity protection in Indonesia. Int Breastfeed J 2019; 14:27. [PMID: 31289458 PMCID: PMC6593591 DOI: 10.1186/s13006-019-0221-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/03/2019] [Indexed: 01/01/2023] Open
Abstract
Background Almost half of all Indonesian children under 6 months of age were not exclusive breastfed in 2017. Optimizing maternity protection programs may result in increased breastfeeding rates. This study aims to: estimate the potential cost implications of optimizing the current paid maternity protection program, estimate budgets needed to increase coverage of lactation rooms in mid and large firms, and explore challenges in its implementation in Indonesia. Methods The potential cost implication of the current and increased maternity leave length (three and 6 months) as well as the potential budget impact to the government were estimated for 2020 to 2030. The cost of setting up lactation rooms in formal sector companies was estimated using the Alive & Thrive standards. Interviews were conducted in five different provinces to 29 respondents in 2016 to identify current and potential challenges in implementing both existing and improved maternity protection policies. Results The costs of expanding paid maternity leave from three to 6 months and incorporating standardized lactation rooms in 80% of medium and large size firms in Indonesia was estimated at US$1.0 billion (US$616.4/mother per year) from 2020 to 2030, covering roughly 1.7 million females. The cost of setting up a basic lactation room in 80% of medium and large companies may reach US$18.1 million over 10 years. The three main barriers to increasing breastfeeding rates were: breastmilk substitutes marketing practices, the lack of lactation rooms in workplaces, and local customs that may hamper breastfeeding according to recommendations. Conclusions The cost of expanding paid maternity leave is lower than the potential cost savings of US$ 1.5 billion from decreased child mortality and morbidity, maternal cancer rates and cognitive loss. Sharing the cost of paid maternity leave between government and the private sector may provide a feasible economic solution. The main barriers to increasing breastfeeding need to be overcome to reap the benefits of recommended breastfeeding practices. Electronic supplementary material The online version of this article (10.1186/s13006-019-0221-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Adiatma Y M Siregar
- 1Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Jl. Hayam Wuruk 6-8, Bandung, West Java 40115 Indonesia
| | - Pipit Pitriyan
- 1Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Jl. Hayam Wuruk 6-8, Bandung, West Java 40115 Indonesia
| | - Dylan Walters
- 2Canadian Centre for Health Economics, Institute of Health Policy, Management and Evaluation, University of Toronto, and Nutrition International, Ottawa, Ontario Canada
| | - Matthew Brown
- Alive & Thrive, Southeast Asia, 7F, Opera Business Center, 60 Ly Thai To Street, Hanoi, Vietnam
| | - Linh T H Phan
- Alive & Thrive, Southeast Asia, 7F, Opera Business Center, 60 Ly Thai To Street, Hanoi, Vietnam
| | - Roger Mathisen
- Alive & Thrive, Southeast Asia, 7F, Opera Business Center, 60 Ly Thai To Street, Hanoi, Vietnam
| |
Collapse
|
17
|
Heymann J, Levy JK, Bose B, Ríos-Salas V, Mekonen Y, Swaminathan H, Omidakhsh N, Gadoth A, Huh K, Greene ME, Darmstadt GL. Improving health with programmatic, legal, and policy approaches to reduce gender inequality and change restrictive gender norms. Lancet 2019; 393:2522-2534. [PMID: 31155271 DOI: 10.1016/s0140-6736(19)30656-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 11/17/2022]
Abstract
Evidence that gender inequalities and restrictive norms adversely affect health is extensive; however, far less research has focused on testing solutions. We first comprehensively reviewed the peer-reviewed and grey literature for rigorously evaluated programmes that aimed to reduce gender inequality and restrictive gender norms and improve health. We identified four mutually reinforcing factors underpinning change: (1) multisectoral action, (2) multilevel, multistakeholder involvement, (3) diversified programming, and (4) social participation and empowerment. Following this review, because little research has investigated the effects of national-level law and policy reforms, we conducted original quasi-experimental studies on laws and policies related to education, work, and income, all social determinants of health in which deep gender inequalities exist. We examined whether the laws and policies significantly affected health outcomes and gender norms, and whether law-induced and policy-induced changes in gender norms mediated the health effects, in areas for which longitudinal data existed. Laws and policies that made primary education tuition-free (13 intervention countries with the law and/or policy and ten control countries without) and that provided paid maternity and parental leave (seven intervention and 15 control countries) significantly improved women's and their children's health (odds ratios [OR] of 1·16-2·10, depending on health outcome) and gender equality in household decision making (OR 1·46 for tuition-free and 1·45 for paid maternity and parental leave) as a proxy indicator of gender norms. Increased equality partially mediated the positive effects on health outcomes. We conclude by discussing examples of how improved governance can support gender-equitable laws, policies, and programmes, immediate next steps, and future research needs.
Collapse
Affiliation(s)
- Jody Heymann
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
| | - Jessica K Levy
- Brown School at Washington University in St Louis, St Louis, MO, USA
| | - Bijetri Bose
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Vanessa Ríos-Salas
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | - Hema Swaminathan
- Centre for Public Policy, Indian Institute of Management Bangalore, Bangalore, India
| | - Negar Omidakhsh
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Adva Gadoth
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Kate Huh
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | - Gary L Darmstadt
- Department of Pediatrics, and Center for Population Health Sciences, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
18
|
Morain S, Schoen L, Marty M, Schwarz EB. Parental Leave, Lactation, and Childcare Policies at Top US Schools of Public Health. Am J Public Health 2019; 109:722-728. [PMID: 30896996 PMCID: PMC6459636 DOI: 10.2105/ajph.2019.304970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To describe policies related to parental leave, breastfeeding, and childcare for faculty and staff at top schools of public health in the United States. METHODS We identified the top 25 schools of public health from the US News and World Report rankings. We reviewed each institutional Web site to identify publicly available policies as of July 2018. RESULTS For birth mothers, 80% (20/25) of the schools provided paid childbearing leave to faculty (mean = 8.2 weeks), and 48% (12/25) provided paid childbearing leave for staff (mean = 5.0 weeks). For nonbirth parents, 68% (17/25) provided paid parental leave for faculty and 52% (13/25) for staff (range = 1-15 weeks). We found that 64% (16/25) of the schools had publicly available lactation policies, and 72% (18/25) of the schools had at least 1 university-run on-campus childcare center. CONCLUSIONS The majority of top US schools of public health provide paid leave to faculty birth mothers. However, most schools fall short of the 14 weeks recommended by the American Public Health Association.
Collapse
Affiliation(s)
- Stephanie Morain
- Stephanie Morain is with the Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX. At the time of the study, Lauren Schoen was a research assistant at the Center for Medical Ethics & Health Policy, Baylor College of Medicine. Makenna Marty is a medical student at California Northstate University, Elk Grove. Eleanor Bimla Schwarz is with the Department of General Internal Medicine at University of California Davis, Sacramento
| | - Lauren Schoen
- Stephanie Morain is with the Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX. At the time of the study, Lauren Schoen was a research assistant at the Center for Medical Ethics & Health Policy, Baylor College of Medicine. Makenna Marty is a medical student at California Northstate University, Elk Grove. Eleanor Bimla Schwarz is with the Department of General Internal Medicine at University of California Davis, Sacramento
| | - Makenna Marty
- Stephanie Morain is with the Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX. At the time of the study, Lauren Schoen was a research assistant at the Center for Medical Ethics & Health Policy, Baylor College of Medicine. Makenna Marty is a medical student at California Northstate University, Elk Grove. Eleanor Bimla Schwarz is with the Department of General Internal Medicine at University of California Davis, Sacramento
| | - Eleanor Bimla Schwarz
- Stephanie Morain is with the Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX. At the time of the study, Lauren Schoen was a research assistant at the Center for Medical Ethics & Health Policy, Baylor College of Medicine. Makenna Marty is a medical student at California Northstate University, Elk Grove. Eleanor Bimla Schwarz is with the Department of General Internal Medicine at University of California Davis, Sacramento
| |
Collapse
|
19
|
Richardson DM, Steeves-Reece A, Martin A, Hurtado DA, Dumet LM, Goodman JM. Employee Experiences with a Newly Adopted Paid Parental Leave Policy: Equity Considerations for Policy Implementation. Health Equity 2019; 3:117-123. [PMID: 30989153 PMCID: PMC6461060 DOI: 10.1089/heq.2019.0007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Paid parental leave (PPL) policies offer immense opportunity to enhance health equity by providing financial stability to workers and promoting the health of families in the United States. Working in partnership with a local county government, which recently adopted a paid leave policy, we engaged in a qualitative substudy to enhance our understanding of how workers perceived and experienced the policy across levels of the socioecological framework. Methods: Working in partnership with Multnomah County, a large public-sector employer in Portland, OR that recently adopted a PPL policy, we collected qualitative data through focus groups with employees. Data were transcribed, coded, and analyzed thematically. Results: We conducted seven focus groups with county employees (N=35) in the fall of 2017. Three major themes emerged from the focus group data: intersectional inequities, disparities by department, and uneven benefits. Conclusions: Our findings highlight the inequities of experience with the PPL policy across employees at individual, organization, and environmental levels. These findings offer insight and guidance for entities considering the adoption and implementation of such policies to consider concrete steps to enhance equity of access and experience.
Collapse
Affiliation(s)
- Dawn M. Richardson
- Health Promotion & Community Health Program, OHSU-PSU School of Public Health, Portland, Oregon
| | - Anna Steeves-Reece
- Health Promotion & Community Health Program, OHSU-PSU School of Public Health, Portland, Oregon
| | - Allea Martin
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - David A. Hurtado
- Health Promotion & Community Health Program, OHSU-PSU School of Public Health, Portland, Oregon
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon
| | - Lisset M. Dumet
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon
| | - Julia M. Goodman
- Health Management & Policy Program, OHSU-PSU School of Public Health, Portland, Oregon
| |
Collapse
|
20
|
Affiliation(s)
- Rebekah Diamond
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia College of Physician and Surgeons, New York, New York
- New York Presbyterian Morgan Stanley Children's Hospital, New York
| |
Collapse
|
21
|
Chai Y, Nandi A, Heymann J. Does extending the duration of legislated paid maternity leave improve breastfeeding practices? Evidence from 38 low-income and middle-income countries. BMJ Glob Health 2018; 3:e001032. [PMID: 30364395 PMCID: PMC6195155 DOI: 10.1136/bmjgh-2018-001032] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 11/04/2022] Open
Abstract
Introduction Among all barriers to breastfeeding, the need to work has been cited as one of the top reasons for not breastfeeding overall and for early weaning among mothers who seek to breastfeed. We aimed to examine whether extending the duration of paid maternity leave available to new mothers affected early initiation of breastfeeding, exclusive breastfeeding under 6 months and breastfeeding duration in low-income and middle-income countries (LMICs). Methods We merged longitudinal data measuring national maternity leave policies with information on breastfeeding related to 992 419 live births occurring between 1996 and 2014 in 38 LMICs that participated in the Demographic and Health Surveys. We used a difference-in-differences approach to compare changes in the prevalence of early initiation and exclusive breastfeeding, as well as the duration of breastfeeding, among treated countries that lengthened their paid maternity leave policy between 1995 and 2013 versus control countries that did not. Regression models included country and year fixed effects, as well as measured individual-level, household-level and country-level covariates. All models incorporated robust SEs and respondent-level sampling weights. Results A 1-month increase in the legislated duration of paid maternity leave was associated with a 7.4 percentage point increase (95% CI 3.2 to 11.7) in the prevalence of early initiation of breastfeeding, a 5.9 percentage point increase (95% CI 2.0 to 9.8) in the prevalence of exclusive breastfeeding and a 2.2- month increase (95% CI 1.1 to 3.4) in breastfeeding duration. Conclusion Extending the duration of legislated paid maternity leave appears to promote breastfeeding practices in LMICs. Our findings suggest a potential mechanism to reduce barriers to breastfeeding for working mothers.
Collapse
Affiliation(s)
- Yan Chai
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health and Institute for Health and Social Policy, MGill University, Montreal, Quebec, Canada
| | - Jody Heymann
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California, USA
| |
Collapse
|
22
|
Access to Paid Parental Leave for Academic Surgeons. J Surg Res 2018; 233:144-148. [PMID: 29397145 DOI: 10.1016/j.jss.2018.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/15/2017] [Accepted: 01/03/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Parental leave is linked to health benefits for both child and parent. It is unclear whether surgeons at academic centers have access to paid parental leave. The aim of this study was to determine parental leave policies at the top academic medical centers in the United States to identify trends among institutions. METHODS The top academic medical centers were identified (US News & World Report 2016). Institutional websites were reviewed, or human resource departments were contacted to determine parental leave policies. "Paid leave" was defined as leave without the mandated use of personal time off. Institutions were categorized based on geographical region, funding, and ranking to determine trends regarding availability and duration of paid parental leave. RESULTS Among the top 91 ranked medical schools, 48 (53%) offer paid parental leave. Availability of a paid leave policy differed based on private versus public institutions (70% versus 38%, P < 0.01) and on medical center ranking (top third = 77%; middle third = 53%; and bottom third = 29%; P < 0.01) but not based on region (P = 0.06). Private institutions were more likely to offer longer paid leaves (>6 wk) than public institutions (67% versus 33%; P = 0.02). No difference in paid leave duration was noted based on region (P = 0.60) or rank (P = 0.81). CONCLUSIONS Approximately, 50% of top academic medical centers offer paid parental leave. Private institutions are more likely to offer paid leave and leave of longer duration. There is considerable variability in access to paid parenteral leave for academic surgeons.
Collapse
|
23
|
Reynolds MM, Avendano M. Social Policy Expenditures and Life Expectancy in High-Income Countries. Am J Prev Med 2018; 54:72-79. [PMID: 29254555 PMCID: PMC5739520 DOI: 10.1016/j.amepre.2017.09.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/31/2017] [Accepted: 09/06/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The U.S. spends more than any other country on health care, yet Americans have lower life expectancy than people in most industrialized countries. Recent studies suggest that lower expenditures on social policies in the U.S. may contribute to less-favorable trends in life expectancy. This study tests the hypothesis that greater social spending will be positively associated with life expectancy across the countries of the Organisation of Economic Co-operation and Development and that the magnitude of these associations will outweigh those between government healthcare spending and life expectancy. METHODS In 2016, longitudinal data on six domains of social expenditures for the U.S. and 19 other wealthy nations between 1980 and 2010 were used to estimate the associations between prior year expenditures on education, family, unemployment, incapacity, old age, and active labor market programs, and period life expectancy using fixed effects models. RESULTS Controlling for a wide set of confounders and government healthcare expenditures, a 1% increase in prior year education expenditures was associated with 0.160 (95% CI=0.033, 0.286) of a year gain in life expectancy, whereas a 1% increase in prior year incapacity benefit expenditures was associated with 0.168 (95% CI=0.003, 0.333) of a year gain in life expectancy. Counterfactual models suggest that if the U.S. were to increase expenditures on education and incapacity to the levels of the country with the maximum expenditures, life expectancy would increase to 80.12 years. CONCLUSIONS The U.S. life expectancy lag could be considerably smaller if U.S. expenditures on education and incapacity programs were comparable with those in other high-income countries.
Collapse
Affiliation(s)
- Megan M Reynolds
- Department of Sociology, University of Utah, Salt Lake City, Utah.
| | - Mauricio Avendano
- Department of Global Health and Social Medicine, King's College London, London, England; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts
| |
Collapse
|
24
|
Kwegyir-Afful E, Adu G, Spelten ER, Räsänen K, Verbeek J. Maternity leave duration and adverse pregnancy outcomes: An international country-level comparison. Scand J Public Health 2017; 46:798-804. [PMID: 29212432 DOI: 10.1177/1403494817745737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Preterm birth and low birthweight (LBW) lead to infant morbidity and mortality. The causes are unknown. This study evaluates the association between duration of maternity leave and birth outcomes at country level. METHOD We compiled data on duration of maternity leave for 180 countries of which 36 specified prenatal leave, 190 specified income, 183 specified preterm birth rates and 185 specified the LBW rate. Multivariate and seemingly unrelated regression analyses were done in STATA. RESULTS Mean maternity leave duration was 15.4 weeks ( SD=7.7; range 4-52 weeks). One additional week of maternity leave was associated with a 0.09% lower preterm rate (95% confidence interval [CI] -0.15 to -0.04) adjusting for income and being an African country. An additional week of maternity leave was associated with a 0.14% lower rate of LBW (95% CI -0.24 to -0.05). Mean prenatal maternity leave across 36 countries was six weeks ( SD=2.7; range 2-14 weeks). One week of prenatal maternity leave was associated with a 0.07% lower preterm rate (95% CI -0.10 to 0.24) and a 0.06% lower rate of LBW (95% CI -0.14 to 0.27), but these results were not statistically significant. By adjusting for income status categories, the preterm birth rate was 1.53% higher and the LBW rate was 2.17% higher in Africa compared to the rest of the world. CONCLUSIONS Maternity leave duration is significantly associated with birth outcomes. However, the association was not significant among 36 countries that specified prenatal maternity leave. Studies are needed to evaluate the correlation between prenatal leave and birth outcomes.
Collapse
Affiliation(s)
- Emma Kwegyir-Afful
- 1 University of Eastern Finland, School of Medicine, Institute of Public Health and Clinical Nutrition, Finland
| | - George Adu
- 3 Department of Economics, Kwame Nkrumah University of Science and Technology, Ghana
| | - Evelien R Spelten
- 4 Department of Public Health, La Trobe Rural Health School, La Trobe University, Australia
| | - Kimmo Räsänen
- 1 University of Eastern Finland, School of Medicine, Institute of Public Health and Clinical Nutrition, Finland
| | - Jos Verbeek
- 2 Finnish Institute of Occupational Health, Finland
| |
Collapse
|
25
|
Heymann J, Sprague AR, Nandi A, Earle A, Batra P, Schickedanz A, Chung PJ, Raub A. Paid parental leave and family wellbeing in the sustainable development era. Public Health Rev 2017; 38:21. [PMID: 29450093 PMCID: PMC5810022 DOI: 10.1186/s40985-017-0067-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/21/2017] [Indexed: 11/27/2022] Open
Abstract
Background The Sustainable development goals (SDGs) have the potential to have a significant impact on maternal and child health through their commitments both to directly addressing health services and to improving factors that form the foundation of social determinants of health. To achieve change at scale, national laws and policies have a critical role to play in implementing the SDGs’ commitments. One particular policy that could advance a range of SDGs and importantly improve maternal and infant health is paid parental leave. Methods This article analyzes literature on paid leave and related policies relevant to SDG 1 (poverty), SDG 3 (health), SDG 5 (gender equality), SDG 8 (decent work), and SDG 10 (inequality). In addition, this article presents global data on the prevalence of policies in all 193 UN Member States. Results A review of the literature finds that paid parental leave may support improvements across a range of SDG outcomes relevant to maternal and child health. Across national income levels, paid leave has been associated with lower infant mortality and higher rates of immunizations. In high-income countries, studies have found that paid leave increases exclusive breastfeeding and may improve women’s economic outcomes. However, factors including the duration of leave, the wage replacement rate, and whether leave is made available to both parents importantly shape the impacts of paid leave policies. While most countries now offer at least some paid maternal leave, many provide less than the 6 months recommended for exclusive breastfeeding, and only around half as many provide paternal leave. Conclusions To accelerate progress on the SDGs’ commitments to maternal and child health, we should monitor countries’ actions on enacting or strengthening paid leave policies. Further research is needed on the duration, wage replacement rate, and availability of leave before and after birth that would best support both child and parental health outcomes and social determinants of health more broadly. In addition, further work is needed to understand the extent to which paid leave policies extend to the informal economy, where the majority of women and men in low- and middle-income countries work.
Collapse
Affiliation(s)
- Jody Heymann
- 1UCLA Fielding School of Public Health, 650 Charles E Young Dr S, Los Angeles, CA 90095 USA
| | - Aleta R Sprague
- 2WORLD Policy Analysis Center, UCLA Fielding School of Public Health, 621 Charles E. Young Drive S, 2213-LSB, Los Angeles, CA 90095 USA
| | - Arijit Nandi
- 3Institute for Health and Social Policy and Department of Epidemiology, McGill University, 1130 Pine Avenue West, Montreal, Montreal, H3A 1A3 Canada
| | - Alison Earle
- 2WORLD Policy Analysis Center, UCLA Fielding School of Public Health, 621 Charles E. Young Drive S, 2213-LSB, Los Angeles, CA 90095 USA
| | - Priya Batra
- 4U.C. Riverside School of Medicine, 900 University Ave. Riverside, Riverside, CA 92507 USA
| | - Adam Schickedanz
- 5Department of Pediatrics, David Geffen School of Medicine, UCLA, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024 USA
| | - Paul J Chung
- 6Department of Pediatrics, David Geffen School of Medicine, UCLA, 10833 LeConte Ave, B2-433 MDCC, Los Angeles, CA 90095 USA
| | - Amy Raub
- 2WORLD Policy Analysis Center, UCLA Fielding School of Public Health, 621 Charles E. Young Drive S, 2213-LSB, Los Angeles, CA 90095 USA
| |
Collapse
|
26
|
Maternity Leave Access and Health: A Systematic Narrative Review and Conceptual Framework Development. Matern Child Health J 2017; 20:1178-92. [PMID: 26676977 DOI: 10.1007/s10995-015-1905-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background Maternity leave is integral to postpartum maternal and child health, providing necessary time to heal and bond following birth. However, the relationship between maternity leave and health outcomes has not been formally and comprehensively assessed to guide public health research and policy in this area. This review aims to address this gap by investigating both the correlates of maternity leave utilization in the US and the related health benefits for mother and child. Methods We searched the peer-reviewed scholarly literature using six databases for the years 1990 to early 2015 and identified 37 studies to be included in the review. We extracted key data for each of the included studies and assessed study quality using the "Weight of the Evidence" approach. Results The literature generally confirms a positive, though limited correlation between maternity leave coverage and utilization. Likewise, longer maternity leaves are associated with improved breastfeeding intentions and rates of initiation, duration and predominance as well as improved maternal mental health and early childhood outcomes. However, the literature points to important disparities in access to maternity leave that carry over into health outcomes, such as breastfeeding. Synthesis We present a conceptual framework synthesizing what is known to date related to maternity leave access and health outcomes.
Collapse
|
27
|
Jahagirdar D, Harper S, Heymann J, Swaminathan H, Mukherji A, Nandi A. The effect of paid maternity leave on early childhood growth in low-income and middle-income countries. BMJ Glob Health 2017; 2:e000294. [PMID: 29988584 PMCID: PMC6027064 DOI: 10.1136/bmjgh-2017-000294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/06/2017] [Accepted: 06/14/2017] [Indexed: 01/05/2023] Open
Abstract
Background Despite recent improvements, low height-for-age, a key indicator of inadequate child nutrition, is an ongoing public health issue in low-income and middle-income countries. Paid maternity leave has the potential to improve child nutrition, but few studies have estimated its impact. Methods We used data from 583 227 children younger than 5 years in 37 countries surveyed as part of the Demographic and Health Surveys (2000–2014) to compare the change in children’s height-for-age z score in five countries that increased their legislated duration of paid maternity leave (Uganda, Zambia, Zimbabwe, Bangladesh and Lesotho) relative to 32 other countries that did not. A quasiexperimental difference-in-difference design involving a linear regression of height-for-age z score on the number of weeks of legislated paid maternity leave was used. We included fixed effects for country and birth year to control for, respectively, fixed country characteristics and shared trends in height-for-age, and adjusted for time-varying covariates such as gross domestic product per capita and the female labour force participation rate. Results The mean height-for-age z scores in the pretreatment period were -1.91 (SD=1.44) and –1.47 (SD=1.57) in countries that did and did not change their policies, respectively. The scores increased in treated and control countries over time. A 1-month increase in legislated paid maternity leave was associated with a decrease of 0.08(95% CI −0.20 to 0.04) in child height-for-age z score. Sensitivity analyses did not support a robust association between paid maternity leave policies and height-for-age z score. Conclusion We found little evidence that recent changes in legislated paid maternity leave have been sufficient to affect child height-for-age z scores. The relatively short durations of leave, the potential for low coverage and the strong increasing trend in children’s growth may explain our findings. Future studies considering longer durations or combined interventions may reveal further insight to support policy.
Collapse
Affiliation(s)
- Deepa Jahagirdar
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Sam Harper
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - Jody Heymann
- Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Hema Swaminathan
- Indian Institute of Management Bangalore, Centre for Public Policy, Bangalore, India
| | - Arnab Mukherji
- Indian Institute of Management Bangalore, Centre for Public Policy, Bangalore, India
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health, Institute for Health and Social Policy, McGill University, Montreal, Canada
| |
Collapse
|
28
|
Patton D, Costich JF, Lidströmer N. Paid Parental Leave Policies and Infant Mortality Rates in OECD Countries: Policy Implications for the United States. WORLD MEDICAL & HEALTH POLICY 2017. [DOI: 10.1002/wmh3.214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
29
|
Richter LM, Daelmans B, Lombardi J, Heymann J, Boo FL, Behrman JR, Lu C, Lucas JE, Perez-Escamilla R, Dua T, Bhutta ZA, Stenberg K, Gertler P, Darmstadt GL. Investing in the foundation of sustainable development: pathways to scale up for early childhood development. Lancet 2017; 389:103-118. [PMID: 27717610 PMCID: PMC5880532 DOI: 10.1016/s0140-6736(16)31698-1] [Citation(s) in RCA: 382] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 08/15/2016] [Accepted: 08/22/2016] [Indexed: 01/21/2023]
Abstract
Building on long-term benefits of early intervention (Paper 2 of this Series) and increasing commitment to early childhood development (Paper 1 of this Series), scaled up support for the youngest children is essential to improving health, human capital, and wellbeing across the life course. In this third paper, new analyses show that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed. Greater political prioritisation is core to scale-up, as are policies that afford families time and financial resources to provide nurturing care for young children. Effective and feasible programmes to support early child development are now available. All sectors, particularly education, and social and child protection, must play a role to meet the holistic needs of young children. However, health provides a critical starting point for scaling up, given its reach to pregnant women, families, and young children. Starting at conception, interventions to promote nurturing care can feasibly build on existing health and nutrition services at limited additional cost. Failure to scale up has severe personal and social consequences. Children at elevated risk for compromised development due to stunting and poverty are likely to forgo about a quarter of average adult income per year, and the cost of inaction to gross domestic product can be double what some countries currently spend on health. Services and interventions to support early childhood development are essential to realising the vision of the Sustainable Development Goals.
Collapse
Affiliation(s)
- Linda M Richter
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa.
| | - Bernadette Daelmans
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | | | - Jody Heymann
- UCLA Fielding School of Public Health and WORLD Policy Analysis Center, University of California Los Angeles, CA, USA
| | | | - Jere R Behrman
- Departments of Economics and Sociology, University of Pennsylvania, Philadelphia, PA, USA
| | - Chunling Lu
- Division of Global Health Equity, Brigham & Women's Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Jane E Lucas
- Consultant in International Health and Child Development, New York, NY, USA
| | - Rafael Perez-Escamilla
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Tarun Dua
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada; Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Karin Stenberg
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Paul Gertler
- Haas School of Business and the School of Public Health, University of California Berkeley, CA, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
30
|
Austin SE, Biesbroek R, Berrang-Ford L, Ford JD, Parker S, Fleury MD. Public Health Adaptation to Climate Change in OECD Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13090889. [PMID: 27618074 PMCID: PMC5036722 DOI: 10.3390/ijerph13090889] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 11/25/2022]
Abstract
Climate change is a major challenge facing public health. National governments play a key role in public health adaptation to climate change, but there are competing views on what responsibilities and obligations this will—or should—include in different nations. This study aims to: (1) examine how national-level public health adaptation is occurring in Organization for Economic Cooperation and Development (OECD) countries; (2) examine the roles national governments are taking in public health adaptation; and (3) critically appraise three key governance dimensions of national-level health adaptation—cross-sectoral collaboration, vertical coordination and national health adaptation planning—and identify practical examples suited to different contexts. We systematically reviewed publicly available public health adaptation to climate change documents and webpages by national governments in ten OECD countries using systematic web searches, assessment of self-reporting, and content analysis. Our findings suggest national governments are primarily addressing infectious disease and heat-related risks posed by climate change, typically emphasizing capacity building or information-based groundwork initiatives. We find national governments are taking a variety of approaches to public health adaptation to climate change that do not follow expected convergence and divergence by governance structure. We discuss practical options for incorporating cross-sectoral collaboration, vertical coordination and national health adaptation planning into a variety of contexts and identify leaders national governments can look to to inform their public health adaptation planning. Following the adoption of the Paris Agreement and subsequent increased momentum for adaptation, research tracking adaptation is needed to define what health adaptation looks like in practice, reveal insights that can be taken up across states and sectors, and ensure policy orientated learning.
Collapse
Affiliation(s)
- Stephanie E Austin
- Department of Geography, McGill University, Burnside Hall Building Room 705, 805 Sherbrooke Street West, Montreal, QC H3A 0B9, Canada.
- Tracking Adaptation to Climate Change Collaboration (TRAC3), McGill University, Burnside Hall Building Room 705, 805 Sherbrooke Street West, Montreal, QC H3A 0B9, Canada.
| | - Robbert Biesbroek
- Tracking Adaptation to Climate Change Collaboration (TRAC3), McGill University, Burnside Hall Building Room 705, 805 Sherbrooke Street West, Montreal, QC H3A 0B9, Canada.
- Public Administration and Policy Group, Wageningen University and Research Centre, P.O. Box 8130, 6700EW Wageningen, The Netherlands.
| | - Lea Berrang-Ford
- Department of Geography, McGill University, Burnside Hall Building Room 705, 805 Sherbrooke Street West, Montreal, QC H3A 0B9, Canada.
- Tracking Adaptation to Climate Change Collaboration (TRAC3), McGill University, Burnside Hall Building Room 705, 805 Sherbrooke Street West, Montreal, QC H3A 0B9, Canada.
| | - James D Ford
- Department of Geography, McGill University, Burnside Hall Building Room 705, 805 Sherbrooke Street West, Montreal, QC H3A 0B9, Canada.
- Tracking Adaptation to Climate Change Collaboration (TRAC3), McGill University, Burnside Hall Building Room 705, 805 Sherbrooke Street West, Montreal, QC H3A 0B9, Canada.
| | - Stephen Parker
- Enteric Surveillance and Population Studies Division, Centre for Food-Borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, 255 Woodlawn Road West, Unit 120, Guelph, ON N1H 8J1, Canada.
| | - Manon D Fleury
- Enteric Surveillance and Population Studies Division, Centre for Food-Borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, 255 Woodlawn Road West, Unit 120, Guelph, ON N1H 8J1, Canada.
| |
Collapse
|
31
|
Burtle A, Bezruchka S. Population Health and Paid Parental Leave: What the United States Can Learn from Two Decades of Research. Healthcare (Basel) 2016; 4:E30. [PMID: 27417618 PMCID: PMC4934583 DOI: 10.3390/healthcare4020030] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/18/2016] [Accepted: 05/24/2016] [Indexed: 11/17/2022] Open
Abstract
Over the last two decades, numerous studies have suggested that dedicated time for parents to be with their children in the earliest months of life offers significant benefits to child health. The United States (US) is the only wealthy nation without a formalized policy guaranteeing workers paid time off when they become new parents. As individual US states consider enacting parental leave policies, there is a significant opportunity to decrease health inequities and build a healthier American population. This document is intended as a critical review of the present evidence for the association between paid parental leave and population health.
Collapse
Affiliation(s)
- Adam Burtle
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA 98195, USA.
| | - Stephen Bezruchka
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA 98195, USA.
| |
Collapse
|
32
|
Nandi A, Hajizadeh M, Harper S, Koski A, Strumpf EC, Heymann J. Increased Duration of Paid Maternity Leave Lowers Infant Mortality in Low- and Middle-Income Countries: A Quasi-Experimental Study. PLoS Med 2016; 13:e1001985. [PMID: 27022926 PMCID: PMC4811564 DOI: 10.1371/journal.pmed.1001985] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 02/18/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Maternity leave reduces neonatal and infant mortality rates in high-income countries. However, the impact of maternity leave on infant health has not been rigorously evaluated in low- and middle-income countries (LMICs). In this study, we utilized a difference-in-differences approach to evaluate whether paid maternity leave policies affect infant mortality in LMICs. METHODS AND FINDINGS We used birth history data collected via the Demographic and Health Surveys to assemble a panel of approximately 300,000 live births in 20 countries from 2000 to 2008; these observational data were merged with longitudinal information on the duration of paid maternity leave provided by each country. We estimated the effect of an increase in maternity leave in the prior year on the probability of infant (<1 y), neonatal (<28 d), and post-neonatal (between 28 d and 1 y after birth) mortality. Fixed effects for country and year were included to control for, respectively, unobserved time-invariant confounders that varied across countries and temporal trends in mortality that were shared across countries. Average rates of infant, neonatal, and post-neonatal mortality over the study period were 55.2, 30.7, and 23.0 per 1,000 live births, respectively. Each additional month of paid maternity was associated with 7.9 fewer infant deaths per 1,000 live births (95% CI 3.7, 12.0), reflecting a 13% relative reduction. Reductions in infant mortality associated with increases in the duration of paid maternity leave were concentrated in the post-neonatal period. Estimates were robust to adjustment for individual, household, and country-level characteristics, although there may be residual confounding by unmeasured time-varying confounders, such as coincident policy changes. CONCLUSIONS More generous paid maternity leave policies represent a potential instrument for facilitating early-life interventions and reducing infant mortality in LMICs and warrant further discussion in the post-2015 sustainable development agenda. From a policy planning perspective, further work is needed to elucidate the mechanisms that explain the benefits of paid maternity leave for infant mortality.
Collapse
Affiliation(s)
- Arijit Nandi
- Institute for Health and Social Policy, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- * E-mail:
| | - Mohammad Hajizadeh
- School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sam Harper
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Alissa Koski
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Erin C. Strumpf
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Economics, McGill University, Montreal, Quebec, Canada
| | - Jody Heymann
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States of America
| |
Collapse
|
33
|
Ford JD, Berrang-Ford L. The 4Cs of adaptation tracking: consistency, comparability, comprehensiveness, coherency. MITIGATION AND ADAPTATION STRATEGIES FOR GLOBAL CHANGE 2016; 21:839-859. [PMID: 30197563 PMCID: PMC6108005 DOI: 10.1007/s11027-014-9627-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 11/25/2014] [Indexed: 05/20/2023]
Abstract
Adaptation tracking seeks to characterize, monitor, and compare general trends in climate change adaptation over time and across nations. Recognized as essential for evaluating adaptation progress, there have been few attempts to develop systematic approaches for tracking adaptation. This is reflected in polarized opinions, contradictory findings, and lack of understanding on the state of adaptation globally. In this paper, we outline key methodological considerations necessary for adaptation tracking research to produce systematic, rigorous, comparable, and usable insights that can capture the current state of adaptation globally, provide the basis for characterizing and evaluating adaptations taking place, facilitate examination of what conditions explain differences in adaptation action across jurisdictions, and can underpin the monitoring of change in adaptation over time. Specifically, we argue that approaches to adaptation tracking need to (i) utilize a consistent and operational conceptualization of adaptation, (ii) focus on comparable units of analysis, (iii) use and develop comprehensive datasets on adaptation action, and (iv) be coherent with our understanding of what constitutes real adaptation. Collectively, these form the 4Cs of adaptation tracking (consistency, comparability, comprehensiveness, and coherency).
Collapse
Affiliation(s)
- James D. Ford
- Department of Geography, McGill University, Montreal, QC H3A0B9 Canada
| | - Lea Berrang-Ford
- Department of Geography, McGill University, Montreal, QC H3A0B9 Canada
| |
Collapse
|
34
|
Hajizadeh M, Heymann J, Strumpf E, Harper S, Nandi A. Paid maternity leave and childhood vaccination uptake: Longitudinal evidence from 20 low-and-middle-income countries. Soc Sci Med 2015. [DOI: 10.1016/j.socscimed.2015.07.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
35
|
Shepherd-Banigan M, Bell JF. Paid leave benefits among a national sample of working mothers with infants in the United States. Matern Child Health J 2014; 18:286-295. [PMID: 23584928 DOI: 10.1007/s10995-013-1264-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To describe a range of employment benefits, including maternity and other paid leave, afforded to working women with infants; and to examine the geographic, socio-demographic correlates of such benefits to inform the workplace policy agenda in the US. Using data from the Listening to Mothers II Survey, a national sample of English-speaking women who gave birth in 2005, we conducted multivariable linear and logistic regression analyses to examine the associations between socio-demographic factors and employment leave variables (paid maternity, sick and personal leave). Forty-one percent of women received paid maternity leave for an average of 3.3 weeks with 31 % wage replacement. On average women took 10 weeks of maternity leave and received 10.4 days of paid sick leave and 11.6 days of paid personal time per year. Women who were non-Hispanic Black, privately insured, working full-time, and from higher income families were more likely to receive paid maternity leave, for more time, and at higher levels of wage replacement, when controlling for the other socio-demographic characteristics. Race/ethnicity, family income and employment status were associated with the number of paid personal days. Currently, the majority of female employees with young children in the US do not receive financial compensation for maternity leave and women receive limited paid leave every year to manage health-related family issues. Further, women from disadvantaged backgrounds generally receive less generous benefits. Federal policy that supports paid leave may be one avenue to address such disparities and should be modified to reflect accepted international standards.
Collapse
Affiliation(s)
| | - Janice F Bell
- Department of Health Services, University of Washington, Seattle, WA, 98195, USA
| |
Collapse
|
36
|
Borrell C, Palencia L, Muntaner C, Urquia M, Malmusi D, O'Campo P. Influence of Macrosocial Policies on Women's Health and Gender Inequalities in Health. Epidemiol Rev 2013; 36:31-48. [DOI: 10.1093/epirev/mxt002] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
37
|
Heymann J, Cassola A, Raub A, Mishra L. Constitutional rights to health, public health and medical care: the status of health protections in 191 countries. Glob Public Health 2013; 8:639-53. [PMID: 23826994 DOI: 10.1080/17441692.2013.810765] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
United Nations (UN) member states have universally recognised the right to health in international agreements, but protection of this right at the national level remains incomplete. This article examines the level and scope of constitutional protection of specific rights to public health and medical care, as well as the broad right to health. We analysed health rights in the constitutions of 191 UN countries in 2007 and 2011. We examined how rights protections varied across the year of constitutional adoption; national income group and region; and for vulnerable groups within each country. A minority of the countries guaranteed the rights to public health (14%), medical care (38%) and overall health (36%) in their constitutions in 2011. Free medical care was constitutionally protected in 9% of the countries. Thirteen per cent of the constitutions guaranteed children's right to health or medical care, 6% did so for persons with disabilities and 5% for each of the elderly and the socio-economically disadvantaged. Valuable next steps include regular monitoring of the national protection of health rights recognised in international agreements, analyses of the impact of health rights on health outcomes and longitudinal multi-level studies to assess whether specific formulations of the rights have greater impact.
Collapse
Affiliation(s)
- Jody Heymann
- Fielding School of Public Health, University of California, Los Angeles, CA, USA.
| | | | | | | |
Collapse
|
38
|
Kim D, Saada A. The social determinants of infant mortality and birth outcomes in Western developed nations: a cross-country systematic review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:2296-335. [PMID: 23739649 PMCID: PMC3717738 DOI: 10.3390/ijerph10062296] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 04/26/2013] [Accepted: 05/16/2013] [Indexed: 11/17/2022]
Abstract
Infant mortality (IM) and birth outcomes, key population health indicators, have lifelong implications for individuals, and are unequally distributed globally. Even among western industrialized nations, striking cross-country and within-country patterns are evident. We sought to better understand these variations across and within the United States of America (USA) and Western Europe (WE), by conceptualizing a social determinants of IM/birth outcomes framework, and systematically reviewing the empirical literature on hypothesized social determinants (e.g., social policies, neighbourhood deprivation, individual socioeconomic status (SES)) and intermediary determinants (e.g., health behaviours). To date, the evidence suggests that income inequality and social policies (e.g., maternal leave policies) may help to explain cross-country variations in IM/birth outcomes. Within countries, the evidence also supports neighbourhood SES (USA, WE) and income inequality (USA) as social determinants. By contrast, within-country social cohesion/social capital has been underexplored. At the individual level, mixed associations have been found between individual SES, race/ethnicity, and selected intermediary factors (e.g., psychosocial factors) with IM/birth outcomes. Meanwhile, this review identifies several methodological gaps, including the underuse of prospective designs and the presence of residual confounding in a number of studies. Ultimately, addressing such gaps including through novel approaches to strengthen causal inference and implementing both health and non-health policies may reduce inequities in IM/birth outcomes across the western developed world.
Collapse
Affiliation(s)
- Daniel Kim
- Behavioural and Policy Sciences Department, RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA 02116, USA
- Department of Social and Behavioural Sciences, Ecole des Hautes Etudes en Santé Publique, Rennes 35043, France
| | - Adrianna Saada
- Center for Health Decision Science, Harvard School of Public Health, Boston, MA 02115, USA; E-Mail:
| |
Collapse
|
39
|
Heymann J, Earle A, McNeill K. The Impact of Labor Policies on the Health of Young Children in the Context of Economic Globalization. Annu Rev Public Health 2013; 34:355-72. [DOI: 10.1146/annurev-publhealth-031912-114358] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jody Heymann
- McGill University, Institute for Health and Social Policy, Montreal, QC H3A 1A3, Canada; ,
| | - Alison Earle
- Brandeis University, Institute on Child, Youth and Family Policy, Waltham, Massachusetts 02453, USA;
| | - Kristen McNeill
- McGill University, Institute for Health and Social Policy, Montreal, QC H3A 1A3, Canada; ,
| |
Collapse
|
40
|
Bezruchka S. The Hurrider I Go the Behinder I Get: The Deteriorating International Ranking of U.S. Health Status. Annu Rev Public Health 2012; 33:157-73. [DOI: 10.1146/annurev-publhealth-031811-124649] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Stephen Bezruchka
- Departments of Health Services and Global Health, School of Public Health, University of Washington, Seattle, Washington 98195-7660;
| |
Collapse
|
41
|
Sadana R, Harper S. Data systems linking social determinants of health with health outcomes: advancing public goods to support research and evidence-based policy and programs. Public Health Rep 2011; 126 Suppl 3:6-13. [PMID: 21836730 PMCID: PMC3150122 DOI: 10.1177/00333549111260s302] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ritu Sadana
- Ritu Sadana is a Coordinator at the World Health Organization (WHO) in Geneva, Switzerland, and in 2009 helped set up the WHO Scientific Research Group on Equity Analysis and Research. Sam Harper is an Assistant Professor at McGill University in the Department of Epidemiology, Biostatistics and Occupational Health in Montreal, QC, Canada. Dr. Harper is supported by a Chercheur-boursier from the Fonds de la Recherche en Sante du Québec
| | - Sam Harper
- Ritu Sadana is a Coordinator at the World Health Organization (WHO) in Geneva, Switzerland, and in 2009 helped set up the WHO Scientific Research Group on Equity Analysis and Research. Sam Harper is an Assistant Professor at McGill University in the Department of Epidemiology, Biostatistics and Occupational Health in Montreal, QC, Canada. Dr. Harper is supported by a Chercheur-boursier from the Fonds de la Recherche en Sante du Québec
| |
Collapse
|
42
|
Harrison KM, Dean HD. Use of data systems to address social determinants of health: a need to do more. Public Health Rep 2011; 126 Suppl 3:1-5. [PMID: 21836729 PMCID: PMC3150121 DOI: 10.1177/00333549111260s301] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kathleen McDavid Harrison
- Kathleen McDavid Harrison is Associate Director for Health Equity and Hazel Dean is Deputy Director, both at the Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention in Atlanta, Georgia
| | - Hazel D. Dean
- Kathleen McDavid Harrison is Associate Director for Health Equity and Hazel Dean is Deputy Director, both at the Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention in Atlanta, Georgia
| |
Collapse
|