Association for Public Policy Analysis & Management

Although it is well-established that early life experiences have important and lasting effects on health, the US is the only developed country that does not guarantee a period of paid and job-protected leave for new parents. As a result, coverage is both limited and highly unequal. The situation is slowly starting to change, as four states – California, New Jersey, New York and Rhode Island – as well as Washington DC (subject to congressional approval) have paid family leave (PFL) programs in place or scheduled to go into effect that provide a period of paid leave to new parents. The first of these programs was implemented in California in 2004, offering families up to six weeks of paid family leave at a 55% wage replacement rate. While we know much about the labor market and employer effects of California’s PFL program, its impacts on infant and child health has been much less studied. Accordingly, we investigate the effects of the California PFL law on three important health related outcomes - breastfeeding initiation and duration, immunizations, and pediatric well-child visits -- using a large, representative sample of over 250,000 children drawn from the National Immunization Study. We identify the effect of PFL using differences-in-differences models comparing the outcomes for California children to those in four groups of control states as well as a synthetic California control group. In addition to studying the average effects of PFL, we also examine heterogeneity of effects by maternal education, marital status, maternal age at birth, race/ethnicity, and income to explore whether the law mitigated disparities.

Paramount to this study is the measurement of outcomes related to infant and young child health. We explore several alternative indicators including the incidence and duration of breastfeeding and exclusive breastfeeding, the adequacy, frequency, and order of immunizations, and pediatric visits for infants and young children. We discuss the implications of these measures and the obstacles in balancing precision against practicality while obtaining an apt characterization of infant and child health. Our initial findings suggest that PFL significantly increases the duration of breastfeeding. Infants born to women from more disadvantaged backgrounds were more likely to further extend breastfeeding duration (this includes women who were impoverished, had participated in WIC, or who had less than 12 years of education). Our conference paper (in progress) will also present findings related to immunizations and pediatric visits. Our findings will provide important evidence regarding the possible health effects of expanding these PFL policies beyond the few states where they currently exist.