We spend a lot of time thinking about the short-term benefits of comprehensive parental leave policies—keeping mothers in the paid workforce, improving outcomes for children—but what about the long-term effects? This week’s WAPPP seminar featured Lisa F. Berkman, Thomas Cabot Professor of Public Policy and Epidemiology at the Harvard T.H. Chan School of Public Health and Director of the Harvard Center for Population and Development Studies. Professor Berkman places particular emphasis on the long-term health impacts of social and economic policies. She shared her findings regarding maternity leave policies and women’s long-run mental and physical health.
Background: Lagging Women’s Health and Work-Family Conflict
The impetus for Professor Berkman’s work stems from diverging life expectancies for women in the United States. From the 1940’s to the 1980’s, the U.S. was solidly middle-of-the-pack in terms of female life expectancy among OECD countries. However, over the last 30 years we have seen a dramatic shift. While women’s life expectancy increased slightly in the U.S. over that period, other countries have zoomed ahead. The U.S. is now dead last in female life expectancy relative to other OECD countries. The reason for this shift is unexplained. A study by the National Academy of Sciences examined smoking, obesity, economic inequality, social networks, access to medical care, and hormonal issues, but none of these “usual suspects” was able to explain this lag.
A recent Brookings report on inequality indicates that life expectancy has stagnated for low-income women. In examining cohorts of women born in 1920 and 1940, they found almost no change in life expectancy for women in the lowest income deciles over time. By contrast, women in the top income decile show significant increases in life expectancy. High-income women born in 1940 have a life expectancy 4-5 years longer than those born in 1920.
The changing work-family landscape in the U.S. may account for these changes. The number of births to single mothers and the share of women with children in the workforce have skyrocketed in the last 25 years. Formal social protection policies are lacking in the U.S. There is no federally-mandated paid leave, and the Family and Medical Leave Act covers only some workers. Professor Berkman calls this the “perfect storm” that is unique to the U.S. – fertility has remained high, more women have entered the labor force, and workers have few social protections. How does work-family conflict relate to long-term health?
The Long-Run Effect of Maternal Leave Benefits on Women’s Mental Health
Depression, according to Professor Berkman, is the second leading cause of disability worldwide. Depressive symptoms are very common in older people. It may be that a lack of comprehensive maternity leave policies increases the risk of depression for women later in life. Strong social support policies reduce immediate pressures and post-partum stress, and stressful life events may be related to recurrent depression.
To test this explanation, Professor Berkman examined SHARE, a cross-country sample representative of the 50+ population across Europe. The dataset includes complete working histories, fertility histories, and extensive measures of mental health, physical health, and labor market behavior. She also examined the Family Policy Database on maternity leave policies in these countries. This study focused on first births.
Professor Berkman found that at low levels of maternity leave benefits, working women had a slightly higher depression score than non-working women. However, once maternity leave benefits kick in, there is a significant change. With more than five weeks’ paid leave, working women were much less likely to show signs of depression than non-working women. Statistical analysis showed a 16.2% difference in depression scores in old age for working and non-working women in high-benefits countries.
This result seems a bit perplexing—why do non-working women in high-benefits countries have a higher depression rate in old age? This may be an issue of social comparison. Women who live in countries with strong maternity leave policies may regret not being in the paid labor force. While the mechanism is unclear, the relationship is strong. Depression in old age is clearly correlated with maternity leave policies during the birth of one’s first child.
This finding has significant policy implications. Depression is costly, and older people with depression use more health services, medical supplies, home care, and assisted living than those without depression. As some countries have moved to cut parental leave benefits, these costs should be factored into the long-run impacts of such policy decisions.
The Breaking Point: Work Stress, Motherhood, and Marital Status as Risk Factors for Mortality among Working U.S. Women
Having looked at mental health outcomes, Professor Berkman shifted to thinking about physical health outcomes based on work-family conflict. One weakness of existing literature is that many studies assume women’s work-family situations are consistent throughout their adult life. However, many women show significant variation over time in whether they are married, in the paid labor force, and have children at home. Theoretically, there are 4.06*10^31 ways to combine marriage, work, and children between the ages of 16 and 50! The researchers focused on seven distinct work-family patterns in the sample and looked at overall age-standardized mortality rates across these groups.
Married working mothers who took some time off or work do the best in terms of low mortality, followed by working non-mothers. Married mothers who always worked and married mothers who never worked fall in the middle of the mortality distribution. Single working mothers and single non-working mothers round out the bottom of the spectrum and have the worst mortality outcomes. There are obvious selection effects here: single mothers are far more likely to be in poverty, and there are a number of other confounding factors that influence these results.
Professor Berkman hypothesized that lifetime job demands and job control could be mediating factors for mortality. Demanding jobs are likely to cause stress that can negatively affect health outcomes. Having control over one’s work schedule, by contrast, likely reduces stress. Professor Berkman looked at the self-reported longest-held job for each individual in the dataset and assigned continuous demand and control scores to each person. Results show that low job control greatly increases mortality for each group, but particularly for single mothers. This study is another example of how public policies can have long-run health impacts. Work-family conflict can have a profound impact on health, especially for those with limited social and economic resources.