Does Paid Family Leave Make New Parents Healthier?

"As a parent, you experience the most of everything. The most love, the most fear, the most hurt and the most tired, the most of every emotion" — Sarah Shahi

Becoming a parent for the first time is a scary, exhilarating, life-changing experience.

Along with the obvious social, and economic, changes that every new parent goes through, there are biological and psychological changes as well. Not only are new parents typically sleep-deprived during the first few months of their child's life, but they are often unprepared for the stress that goes with forming a new daily routine around the newborn infant. This includes dealing with (or at times, fending off) well-wishers and doting family members, as well as making new lifestyle choices that reflects their new role as parents. Also, for most new parents, there is the inevitable job stress that comes from juggling work and family responsibilities, especially for first-time mothers who may feel torn by being separated from their new infant for even a few hours each day.

Given these various stressors in a new parent's life, it's hardly surprising that first-time parents are vulnerable to a wide range of health issues. Along with postpartum depression (which can affect fathers as well as mothers), research studies show that first-time parents are also prone to stress-related issues, including a potentially compromised immune system and increased risk of anxiety and mood disorders. They also have less time for exercise than non-parents and their eating habits can change significantly as well. As a result, many first-time mothers and fathers face the increased risk of obesity which, in turn, can lead to cardiovascular problems later in life.

One particular indicator of potential health problems in new parents is the increased allostatic load, i.e., the "wear and tear" on the body that can occur due to stress. While there has been relatively little research looking at physiological measures of stress in new mothers and fathers, studies done to date suggest that new parents have a significant increase in cortisol levels (cortisol is also known as the "stress hormone"). Studies looking at parents of older children also indicate that much of the stress linked to parenthood (including relationship issues, work-family balance, and dividing childcare duties) can also affect the body's ability to cope with stress.

The impact of stress on new parents appears particularly acute in low-income families. One recent study looking at low-income mothers two to three months following childbirth found significant evidence of a compromised immune system, including greater production of cytokines linked to parental stress and poor sleep quality (particularly in African-American mothers). This also suggests greater proneness to inflammation, increased vulnerability to infection, and potentially greater risk of health problems later in life. Not surprisingly, financial stress also has a significant impact on stress levels, particularly in single-parent households.

A new review article published in the journal American Psychologist suggests that the transition to parenthood represents an "inflection point" that can shape the direction an adult's life can take well into mid-life and beyond. Written by Darby Saxbe and Diane Goldenberg of the University of Southern California, and Maya Rossin-Slater of the Stanford University School of Medicine, the article makes the case for first-time parenthood being a period of increased neuroplasticity during which significant neural changes occur.

While these changes are particularly prominent in new mothers due to hormonal changes, they also occur in first-time fathers who develop neural responses to infant-related stimuli that are quite similar to a mothers. Fathers also undergo changes in testosterone levels that appear to be linked to caregiving. Interestingly enough, these changes also occur in same-sex couples who become parents, with primary caregivers showing greater changes than secondary caregivers.

Recognizing the stressful life transition that comes with new parenthood, most countries around the world provide new parents with statutory paid family leave (PFL). Though the length offered can range from as short as six weeks to a full year in some places, PFL is commonly viewed as a sensible and necessary policy aimed at promoting public health. In fact, the United States is one of only three countries without statutory PFL for new parents (Papua New Guinea and Suriname are the other two).

At the state level, only six U.S. states and one district have passed legislation providing paid workers with PFL These include California, New Jersey, Washington, Massachusetts, Rhode Island, New York, and the District of Columbia. Such PFL plans typically only apply to new mothers rather than fathers or adoptive parents, and often vary widely in terms of amount of leave and actual benefits received.

Though the Family and Medical Leave Act (FMLA) grants 12 weeks of job-protected unpaid leave, this is small comfort for low-income families unable to afford the loss of income involved. For this reason, many low-income families are left without any legal protection following the birth or adoption of a new infant. As a result, an estimated one in four new mothers are forced to return to work within two weeks of delivering a new infant or face termination. Fathers often have even fewer rights and can be forced to return to work with no time off at all. But along with enormous economic challenges that come with being denied paid family leave, there are typically health problems as well stemming from the added stress that a forced return to work can cause.

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So, what is the role that paid family leave plays in helping new parents avoid many of these health risks? As Darby Saxbe and her co-authors point out in their review article, the United States is unique among industrialized countries in not providing paid leave for new parents. Unfortunately, actual health data linking paid family leave to employee health in the United States is relatively scarce. Still, studies from Australia, Norway, Sweden, Canada, and Lebanon indicate that paid leave is strongly correlated with reduced risk of depression and better overall health. In one study comparing maternal health before and the introduction of a paid family leave in Norway, mothers were found for up to 15 years after the birth of their child with results showing positive benefits in terms of body/mass index (BMI), obesity, blood pressure, pain, and perceived mental health.

As for the United States, studies looking at the FMLA found that the 12 weeks of unpaid leave it provides has a positive benefit for child health, including higher birth weight and reduced infant mortality. Still, this only seems to apply to the more affluent families that can afford to take advantage of the policy. In looking specifically at those states providing some form of paid leave, the greatest impact appears to be on the children of low-income and single-parent households (no data is currently available on how parents are affected).

But most research to date focuses on how paid family leave affects mothers rather than fathers. While paternal leave is becoming more popular after the birth of a child, men are still far less likely to taken time off than mothers. For example, a 2018 study found, despite a paid family leave law in California allowing time off for men, only 12 percent of new fathers take advantage of it compared to 47 percent of new mothers. To date, because of this disparity, there isn't as much research data looking at the health benefits that family leave can bring. While one Swedish study suggests that fathers who take paternal leave may live longer than those who don't, much more research still needs to be done.

So, what can we say at this point? Though there is no disputing that becoming a new parent can be an enormous challenge, Darby Saxbe and her co-authors build a strong case showing that it can also have a dramatic impact on health as well. Along with health issues such as obesity and mood disorders, the stress of new parenting also impacts the immune system and may continue to impact health much later in life. While paid family leave can help offset some of that stress by allowing mothers and fathers time after the birth of a new child, many new parents in the United States don't have this option and, as a result, may develop medical problems that might have been otherwise prevented.

Despite being an enormously popular issue with voters (one recent work survey puts support for maternal leave at 93% for mothers and 85% for fathers), there seems little prospect of US legislators introducing a federal paid family leave policy in the foreseeable future. Still, the value of paid family leave, both as a public health measure and as an investment for the future can't be underestimated. The health dividends of such a leave policy in reducing stress for new parents would more than repay any of the the social investment costs involved.