Heshmati Amy, Dunlavy Andrea, Mussino Eleonora, Fritzell Sara, Juárez Sol P
Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden.
Department of Public Health Sciences, Stockholm University, Albanovägen 12, Stockholm, 10 691, Sweden.
BMC Public Health. 2025 Mar 18;25(1):1045. doi: 10.1186/s12889-025-22248-8.
Parental leave generosity is protective for mothers' mental health in the postpartum period and beyond. Strong work requirements exist for parents in Sweden to receive more generous benefits which might penalise individuals who, due to poor health, have a weak labour market attachment. The aim of the study was to examine whether mothers with poor health prior to pregnancy are less likely to be eligible for more generous benefits in Sweden.
We used total population registers to study first-time mothers, aged 25-45 years, who were resident in Sweden and gave birth between 1 January 2009 and 30 September 2013 (n = 151,452). We used logistic regression to examine the association between health one and two consecutive years prior to pregnancy (to assess chronicity) and eligibility for earnings-related parental leave benefits.
Mothers who were admitted to hospital or received specialist outpatient care for any health condition in the year prior to pregnancy were less likely to be eligible for earnings-related benefits (OR 0·79, 95%CI 0·76-0·83) compared to healthy mothers, particularly those with chronic health issues (OR 0·64, 95%CI 0·62-0·68). Findings were driven by mothers with mental disorders (OR 0·22, 95%CI 0·20-0·23 for the year before pregnancy), and associations were stronger for those with chronic health issues and for Swedish-born mothers.
Mothers with prior health conditions, particularly mental disorders, are less likely to benefit from the protective health effect of parental leave as they may not meet the eligibility requirements for more generous remunerations. This study highlights how the strong work requirement for accessing generous parental leave benefits could unintentionally exacerbate socioeconomic inequalities between mothers with and without poor mental health. Easing work requirements for eligibility to more generous parental leave remuneration could help reduce these inequalities and thus promote better mental health for all, particularly among more disadvantaged groups. As such, our findings empirically support the need for adopting the Health in All Policies framework when designing parental leave policies in order to minimise health inequalities.
育儿假福利丰厚对母亲产后及更长时间的心理健康具有保护作用。在瑞典，父母要获得更丰厚的福利有严格的工作要求，这可能会对那些因健康状况不佳而劳动力市场依附性较弱的个人不利。本研究的目的是调查怀孕前健康状况不佳的母亲在瑞典获得更丰厚福利的可能性是否较低。
我们利用总人口登记册研究了2009年1月1日至2013年9月30日期间居住在瑞典、年龄在25至45岁之间的初产妇（n = 151,452）。我们使用逻辑回归分析来研究怀孕前连续一到两年的健康状况（以评估慢性病情况）与与收入相关的育儿假福利资格之间的关联。
与健康母亲相比，怀孕前一年因任何健康状况住院或接受专科门诊治疗的母亲获得与收入相关福利的可能性较小（优势比0.79，95%置信区间0.76 - 0.83），尤其是那些患有慢性健康问题的母亲（优势比0.64，95%置信区间0.62 - 0.68）。研究结果主要由患有精神障碍的母亲驱动（怀孕前一年的优势比为0.22，95%置信区间0.20 - 0.23），对于患有慢性健康问题的母亲和瑞典出生的母亲，这种关联更强。
孕前有健康问题，尤其是精神障碍的母亲，不太可能从育儿假对健康的保护作用中受益，因为她们可能不符合获得更丰厚薪酬的资格要求。这项研究凸显了获得丰厚育儿假福利的严格工作要求可能会无意中加剧心理健康状况不佳和良好的母亲之间的社会经济不平等。放宽获得更丰厚育儿假薪酬资格的工作要求有助于减少这些不平等，从而促进所有人，尤其是处境更为不利群体的心理健康。因此，我们的研究结果从实证角度支持了在设计育儿假政策时采用“所有政策皆健康”框架的必要性，以尽量减少健康不平等。
