The First 1,000 Days and Paid Family Leave

This story is part of our ongoing series on the Social Determinants of Health, and where they connect and interact with the Developmental Origins of Health and Disease. Here we explore paid family leave, demonstrating the many ways this policy can benefit public health. 
_________________________________________________________________________________________________

A healthy start to life includes more than prenatal care. It includes a healthy environment, supportive relationships, access to resources, healthy food and comprehensive care before, during, and long after pregnancy. Research surrounding the Developmental Origins of Health and Disease (DOHaD) has illuminated that a majority of adult health and chronic disease risk is programmed in the first 1,000 days, from conception until about age two.₁ This is a critical period of development, as the rapidly growing body responds to its environment–both within and outside of the womb.₁₃

The conditions people experience in the environments in which they are born, live, work, and play are known as the social determinants of health. The social determinants are in turn shaped by unjust systems of power (racism, heterosexism, sexism, classism, ableism) and policies that affect how wealth, resources, and opportunities are distributed across communities and society more broadly. Without a fundamental shift towards interventions that target the drivers of health inequities (moving “upstream”), people will continue to be denied the opportunity for a healthy start to life.₁₃ One policy that could help advance economic and health equity, and have a profound impact during the first 1,000 days, is Paid Family Leave.₁₃

What is Paid Family Leave?
Paid family Leave (PFL) policies let parents take paid time off work to care for a newborn, newly adopted child or foster child. Time off is essential for allowing mothers to heal post-childbirth and to begin and maintain breastfeeding. It also provides the opportunity for parents to bond with a new child and can set the course for healthy physical, cognitive, and emotional functioning.₆,₁₀ However, the United States is one of only eight countries in the world that have not adopted a federal PFL policy.₆ This means that the ability to take time off during the prenatal and postpartum periods while maintaining financial security is limited to only a wealthy, primarily white, few.₈

Social Determinant of Health: Economic Stability
Low income, Black, Indigenous, Hispanic, Asian and other people of color are disproportionately forced to make the impossible choice between their health or the health of their family, and maintaining a steady job income.₈ Economic inequities, that have been shaped across history by discriminatory employment, housing, property ownership, and educational policies, have resulted in many families not having the financial means to meet their basic needs.₈

Research indicates that family socioeconomic status during childhood may have a larger impact on adult health than later life financial status.₂ Policies that aim to increase economic mobility for families could help improve financial situations and alleviate long-term health effects associated with poverty.₅ For instance, PFL policies have been shown to increase household income, decrease poverty risk, and reduce household rates of food insecurity in the year following birth.₄,₁₀ Across the board, PFL has had the greatest economic impact for low-socioeconomic status, single-parent, and racial minority families.₄,₆

Harnessing the power of PFL for Health Across the Life-Course
There is a plethora of research outlining the beneficial effects of parental leave-taking for both new parents and their children.₄ Evidence from countries and the few states that have implemented PFL policies demonstrate that there are many pathways through which PFL can yield life-long health benefits.₆

These beneficial pathways include: 

1. Breastfeeding. PFL is associated with increased initiation and duration of breastfeeding.₄,₆,₈,₁₀ Breastfeeding has numerous lasting health benefits for both mother and child.₆ For instance, breastfed infants are less likely to develop asthma, less likely to experience ear or gastrointestinal infection, and have reduced risk for developing Type I or Type II diabetes later in life.₆
    
2.  Reducing maternal stress and depression. High levels of stress during pregnancy can adversely affect fetal development and may have lasting implications for biological and cognitive functioning.₁₃ PFL allows new mothers to take necessary time off both before and after childbirth to rest and recover while maintaining job and financial security.₆,₁₁ This may help lower prenatal and postpartum stress, and reduce the risk for postpartum depression.₆ A longitudinal study by Chatterji & Markowitz found that taking at least eight weeks of PFL is associated with reduction in maternal depressive symptoms and improved overall maternal health status.₃
    
3.  Forming secure attachment. Paid time off from work after birth provides parents the opportunity to bond with a new child, setting the stage for healthy attachment as the brain develops.₁₀ Secure attachment fosters healthy social, cognitive, and emotional functioning, builds resilience, and reduces the risk for depression and anxiety disorders across the lifecourse.₁₄
    
4. Increasing healthcare utilization and frequency. PFL is associated with increased frequency of well-child and medical check-ups during the first year of life and improved childhood vaccination rates.₁₀  Additionally, PFL has been shown to reduce the rate of infant hospitalization and infant mortality, especially among lower income households.₁₀
    
5. Reducing low birthweight and preterm births. A 2015 study found that there was an overall 3.2% reduction in low birthweight births, and a 6.6% decreased likelihood for preterm birth, among states that had implemented paid leave during pregnancy.₁₁,₁₂ DOHaD research has illuminated that low birthweight and preterm birth are associated with increased risk for early-onset chronic disease in adulthood.₇ Thus, PFL policies have the potential to reduce chronic disease risk by improving maternal health, and through supporting healthy fetal/infant growth and development.₁₃

A Movement Towards PFL in Oregon
As research demonstrates, the equity potential of PFL policies for enhancing economic stability and improving child and maternal health outcomes is profound.₄,₁₃ There are eight states that currently offer PFL to their residents, but, in 2023, Oregon will bump that number up to nine.₄ Oregon’s Paid Family and Medical Leave Insurance program will ensure that all working parents, regardless of wage earned, have the opportunity to take paid time off to care for a newborn during the first year of life.₄ The numerous health and financial benefits that may result from this policy will help advance equity and improve the health of generations of Oregonians to come. As PFL demonstrates, policies rooted in DOHaD science and the first 1,000 days will direct prevention efforts and societal resources to where they can have a profound impact in helping to set the course for a healthy life for all.₁₃

Back to the main social determinants of health page

______________________________________________________________________________________________________________
References
          (1) Barnes, M., Heaton, T., Goates, M., & Packer, J. (2016). Intersystem Implications of the Developmental Origins of Health and Disease: Advancing Health Promotion in the 21st Century. Healthcare, 4(3). https://doi.org/10.3390/healthcare4030045
          (2) Bezruchka, S. (2015). Early Life or Early Death: Support for Child Health Lasts a Lifetime. International Journal of Child, Youth and Family Studies, 6(2), 204-229. https://static1.squarespace.com/static/5b16147f5b409b3051792e9f/t/5b1da4ca575d1f37d74ab458/1528669387119/BezruchkaEarlyLifeEarlyDeath15.pdf
          (3) Chatterji, P., & Markowitz, S. (2012). Family leave after birth and the mental health of new mothers. Journal of Mental Health Policy and Economics, 15(2), 61-76. https://pubmed.ncbi.nlm.nih.gov/22813939/
          (4) Goodman, J., Williams, C., & Dow, W. (2021). Racial/Ethnic Inequities in Paid Parental Leave Access. Health Equity, 5(1). https://www.liebertpub.com/doi/full/10.1089/heq.2021.0001
          (5) Healthy People 2020. (2022). Poverty. Office of Disease Prevention and Health Promotion. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/poverty
          (6) Khan, M. (2020). Paid family leave and children health outcomes in OECD countries. Child Youth and Services Review, 116. https://doi.org/10.1016/j.childyouth.2020.105259
          (7) Luu, T., Katz, S., Leeson, P., Thebaud, B., & Nuyt, A-M. (2016). Preterm birth: risk factor for early-onset chronic diseases. Canadian Medical Association Journal, 188(10), 736-746. https://doi.org/10.1503/cmaj.150450
          (8) Mason, J., Acosta, P., Atkinson, I., & Andara, K. (2021). Called to Care: A Radically Just Recovery Demands Paid Family and Medical Leave. National Partnership for Women & Families. https://www.nationalpartnership.org/our-work/resources/economic-justice/paid-leave/called-to-care-a-racially-just-recovery-demands-paid-family-and-medical-leave.pdf
          (9) National Partnership. (2018). Paid Family and Medical Leave: A Racial Justice Issue–and Opportunity. Issue Brief. https://www.nationalpartnership.org/our-work/economic-justice/reports/paid-family-and-medical-leave-a-racial-justice-issue-and-opportunity.html
          (10) Robert Wood Johnson Foundation. (2021). Improving Access to Paid Family Leave to Achieve Health Equity. https://www.rwjf.org/en/library/research/2021/05/improving-access-to-paid-family-leave-to-achieve-health-equity.html
          (11) Rossin-Slater, M., & Uniat, L. (2019). Paid Family Leave Policies and Population Health. Health Affairs. https://www.healthaffairs.org/do/10.1377/hpb20190301.484936/full/   
          (12) Stearns, J. (2015). The effects of paid maternity leave: Evidence from Temporary Disability Insurance. Journal of Health Economics, 43, 85-102. https://doi.org/10.1016/j.jhealeco.2015.04.005  
          (13) Wallack, L., & Thornburg, K. (2016). Developmental Origins, Epigenetics, and Equity: Moving Upstream. Maternal and Child Health Journal, 20, 935-940. https://doi.org/10.1007/s10995-016-1970-8
          (14) Winston, R., & Chicot, R. (2016). The importance of early bonding on the long-term mental health and resilience of children. London Journal of Primary Care, 8(1), 12-14. https://doi.org/10.1080/17571472.2015.1133012