Relationships between Paid Maternity Leave, State Policy, and Maternal Health: Evidence from Eleven States in the U.S

Background and Purpose. To fill gaps left by the 1993 Family and Medical Leave Act, several states have either adopted, or taken steps to adopt, programs that provide wage replacement for workers who take time off to care for an ill family member or bond with a new child.

However, the research to-date evaluating the effects of state policies on both leave-taking and health outcomes is limited. This study addressed several factors that have challenged past studies, including (a) the lack of large, representative samples of workers with (and without) access to leave and with a recent birth, (b) a lack of information on whether leaves were paid or unpaid, (c) time lag between the birth and data collection, and (d) insufficient state-specific data.

Drawing on a state-representative sample of mothers who had worked at some point during their pregnancies and either had returned or were planning to return to work, I examined whether there were relationships between paid leave-taking and a set of maternal health outcomes. I then investigated relationships between residence in states with public policies that provide wage replacement during periods of leave and the likelihood of accessing paid leave, as well as whether the size or direction of this relationship varied by income status of the mother.

Methods. I analyzed data from the Centers for Disease Control and Prevention’s (CDC) Pregnancy Risk Assessment and Monitoring System (PRAMS) surveys (https://www.cdc.gov/prams/).

The PRAMS surveys mothers, within three-to-nine months after giving birth, about their experiences before, during, and after pregnancy. The CDC estimates that PRAMS data represent 83% of all U.S. births (CDC, 2017). Women who have had a recent live birth are randomly selected from each participating state’s birth certificate file, with final sample sizes of between 1,000 and 3,400 women per state.  

For PRAMS Phase 7 (2012 – 2015), the CDC made available a series of maternal leave questions for state health departments to select for inclusion in their annual surveys. Eleven states/regions, including two with active temporary disability and/or family leave insurance programs, opted to include the leave questions.

Results. In models that controlled for socio-demographic characteristics, state, year, and pre-pregnancy depression, paid leave-taking was significantly associated with a decreased likelihood of self-reported postpartum depression, and with an increased likelihood of completion of a postpartum checkup. For example, women who reported a paid leave were 33.5% more likely than women who reported unpaid or no leave to report at least one postpartum doctor’s visit (p=.003). Using state-level data allowed for documentation of an association between residence in a state/region with a leave insurance program and the likelihood of reporting paid leave, particularly for women with low incomes.

Conclusions and Implications. In the past five years, the number of states with family leave insurance programs doubled from two to four, with lawmakers in at least two other states actively pursuing proposals. Given this study’s findings, particularly for women with low household incomes, the current policy landscape seems a particularly rich arena for social work involvement.