Paid Leave Availability and Public Health and Nutrition Program Participation Following a Birth

Background:

Recent research has found that implementation of Paid Family Leave programs in the U.S. are associated with reductions in cash welfare enrollment among lower-income women in the period surrounding a birth (Houser & Vartanian, 2012; Ybarra, Stanczyk, & Ha, under review). While cash welfare participation tends to be relatively short in duration other public assistance programs, health and nutrition programs in particular, are typically longer in duration for lower-income families and are associated with improved maternal and child health in the period surrounding a birth (Currie & Grogger, 2002; Bitler & Currie, 2005; Hoynes, Page, & Stevens, 2011; Cook et al., 2004; Hoynes, Schanzenbach, & Almond, 2016). Therefore, understanding whether PFL is also associated with reductions in public health and nutrition programs following a birth is critical to understanding poverty and inequality and public health more broadly around a birth for lower-income families.

To contribute to this gap in knowledge this study explores the relationship between paid leave availability and enrollment in SNAP, Medicaid, and WIC following a birth among lower-income women in the U.S. . We use a nationally representative sample of lower-income women who have recently given birth from the Survey of Income and Program Participation to estimate the likelihood of participating in public health and nutrition programs immediately and one-year post-birth.

We hypothesize that women who reside in states that provide paid leave will be less likely to participate in publicly available health and nutrition programs.

Methods:

Data are from the Survey of Income and Public Program Participation (SIPP), a nationally representative panel survey data set. Study population includes single low-income SIPP participants who gave birth between 1997 and 2011 and have relevant information on family structure, public program participation, and work and earnings (N=1,168). Descriptive tests of significance and probit regression models are used to examine the relationship between paid leave availability and participation in SNAP, Medicaid, and WIC immediately following birth and at twelve months after.

Results:

Descriptive analyses suggest significantly lower enrollment in SNAP (52% vs. 65%) but not Medicaid or WIC following a birth for single low-income women in PL states compared to those in non-PL states. The finding of significantly lower SNAP participation immediately following (p<0.01) and twelve months (p<0.05) after a birth in PL states holds in probit models including potentially-relevant mother, household, and state controls. Similar probit models find a significant greater likelihood of Medicaid participation immediately following a birth (p<0.05) but not at twelve months in PL states. Probit models revealed no significant difference in WIC participation immediately following a birth and at twelve months for PL states and non-PL states.

Implications:

Results support previous research finding that SNAP participation following a birth is higher in non-PL states compared to PL states. The counterintuitive finding that PL states have higher participation in Medicaid may be due to these states doing a better job of connecting low-income women to Medicaid. Discussion will address implications for maternal and child health and federal and state social policy.