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Journal Issue: Work and Family Volume 21 Number 2 Fall 2011

International Perspectives on Work-Family Policies: Lessons from the World's Most Competitive Economies
Alison Earle Zitha Mokomane Jody Heymann

Relationship of Parental Working Conditions to Children's Outcomes

Research in the United States and in other developed as well as developing countries suggests that workplace policies that support parents' ability to be available for their children at crucial periods of their lives have measurable effects on children's outcomes.

Paid Parental Leave. Research shows that the availability of paid leave following childbirth has the potential to improve infant and child health by making it affordable and feasible for parents to stay home and provide the intensive care newborns and infants need, including breast feeding and a high caregiver-to- infant ratio that most child-care centers are unable to match.2 Parental leave can have substantial benefits for child health. Christopher Ruhm's examination of more than two decades of data from sixteen European countries found that paid parental leave policies were associated with lower rates of infant and child mortality after taking into account per capita income, the availability of health services and technology, and other factors linked with child health. Ruhm found that a ten-week paid maternity leave was associated with a reduction in infant mortality rates of 1–2 percent; a twenty-week leave, with a 2–4 percent reduction; and a thirty-week leave, with a 7–9 percent reduction.3

Sasiko Tanaka reaffirmed these findings in a study that analyzed data from Ruhm's sixteen European countries plus the United States and Japan. The data covered the thirty years between 1969 and 2000 including the period between 1995 and 2000 when several significant changes were made in parental leave policies.4 Tanaka found that a ten-week extension in paid leave was associated with a 2.6 percent decrease in infant mortality rates and a 3.0 percent decrease in child mortality rates. Maternity leave without pay or a guarantee of a job at the end of the leave had no significant effect on infant or child mortality rates in either study.

One of the most important mechanisms through which paid parental leave can benefit infants is by increasing a mother's ability to initiate and sustain breast feeding, which a wealth of research has shown to be associated with a markedly lower risk of gastrointestinal, respiratory tract, skin, ear, and other infections; sudden infant death syndrome; and overall mortality.5 Health benefits of breast feeding have also been reported for mothers, including reduced risk of premenopausal breast cancer and potentially reduced risks of ovarian cancer and osteoporosis.6

Generous maternity leave benefits available across European countries make it possible for mothers to breast feed their infants for a lengthy period of time without having to supplement feedings with formula. In some cases the leave is long enough that mothers can exclusively breast feed for at least six months, as recommended by the World Health Organization; and in countries with more than half a year of leave, mothers can continue breast feeding (while also adding appropriate solid foods).7 In contrast, in countries with less generous maternity leave, such as the United States, working women are less likely to start breast feeding their babies, and those who do breast feed stop sooner, on average, than mothers in countries with these supportive policies.8 Lacking paid maternity leave, American mothers also return to work earlier than mothers in most other advanced countries, and research has found that early return to work is associated with lower rates of breast feeding and immunizations.9

While far less research has been conducted on the impact of paternity leave policies, there is ample reason to believe that paternal leave can support children's healthy development in ways parallel to maternal leave, with the obvious exception of breast feeding. Although fathers can take time off under parental leave policies that can be used by one or both parents, they are more likely to stay at home to care for a new child when paternity leave is available.10

The longer the period of leave allowed, the more involved with their infants and families fathers are.11 Moreover, longer leaves increase the probability that fathers will continue their involvement and share in child care even after the leave ends.12 The benefits of fathers' engagement for children's social, psychological, behavioral, emotional, and cognitive functioning are significant.13 In short, paternity leave policies are associated with greater gender equity at home and, through fathers' increased involvement with their infants, with positive cognitive and social development of young children.

Leave for Children's Health Needs. Four decades of research have documented that children's health outcomes improve when parents participate in their children's health care, whether it is a treatment for an acute illness or injury or management of a chronic condition.14 As Mark Schuster, Paul Chung, and Katherine Vestal discuss in this volume, children heal faster and have shorter hospital stays when parents are present and involved during inpatient surgeries and treatments as well as during outpatient medical procedures. 15 Parents' assistance is especially important for children with chronic conditions such as diabetes and asthma, among others.16 Parents can help improve children's health outcomes in many ways including by maintaining daily medical routines, administering medication, and providing emotional support as children adjust to having a chronic physical or mental health problem.17

If children are sick and parents do not have any schedule flexibility or paid leave that can be used to address a family member's health issue, children may be left home alone, unable to get themselves to a doctor or pharmacy for medication or to a hospital if a crisis occurs. Alternatively, parents may have no choice but to send a sick child to school or day care. The contact with other children and teachers contributes to the rapid spread and thus high incidence of infectious diseases in day-care centers, including respiratory infections, otitis media, and gastrointestinal infections.18

Research has also documented how significantly parental availability influences the level of preventive care children receive. Getting a child to a clinic or doctor's office for a physical exam or immunizations usually requires parents or other caregivers to take time off work. Working parents in a range of countries have cited schedule conflicts and workplace inflexibility as important obstacles to getting their children immunized against preventable childhood diseases.19 One study of a large company in the United States found that employees who faced difficulties taking time off from work were far more likely to report that their children were not fully immunized.20

In contrast to the vast majority of countries around the globe, the United States has no federal policy requiring employers to provide paid leave for personal illness, let alone to address family members' health issues. (The Family and Medical Leave Act covers only serious health issues of immediate family members and is unpaid.) Only 30 percent of Americans report that their employer voluntarily offers paid sick leave that can be used for family members' care.21 As a result, many parents are unable to be present to attend to their children's health needs. Parents whose employers provide paid sick days are more than five times as likely to be able to personally provide care to their sick children as parents whose employers do not offer paid sick days.22 Working adults with no paid leave who take time off to care for ill family members are at risk of losing wages or even their job.23 The risk of job loss is even greater for parents whose child has a chronic health problem, which typically involves more visits to the doctor or the hospital and more days of illness. In a longitudinal study of working poor families in the United States, we found that having a child with health problems was associated with a 36 percent increase in job loss.24

Leave and Availability for Children's Educational and Developmental Needs. When parents are involved in their children's education, whether at the preschool, elementary, or secondary level, children perform better in school.25 Parental involvement has been linked with children's improved test scores in language and math, fewer emotional and behavioral problems, lower dropout rates, and better planning for and transitions into adulthood.26 Greater parental involvement in schools appears to improve the quality of the education received by all students in the school.27 Research has found that fathers' involvement, like that of mothers, is associated with significantly better exam scores, higher educational expectations, and higher grades.28

Parental participation and assistance can improve school outcomes for at-risk children.29 Educational outcomes for children with learning disabilities improve when parents are involved in their education both at school and helping at home with homework in math as well as reading.30 Low-income children can also benefit markedly when their parents are involved in their classrooms and with their teachers at school.31 Studies suggest that low-income children benefit as much or more when their parents also spend time assisting their children in learning skills and material outside the classroom; training or instructing parents in providing this assistance further boosts the gains of time spent together.32

Parents' working conditions can markedly affect their ability to play an active role in their children's education. Active parental involvement often requires the flexibility to meet with teachers or consult with specialists during the workday. To be able to help with homework, parents need to have a work schedule that allows them time with their children after school and before children go to sleep. Our national research on the availability of paid leave and schedule flexibility among parents of school-age children in the United States shows that parents whose children were struggling academically and most needed parental support were at a significant disadvantage. More than half of parents who had a child scoring in the bottom quartile on math assessments did not have consistent access to any kind of paid leave, and nearly three-fourths could not count on schedule flexibility. One in six of these parents worked during evening hours, and more than one in ten worked nights, making it impossible to help their children routinely. Families in which a child scored in the bottom quartile in reading had equally challenging working conditions.33