Evaluating the effect of San Francisco’s Paid Parental Leave Ordinance on preterm birth and associated maternal and newborn outcomes

Name of Awardee: Deborah Karasek, PhD, MPH & Julia Goodman, PhD, MPH

Background

San Francisco’s Paid Parental Leave Ordinance (PPLO) allows parents who work for private-sector employers to take 6 weeks of fully-paid parental leave. Previous studies have linked parental leave with health improvements for birthing people and babies, although evidence for preterm birth (PTB) is limited.

Hypothesis

We hypothesized that PPLO may have improved birth outcomes via reduced stress during pregnancy due to anticipation of postnatal leave.

Method

We used linked CA birth certificates and discharge records from January 2013 to December 2018. Births from January 2017 through December 2018 among working San Francisco (SF) women were considered “exposed” to PPLO; births during this time among working women outside of SF, as well as all births before 2017, served as controls. We used difference-in-difference (DD) models to compare outcomes among SF births before and after PPLO to outcomes among births in control counties. We conducted separate analyses by race/ethnicity, education, and Medicaid coverage at delivery.

Results

The final sample included 1,812,189 births. Overall analyses indicated no significant association between PPLO and birth outcomes, after adjusting for covariates and indicators for time and seasonality. Subgroup analyses indicate that PTB decreased for college-educated and non-Medicaid-covered pregnant people and increased among those who were Medicaid-covered. Early-term birth increased among Black pregnant people.

Conclusion