Paid Parental Leave Policies and Infant Mortality Rates in OECD Countries: Policy Implications for the United States

• Date: 01 March 2017
• Author: Niklas Lidströmer,Dana Patton,Julia F. Costich
• DOI: http://doi.org/10.1002/wmh3.214
• Published date: 01 March 2017

Paid Parental Leave Policies and Infant Mortality

Rates in OECD Countries: Policy Implications for

the United States

Dana Patton, Julia F. Costich, and Niklas Lidstr€

omer

Infant mortality is an important indicator of a nation’s overall health and well-being because of its

association with education, availability and accessibility of health services, and income inequality.

In this paper, we examine the effect of job-protected paid parental leave on infant and post-neonatal

mortality rates in 19 OECD countries from 1960 to 2012. We utilize a generalized least squares

model controlling for a host of variables traditionally examined in studies of infant mortality rates,

as well as year f‌ixed effects, country f‌ixed effects, and country time trends. We f‌ind a statistically

signif‌icant association between job-protected paid parental leave and a reduction in both infant

mortality rates and post-neonatal mortality rates. The f‌indings are particularly relevant for

policymakers in the United States, the only industrialized democracy in the world that does not

provide job-protected paid parental leave to working women and men.

KEY WORDS: paid parental leave, infant mortality rate, OECD countries

Introduction

Governments and employers implement paid parental leave to help workers

maintain a healthy work–life balance, to retain workers (particularly women), to

boost fertility rates in the context of aging national populations, to promote gender

equality, and to enhance child and maternal health (International Labour Organiza-

tion [ILO], 2014; Ruhm, 2011). The following analysis examines the effects of job-

protected paid parental leave on child health, specif‌ically on infant mortality rates

and post-neonatal mortality rates, in 19 OECD countries. We begin with a brief

discussion of the importance of infant mortality rate as a measure and how its

changes over time have varied across countries. We then review previous f‌indings

regarding the effect of parental leave on the major types of infant mortality. Next,

we highlight the United States as an outlier among its peers, in terms of both paid

parental leave and infant death rates. Our analysis provides evidence that paid

parental leave reduces the post-neonatal mortality rate, which recent research

suggests is the primary driver of the high infant mortality rate in the United States

World Medical & Health Policy, Vol. 9, No. 1, 2017

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1948-4682 #2017 Policy Studies Organization

Published by Wiley Periodicals, Inc., 350 Main Street, Malden, MA 02148, USA, and 9600 Garsington Road, Oxford, OX4 2DQ.

(Chen, Oster, & Williams, 2016). We thus conclude with a discussion of the

importance of adopting job-protected paid parental leave in the United States as a

mechanism for reducing infant mortality.

Infant Mortality and Parental Leave

Infant mortality rate is considered a signif‌icant indicator of a nation’s overall

health (Anderson, 1973; Judge, Mulligan, & Benzeval, 1998; MacDorman,

Mathews, Mohangoo, & Zeitlin, 2014; Nersesian, 1988; Reidpath & Allotey, 2003).

A country’s infant mortality rate is measured as the number of infant deaths

before age 1 per 1,000 live births. Infant mortality falls into three major classes:

(i) Perinatal mortality: fetal death from the 22nd week of gestation through the

f‌irst postpartum week; (ii) Neonatal mortality: death of newborns within the f‌irst

28 days; and (iii) Post-neonatal mortality: deaths from day 28 through the rest of

the f‌irst year of life. The major medical predisposing factors for infant mortality

are low birth weight, malnutrition, sudden infant death syndrome (SIDS), and

infectious diseases (Stevens-Simon & Orleans, 1999). Across all countries, about

half of all infant mortality occurs within the perinatal and neonatal time frame

(WHO, 2011). In the OECD countries, two thirds of infant deaths occur within

this window, that is, during the f‌irst month (OECD, 2015a). It is important to

distinguish between the perinatal/neonatal time frame and the post-neonatal

time frame because the differences in causes of death suggest that different policy

approaches may be needed for death occurring in each period (Heron, 2013;

OECD, 2015b; Rudolph & Borker, 1987).

Over the past f‌ive decades, the infant mortality rate has fallen steadily in

OECD countries (OECD, 2011). In 1970, the OECD average infant mortality rate

was 30 deaths per 1,000 live births, whereas the current average is 4.3,

representing an 85 percent cumulative reduction (OECD, 2012). Some OECD

countries have enjoyed larger and more rapid infant mortality declines. The

Nordic countries, Japan, and Portugal have the lowest infant mortality rates,

ranging from 2.5 to under 3.0. The United States stands out with its rate of over

6.0 per 1,000 live births. In 2010, the U.S. rate dropped from 6.1 to 4.2 when births

at less than 24 weeks of gestation were excluded, but the U.S. rate was still higher

than those of most European countries (MacDorman et al., 2014). Using a small

sample of countries with available microdata, Chen et al. (2016) show that infant

mortality in the United States “accelerates after the f‌irst month of life” (91).

Importantly, this f‌inding holds for normal weight births, that is, the higher post-

neonatal mortality rate is not driven by delaying death with extended intensive

care unit stays.

Only a handful of studies have examined the relationship between paid

parental leave and infant mortality rates. Winegarden and Bracy (1995) examined

the effects of paid maternity leave across 17 OECD countries and four time periods.

They found that paid maternity leave reduces infant mortality, but did not control

for a variety of variables that may affect infant mortality. Ruhm (2000) improved

on Winegarden and Bracy’s research design, utilizing additional control variables

Patton/Costich/Lidstr€

omer: Paid Parental Leave and IMR 7