By Asiya Validova, PhD. Urban Health Collaborative, Dornsife School of Public Health, Drexel University. Research Assistant Professor at Texas A&M University, School of Public Health.

The trajectory of infant mortality in Latin America, while historically declining, has seen a concerning stagnation since 2005. This plateau signals a need to address fundamental drivers of health, particularly those related to social inequalities. In our recent SALURBAL study across 148 cities in Chile, Colombia, and Mexico, published in Social Science & Medicine, we found that comprehensive paid parental leave policies, particularly those that combine generous maternity leave with new paternity leave, can significantly reduce infant and neonatal mortality.

Research in Urban Context 

These findings highlight the case of Chile as a success story. In 2011, Chile implemented a significant reform, extending paid maternity leave to a total of 126 days and introducing 5 days of paid paternity leave. The reforms were associated with a 2% steeper decline in infant mortality and a 3% steeper decline in neonatal mortality, after accounting for other socioeconomic changes. However, an earlier, smaller increase in Chile's maternity leave in 2003 (from 84 to 126 days) showed no such impact. This suggests that the magnitude of the leave extension, and crucially, the combination with paternity leave, may be key.

Lessons from Colombia and Mexico are different. In Colombia, where paid maternity leave was extended by a smaller amount (14 days) in 2011 and paid paternity leave (8 days) was introduced separately in 2002, we didn't observe statistically significant changes in infant or neonatal mortality trends. Similarly, in Mexico, where only paid paternity leave was introduced and maternity leave remained unchanged, we found no significant impact on infant or neonatal mortality.

Why Does Comprehensive Parental Leave Matter?

How does paid parental leave translate into fewer infant deaths? The answer lies in several interconnected benefits, offering a protective buffer against hardship and reducing stress, therefore, improving population health.

Empowering Mothers: Paid maternity leave secures a mother's income during a critical period, allowing her to recover from childbirth and remain in the workforce. This stability contributes to household wealth and child well-being¹. It also provides essential time for longer breastfeeding², crucial health check-ups, and timely immunizations³. Maternity leave has also been linked to improved birth outcomes⁴.

Engaging Fathers: Paid paternity leave promotes more egalitarian gender roles⁵, by encouraging fathers to participate actively in childcare⁶, alleviating some of the burden on mothers and creating a more supportive family environment⁷. This shared responsibility can indirectly amplify the positive effects of maternity leave on child health. Paid leave also helps mitigate the labor market’s gender inequities⁸. 

Lessons for Policy and Research

Our findings offer valuable insights for policymakers aiming to improve infant and neonatal health by highlighting the importance of:

Generous Extensions: The size of the leave extension matters. Significant increases in paid maternity leave, rather than minor adjustments, seem to be more effective⁹.

Combined Parental Leave: Introducing or expanding both paid maternity and paternity leave simultaneously appears to be the most impactful strategy.

This study also suggests areas for future research. We need to better understand how specific policy characteristics, like the duration of pre- and post-natal leave, affect health outcomes. We also need to explore the long-term impacts of these policies and how they interact with factors like informal employment rates. These high rates of informal employment could influence the observed impacts of paid leave policies. Additionally, further research is needed to better understand the low uptake by fathers of shared parental leave in Latin America¹⁰.

Looking from the global perspective, we emphasize that it matters beyond Latin America. The role of paid parental leave policies not only relevant in the context of highly unequal Latin American cities, where addressing gender bias in childcare is still a pending issue¹¹, but also to the United States. Despite spending more on healthcare than any other high-income country, the U.S. has the highest infant mortality rate among them. Limited paid leave policies and large income and gender inequalities in health in many U.S. cities bear important similarities to Latin American ones¹². Our study shows that policies like those in Chile could be a crucial tool for the U.S. to address social and health risk factors that contribute to its high infant mortality rates.

Our findings offer critical lessons: investing in comprehensive paid parental leave is not just a family-friendly policy, it's an investment in healthier, more equitable futures for our children.

References

1. Chatterji and Markowitz, 2012.

2. Navarro-Rosenblatt and Garmendia, 2018. Ogbuanu et al., 2011.

3. Montoya-Williams, Passarella, and Lorch, 2020. Galván et al., 2022.

4. Guendelman et al., 2009. Rossin, 2011. Pihl and Basso, 2019.

5. Borrell et al., 2014. Harrington et al., 2014.

6. Patnaik, 2019.

7. Campaña, Gimenez-Nadal, & Molina, 2016.

8. Ferrant, Pesando, & Nowacka, 2014. King-Dejardin, 2019.

9. Heymann et al., 2017.

10. Fernandez, 2022.

11. Duren et al., 2020.

12. Mitchell, 2004. Stearns, 2015. Jou et al., 2018. Bartel et al., 2019.