A woman holds a baby by a window

Paid Leave as a Public Health Issue

Earlier this month, Claire Cain Miller and Jim Tankersley wrote for the New York Times Upshot about Gavin Newsom’s anticipated paid leave proposal for California. Their piece highlights economic research showing that the absence of paid leave policies in the U.S. hinder women’s participation in the workforce and, in turn, hurts the U.S. economy. (For example, Miller and Tankersley cite a letter from the Federal Reserve Bank of San Francisco projecting that a national parental leave policy could result in 5 million more workers joining the labor force.)

As politicians like Newsom grapple with the question of how to pay for more robust paid leave policies at the state-level, defining the costs of our current systems will be an important part of the process.

The health costs of not providing parental leave are another—and under-explored—part of the equation. Two recently published papers point to the negative public health outcomes of our current leave policies, specifically for new mothers.

A study published last February in the Maternal and Child Health Journal, for instance, showed a 51 percent decrease in re-hospitalization for women who elected to take paid maternity leave. While the study was subject to limitations and potential confounding bias—the researchers used proxy variables to predict the availability of leave—it nevertheless suggests an association between leave-taking and maternal health. Similarly, an October study showed that paid leave was associated with better mental health in new mothers. These papers add to a small body of research suggesting that leave policies may improve maternal health.

The costs to infant health of the absence of parental leave policies are better explored. For example, research shows that a lack of paid leave is related to suboptimal breastfeeding in infants. (The cited study also suggests that suboptimal breastfeeding also carries significant maternal mortality risks, with 79 percent of the costs of suboptimal breastfeeding associate with maternal health complications.)

A study of leave policies in Europe showed that paid parental leave was associated with decreased infant mortality. Unpaid leave has been shown to improve infant health measures like body weight. As mounting research shows that early childhood development is predictive of a range of other important social outcomes like literacy and future earnings, the costs of our current leave policies (or lack thereof) are likely reverberating.

While more research in this area is clearly needed, these studies show that (1) paid leave can and should be framed as a public health issue, and (2) the health costs of not providing paid leave should be incorporated into policy discussions.

Alexandra Slessarev

Alexandra Slessarev graduated from Harvard's joint JD/MPH program in 2019, and she will be clerking for Judge Ronald Lee Gilman on the 6th Circuit beginning in August 2019. Her Petrie-Flom fellowship paper was entitled "Curbing Pharmaceutical Detailing Practices in the Opioid Era." Alex's public health research interests include maternal and reproductive health, state-level Medicaid implementation, and the intersection of health and the environment. Prior to starting her dual-degree program, Alexandra spent a year working as a research assistant at the Bixby Center for Global Reproductive Health at the University of California, San Francisco, where she worked on several projects related to long-acting reversible contraception provision and education.

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