How Does Job-Protected Maternity Leave Affect Mothers' Employment and Infant Health?

Maternity leaves can affect mothers' and infants' welfare if they first affect the amount of time working women stay at home post birth. We provide new evidence of the labor supply effects of these leaves from an analysis of the introduction and expansion of job-protected maternity leave in Canada. The substantial variation in leave entitlements across mothers by time and space is likely exogenous to their unobserved characteristics. This is important because unobserved heterogeneity correlated with leave entitlement potentially biases many previous studies of this topic. We find that modest mandates of 17-18 weeks do not increase the time mothers spend at home. The physical demands of birth and private arrangements appear to render short mandates redundant. These mandates do, however, decrease the proportion of women quitting their jobs, increase leave taking, and increase the proportion returning to their pre-birth employers. In contrast, we find that expansions of job-protected leaves to lengths up to 70 weeks do increase the time spent at home (as well as leave-taking and job continuity). We also examine whether this increase in time at home affects infant health, finding no evidence of an effect on the incidence of low birth weight or infant mortality.

Maternal employment, breastfeeding, and health: Evidence from maternity leave mandates

Public health agencies around the world have renewed efforts to increase the incidence and duration of breastfeeding. Maternity leave mandates present an economic policy that could help achieve these goals. We study their efficacy focusing on a significant increase in maternity leave mandates in Canada. We find very large increases in mothers' time away from work post-birth and in the attainment of critical breastfeeding duration thresholds. However, we find little impact on the self-reported indicators of maternal and child health captured in our data.

The Retirement Incentive Effects of Canada's Income Security Programs

Like most other developed nations, Canada has a large income security system for retirement that provides significant and widely varying disincentives to work at older ages. Empirical investigation of their effects has been hindered by lack of appropriate data. We provide an empirical analysis of the retirement incentives of the Canadian Income Security (IS) system using a new and comprehensive administrative data base. We find that the work disincentives inherent in the Canadian IS system have large and statistically significant impacts on retirement. This suggests that program reform can some play a role in responses to the fiscal crises these programs periodically experience. We also demonstrate the importance of controlling for lifetime earnings in retirement models. Specifications without these controls overestimate the effects of the IS system. Finally, our estimates vary in sensible ways across samples lending greater confidence to our estimates.

Universal Childcare, Maternal Labor Supply, and Family Well-Being

The growing labor force participation of women with small children in both the U.S. and Canada has led to calls for increased public financing for childcare. The optimality of public financing depends on a host of factors, such as the %u201Ccrowd-out%u201D of existing childcare arrangements, the impact on female labor supply, and the effects on child well-being. The introduction of universal, highly-subsidized childcare in Quebec in the late 1990s provides an opportunity to address these issues. We carefully analyze the impacts of Quebec%u2019s %u201C$5 per day childcare%u201D program on childcare utilization, labor supply, and child (and parent) outcomes in two parent families. We find strong evidence of a shift into new childcare use, although approximately one third of the newly reported use appears to come from women who previously worked and had informal arrangements. The labor supply impact is highly significant, and our measured elasticity of 0.236 is slightly smaller than previous credible estimates. Finally, we uncover striking evidence that children are worse off in a variety of behavioral and health dimensions, ranging from aggression to motor-social skills to illness. Our analysis also suggests that the new childcare program led to more hostile, less consistent parenting, worse parental health, and lower-quality parental relationships.

Simulating the Response to Reform of Canada's Income Security Programs

We explore the fiscal implications of reforms to the Canadian retirement income system by decomposing the fiscal effect of reforms into two components. The mechanical effect captures the change in the government's budget assuming no behavioral response to the reform. The second component is the fiscal implication of the behavioral effect, which captures the influence of any induced changes in elderly labor supply on government budgets. We find that the behavioral response can account for up to half of the total impact of reform on government budgets. The behavioral response affects government budgets not only in the retirement income system but also through increased income, payroll, and consumption tax revenue on any induced labor market earnings among the elderly. We show that fully accounting for the behavioral response to reforms can change the cost estimates and distributive impact of retirement income reforms.

The Retirement Incentive Effects of Canada's Income Security Programs

Like most other developed nations, Canada has a large income security system for retirement that provides significant and widely varying disincentives to work at older ages. Empirical investigation of their effects has been hindered by lack of appropriate data. We provide an empirical analysis of the retirement incentives of the Canadian Income Security (IS) system using a new and comprehensive administrative data base. We find that the work disincentives inherent in the Canadian IS system have large and statistically significant impacts on retirement. This suggests that program reform can play some role in responses to the fiscal crises these programs periodically experience. We also demonstrate the importance of controlling for lifetime earnings in retirement models. Specifications without these controls overestimate the effects of the IS system. Finally, our estimates vary in sensible ways across samples lending greater confidence to our estimates.retirement; income security

Can improved paediatric pneumonia diagnostic aids support frontline health workers in low resource settings? : large scale evaluation of four respiratory rate timers and five pulse oximeters in Cambodia, Ethiopia, South Sudan and Uganda

Background: Pneumonia is the leading cause of infectious death in children under-five in sub-Saharan Africa and Southeast Asia. Currently, the diagnostic criterion for pneumonia is based on increased respiratory rate (RR) in children with cough and/or difficulty breathing. Low oxygen saturation, usually measured using pulse oximeters, is an indication of severe pneumonia. Health workers report finding it difficult to accurately count the number of breaths and current RR counting aids are often difficult to use or unavailable. Improved RR counting aids and lower-cost pulse oximeters are now available but their suitability in these settings and for these populations are untested. Objective: The studies sought to identify and evaluate the most accurate, acceptable and user-friendly respiratory rate counting devices and pulse oximeters for diagnosis of pneumonia symptoms and severity in children by frontline health workers in low-resource settings. Methods: Three sub-studies (I-III) were conducted among health workers, children under five and their caregivers, and national stakeholders. Sub-study I uses an explanatory qualitative approach with pile sorting and focus group discussions with frontline health workers and national stakeholders to explore their perspectives regarding the potential usability and scalability of seven pneumonia diagnostic aids. In sub-study II (a & b) four RR counters and five pulse oximeters were evaluated for performance by a cross-sectional sample of frontline health workers in hospital settings against reference standards in Cambodia, Ethiopia, South Sudan and Uganda. In sub-study III the same nine devices were evaluated using mixed methods for usability and acceptability in routine practice, over three months, in the four countries. Findings: Frontline health workers and national stakeholders’ universally valued device simplicity, affordability and sustainability. They prioritised different device characteristics according to their specific focus of work, with health workers focusing more on device acceptability and national stakeholders’ being less accepting of new technologies (Sub-study I). In sub-study IIa most CHWs managed to achieve a RR count with the four devices. The agreement with the reference standard was low for all; the mean difference of RR measurements or breaths per minute (bpm) from the reference standard for the four devices ranged from 0.5 bpm (95% CI -2.2 to 1.2) for the respirometer to 5.5 bpm (95% CI 3.2 to 7.8) for Rrate. Performance was consistently lower for young infants (0 to <2 months) than for older children (2 to ≤59 months). Agreement of RR classification into fast and normal breathing was moderate across all four devices, with Cohen’s Kappa statistics ranging from 0.41 (SE 0.04) to 0.49 (SE 0.05). In Sub-study IIb, although all five pulse oximeters tested in the field had performed well on a simulator (±2% SpO2 from the simulator), their performance was more varied when used on real children by frontline health workers. The handheld pulse oximeters had greater overall agreement with the reference standard, ranging from -0.6% SpO2 (95% CI -0.9, 0.4) to -3.0% SpO2 (95% CI -3.4, -2.6) than the finger-tip pulse oximeters, which ranged from -3.9% SpO2 (95% CI -4.4, -3.4) to -7.9% SpO2 (95% CI -8.6,-7.2). This was particularly pronounced in the younger children, where handheld devices had -0.7 SpO2 (95% CI -1.4, -0.1) to -5.9 SpO2 (95% CI -6.9, -4.9) agreement, compared to fingertip devices, which had -8.0 SpO2 (95% CI -9.4, -6.6) to -13.3 SpO2 (95% CI -15.1, -11.5) agreement. First level health facility workers had better agreement in classification of hypoxaemia with the reference standard (=0.32; SE 0.05 to =0.86; SE 0.07) for all five devices, when compared to CHWs (=0.15; SE 0.02 to =0.59; SE 0.03). In Sub-study III health workers reported being better supported by assisted RR counters, which provided more support than their standard practice ARI timer in counting and classifying RR in sick children under 5 in these settings. Conclusions: Frontline health workers were able to use the nine test devices to measure RR and oxygen saturation in children under 5, but with variable performance, and found it more difficult to get a successful measurement in younger children. Frontline health workers were better supported by assisted RR counters, such as Rrate and respirometer, compared to their standard practice diagnostic aid, MK2 ARI timer. Handheld pulse oximeters with multiple probes performed better than fingertip pulse oximeters, especially in younger children. The views of different stakeholder groups should be considered when looking to take these types of pneumonia diagnostic aids to scale. A consensus view on a robust research method and reference standard to evaluate future pneumonia diagnostic aids needs to be reached. While laboratory testing of new diagnostic aids can be valuable it should not replace field testing with frontline health workers in routine practice. Automated, easy to use, robust and affordable pneumonia diagnostics aids need to be developed and launched at scale to better support frontline health workers to address the high pneumonia burden in resource poor settings