Evaluating the Effect of San Francisco's Paid Parental Leave Ordinance on Birth Outcomes.

Since 2017, San Francisco’s Paid Parental Leave Ordinance (PPLO) has allowed parents who work for private-sector employers to take 6 weeks of fully paid postnatal parental leave. Previous studies have linked paid parental leave with health improvements for birthing people and babies, although evidence for birth outcomes is limited. We hypothesized that the PPLO may have improved birth outcomes via reduced stress during pregnancy due to anticipation of increased financial security and postnatal leave. We used linked California birth certificate and hospital discharge records from January 2013 to December 2018 (n = 1,420,781). We used quasi-experimental difference-in-difference (DD) models to compare outcomes among SF births before and after PPLO to outcomes among births in control counties. Births from January 2017 through December 2018 among working San Francisco (SF) people were considered “exposed” to PPLO; births during this time among working people outside of SF, as well as all births before 2017, served as controls. We conducted subgroup analyses by race/ethnicity, education and Medicaid coverage at delivery. Overall analyses adjusting for covariates and indicators for time and seasonality indicated no association between PPLO and birth outcomes. Our results indicate that PPLO may not have affected the birth outcomes we examined among marginalized groups who, due to structural racism, are at heightened risk of poor outcomes. We speculate that this result is due to the PPLO’s design and focus on postnatal leave. Future work should examine the policy’s effects on other outcomes.

自2017年以来，旧金山的带薪育儿假条例（PPLO）允许在私营企业工作的父母享受6周的全薪产后育儿假。先前的研究已将带薪育儿假与产妇和婴儿的健康改善联系起来，尽管关于生育结果的证据有限。我们假设，由于预期经济保障增加和产后休假，PPLO可能通过减轻孕期压力而改善了生育结果。我们使用了2013年1月至2018年12月加利福尼亚州相关的出生证明和出院记录（n = 1,420,781）。我们使用准实验性的双重差分（DD）模型，将旧金山在PPLO实施前后的生育结果与对照县的生育结果进行比较。2017年1月至2018年12月在旧金山工作的人的生育被视为“受到”PPLO“影响”；在此期间旧金山以外工作的人的生育以及2017年之前的所有生育作为对照。我们按种族/族裔、教育程度和分娩时的医疗补助覆盖范围进行了亚组分析。对协变量以及时间和季节性指标进行调整后的总体分析表明，PPLO与生育结果之间没有关联。我们的结果表明，PPLO可能没有影响我们在边缘化群体中所研究的生育结果，由于结构性种族主义，这些群体出现不良结果的风险更高。我们推测这一结果是由于PPLO的设计以及侧重于产后休假。未来的工作应该研究该政策对其他结果的影响。