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The impact of paid family leave in the United States on birth outcomes and mortality in the first year of life.

ABSTRACT: OBJECTIVE:To evaluate the effect of paid family leave in California on statewide rates of preterm birth, low birthweight, postneonatal mortality, and overall infant mortality. DATA SOURCES:Live birth and death certificates from all in-hospital deliveries occurring in California (state exposed to the family leave policy) and two unexposed states (Missouri and Pennsylvania) from 1999 to 2008 (n = 6 164 203). STUDY DESIGN:We used a difference-in-differences approach to compare rates of infant health outcomes before and after implementation of the 2004 policy in California with rates in two states without paid family leave policies. Prespecified stratified analyses examined whether policy response differed by maternal characteristics. Conditional regression models using comparisons matched on a mother's likelihood of living in California in the pre-family leave period were then employed as sensitivity analyses to confirm our findings. DATA COLLECTION/EXTRACTION METHODS:Probabilistic methods were used to match live birth records to maternal and newborn hospital records. Only singleton births were included. Dyads were excluded if the infant gestational age was <23 weeks or greater than 44 weeks or if the birthweight was an outlier. PRINCIPAL FINDINGS:Compared to the unexposed states, adjusted postneonatal mortality rates decreased by 12 percent in California after 2004 (aOR 0.88, 95% CI 0.80-0.97). There were no significant effects on the other outcomes. There were no differences in the effect by race/ethnicity or insurance status except for increased odds of low birthweight among privately insured women in California after 2004. Point estimates in the propensity score-matched sensitivity models were similar to the results of the fully adjusted models for all four outcomes, but confidence intervals crossed one. CONCLUSIONS:Implementation of paid family leave policies in California was associated with a 12 percent reduction in postneonatal mortality after adjusting for maternal and neonatal factors.

SUBMITTER: Montoya-Williams D

PROVIDER: S-EPMC7518811 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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The impact of paid family leave in the United States on birth outcomes and mortality in the first year of life.

Montoya-Williams Diana D Passarella Molly M Lorch Scott A SA

Health services research 20200405

<h4>Objective</h4>To evaluate the effect of paid family leave in California on statewide rates of preterm birth, low birthweight, postneonatal mortality, and overall infant mortality.<h4>Data sources</h4>Live birth and death certificates from all in-hospital deliveries occurring in California (state exposed to the family leave policy) and two unexposed states (Missouri and Pennsylvania) from 1999 to 2008 (n = 6 164 203).<h4>Study design</h4>We used a difference-in-differences approach to compare ...[more]

PMID: 32249413

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Project description:Over the last decade, planned home births in the United States (US) have increased, and have been associated with increased neonatal mortality and other morbidities. In a previous study we reported that neonatal mortality is increased in planned home births but we did not perform an analysis for the presence of professional certification status.The objective of this study therefore was to undertake an analysis to determine whether the professional certification status of midwives or the home birth setting are more closely associated with the increased neonatal mortality of planned midwife-attended home births in the United States.This study is a secondary analysis of our prior study. The 2006-2009 period linked birth/infant deaths data set was analyzed to examine total neonatal deaths (deaths less than 28 days of life) in term singleton births (37+ weeks and newborn weight ≥ 2,500 grams) without documented congenital malformations by certification status of the midwife: certified nurse midwives (CNM), nurse midwives certified by the American Midwifery Certification Board, and "other" or uncertified midwives who are not certified by the American Midwifery Certification Board.Neonatal mortality rates in hospital births attended by certified midwives were significantly lower (3.2/10,000, RR 0.33 95% CI 0.21-0.53) than home births attended by certified midwives (NNM: 10.0/10,000; RR 1) and uncertified midwives (13.7/10,000; RR 1.41 [95% CI, 0.83-2.38]). The difference in neonatal mortality between certified and uncertified midwives at home births did not reach statistical levels (10.0/10,000 births versus 13.7/10,000 births p = 0.2).This study confirms that when compared to midwife-attended hospital births, neonatal mortality rates at home births are significantly increased. While NNM was increased in planned homebirths attended by uncertified midwives when compared to certified midwives, this difference was not statistically significant. Neonatal mortality rates at home births were not significantly different in relationship to professional certification status of the birth attendant, whether the delivery was by a certified or an uncertified birth attendant.

Project description:BackgroundThe World Health Organization currently defines severe acute malnutrition (SAM) in infants aged under 6 months of age using weight-for-length Z score (WLZ). Given widespread use of mid-upper arm circumference (MUAC) for identifying SAM in older children and weight-for-age (WAZ) for growth monitoring, there is increasing debate about the optimal anthropometric criteria to best identify infants u6m at-risk of mortality.ObjectiveTo determine the discriminatory value for mortality during the first 12 months of life of anthropometry taken at birth and at age two months (approximate age of routine vaccination).DesignData were analyzed from a birth cohort recruited between April and December of 2004 at four health facilities within Bansalogho District in Burkina Faso. Infants were followed up for 12 months. Mortality risks were estimated using hazards ratios (HR). Discriminatory value was assessed using receiver operating characteristic curves.ResultsOf 1,103 infants, 227 (21%) were low birthweight (LBW). During 12 months, 86 (7.8%) infants died; 38 (44%) among the LBW group. At birth, MUAC<9.0cm, weight<2.5kg, length<44.2cm and incalculable WLZ were associated with mortality. Sixty (70%) deaths occurred after the age of two months; 26 (43%) among LBW infants. At age two months, any MUAC <11.5cm, weight <3.8kg (WAZ<-3) and length <52.4cm (LAZ<-3) were associated with risk of mortality. WLZ was not associated with mortality at any threshold. Birth weight did not modify the effect of the association between month two MUAC and one-year mortality (P = 0.33).ConclusionInfants at heightened risk of mortality and are better identified during early infancy by MUAC or WFA than by WLZ. LBW infants with low anthropometry at the age of routine immunizations remain at elevated risk than normal birth weight (NBW)infants and require intervention. Effectiveness, cost-effectiveness and coverage of applying proposed thresholds should be investigated as a priority to inform policy and practice.

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The impact of paid family leave in the United States on birth outcomes and mortality in the first year of life.

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The impact of paid family leave in the United States on birth outcomes and mortality in the first year of life.

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