Effect of Paid Family Leave on Positive Early Childhood Experiences

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

Abstract

Early childhood experiences play a critical role in health and wellbeing. Adverse childhood experiences (ACEs) are strongly linked to higher risks of chronic disease, mental illness, and other long-term health problems (Felitti et al., 1998; Merrick et al., 2019; Hughes et al., 2017), while positive childhood experiences (PCEs) have been shown to promote resilience, buffer toxic stress, and improve long-term physical and mental health (Bethell et al., 2019; Graupensperger et al., 2023; Huang et al., 2023; Sege et al., 2025). A burgeoning research literature has demonstrated that Paid Family and Medical Leave (PFML) policies are associated with the reduced incidence of ACEs, including child abuse and neglect (Tanis et al., 2024; Klevens et al., 2016; Bullinger et al., 2023; Bullinger et al., 2025; Tanis et al., 2026) and improved maternal mental health (Doran et al., 2020), however research has yet to evaluate the association between PFML and PCEs. To address this gap in the literature, this analysis examines the effects of PFML policies across multiple states, evaluating their impact on PCEs in early childhood.

Data comes from the 2016-2023 National Survey of Children’s Health (NSCH), which collects cross-sectional family-level information on the wellbeing of children from birth to age 17. Study states included those that implemented PFML after 2016, specifically New York, the District of Columbia, Washington, Massachusetts, and Connecticut. States with pre-2016 PFML policies are excluded. Comparison states include those without a mandatory, voluntary or pending PFML policy (n=29). To focus on early childhood experiences, we restricted our analysis to families with at least one child under the age of one (N=7,720; 1,257 intervention, 6,463 control). The outcome of interest in this analysis is the Family Resilience and Connection Index (FRI) (range 0-5, higher scores are better), a validated composite measure developed by Bethell et al. 2019, which aligns with nationally recognized constructs of early childhood positive experiences. Our analytic approach uses a staggered adoption difference-in-differences design (Callaway & Sant’Anna, 2021) to compare FRI outcomes in states with PFML to states that never implemented PFML, while adjusting for family poverty level and parent-respondent age and sex and accounting for clustering by state.

Preliminary results show that PFML is linked to a 0.19-point increase (95% CI=0.02, 0.36) in the FRI in treated states based on group aggregation. We find heterogeneity across states, with the largest positive effects observed in Massachusetts (0.82, 95%CI=0.60, 1.04) and Connecticut (0.33, 95%CI=0.10, 0.57), where PFML was implemented more recently (2021-2022).

Additional work is planned to refine the study sample by limiting it to families with at least one employed parent and expanding inclusion to households with at least one child under age 5. This approach aims to better capture families likely to utilize both the family and medical leave components of PFML. Additional sensitivity analyses for the difference-in-differences approach will be conducted to evaluate key assumptions. These findings underscore the potential for PFML policies to impact family resilience and promote PCEs.

Author

• Dina Burstein, Tufts Medical Center
  Presenting Author