Paid Family and Medical Leave and Physical Abuse During Pregnancy: A Multi-state Quasi-Experimental Study

• In Event: Impacts of State Paid Leave Policies on Maternal, Worker, and Child Wellbeing: New Quasi-Experimental Evidence

Abstract

Abuse during pregnancy is associated with serious maternal and infant health consequences. Economic policies may influence risk of abuse by reducing financial stress and relationship conflict. Paid Family and Medical Leave (PFML), although typically used postpartum, may affect prenatal experiences by shaping economic security and household dynamics around childbirth. Evidence, though, on whether state PFML adoption is associated with abuse during pregnancy is limited.

We used data from the Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based survey of postpartum individuals, from 2004–2022 and restricted the analysis to respondents with valid information on physical abuse during pregnancy. The outcome was a binary indicator of self-reported physical abuse by a husband or partner during pregnancy. The exposure was state adoption of a PFML policy, defined as the first year that benefits became available. We estimated the association between PFML adoption and abuse during pregnancy using a staggered difference-in-differences design that compared states with PFML policies to those that had not yet adopted PFML. Event-study estimates were used to assess pre-policy trends and post-adoption dynamics. Standard errors were clustered at the state level.

Between 2009 and 2021, six states participating in PRAMS adopted PFML. Overall, 2.3% of respondents reported physical abuse during pregnancy. Event-study estimates showed no evidence of differential pre-policy trends between treated and comparison states. We found that PFML adoption was associated with modest reductions in self-reported physical abuse by a husband or partner during pregnancy, with estimated effects emerging shortly after implementation and increasing over time. The average reduction across post-adoption years was 0.22 percentage points (95% CI: −0.43, −0.01), with larger estimated effects observed five to eight years after implementation (−0.37; 95% CI: −0.68, −0.05).

These findings suggest that PFML may contribute to violence prevention by addressing underlying economic risk factors. As states continue to adopt and expand PFML programs, incorporating considerations of abuse and survivor needs into policy design and implementation may enhance their public health impact.

Author

• Avanti Adhia, University of Washington
  Presenting Author