Maternity leave policies in U.S. states: Associations with maternal and child health status, healthcare utilization, role function, and health-related behaviors

 说明(由申请人提供)：产假与儿童的积极健康和认知结果有关，特别是在带薪且超过六周的情况下，还可能有助于产妇的身心健康。目前，美国女性只有通过家庭和医疗休假法(FMLA)才能获得产假保障，该法案要求雇主为符合条件的员工提供长达12周的无薪工作保护假，以照顾包括新生儿在内的家庭成员。然而，多达40%的妇女没有资格或负担不起长期无薪休假。此外，关于产假与女性身心健康之间的关系的研究结果喜忧参半，现有的大多数研究要么使用国际样本，要么使用较小的地区性样本，这些样本很难推广到美国人口。美国上一次关于产假的全面研究是在20多年前进行的。这项研究将使用两个新的、具有全国代表性的数据集来确定美国PAI和无薪产假的可获得性、使用率和持续时间的趋势，并探索假期和健康之间的联系。听妈妈的话III是一项在全国范围内对18-45岁的育龄妇女进行的调查，这些妇女在2011-12年间在美国一家医院分娩(N=2400)。它包括对妇女在怀孕和产后的就业经历；产假的可获得性、使用和持续时间；以及妇女和婴儿的健康状况、医疗保健利用和产后健康相关行为的独特衡量标准。2006-2010年全国家庭增长调查是由疾病控制和预防中心通过家庭访谈进行的；其怀孕补充资料包括4579名在过去5年内生育的妇女的答复。它是仅有的包含就业和产假详细信息的数据集之一，样本量足够大，可以按受访者出生时的居住国对产假的提供、使用和持续时间进行比较分析。这项研究的预期结果包括以下方面的新信息：1)美国妇女和婴儿产假与健康之间的关系，区分带薪假期和无薪假期；2)居住在已实施了扩大了FMLA最低规定政策的州的妇女是否在可获得、使用和持续时间方面获得了更多的产假；3)这些政策是否通过对获得假期的影响，与各州的妇幼健康存在显著差异有关。该项目涉及与AHRQ优先人口--妇女和儿童、低收入人口和少数民族健康--高度相关的问题。这项研究的结果将对妇女、儿童和家庭、寻求平衡向员工提供产假福利的成本和收益的雇主、以及寻求在其决策过程中使用研究证据的政策制定者感兴趣，特别是在带薪家庭假进入国家政策议程的情况下。

 DESCRIPTION (provided by applicant): Maternity leave is associated with positive health and cognitive outcomes for children, especially when paid and longer than six weeks, and may also contribute to maternal physical and mental health. Currently, U.S. women are guaranteed access to maternity leave only through the Family and Medical Leave Act (FMLA), which requires employers to offer eligible employees up to 12 weeks of unpaid job-protected leave to care for family members, including newborn children. However, as many as 40% of women are either ineligible or cannot afford to take extended leaves of absence from work without pay. In addition, findings on the association between maternity leave and women's physical and mental health are mixed, with most existing research using either international or small, regional samples that are difficult to generalize to the U.S. population. The last comprehensive study on maternity leave in the U.S. was conducted over two decades ago. This study will use two new, nationally-representative datasets to identify trends in the availability, use, and duration of pai and unpaid maternity leave in the U.S. and to explore the association between leave and health. Listening to Mothers III is a survey conducted among a national sample of childbearing women ages 18-45 who gave birth in a U.S. hospital in 2011-12 (N=2,400). It includes unique measures for women's employment experiences during pregnancy and postpartum; maternity leave availability, use, and duration; and women's and infants' health status, healthcare utilization, and health-related behaviors postpartum. The National Survey of Family Growth 2006-2010 was conducted by the Centers for Disease Control and Prevention (CDC) via household interviews; its Pregnancy Supplement includes responses from 4,579 women who gave birth within the last 5 years. It is one of the only datasets containing detailed information on employment and maternity leave with a large enough sample size to conduct comparative analyses of maternity leave availability, use, and duration by respondents' state of residence at the time of birth. The expected outcomes of this research include new information on: 1) associations between maternity leave and health for U.S. women and infants, differentiating between paid and unpaid leave; 2) whether women residing in states that have implemented policies expanding on the minimum provisions of the FMLA have significantly more access to maternity leave in terms of availability, use and duration; and 3) whether these policies are associated with significant differences in maternal and child health across states, via their impact on access to leave. This project addresses issues highly pertinent to the AHRQ priority populations of Women and Children, Low-Income Populations, and Minority Health. The results of this research will be of interest to women, children, and families; to employers seeking to balance the costs and benefits of offering maternity leave benefits to employees; and to policymakers seeking to use research evidence in their decision- making processes, especially as paid family leave enters the national policy agenda.