Economic security laws and maternal health - ABSTRACT/PROJCT SUMMARY: Poverty is the most widely studied fundamental determinant of maternal mental health, morbidity, and mortality in the U.S. and worldwide. Low absolute and relative income are associated with financial hardship, food and housing insecurity, limited healthcare access, and subsequent depression during the preconception, perinatal, postpartum, and parenting years. Economic resources and supports during the early childbearing years can set life-long trajectories of maternal and child wellbeing. Investments in economic security have strong potential to enhance women’s mental health; yet the most timely and promising state-level investments within the dynamic, complex legal landscape over the last two decades have not been collectively or rigorously evaluated. The goal of this R01 is to empirically test the effects of six state-level economic security laws on maternal mental health outcomes across the U.S. over the last 20 years. We focus on Paid Family Leave, Paid Medical Leave, Child Care and Development Fund, Earned Income Tax Credits, Minimum Wage, and Temporary Assistance for Needy Families. First, we will use our team’s validated novel legal measurement, analysis, and mapping methods to conduct a detailed state- year-level surveillance study of the six economic security laws across all 50 states and Washington D.C. from 2000 to 2023. Second, we will estimate the independent effects of each economic security law (and specific dimensions of each law) on a range of mental health indicators spanning the preconception, perinatal, postpartum, and parenting periods among U.S. women ages 18 to 45. We will use a rigorous quasi- experimental approach (difference-in-differences), exploiting state-year level legal variation and six different population datasets, to provide causal estimates and maximize statistical power. We will examine differences in the effects of the laws by women’s characteristics, including rurality/urbanicity and age. Third, we will use interaction analyses to test whether combinations of economic security laws have greater impact than each alone and determine which combinations of laws have the greatest effects on maternal mental health outcomes. Fourth, we will use mediation analysis to test whether economic outcomes, health care access, psychosocial and behavioral outcomes, and social stressors are mechanisms linking the economic security laws to health. This research will substantially advance our understanding of whether and how economic security investments can enhance population maternal health.
