Children and Families

Severe maternal morbidity (SMM)—defined by the Centers for Disease Control and Prevention as unintended outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health—is a major determinant of maternal mortality. Each year 15 of every 1,000 people hospitalized for a delivery experience SMM. In addition to adverse health outcomes, SMM can lead to disruptions in mother-infant bonding, which can compromise children’s social and emotional development, and confers substantial economic costs to families, communities, and insurers including Medicaid.

Childhood poverty is associated with worse health outcomes, including poor physical and cognitive development, and can adversely influence social and health outcomes in later life. While there is increasing interest in policies to address childhood poverty, limited research exists on whether current U.S. poverty alleviation policies, including the largest such program, the Earned Income Tax Credit (EITC), improve children's health.

Since the early 1990s, Medicaid has been critical in providing insurance coverage for pregnant women with low incomes in the United States - pregnancy-related Medicaid coverage is available to women with incomes up to 200 percent of the federal poverty level in most states. Because pregnancy-related Medicaid eligibility is almost always more generous than eligibility for other adults, many women with low incomes not otherwise eligible for Medicaid gain coverage during their pregnancies but then lose that coverage sixty days after delivery, when their pregnancy-related eligibility expires. The American Rescue Plan Act of 2021 included an option for states to extend Medicaid coverage for twelve months postpartum. While the ACA provided coverage improvements for pregnant women outside of pregnancy, especially in states expanding Medicaid, many low-income women remain uninsured before or after their pregnancies. Building on existing studies tracking changes in Medicaid coverage and uninsurance under the law, researchers Emily M. Johnston, Stacey McMorrow, Clara Alvarez Caraveo and Lisa Dubay examined data for new mothers with Medicaid-covered prenatal care in this study published in Health Affairs.

The period before pregnancy is critically important for the health of a woman and her infant, yet not all women have access to health insurance during this time. Rebecca Myerson of the University of Wisconsin-Madison, Samuel Crawford of the University of Southern California, and Laura R. Wherry of New York University evaluated whether increased access to health insurance under the Affordable Care Act (ACA) Medicaid expansions affected ten preconception health indicators, including the prevalence of chronic conditions and health behaviors, birth control use and pregnancy intention, and the receipt of preconception health services.

The advent of just-in-time scheduling technology and practices in the mid-1990s has led to increased schedule instability, resulting in a growing movement to address the need for predictable, stable schedules for workers paid low wages. Unstable schedules have been associated with earnings instability, increased stress and fatigue, sleep irregularity, and worse mental health outcomes for workers.  In this report, P4A researchers Amelia Coffey, Eleanor Lauderback and H. Elizabeth Peters, along with their partners at the University of Oregon’s Department of Sociology Lola Loustaunau, Larissa Petrucci, Ellen Scott and Lina Stepick, examine Oregon’s implementation of S.B. 828, the first statewide predictive scheduling law in the nation, in its first year.

The Earned Income Tax Credit (EITC) is one of the largest safety net programs in the United States. In 2019, the EITC reached 25 million tax filers at a total cost of $63 billion. Using variation in the federal and state EITC, Breno Braga, Fredric Blavin and Anuj Gangopadhyaya evaluated the long-term impact of EITC exposure during childhood on the health of young adults.

Paid family leave policies have the potential to reduce health disparities, yet access to paid leave remains limited and unevenly distributed in the United States. The US is the only OECD country that does not provide paid leave for new parents, and just 8 states and the District of Columbia have passed partially-paid family leave policies. In a new paper, Julia Goodman of the OHSU-PSU School of Public Health, Will Dow of UC Berkeley, and Holly Elser of Stanford University examine the impact of the 2017 San Francisco Paid Parental Leave Ordinance (PPLO), the first in the US to provide parental leave with full pay. 

The earned income tax credit (EITC) is the largest US poverty alleviation program for families with children, with well-documented positive effects on recipient health. In addition to the federal EITC, over half of US states have implemented supplemental EITC programs.

Paid family and medical leave has important health benefits for parents and their children, but access to job-protected leave is limited and highly disparate in the United States. Increasingly, state and local governments have established policies such as paid leave to support parents and other caregivers. While these policies have been crucial in enabling more workers to take leave, their effects have been weakened due to only partial coverage of job protection laws. As part of their ongoing work evaluating the 2017 San Francisco Paid Parental Leave Ordinance, investigators Julia M. Goodman (Oregon Health & Science University/Portland State University) and William H. Dow (University of California, Berkeley) published an issue brief examining paid leave protections in the California Bay Area.

Approximately 16 percent of children in the U.S. live in families with incomes below the federal poverty threshold. This early-life exposure to poverty may have negative long-term health effects. In a new working paper, Hansoo Ko, Renata Howland, and Sherry Glied of the P4A Research Hub at New York University Robert F. Wagner Graduate School of Public Service, estimate the causal impacts of the Supplemental Security Income program on child health outcomes and medical expenditures.

As shoppers prepare for the holidays with trips to the mall, supermarket, and big box stores, many workers who stock the shelves and work the registers are scrambling to piece together child care to match their unpredictable work schedules.