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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Postpartum Visit.

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Strategy. Workplace Support

Approach. Promote workplace policies that support paid leave for new parents and facilitate postpartum visit attendance

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Overview. Paid maternity leave is associated with reduced postpartum depression and hospitalization readmission and may help reduce challenges in postpartum care use.[1,2,3] Emerging evidence suggests that paid leave policies may also increase the rate of postpartum visit attendance.[3] However, only 27% of private industry employees have access to paid leave, and most states do not have a statewide paid leave policy.[2,4] Support for paid maternity/paternity leave policies—whether at the employer or government level—can help alleviate negative health outcomes and improve access to postpartum care.

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • Policy. This strategy helps to promote decisions, laws, and regulations that promote public health practices and interventions.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of employers, organizations, and policymakers partnered with Title V that adopt and implement paid leave policies for new parents, including provisions for postpartum visit attendance. (Measures the policy adoption and implementation of the strategy)
  • Number of educational campaigns, resources, and tools developed and disseminated to raise awareness and support for paid leave policies among employers, employees, and the public. (Assesses the support and communication efforts of the strategy)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of employers, organizations, and policymakers partnered with Title V that adopt and implement paid leave policies for new parents, including provisions for postpartum visit attendance. (Measures the policy adoption and implementation of the strategy)
  • Percent of educational campaigns, resources, and tools developed and disseminated to raise awareness and support for paid leave policies among employers, employees, and the public. (Assesses the support and communication efforts of the strategy)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of postpartum mothers supported by Title V who report high satisfaction, reduced stress, and improved work-life balance as a result of having access to paid leave and support for postpartum visit attendance. (Measures the employee well-being and experience outcomes of the strategy)
  • Number of employers and organizations partnered with Title V that experience improved employee retention, productivity, and morale, as well as reduced healthcare costs and absenteeism, by offering paid leave policies for new parents. (Measures the business and economic benefits of the strategy)

OUTCOME MEASURES:

  • Number of industries, sectors, and communities that experience transformative shifts in norms, values, and practices related to supporting the health and well-being of new parents and families, catalyzed by the widespread adoption of paid leave policies. (Measures the societal impact of the strategy)
  • Number of maternal and child health champions, supporters, and leaders developed and mobilized through the paid leave policy support and implementation efforts, creating a pipeline of change agents for advancing family-friendly policies and practices. (Assesses the capacity building and leadership development outcomes of the strategy)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of postpartum mothers supported by Title V who report high satisfaction, reduced stress, and improved work-life balance as a result of having access to paid leave and support for postpartum visit attendance. (Measures the employee well-being and experience outcomes of the strategy)
  • Percent of employers and organizations partnered with Title V that experience improved employee retention, productivity, and morale, as well as reduced healthcare costs and absenteeism, by offering paid leave policies for new parents. (Measures the business and economic benefits of the strategy)

OUTCOME MEASURES:

  • Percent of industries, sectors, and communities that experience transformative shifts in norms, values, and practices related to supporting the health and well-being of new parents and families, catalyzed by the widespread adoption of paid leave policies. (Measures the societal impact of the strategy)
  • Percent of maternal and child health champions, supporters, and leaders developed and mobilized through the paid leave policy support and implementation efforts, creating a pipeline of change agents for advancing family-friendly policies and practices. (Assesses the capacity building and leadership development outcomes of the strategy)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Jou, J., Kozhimannil, K. B., Abraham, J. M., Blewett, L. A., & McGovern, P. M. (2018). Paid Maternity Leave in the United States: Associations with Maternal and Infant Health. Maternal and child health journal, 22(2), 216–225. https://doi.org/10.1007/s10995-017-2393-x.
[2] Van Niel, M. S., Bhatia, R., Riano, N. S., de Faria, L., Catapano-Friedman, L., Ravven, S., Weissman, B., Nzodom, C., Alexander, A., Budde, K., & Mangurian, C. (2020). The Impact of Paid Maternity Leave on the Mental and Physical Health of Mothers and Children: A Review of the Literature and Policy Implications. Harvard review of psychiatry, 28(2), 113–126. https://doi.org/10.1097/HRP.0000000000000246.
[3] Steenland, M. W., Short, S. E., & Galarraga, O. (2021). Association Between Rhode Island's Paid Family Leave Policy and Postpartum Care Use. Obstetrics and gynecology, 137(4), 728–730. https://doi.org/10.1097/AOG.0000000000004303.
[4] U.S. Bureau of Labor Statistics. Employee Benefits March 2023. https://www.bls.gov/ebs/factsheets/family-leave-benefits-fact-sheet.htm#:~:text=Twenty%2Dseven%20percent%20of%20private,Created%20with%20Highcharts%2010.3.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.