Alison Earle

The impact of welfare reform on parents' ability to care for their children's health.

OBJECTIVES Most of the national policy debate regarding welfare assumed that if middle-income mothers could balance work while caring for their childrens health and development, mothers leaving welfare for work should be able to do so as well. Yet, previous research has not examined the conditions faced by mothers leaving welfare for work. METHODS Using data from the National Longitudinal Survey of Youth, this study examined the availability of benefits that working parents commonly use to meet the health and developmental needs of their children; paid sick leave, vacation leave, and flexible hours. RESULTS In comparison with mothers who had never received welfare, mothers who had been on Aid to Families with Dependent Children were more likely to be caring for at least 1 child with a chronic condition (37% vs 21%, respectively). Yet, they were more likely to lack sick leave for the entire time they worked (36% vs 20%) and less likely to receive other paid leave or flexibility. CONCLUSIONS If current welfare recipients face similar conditions when they return to work, many will face working conditions that make it difficult or impossible to succeed in the labor force at the same time as meeting their childrens health and developmental needs.

Breastfeeding policy: a globally comparative analysis.

OBJECTIVE To explore the extent to which national policies guaranteeing breastfeeding breaks to working women may facilitate breastfeeding. METHODS An analysis was conducted of the number of countries that guarantee breastfeeding breaks, the daily number of hours guaranteed, and the duration of guarantees. To obtain current, detailed information on national policies, original legislation as well as secondary sources on 182 of the 193 Member States of the United Nations were examined. Regression analyses were conducted to test the association between national policy and rates of exclusive breastfeeding while controlling for national income level, level of urbanization, female percentage of the labour force and female literacy rate. FINDINGS Breastfeeding breaks with pay are guaranteed in 130 countries (71%) and unpaid breaks are guaranteed in seven (4%). No policy on breastfeeding breaks exists in 45 countries (25%). In multivariate models, the guarantee of paid breastfeeding breaks for at least 6 months was associated with an increase of 8.86 percentage points in the rate of exclusive breastfeeding (P < 0.05). CONCLUSION A greater percentage of women practise exclusive breastfeeding in countries where laws guarantee breastfeeding breaks at work. If these findings are confirmed in longitudinal studies, health outcomes could be improved by passing legislation on breastfeeding breaks in countries that do not yet ensure the right to breastfeed.

The impact of migration on the well-being of transnational families: new data from sending communities in Mexico

We present results from a new study of the effects of migration to the USA on the well-being of transnational families in high emigration communities within Mexico. Our survey measured the well-being of family members in a variety of domains: economic, health, education, and child development for a representative sample drawn from high migration municipalities. Compared to those with no recent emigrants to the USA, Mexican households sending non-caregivers to the USA appear to gain economically without contributing to problems faced by children. However, when family caregivers migrate to the USA, the remaining members in Mexico struggle to meet the familys needs and children are more vulnerable to educational, emotional, and health problems. Children in households where a caregiver migrated were more likely to have frequent illnesses (10% vs. 3%, p<0.0001), chronic illness (7% vs. 3%, p=0.011), emotional problems (10% vs. 4%, p=0.006), and behavioral problems (17% vs. 10%, p=0.018) compared with children in households where the migrant was not a caregiver. Research, policy, and program implications of these findings are discussed.

Creating and Using New Data Sources to Analyze the Relationship Between Social Policy and Global Health: The Case of Maternal Leave

Objectives. Operating at a societal level, public policy is often one of our best approaches to addressing social determinants of health (SDH). Yet, limited data availability has constrained past research on how national social policy choices affect health outcomes. We developed a new data infrastructure to illustrate how globally comparative data on labor policy might be used to examine the impact of social policy on health. Methods. We used multivariate ordinary least squares regression models to examine the relationship between the duration of paid maternal leave and neonatal, infant, and child mortality rates in 141 countries when controlling for overall resources available to meet basic needs measured by per capita gross domestic product, total and government health expenditures, female literacy, and basic health care and public health provision. Results. An increase of 10 full-time-equivalent weeks of paid maternal leave was associated with a 10% lower neonatal and infant mortality rate (p≤0.001) and a 9% lower rate of mortality in children younger than 5 years of age (p≤0.001). Paid maternal leave is associated with significantly lower neonatal, infant, and child mortality in non-Organisation for Economic Co-operation and Development (OECD) countries and OECD countries. Conclusions. This preliminary study, using newly available worldwide policy data, demonstrates the potential strength of using globally comparative data to examine SDH. Further data development to make multilevel modeling of the impact of labor conditions possible and to broaden which social policies can be examined is a critical next step.

An Uneven Burden: Social Disparities in Adult Caregiving Responsibilities, Working Conditions, and Caregiver Outcomes

Using data from a large, nationally representative U.S. survey, the authors examine differences in adult caregiving responsibilities, working conditions, and caregiver outcomes by gender, ethnicity, immigration status, and educational attainment. Women, Hispanics, and first-generation immigrant caregivers are more likely to have worse working conditions including an unsupportive culture at work, less schedule flexibility, and less access to paid vacation leave. Women and first-generation immigrant caregivers are more likely to report caregiving contributing to poor job outcomes including quitting work, retiring early, or reducing hours involuntarily. Caregivers with less than a college degree experience both worse working conditions including lack of access to paid sick days and worse job outcomes including having lost wages or a job. Women, second-generation immigrants, and those with a high school diploma or less are more likely to report that their caregiving responsibilities interfere with their quality of life including negative impacts on their ability to spend time with friends. Research and policy implications are discussed.

Working HIV care-givers in Botswana: Spill-over effects on work and family well-being

Families provide most of the care to the tens of millions of HIV-infected and -affected in Africa. Little research exists on how care-givers balance the demands of holding a job with providing care for those who have become ill or orphaned by HIV/AIDS. Using data from a large survey administered to 1,077 working care-givers in Botswana, we compared the experience of HIV care-givers with non-HIV care-givers. Compared to non-HIV care-givers, HIV care-givers were more likely to worry about routine childcare (44% vs. 31%) and sick childcare (64% vs. 49%). Amongst those working far from home, more HIV care-givers were concerned that their children were not receiving adequate academic support (39% vs. 20%) and emotional support (57% vs. 33%). Parents who were HIV care-givers were less able to spend time with their own children. Children of HIV care-givers were more likely to have physical, mental and academic problems. While HIV care-givers were more likely to take leave from work for care-giving (53% vs. 39%), and for longer periods of time (13 vs. 7.6 days), this leave is more likely to be unpaid. Strategies to support those directly and indirectly affected by HIV and to avoid economic responsibility are discussed.

The cost of caregiving: wage loss among caregivers of elderly and disabled adults and children with special needs

Sixty-one percent of the adults caring for elderly and disabled family members and 53% of parents of children with special needs are employed. Yet studies examining the experience of employed caregivers of children with special needs and elderly or disabled adult family members have not examined the impact on earnings or the workplace policies that might help reduce the conflicts between work and caregiving. This study begins to fill this gap using data from a nationally representative US survey of American adults. We find that employees who live with a child with a health problem are 48% more likely to have lost wages. Each adult with health issues that an employee is responsible for raises the chances of wage loss by 29%. At the same time, access to paid leave for family health needs reduces the likelihood of wage loss by 30%, and having a supportive supervisor reduces the odds of experiencing wage loss by 37%. Implications for employers and US policy-makers are discussed.

Facilitating Working Mothers’ Ability to Breastfeed Global Trends in Guaranteeing Breastfeeding Breaks at Work, 1995-2014

Background: Mothers who work away from home tend to stop breastfeeding earlier than their nonworking counterparts due to workplace barriers. Barriers to breastfeeding discriminate against women and may lead to inequities in children’s health outcomes. Guaranteeing paid breastfeeding breaks at work is 1 mechanism that can improve mothers’ opportunity to breastfeed in the workplace. Objective: This study aimed to assess the trends in the share of countries guaranteeing breastfeeding breaks in the workplace and paid maternal leave that lasts until the infant is 6 months old (the World Health Organization recommended duration for exclusive breastfeeding), between 1995 and 2014. Methods: Legislation and secondary source data were collected and reviewed for 193 United Nations member states. Legislation was analyzed for content on breastfeeding breaks and maternal leave guarantees. Results: Fifty-one countries (26.7%) in 2014 did not guarantee breastfeeding breaks in any form and 4 countries provided only unpaid breaks or breaks that did not cover the first 6 months of life; since 1995, around 15 countries (10.2%) legislated for such a policy. In 2014, out of 55 countries that did not guarantee paid breastfeeding breaks for the first 6 months after birth, 7 countries guaranteed paid maternal leave for the same duration; 48 countries (25.1%) provided neither paid maternal leave nor paid breastfeeding breaks. Conclusion: Progress in the number of countries guaranteeing breastfeeding breaks at work is modest. Adopting measures to facilitate breastfeeding at work can be a critical opportunity for countries to increase breastfeeding rates among the growing number of women in the labor force.

Meeting Children's Needs: How Does the United States Measure Up?

The majority of parents in the United States today must balance work and caregiving responsibilities. Workplace policies and community supports markedly influence the ability of parents to care for their childrens health and education while obtaining, retaining, and advancing in their jobs. The goal of this article is to analyze the dilemmas faced by working parents in general and by low-income families in particular, to present new data on how public policies in the United States compare to policies in over 150 other countries in addressing these dilemmas, and to suggest what more can be done to meet the needs of all working parents and their children across social class and residence.

Bringing a global perspective to community work and family: an examination of extended work hours in families in four countries.

To date, much of the research on the interaction between work and family has focused on single countries or comparative studies on OECD countries. The goal of this paper is to demonstrate the feasibility of bringing a truly global perspective to comparative research on work, family, and community questions. We conducted an examination of extended‐hour work in four countries in Latin America, Africa, and Asia. This paper highlights two facts: first, the feasibility of using existing data sources to carry out comparative research on a more diverse range of countries than has generally been conducted to date, and second, the importance of conducting such analyses because of the critical insights that are gained for improving public policies and services.