The Impact of Paid Sick Leave Mandates on Prenatal Care Use and Birth Outcomes

Background and Purpose: Paid sick leave (PSL) provides workers with job-protected paid leave on an as-needed basis to address their own health or care for an ill family member. Gender and racial/ethnic segregation of work result in differential access to PSL: 37% of private-sector workers cannot take a single paid sick day. The time around childbirth is marked by pregnancy-related health challenges and increased medical appointments requiring workers to take time away from work. Workers who lack access to PSL in the perinatal period could lose income and face other penalties at a time when they often need additional support. State-mandated PSL – requiring employers to provide job security and income replacement – may be a vital workplace support during this portion of the life course to support healthy pregnancies and infants.

Methods: I use restricted data on births in the United States from the National Center for Health Statistics Vital Statistics Birth Data from 2012-2019. The sample is limited to singleton births to gestational parents ages 25-44 to identify individuals more likely to be in the workforce. Outcomes include the number of prenatal care visits, prenatal care initiation in the first trimester, birth weight in grams, low birthweight status, gestational age in weeks, and whether the birth was preterm (<37 weeks). I employ a difference-in-differences research design to obtain causal estimates of the effect of five state-level PSL mandates on prenatal care use and birth outcomes. Adjusted models control for individual characteristics and state-year labor market conditions. Stratified analyses focused on groups more likely to gain paid sick leave through legislation were conducted based on the gestational parent’s educational attainment, nativity, and race/ethnicity.

Results: The results show that PSL mandates significantly increased the number of prenatal care visits by 0.42 visits and initiation of prenatal care in the first trimester by 3.2 percentage points. Additionally, PSL mandates led to small increases in birth weight and gestational age of 46.75 grams and 0.27 weeks, respectively, and reduced the proportion of births considered low birthweight (<2500 grams) by 1.1 percentage points or 2.2%. In stratified analyses, improvements in birthweight and gestational age were largest among infants of white and US-born gestational parents.

Conclusions and Implications: PSL policies hold promise for improving birth outcomes at the population level. However, the concentration of impacts among the white and US-born suggests that PSL mandates do not substantially reduce racial inequalities in birth outcomes. Policymakers should include PSL within the set of policies that support pregnant workers. Advocates should ensure that information and enforcement efforts target employers and workers in industries with low voluntary provision to leverage the PSL mandates’ potential to improve health equity.