The Long-Run Effect of Maternity Leave Benefits on Mental Health: Evidence from European Countries

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.

Reserving Time for Daddy: The Long and Short-Term Consequences of Fathers' Quotas

People often think economists only worry about inflation, interest rates, or fiscal policy, but did you ever think that economics researchers would be working on figuring out ways for couples to share child care and housework more equitably? Well, they do! In the latest edition of the HKS WAPPP Seminar, economist Ankita Patnaik, from Mathematica Policy Research, presented her work on the long term and short term effects of paternity leave on families. She is part of a group of up and coming scholars that, according to Professor Hannah Riley-Bowles, are producing research that reminds us that the topic of gender encompasses more than women; equality concerns everyone.

Patnaik began by providing an overview of encouraging trends that have emerged in recent decades. In some contexts, women have been catching up to men in the formal labor market, though pay gaps remain, and have closed gaps in realms like education. In contrast, 'care work', which includes unpaid tasks such as housework or child care in the home, is strongly characterized by sex-specialization and takes up more of women's time. In the typical household according to studies, women are assigned inflexible tasks that need to be performed regularly and at fixed times, like cooking dinner, for example. In contrast, men usually take on tasks that can be performed at any time and are not routine, like fixing various items or mowing the lawn.

These differences can hurt women at work and reduce their bargaining power within the household. They can result in lower priority assigned to women's activities outside the home. For example, researchers observe that women are more likely to quit their job in response to husband's long work hours and more likely to relocate to accommodate a partner's professional path.

Before Patnaik's research, studies had found a relationship between parental leave schemes that included a paternity leave provision and the number of men taking leave to perform childcare duties. They could not pinpoint a causal relationship though and the effect of fathers' leave on housework sharing was not clear. Her contribution provides answers to these questions by looking at a very special policy episode that happened in Canada in 2006.

Dr. Ankita Patnaik, Mathematica Policy Research

The province of Quebec put into place a parental leave scheme called QPIP Reform, which made it easier to qualify, provided more compensation, and included a five-week 'daddy-only' provision for leave in addition the mother's. Families with babies born beginning on January 1st would be eligible. This allowed Patnaik to compare eligible families with those that just missed the date and would be governed by the old scheme, which only provided with maternity and shared leave. The results are very impressive.

The likelihood that fathers would take paternity leave went up by 53 percentage points, and their leaves became three weeks longer. "Norms play a critical role", she explained. Because this policy is aimed specifically for fathers, social norms become more accepting of men leaving work to take care of a child than when the policy was shared leave. After the quota, "dads are more likely to take their leave if their brother or their boss took it", she remarked. She calls her findings "the flypaper effect", because the quotas stick to the dad's when they are directed specifically to them. Labels matter!

What is even more impressive is that she found that these five weeks of leave can have effects that are much more long lasting than could have been expected. After five years, moms in Quebec were spending an hour longer at work on average, making about $5,000 Canadian dollars more, and more likely to be working full-time. Dads were spending more time doing 'carework' and their work hours and earnings were unaffected.

Ankita Patnaik will continue to work on this issue, her findings are key to any policy maker working on closing gender gaps.

What Do Women Really Want? Equality, to Start

Claiming to know “What Women Want” can be a slippery slope, but fortunately, it was Professor Deborah Rhode of Yale Law School, and not Mel Gibson, making the claim at this week’s WAPPP seminar. Professor Rhode discussed the widespread and varied gender disparities featured in her 2014 book of the same title. She began by speaking about her time in law school and as a young law professor, remembering that gender was noticeably absent from the curriculum, and comments that would be considered sexual harassment today ran rampant and unchecked.

Rhode argued that changing gender disparities begins by recognizing them, though there is a gap between those who recognize such inequality and those who self-identify as feminists. When the definition of feminism is provided, between two-thirds and four-fifths of women identify as feminists, yet when the definition is not provided, only one quarter of women self-identify. This is important because identifying as a feminist is correlated with activism around gender equity issues.

Though we often discuss the harms of gender inequality anecdotally - our friend who struggles to balance her job and parenting duties, the story of a survivor of campus sexual assault in the news - Rhode made the case for just how widespread and systematic these disparities are. This unfortunate truth is exacerbated by the fact that many women who experience discrimination aren't likely to challenge it. Even individuals who have convincing evidence of bias are hesitant to challenge the institution responsible for it; many are deterred by the high psychological and financial cost of challenging their institutions, paired with the low probability of success. The recent gender discrimination law suit by Ellen Pao against a prominent venture capital firm is a prime example of this.

The statistics in many areas of professional and personal life are bleak. Women constitute over a third of MBA graduates but only 5% of Fortune 500 CEOs. Though much of the country's pay gap is driven by women being clustered in low pay industries, similarly situated women also earn less than men, even when controlling for many relevant factors.

Gender pay disparities are the most pronounced among those who opt out of the formal economy, which are disproportionately women. Less than 1% of men with kids under 15 are stay-at-home dads, and women are responsible for twice as much childcare and three times as much housework as men. The fact that the U.S. is one of three countries in the world without paid maternity leave speaks to how far our society has to go on the issue.

Rhode argued that a major way to remedy these disparities within household labor division is to protect women's reproductive rights, which include working towards making abortion safe and unnecessary. Despite the ideological divides over this issue, about two-thirds of women believe the Supreme Court should not overturn Roe v. Wade.

The intersection of economic opportunities and women's security was also highlighted. Rhode pointed out that inadequate safety nets keep women in violent relationships, and this is especially important when we consider that two-thirds of minimum wage workers are women. In addition, the United States has the highest rate of partner homicide in the developed world, and women in the United States Armed Forces are more likely to be raped by a fellow soldier than killed in action.

Rhode argued that to change the agenda and move the dial on all of these issues, we must get more women into leadership roles. It's well-documented that the statistics on women in political leadership in this country is dismal. The U.S. ranks 78th in the world in the percentage women in office, below Saudi Arabia. Indeed, only 10% of American governors and mayors of major cities are female.

Rhode was quick to point out that putting women in positions of power is not the same as empowering women, however, arguing that we also need a strong women’s movement to create political support for these issues. She suggested greater dialogue between generations on strategies for activism and applauded young women tackling campus sexual assault, whose activism led to a Presidential Task Force on the subject.

When asked about the potential use of quotas in American government or corporate boards, similar to those recently instituted by European countries, Rhode expressed concern. In addition to what she deemed America's negative knee-jerk reaction to affirmative action programs, she also questioned whether appointing more women would change corporate culture. However, Rhode argued that more disclosure on the gender breakdown within organizations could be used to embarrass institutions that have large gender disparities.

In closing, Rhode made sure to remind the audience that it is difficult to know what women really want because we don’t know what preferences would be in an equal world. There are currently far too many ways in which society constructs and constrains the choices of women, so our desires might be very different in a world in which women could really choose.