Unintended health consequences of Swedish parental leave policy (ParLeHealth): protocol for a quasi-experimental study

Juárez, Sol; Honkaniemi, Helena; Heshmati, Amy; Debiasi, Enrico; Dunlavy, Andrea; Hjern, Anders; Rostila, Mikael; Mussino, Eleonora; Katikireddi, Srinivasa Vittal; Duvander, Ann‐Zofie

doi:10.1136/bmjopen-2021-049682

Cited by 4 publications

(3 citation statements)

References 42 publications

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“…This cross-sectional study, conducted as part of the Unintended health consequences of Swedish parental leave policy (ParLeHealth) research project, was conducted based on a pub-lished peer-reviewed protocol. 12 This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. The study was approved by the Swedish Ethical Review Authority.…”

Section: Methodsmentioning

confidence: 99%

Unintended Perinatal Health Consequences Associated With a Swedish Family Policy

Debiasi,

Honkaniemi,

Aradhya

et al. 2024

JAMA Pediatr

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ImportanceThe 1980 and 1986 Swedish so-called speed premium policies aimed at protecting parents’ income-based parental leave benefits for birth intervals shorter than 24 and 30 months, respectively, but indirectly encouraged shorter birth spacing and childbearing at older ages, both risk factors for several perinatal health outcomes. Whether those policy changes are associated with perinatal health remains unknown.ObjectiveTo evaluate the association between the 1980 and 1986 speed premium policies and perinatal health outcomes.Design, Setting, and ParticipantsThis cross-sectional study investigated data from 1 762 784 singleton births in the Swedish Medical Birth Register from January 1, 1974, through December 31, 1991. Data were analyzed from October 11, 2022, to December 12, 2023.InterventionsSpeed premium policy introduction (January 1, 1980) and extension (January 1, 1986).Main Outcomes and MeasuresTotal population register data were used in an interrupted time series analysis with segmented logistic regression to calculate the odds of preterm birth, low birth weight, small for gestational age (SGA) at preterm, and stillbirth measured before and after the speed premium policy reforms. Subgroup analyses by maternal origin were conducted to evaluate changes by different policy responses.ResultsAmong 1 762 784 births analyzed, 4.8% were preterm (of which 12.0% were SGA), 3.2% had low birth weight, and 0.3% were stillbirths. The 1980 speed premium policy was associated with a 0.3% monthly increase in the odds of preterm birth compared with the period before the reform (odds ratio [OR], 1.0029 [95% CI, 1.002-1.004]), equivalent to a 26.4% increase from January 1, 1980, to December 31, 1985. After the 1986 relaxation of the policy, preterm birth odds decreased 0.5% per month (OR, 0.9951 [95% CI, 0.994-0.996]), equivalent to an 11.1% decrease across the next 6 years. Low birth weight displayed a similar pattern for both reform periods, that is, increased 0.2% (OR, 1.0021; 95% CI, 1.001-1.003) per month in 1980 through 1985 compared with baseline, and decreased 0.3% (OR, 0.9975; 95% CI, 0.996-0.998) per month in the following period, but was attenuated when considering low birth weight at term. Odds of SGA at preterm were decreased after 1980 (OR, 0.9965; 95% CI, 0.994-0.999) but not in 1986 (OR, 1.0009; 95% CI, 0.998-1.003), whereas stillbirths did not change following either reform (1980: OR, 1.0020 [95% CI, 0.999-1.005]; 1986: OR, 1.0002 [95% CI, 0.997-1.003]). Subgroup analyses suggested that perinatal health changes were restricted to births to Swedish- and Nordic-born mothers, the primary groups to adjust their fertility behaviors to the reforms.Conclusions and RelevanceDespite its economic advantages for couples, especially for mothers, the introduction of the speed premium policy was associated with adverse perinatal health consequences, particularly for preterm births. Family policies should be carefully designed with a “Health in All Policies” lens to avoid possible unintended repercussions for fertility behaviors and, in turn, perinatal health.

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Section: Methodsmentioning

confidence: 99%

Unintended Perinatal Health Consequences Associated With a Swedish Family Policy

Debiasi,

Honkaniemi,

Aradhya

et al. 2024

JAMA Pediatr

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“…The study is part of the 'Unintended health consequences of Swedish parental leave policy' (ParLeHealth) project based on a published study protocol [17]. It was approved by the Swedish Ethical Review Authority (decision no.…”

Section: Methodsmentioning

confidence: 99%

Alcohol‐related morbidity and mortality by fathers' parental leave: A quasi‐experimental study in Sweden

Honkaniemi,

Juárez

2023

Addiction

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Background and AimsFathers' parental leave has been associated with decreased risks of alcohol‐related hospitalizations and mortality. Whether this is attributable to the health protections of parental leave itself (through stress reduction or behavioral changes) or to selection into leave uptake remains unclear, given that fathers are more likely to use leave if they are in better health. Using the quasi‐experimental variation of a reform incentivizing fathers' leave uptake (the 1995 Father's quota reform), this study aimed to assess whether fathers' parental leave influences alcohol‐related morbidity and mortality.DesignQuasi‐experimental interrupted time series and instrumental variable analyses.SettingSweden.ParticipantsFathers of singleton children born from January 1992 to December 1997 (n = 220 412).MeasurementsExposure was indicated by the child's birthdate before or after the reform and used to instrument fathers' 2‐ and 8‐year parental leave uptake. Outcomes included fathers' hospitalization rates for acute alcohol‐related (intoxication; mental and behavioral disorders) and chronic alcohol‐related diagnoses (cardiovascular, stomach and other diseases; liver diseases), as well as alcohol‐related mortality, up to 2, 8 and 18 years after the first child's birthdate.FindingsIn interrupted time series analyses, fathers of children born after the reform exhibited immediate decreases in alcohol‐related hospitalization rates up to 2 (incidence rate ratio [IRR] = 0.66, 95% confidence interval [CI] = 0.51–0.87), 8 (IRR = 0.74, 95% CI = 0.57–0.96) and 18 years after birth (IRR = 0.72, 95% CI = 0.54–0.96), particularly in acute alcohol‐related hospitalization rates, compared with those with children born before. No changes were found for alcohol‐related mortality. Instrumental variable results suggest that alcohol‐related hospitalization decreases were driven by fathers' parental leave uptake (e.g. 2‐year hospitalizations: IRR = 0.16, 95% CI = 0.03–0.84).ConclusionsIn Sweden, a father's parental leave eligibility and uptake may protect against alcohol‐related morbidity.

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“…leave policy (ParLeHealth) project, based on a pre-published study protocol. 20 In a quasi-experimental design, the 1995 Father's quota was used as an exogenous intervention to incentivise fathers' leave uptake. 18 Longitudinal total population data were drawn from linked Swedish registers, including the Total Population Register (TPR) and Multigenerational Register (MGR); the Longitudinal Integration Database for Health Insurance and Labour Market Studies (LISA); and the Medical Birth Register (MBR), National Patient Register (NPR) and Cause of Death Register (CDR).…”

Section: Original Researchmentioning

confidence: 99%

Psychiatric consequences of a father’s leave policy by nativity: a quasi-experimental study in Sweden

Honkaniemi¹,

Katikireddi

Rostila³

et al. 2021

J Epidemiol Community Health

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BackgroundParental leave use has been found to promote maternal and child health, with limited evidence of mental health impacts on fathers. How these effects vary for minority populations with poorer mental health and lower leave uptake, such as migrants, remains under-investigated. This study assessed the effects of a Swedish policy to encourage fathers’ leave, the 1995 Father’s quota, on Swedish-born and migrant fathers’ psychiatric hospitalisations.MethodsWe conducted an interrupted time series analysis using Swedish total population register data for first-time fathers of children born before (1992–1994) and after (1995–1997) the reform (n=198 589). Swedish-born and migrant fathers’ 3-year psychiatric hospitalisation rates were modelled using segmented negative binomial regression, adjusting for seasonality and autocorrelation, with stratified analyses by region of origin, duration of residence, and partners’ nativity.ResultsFrom immediately pre-reform to post-reform, the proportion of fathers using parental leave increased from 63.6% to 86.4% of native-born and 37.1% to 51.2% of migrants. Swedish-born fathers exhibited no changes in psychiatric hospitalisation rates post-reform, whereas migrants showed 36% decreased rates (incidence rate ratio (IRR) 0.64, 95% CI 0.47 to 0.86). Migrants from regions not predominantly consisting of Organisation for Economic Cooperation and Development countries (IRR 0.50, 95% CI 0.19 to 1.33), and those with migrant partners (IRR 0.23, 95% CI 0.14 to 0.38), experienced the greatest decreases in psychiatric hospitalisation rates.ConclusionThe findings of this study suggest that policies oriented towards promoting father’s use of parental leave may help to reduce native–migrant health inequalities, with broader benefits for family well-being and child development.

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Unintended health consequences of Swedish parental leave policy (ParLeHealth): protocol for a quasi-experimental study

Cited by 4 publications

References 42 publications

Unintended Perinatal Health Consequences Associated With a Swedish Family Policy

Unintended Perinatal Health Consequences Associated With a Swedish Family Policy

Alcohol‐related morbidity and mortality by fathers' parental leave: A quasi‐experimental study in Sweden

Psychiatric consequences of a father’s leave policy by nativity: a quasi-experimental study in Sweden

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