Association for Public Policy Analysis & Management

BACKGROUND: In this study, we investigated whether mothers’ awareness of California’s PFL (CA-PFL) program was associated with lower odds of postpartum hospital admissions and emergency room (ER) visits. Our hypothesis was that CA-PFL increases total replacement income during leave and supports longer maternity leaves, which in turn reduces high-cost health care utilization, including ER visits and hospitalizations. Longer, better-paid family leaves may reduce maternal and family stress and give mothers the opportunity to seek preventive care for health conditions that could lead to an ER visit or hospitalization if ignored.

METHODS: This study drew upon a survey of approximately 2,000 new mothers in California and their electronic health records. The dataset included information on mothers’ demographics, employment, income, leave-taking, health outcomes and health care use. We examined how mothers’ awareness of CA-PFL prior to birth was associated with leave benefit take-up, and concurrent adverse health events including hospital admissions and ER visits controlling an extensive list of demographic and clinical characteristics prior to and immediately after child birth. We also employed propensity scores-based doubly robust estimation methods as a robustness check. To further mitigate the effects of unobserved factors (e.g. employer PFL benefit), we estimated the effect of time off work on ER visits in a mother fixed effect model.

RESULTS: Mothers who were aware that they were eligible for CA-PFL before birth were more likely to take at least 12 weeks of family leave and more likely to receive replacement income equal to at least half of their pre-birth wages. Mothers who were aware of CA-PFL were two-thirds less likely to have a postpartum hospitalization and one-third less likely to have an ER visit than mothers who were not aware. Controlling for unobserved mother level characteristics (e.g. labor market preference, employer maternity policy benefits, etc.), the fixed effect model demonstrated that a total of 24 weeks of leave were associated with 31.1% reduction of ER visits.

CONCLUSION: Although this is a correlational study, the findings support the hypothesis that paid family leave supports longer family leaves, which in turn may give mothers time and resources needed to seek earlier preventive care for health conditions that could lead to an emergency department visit and hospitalization. More importantly, awareness of CA-PFL is shown to be a robust indicator for postpartum adverse health events. Healthcare providers may wish to inquire regarding mothers’ awareness of paid family leave benefits as part of assessing mothers’ overall healthcare risk and plan their postpartum care accordingly.