Are extensions in paid parental leave associated with lower infant and neonatal mortality in Latin American cities? Evidence from 148 cities in Chile, Mexico, and Colombia (2000-2015).

We examined changes in infant and neonatal mortality that occurred after extension in the minimum number of days of paid maternity leave and after the implementation of paid paternity leave in 148 cities using longitudinal city-level data (2000-2015) from Chile, Colombia, and Mexico, compiled and harmonized by the Salud Urbana en America Latina (SALURBAL) study. For Chile we also explored variations in these associations according to the mother's educational attainment as a measure of family socioeconomic standing. We employed interrupted time series analysis in country-specific models, adjusted by time-variant socioeconomic characteristics such as the percent of the population with secondary education and above, and GDP per capita at the city level. In Chile, we found modestly steeper declines in infant and neonatal mortality rates after paid parental leave reform in 2011 which combined the extensions in paid maternity leave and the introduction of paid paternity leave. We did not find significant associations between extensions of paid maternity and/or introduction of paternity leave and infant and neonatal mortality trends in Colombia and Mexico. The magnitude of the extension in days of paid maternity leave may be relevant to the impacts on infant and neonatal mortality. Results from this study highlight the potential importance of combined paid maternal and paternal leave policies for reducing infant and neonatal mortality while promoting more egalitarian gender roles in successful child upbringing. This is particularly relevant in the context of highly unequal Latin American cities, where women continue to provide the majority of childcare.