Are extensions in paid parental leave associated with lower infant and neonatal mortality in Latin American cities? Evidence from 148 cities in Chile, Mexico, and Colombia (2000-2015)

Abstract

We examined changes in infant and neonatal mortality that occurred after extension in the minimum number of days of paid maternity leave and after the implementation of paid paternity leave in 148 cities using longitudinal city-level data (2000-2015) from Chile, Colombia, and Mexico, compiled and harmonized by the Salud Urbana en America Latina (SALURBAL) study. For Chile we also explored variations in these associations according to the mother's educational attainment as a measure of family socioeconomic standing. We employed interrupted time series analysis in country-specific models, adjusted by time-variant socioeconomic characteristics such as the percent of the population with secondary education and above, and GDP per capita at the city level. In Chile, we found modestly steeper declines in infant and neonatal mortality rates after paid parental leave reform in 2011 which combined the extensions in paid maternity leave and the introduction of paid paternity leave. We did not find significant associations between extensions of paid maternity and/or introduction of paternity leave and infant and neonatal mortality trends in Colombia and Mexico. The magnitude of the extension in days of paid maternity leave may be relevant to the impacts on infant and neonatal mortality. Results from this study highlight the potential importance of combined paid maternal and paternal leave policies for reducing infant and neonatal mortality while promoting more egalitarian gender roles in successful child upbringing. This is particularly relevant in the context of highly unequal Latin American cities, where women continue to provide the majority of childcare.

Keywords: Infant mortality; Interrupted time series analysis; Maternity leave; Neonatal mortality; Paternity leave; Urban health.

Fig. 1.

Trends in infant and neonatal mortality rates in cities pre and post interventions and changes associated with extension in paid maternal and paternal leave in Chile and Colombia (2000–2015). Notes: Labelled brackets denote the relative difference in mortality trend pre and post intervention, 95 % CI, p-value The second-intervention period for Chile denotes the effect of two policies, an increase in maternal leave and the implementation of paternal leave. For Chile: ^aSecond-intervention vs pre-intervention period. ^bFirst-intervention vs pre-intervention period. ^cSecond-intervention vs first-intervention period. For Colombia: ^d post vs pre-intervention period.

Fig. 2.

Trends in infant and neonatal mortality rates in cities pre and post interventions and changes associated with extension in paid paternal leave in Colombia and Mexico (2000–2015). Notes:Labelled brackets denote the relative difference in changes in mortality, 95 % CI, p-value. ^a Post intervention vs pre-intervention period.

Fig. 3.

Trends in infant and neonatal mortality rates in cities pre and post interventions and changes associated with extension in paid maternal and paternal Leave by mother’s educational level in Chile 2000–2015. Notes: Labelled brackets denote the relative difference in change in mortality, 95 % CI, p-value. The second-intervention period denotes the effect of two policies, an increase in maternal leave and the implementation of paternal leave. ^aLess than secondary, second-intervention vs first-intervention period. ^bLess than secondary, first-intervention vs pre-intervention period. ^cLess than secondary, second-intervention vs first-intervention period. ^dSecondary or above, second-intervention vs first-intervention period. ^eSecondary or above, first-intervention vs pre-intervention period. ^fSecondary or above, second-intervention vs first-intervention period.