State paid family and medical leave and postpartum outcomes

State paid family and medical leave (PFML) policies may affect birth outcomes. Only ten states and the District of Columbia (DC) provide PFML that could be used for maternity leave. This study aimed to evaluate the association of state PFML policies with the likelihood of breastfeeding, postpartum depression symptoms, and attendance at the postpartum visit (PPV). This was a cross-sectional analysis using the 2016 to 2019 Pregnancy Risk Assessment Monitoring System (PRAMS) for 43 states and DC, linked with state PFML data from the Kaiser Family Foundation. The associations of state PFML with the likelihood of breastfeeding at 3 months postpartum, postpartum depression symptoms and attendance at the PPV were tested by logistic and Poisson regression models, controlling for respondent sociodemographic characteristics. An analysis limited to respondents with Medicaid deliveries was performed. In this weighted analysis of an estimated 7,511,924 residents, 24% lived in states with PFML, 60.5% reported breastfeeding at 3 months postpartum, 12.5% reported experiencing postpartum depression symptoms and 90.4% reported PPV attendance. In states with PFML, more participants reported breastfeeding and PPV attendance and fewer reported postpartum depression symptoms (all p < 0.001; Figure). In adjusted analyses, breastfeeding at 3 months was 20% more likely (aOR 1.20, 95% CI 1.15, 1.25) for individuals living in states with PFML and 32% more likely (aOR 1.32, 95% CI 1.22, 1.42) when limited to respondents with deliveries covered by Medicaid (Table). PFML was only associated with postpartum depression for respondents with Medicaid (aIRR 0.86, 95% CI 0.81, 0.96) and was not significantly associated with PPV attendance. In states with PFML respondents had a greater likelihood of breastfeeding and respondents covered by Medicaid had a lower likelihood of postpartum depression symptoms. Despite evidence of the benefits of PFML policies, the US is one of the few countries without federally mandated paid parental leave.View Large Image Figure ViewerDownload Hi-res image Download (PPT)