WIC in Your Neighborhood: New Evidence on the Impacts of Geographic Access to Clinics

A large body of evidence indicates that conditions in-utero and health at birth are predictive of individuals' long-run outcomes, pointing to the potential value in programs aimed at pregnant women and new mothers. This paper uses a novel identification strategy and data set to provide causal estimates of the effects of geographic access to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), the major US program aimed at improving the well-being of low-income pregnant and post-partum women, infants, and children under age 5. I utilize data on sibling births over 2005-2009 and administrative records on the locations and dates of openings and closings of WIC clinics over the same time period. The empirical approach uses within-zip-code variation in WIC clinic presence together with maternal fixed effects, and accounts for the potential endogeneity of mobility, gestational-age bias, and measurement error in gestation. The results show that geographic access to WIC clinics increases the likelihood of WIC food benefit take-up, and decreases the likelihood of gaining too little weight during pregnancy. I also provide some evidence that other aspects of the WIC program, such as health screenings and referrals to other services may have effects on women's behaviors during pregnancy. Finally, I show that access to WIC increases average birth weight and the likelihood of breastfeeding at the time of hospital discharge. The effects are strongest for mothers with a high school education or less, who are most likely eligible for WIC services

The Effects of California’s Paid Family Leave Program on Mothers’ Leave-Taking and Subsequent Labor Market Outcomes

This analysis uses March Current Population Survey data from 1999-2010 and a differences-in-differences approach to examine how California’s first in the nation paid family leave (PFL) program affected leave-taking by mothers following childbirth, as well as subsequent labor market outcomes. We obtain robust evidence that the California program more than doubled the overall use of maternity leave, increasing it from around three to six or seven weeks for the typical new mother – with particularly large growth for less advantaged groups. We also provide suggestive evidence that PFL increased the usual weekly work hours of employed mothers of one-to-three year-old children by 6 to 9% and that their wage incomes may have risen by a similar amount.

Assessing Rhode Island’s Temporary Caregiver Insurance Act: Insights from a Survey of Employers

This report provides new evidence on Rhode Island’s Temporary Caregiver Insurance (TCI) law, which took effect in January 2014, based on a survey of small and medium-sized businesses in the food services and manufacturing sectors in Rhode Island, Connecticut, and Massachusetts that we carried out in December 2013 (just before the law came into effect) and in January/February 2015 (one year after the law came into effect). We collected information about firm characteristics and productivity, employee life events and work flow, and employer-provided benefits. Comparing Rhode Island employers pre-and post-law to Massachusetts and Connecticut employers over the same time period, we found little evidence of significant impacts of the law on employers (although we note that the sample size for these estimates was small; 104 employers in Rhode Island, and 133 in the other two states combined). We also asked Rhode Island employers directly about their views towards TCI one year after it came into effect and found that a majority of the 213 Rhode Island employers interviewed in 2015 support the new law. Thus, our results suggest that laws like Rhode Island’s TCI may not have significant impacts on small and medium-sized employers and could garner support by such employers once they have experienced them

The effects of maternity leave on children's birth and infant health outcomes in the United States

This paper evaluates the impacts of unpaid maternity leave provisions of the 1993 Family and Medical Leave Act (FMLA) on children's birth and infant health outcomes in the United States. My identification strategy uses variation in pre-FMLA maternity leave policies across states and variation in which firms are covered by FMLA provisions. Using Vital Statistics data and difference-in-difference-in-difference methodology, I find that maternity leave led to small increases in birth weight, decreases in the likelihood of a premature birth, and substantial decreases in infant mortality for children of college-educated and married mothers, who were most able to take advantage of unpaid leave. My results are robust to the inclusion of numerous controls for maternal, child, and county characteristics, state and year fixed effects, and state-year interactions, as well as across several different specifications

Trends and Disparities in Leave Use Under California\u27s Paid Family Leave Program: New Evidence from Administrative Data

We use novel administrative data to study trends and disparities in usage of California\u27s first-in-the-nation paid family leave (PFL) program. We show that take-up for both bonding with a new child and caring for an ill family member increased over 2005–2014. Most women combine PFL with maternity leave from the State Disability Insurance system, resulting in leaves longer than 6 weeks. Most men take less than the full 6 weeks of PFL. Individuals in the lowest earnings quartile and in small firms are the least likely to take leave. There are important differences in take-up across industries, especially for men

The impacts of paid family and medical leave on worker health, family well-being, and employer outcomes

This article reviews the evidence on the impacts of paid family and medical leave (PFML) policies on workers' health, family well-being, and employer outcomes. While an extensive body of research demonstrates the mostly beneficial effects of PFML taken by new parents on infant, child, and parental health, less is known about its impact on employees who need leave to care for older children, adult family members, or elderly relatives. The evidence on employers is similarly limited but indicates that PFML does not impose major burdens on them. Taken together, the evidence suggests that PFML policies are likely to have important short- and long-term benefits for population health, without generating large costs for employers. At thesame time, further research is needed to understand the effects of different policy parameters (e.g., wage replacement rate and leave duration) and of other types of leave beyond parental leave

Social Policy and Family Well-Being: Essays in Applied Microeconomics

In my dissertation, I study how individuals respond to changes in their options and constraints as a result of government policies and their local environments. I focus on issues in maternal and child well-being, as well as family structure and behavior, and draw implications for addressing the needs of disadvantaged populations in the United States. I use quasi-experimental empirical strategies with large and varied data sets to provide credible causal estimates. I believe that the results from my research can shed some light on the causes and consequences of disadvantage in the United States, contribute to cost-benefit analyses of some of the largest social welfare programs, and help inform decisions about public spending. The focus on maternal and early childhood well-being is motivated by increasing support for the notion that fetal and infant health are predictive of individuals' later-life outcomes (Almond and Currie, 2011a,b). This evidence highlights the potential value in programs and policies aimed at pregnant women and new mothers. Indeed, successful programs that improve the welfare of disadvantaged women during pregnancy and post-partum may play an important role in ameliorating inequalities at birth, and thereby potentially mitigating the intergenerational transmission of low socio-economic status. In the first essay, titled "The Effects of Maternity Leave on Children's Birth and Infant Health Outcomes in the United States" (published in the Journal of Health Economics, March 2011), I provide the first quasi-experimental analysis of the effects of the unpaid maternity leave provisions of the 1993 Family and Medical Leave Act (FMLA) on children's birth and infant health outcomes in the United States. My identification strategy uses variation in pre-FMLA maternity leave policies across states and variation in which firms are covered by FMLA provisions. Using Vital Statistics data and difference-in-difference-in-difference methodology, I find that maternity leave led to small increases in birth weight, decreases in the likelihood of a premature birth, and substantial decreases in infant mortality for children of college-educated and married mothers. The fact that I only find positive impacts on the health of children of college-educated and married women, while children of less-advantaged women experience no health benefits, suggests that unpaid parental leave policies may exacerbate disparities in child health as they only benefit the parents who can afford to use them. In the second essay, "Engaging Absent Fathers: Lessons from Paternity Establishment Programs," I examine behavior among parents who have children out-of-wedlock. Single-mother households are disproportionately disadvantaged, and children raised in two-parent households fare better along numerous measures of well-being. These facts motivate the implementation of policies that encourage father involvement among unmarried parents. I conduct the first comprehensive causal analysis of one of the largest U.S. policies that aims to engage unmarried fathers with their families, In-Hospital Voluntary Paternity Establishment (IHVPE), and place my findings in the context of a conceptual framework rooted in family economics theory (Edlund, 2011; Browning, Chiappori, and Weiss, forthcoming). The program significantly reduces the costs of formal paternity estabishment, which is the only available legal contract that assigns partial parental rights and obligations to unmarried fathers. Using data from a multitude of sources and variation in the timing of IHVPE initiation across states, I show that IHVPE achieves its stated goal of substantially increasing paternity establishment rates. However, I show that IHVPE also affects another margin of parental behavior. I find a \emph{negative} effect on parental marriage -- specifically, for each additional paternity established as a result of IHVPE, there are 0.13 fewer parental marriages occurring post-childbirth. Accounting for the decline in parental marriage, I find that the net effects on some measures of father involvement are negative, while overall child well-being is largely unaffected. Why might paternity establishment serve as a substitute to marriage for some parents? To explain this finding, I offer a simple conceptual framework, in which parents trade-off their utility from access to children with their match quality. Paternity establishment offers an "intermediate" parental relationship option between the "extremes" of no formal relationship and marriage. When the cost of establishing paternity is lowered, parents who would have previously maintained no formal relationship and parents who would have previously been married are more likely to choose the intermediate contract. If fathers are more involved with their children when they have greater parental rights (Weiss and Willis, 1985; Edlund, 2011), then the net effect on father involvement is ambiguous, and can be negative if the increase in involvement among switchers out of no relationship is lower than the decrease in involvement among switchers out of marriage. My results suggest that the trade-off between access to children and match quality is empirically relevant for parents who have children out-of-wedlock, and policies based on the notion that more father involvement is essential to child and family well-being must account for the parents' agency in choosing their partners. A paternity establishment program that intends to engage absent fathers and increase father involvement can actually have the opposite effects by discouraging some parents from marriage and reducing the support provided by otherwise married fathers. Finally, in the third essay, titled "WIC in Your Neighborhood: New Evidence on the Impacts of Geographic Access to Clinics" (accepted at the Journal of Public Economics), I examine how geographic proximity to Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics affects food benefit take-up, pregnancy behaviors, and birth outcomes. WIC is the major U.S. program with a goal of enhancing the health and nutrition of low-income pregnant women and children. Rigorous evaluation of the program is necessary both for policy-making purposes and for providing new estimates of the determinants of fetal and infant health. Although there are several studies that examine the relationship between WIC and birth outcomes (e.g. Bitler and Currie, 2005; Joyce et al., 2005; Joyce et al., 2008; Figlio et al., 2009; Hoynes et al., 2011), much less attention has been paid to the determinants of WIC benefit take-up. Moreover, consensus on the effectiveness of WIC has not been reached: the existing literature suffers from problems due to omitted variables bias, lack of data on important variables such as benefit take-up and breastfeeding, and other econometric and measurement issues. I employ a novel empirical approach on data from birth and administrative records over 2005-2009 that uses within-zip-code variation in WIC clinic presence together with maternal fixed effects, and accounts for the potential endogeneity of mobility, gestational-age bias, and measurement error in gestation. I find that access to WIC increases food benefit take-up, pregnancy weight gain, birth weight, and the probability of breastfeeding initiation at the time of hospital discharge. The estimated effects are strongest for mothers with a high school education or less, who are most likely eligible for WIC services

Preconception Health and Health Care and Early Childhood Comprehensive Systems: Opportunities for Collaboration

In recent years, the importance of women's preconception health and health care (PCHHC) for improving birth outcomes, especially among high-risk populations, has been highlighted by numerous researchers, advocates, and policymakers. In 2006, the Centers for Disease Control and Prevention (CDC) Select Panel on Preconception Care issued recommendations for improving preconception health and health care. Throughout this report, we refer to preconception health and health care as efforts to promote women's wellbeing and health before, during, and between pregnancies and throughout their childbearing years. A growing body of evidence points to the importance of a woman's physical, mental, environmental, and behavioral health over her life course for her children's birth outcomes, and consequent child development and later life wellbeing. The Early Childhood Comprehensive Systems (ECCS) initiative can play an important role in advancing PCHHC, benefiting women, young children, and families in their communities

Paternity acknowledgment in 2 million birth records from Michigan.

Out-of-wedlock childbearing is more common in the U.S. than in other countries and becoming more so. A growing share of such non-marital births identify the father, which can create a legal entitlement to child support. Relatively little is known about individual determinants of the decision to establish paternity, in part because of data limitations. In this paper, we evaluate all birth records in Michigan from 1993 to 2006, which have been merged to the paternity registry. In 2006, 30,231 Michigan children, almost one quarter of all Michigan births, were born to unmarried mothers and had paternity acknowledged. We find that births with paternity acknowledged have worse outcomes along various health and socio-economic dimensions relative to births to married parents, but better outcomes relative to births to unmarried parents without paternity acknowledgement. Furthermore, unmarried men who father sons are significantly more likely to acknowledge paternity than fathers of daughters