Unintended Perinatal Health Consequences Associated With a Swedish Family Policy.

Importance: The 1980 and 1986 Swedish so-called speed premium policies aimed at protecting parents' income-based parental leave benefits for birth intervals shorter than 24 and 30 months, respectively, but indirectly encouraged shorter birth spacing and childbearing at older ages, both risk factors for several perinatal health outcomes. Whether those policy changes are associated with perinatal health remains unknown. Objective: To evaluate the association between the 1980 and 1986 speed premium policies and perinatal health outcomes. Design, Setting, and Participants: This cross-sectional study investigated data from 1 762 784 singleton births in the Swedish Medical Birth Register from January 1, 1974, through December 31, 1991. Data were analyzed from October 11, 2022, to December 12, 2023. Interventions: Speed premium policy introduction (January 1, 1980) and extension (January 1, 1986). Main Outcomes and Measures: Total population register data were used in an interrupted time series analysis with segmented logistic regression to calculate the odds of preterm birth, low birth weight, small for gestational age (SGA) at preterm, and stillbirth measured before and after the speed premium policy reforms. Subgroup analyses by maternal origin were conducted to evaluate changes by different policy responses. Results: Among 1 762 784 births analyzed, 4.8% were preterm (of which 12.0% were SGA), 3.2% had low birth weight, and 0.3% were stillbirths. The 1980 speed premium policy was associated with a 0.3% monthly increase in the odds of preterm birth compared with the period before the reform (odds ratio [OR], 1.0029 [95% CI, 1.002-1.004]), equivalent to a 26.4% increase from January 1, 1980, to December 31, 1985. After the 1986 relaxation of the policy, preterm birth odds decreased 0.5% per month (OR, 0.9951 [95% CI, 0.994-0.996]), equivalent to an 11.1% decrease across the next 6 years. Low birth weight displayed a similar pattern for both reform periods, that is, increased 0.2% (OR, 1.0021; 95% CI, 1.001-1.003) per month in 1980 through 1985 compared with baseline, and decreased 0.3% (OR, 0.9975; 95% CI, 0.996-0.998) per month in the following period, but was attenuated when considering low birth weight at term. Odds of SGA at preterm were decreased after 1980 (OR, 0.9965; 95% CI, 0.994-0.999) but not in 1986 (OR, 1.0009; 95% CI, 0.998-1.003), whereas stillbirths did not change following either reform (1980: OR, 1.0020 [95% CI, 0.999-1.005]; 1986: OR, 1.0002 [95% CI, 0.997-1.003]). Subgroup analyses suggested that perinatal health changes were restricted to births to Swedish- and Nordic-born mothers, the primary groups to adjust their fertility behaviors to the reforms. Conclusions and Relevance: Despite its economic advantages for couples, especially for mothers, the introduction of the speed premium policy was associated with adverse perinatal health consequences, particularly for preterm births. Family policies should be carefully designed with a "Health in All Policies" lens to avoid possible unintended repercussions for fertility behaviors and, in turn, perinatal health.

Familydemic Cross Country and Gender Dataset on work and family outcomes during COVID-19 pandemic.

Here we present the Familydemic Cross Country and Gender Dataset (FCCGD), which offers cross country and gender comparative data on work and family outcomes among parents of dependent children, before and during the COVID-19 pandemic. It covers six countries from two continents representing diverse welfare regimes as well as distinct policy reactions to the pandemic outbreak. The FCCGD was created using the first wave of a web-based international survey (Familydemic) carried out between June and September 2021, on large samples of parents (aged 20-59) living with at least one child under 12 in Canada, Germany, Italy, Poland, Sweden, and the US. While individual datasets are not available due to country-level restriction policies, the presented database allows for cross-country comparison of a wide range of employment outcomes and work arrangements, the division of diverse tasks of unpaid labour (housework and childcare) in couples, experiences with childcare and school closures due to the pandemic and subjective assessments of changes to work-life balance, career prospects and the financial situation of families (234 variables).

Unintended health consequences of Swedish parental leave policy (ParLeHealth): protocol for a quasi-experimental study.

INTRODUCTION: Sweden has long been praised for a generous parental leave policy oriented towards facilitating a gender-equitable approach to work and parenting. Yet certain aspects of Swedish parental leave could also be responsible for the maintenance of (or even the increase in) health inequalities. Using a 'Health in All Policies' lens, this research project aims to assess the unintended health consequences of various components of Sweden's parental leave policy, including eligibility for and uptake of earnings based benefits. METHODS AND ANALYSIS: We will use individual-level data from multiple Swedish registers. Sociodemographic information, including parental leave use, will be retrieved from the total population register, Longitudinal Integration Database for Health Insurance and Labour Market Studies and Social Insurance Agency registers. Health information for parents and children will be retrieved from the patient, prescribed drug, cause of death, medical birth and children's health registers. We will evaluate parents' mental, mothers' reproductive and children's general health outcomes in relation to several policy reforms aiming to protect parental leave benefits in short birth spacing (the speed premium) and to promote father's uptake (the father's quota) and sharing of parental leave days (the double days reform). We will also examine effects of increases in basic parental leave benefit levels. Using quasi-experimental designs, we will compare health outcomes across these reforms and eligibility thresholds with interrupted time series, difference-in-difference and regression discontinuity approaches to reduce the risk of health selection and assess causality in the link between parental leave use and health. ETHICS AND DISSEMINATION: This project has been granted all necessary ethical permissions from the Stockholm Regional Ethical Review Board (Dnr 2019-04913) for accessing and analysing deidentified data. The final outputs will primarily be disseminated as scientific articles published in open-access, high-impact peer-reviewed international journals, as well as press releases and policy briefs.

Fathers' Use of Parental Leave and Union Dissolution.

With increasing union dissolution and changing gender behaviour, questions have emerged about possible links between gender equality and union stability. The aim of this article is to examine whether and how early fathers' involvement in child-rearing is associated with union dissolution in three Nordic countries. All three countries have reserved part of their parental leave to be used by one parent in order to promote fathers' engagement in child-rearing. Our analysis uses fathers' parental leave as a proxy for his involvement, and we distinguish between fathers who take no leave ("non-conforming fathers"), fathers who take only the reserved part ("policy-conforming fathers") and fathers who take more than the reserved part ("gender-egalitarian-oriented fathers"). We find that couples in which the father uses parental leave have a lower risk of union dissolution than couples in which the father takes no leave. The pattern is consistent for all countries, for the whole study period 1993-2011, and for cohabiting and married couples. However, we do not find support for asserting that the couples with greatest gender equality, in which fathers take longer leave than the policy reserves, are the most stable unions, as the pattern is not uniform in the three countries. We attribute this to the fact that gender equality within the family in the Nordic countries is still an ongoing process, and the relationship between gender behaviour and union stability is still in flux.

Who makes the decision to have children? Couples' childbearing intentions and actual childbearing.

This study investigates how the childbearing intentions of women and men in couples affect actual childbearing over the following years with the aim to explore whether women's or men's intentions may be more important. The study is set in Sweden, a country known for ranking high in terms of gender equality and a country with relatively high fertility. We use the Young Adult Panel Study (YAPS), which gives information about both partners' long-term childbearing intentions in 2009, and follow these couples for five years with register data on childbearing. In 30 percent of the couples, both partners intended to have a child, and out of these about three quarters have a child. The results show that, in general, both partners need to intend to have a child for the couple to do so but that women's intentions tend to have more influence over the decision to have a second or third child. This phenomenon is interpreted as decision-making in relation to the cost and utility of children for women and men.

How can family policies reconcile fertility and women's employment? Comparisons between South Korea and Sweden.

South Korea has extremely low rates of fertility and labor force participation by women during their childbearing years, whereas Sweden has high rates for both. Variations in family policy models may explain differences in fertility and women's employment between the two countries. Drawing upon literature that examines the effects of family policies on fertility and women's employment, this paper compares childcare support for very young children and parental leave policies in South Korea and Sweden. Thereafter, we discuss the importance of providing stronger support for dual-earner rather than single-earner families to reconcile the two objectives of increasing fertility and women's workforce participation. Specifically, it is critical to: (a) enhance the quantity and quality of childcare services for very young children, (b) achieve gender equality in parental leave policies, and

Use It or Save It? Migration Background and Parental Leave Uptake in Sweden.

Sweden is a welfare state with a family policy that strongly emphasizes equality without distinction by place of birth or gender. In this study, we investigate the differences in uptake of parental leave between native and immigrant mothers, and the connection to labour-market attachment. Sweden represents a unique case study, not only because of the strong effort to combine work and family for all women and men, the high level of fertility and the large presence of immigrants in the country; it also enables a detailed and sophisticated analysis based on the high-quality data derived from its population registers. We find that immigrant mothers use more parental leave benefit the first year after their child's birth, but then fewer in the second year compared with native mothers. The differences diminish when labour-market activity is controlled for. Additionally, after a time in Sweden, immigrant mothers use leave more similarly to how native mothers do.

Earner-carer model at the crossroads: reforms and outcomes of Sweden's family policy in comparative perspective.

Following the 2006 election, the Swedish earner-carer model of family policy seems to have come to an important crossroads, and questions have been raised about the future course of policies. Will the prototypical earner-carer model in Sweden persist? The separate reforms in cash transfers, services, and tax systems in several respects seem to point in contradictory directions, simultaneously introducing new principles of social care. In this article, past and present reforms and potential outcomes of policies are discussed from an institutional and comparative perspective. Reviewing research on outcomes of earner-carer policies for gendered patterns of productive and reproductive work, class-based stratification, child well-being, fertility, and work-family conflict, the article also contributes to the discussion about future challenges for family policy institutions in Sweden and other advanced welfare states.