Evaluation of the effectiveness and equity of the maternity protection reform in Chile from 2000 to 2015

English version

Autoři: Iris Delgado ^aff001; Baltica Cabieses ^aff002; Mauricio Apablaza ^aff003; Carla Castillo ^aff001; Ximena Aguilera ^aff001; Isabel Matute ^aff001; Manuel Najera ^aff001; Juan M. Pericàs ^aff004; Joan Benach ^aff004
Působiště autorů: Centro de Epidemiología y Políticas de Salud, CEPS, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile ^aff001; Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, ICIM, Universidad del Desarrollo, Santiago, Chile ^aff002; Centro de Políticas Públicas, Facultad de Gobierno, Universidad del Desarrollo, Santiago, Chile ^aff003; Grupo Desigualdades en Salud (GREDS-EMCONET), Departamento Ciencias Políticas y Sociales, Universitat Pompeu Fabra, Barcelona, España ^aff004; JHU-UPF Public Policy Center, Universitat Pompeu Fabra, Barcelona, España ^aff005; Grupo de Investigación Transdisciplinar sobre Transiciones Socioecológicas (GinTRANS2), Universidad Autónoma de Madrid, Madrid, España ^aff006
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0221150

Souhrn

Introduction

According to the International Labor Organization, Maternity Protection (MP) policies try to harmonize child care and women's paid work, without affecting family health and economic security. Chile Law 20.545 (2011) increased benefits for economically active women and reduced requirements for accessing these benefits. The goals of the reform included: 1) to increase MP coverage; and 2) to reduce inequities in access to the benefits.

Method

This study uses two data sources. First, using individual data routinely collected from 2000 to 2015, yearly MP coverage access over time was calculated. Second, using national representative household surveys collected before and after the Law (2009 and 2013), coverage and a set of measures of inequality were estimated. To compare changes over time, we used non-experimental, before-after intervention design for independent samples. For each variable, we estimated comparative proportions at 95% confidence interval before and after the intervention. Additionally, we included multivariate and propensity score analysis.

Results

Between 2000 and 2015, MP coverage grew from 24.4% to 44.8%. Using comparable 2009 and 2013 survey data, we observed the same trend, with 31.6% of estimated MP coverage in 2009, escalating to 39.5% in 2013. We conclude that: 1) after the reform, there was an increase in MP coverage; and, 2) there was no significant reduction of inequities in the distribution of MP benefits.

Discussion/Conclusion

Few scientific evaluations of MP reforms have been conducted worldwide; even fewer including an equity analysis. This study provides an empirically-based evaluation of MP reform from both a population-level and an equity-focused perspective. We conclude that this reform needs to be complemented with other policies to ensure maternity protection in terms of access and equity in a country with deep socioeconomic stratification.

Klíčová slova:

Social sciences – Sociology – People and places – Population groupings – Geographical locations – Medicine and health sciences – Health care – Women's health – Maternal health – Obstetrics and gynecology – Economics – Pregnancy – Public and occupational health – Labor economics – Employment – Socioeconomic aspects of health – Education – Families – Health care policy – Ecology and environmental sciences – Mothers – South America – Educational attainment – Conservation science – Chile (country) – Child and adolescent health policy

Zdroje

1. International Labor Organization I. Maternity and paternity at work Law and practice across the world. Law and practices across the world. Manager. 2014. doi: 10.1515/9783110870466.116

2. International Labor Organization I. Convention C183—Maternity Protection Convention, 2000 (No. 183) [Internet]. 2000. Available: http://www.ilo.org/dyn/normlex/en/f?p=1000:12100:0::NO::P12100_INSTRUMENT_ID,P12100_LANG_CODE:312328,en:NO

3. Olivetti C, Petrongolo B. The Economic Consequences of Family Policies: Lessons from a Century of Legislation in High-Income Countries. J Econ Perspect. 2017;31: 205–230. doi: 10.1257/jep.31.1.205

4. Blofield M, Martínez J. Trabajo, familia y cambios en la política pública en América Latina: equidad, maternalismo y corresponsabilidad. Rev CEPAL. 2014; 107–125.

5. Chatterji P, Markowitz S. Family Leave After Childbirth and the Mental Health of New Mothers. J Ment Heal Policy Econ. 2012;15: 61–76.

6. Dagher RK, McGovern PM, Dowd BE. Maternity Leave Duration and Postpartum Mental and Physical Health: Implications for Leave Policies. J Health Polit Policy Law. 2014;39: 369–416. doi: 10.1215/03616878-2416247 24305845

7. Avendano M, Berkman LF, Brugiavini A, Pasini G. The long-run effect of maternity leave benefits on mental health: Evidence from European countries. Soc Sci Med. Elsevier Ltd; 2015;132: 45–53. doi: 10.1016/j.socscimed.2015.02.037 25792339

8. Staehelin K, Bertea PC, Stutz EZ. Length of maternity leave and health of mother and child—A review. Int J Public Health. 2007;52: 202–209. doi: 10.1007/s00038-007-5122-1 18030952

9. Hewitt B, Strazdins L, Martin B. The benefits of paid maternity leave for mothers’ post-partum health and wellbeing: Evidence from an Australian evaluation. Soc Sci Med. Elsevier Ltd; 2017;182: 97–105. doi: 10.1016/j.socscimed.2017.04.022 28437694

10. Kristiansen AL, Lande B, Overby NC, Andersen LF. Factors associated with exclusive breast-feeding and breast-feeding in Norway. Public Health Nutr. 2010;13: 2087–2096. doi: 10.1017/S1368980010002156 20707948

11. Lee C-C, Chiou S-T, Chen L-C, Chien L-Y. Breastfeeding-Friendly Environmental Factors and Continuing Breastfeeding Until 6 Months Postpartum: 2008–2011 National Surveys in Taiwan. Birth Issues Perinat Care. 2015;42: 242–248. doi: http://dx.doi.org/10.1111/birt.12170

12. Rossin M. The effects of maternity leave on children’s birth and infant health outcomes in the United States. J Health Econ. Elsevier B.V.; 2011;30: 221–239. doi: 10.1016/j.jhealeco.2011.01.005 21300415

13. Ruhm CJ. The Economic Consequences of Parental Leave Mandates: Lessons from Europe. Q J Econ. 2008;113: 285–317.

14. Blau BFD, Kahn LM. Female Labor Supply: Why Is the United States Falling Behind? Am Econ Rev. 2013;103: 251–256.

15. Thévenon O, Solaz A. Labor Market Effects of Parental Leave Policies in OECD Countries. 2013; http://dx.doi.org/10.1787/5k8xb6hw1wjf-en

16. Lalive R, Schlosser A, Steinhauer A. Parental leave and mothers’ careers: The relative importance of job protection and cash benefits. 2014.

17. Schönberg U, Ludsteck J. Expansions in Maternity Leave Coverage and Mothers’ Labor Market Outcomes after Childbirth. J Labor Econ. 2014;32: 469–505. doi: 10.1086/675078

18. Albagli P, Rau T. The Effects of a Maternity Leave Reform on Children’s Abilities and Maternal Outcomes in Chile. Econ J. 2018; doi: 10.1111/ecoj.12586

19. Network I, Leave ON. 12 th International Review of Leave Policies and Related Research 2016. 2016;

20. International Network on Leave Policies and Research. 13Th International Review of Leave Policies and Related Research 2017. 2017; 1–350.

21. International Labor Organization IP. Trabajo y Familia: Hacia nuevas formas de conciliación con corresponsabilidad social. Primera. Santiago Chile; 2009.

22. Ekberg J, Eriksson R, Friebel G. Parental leave—A policy evaluation of the Sweedish “Daddy-Month” reform. J Public Econ. 2013;97: 131–143.

23. Casas L, Herrera T. Maternity protection vs. maternity rights for working women in Chile: A historical review. Reprod Health Matters. Reproductive Health Matters; 2012;20: 139–47. doi: 10.1016/S0968-8080(12)40666-8 23245419

24. Pribble J. Women and Welfare: The Politics of Coping with New Social Risks in Chile and Uruguay. Lat Am Res Rev. 2006;41. doi: 10.1353/lar.2006.0028

25. Delgado I, Hirmas I, Prieto F. Evolución de las licencias por enfermedad grave del niño(a) menor de un año 2004–2008: Certezas e interrogantes. Rev Med Chil. 2012;140: 30–38. doi: 10.4067/S0034-98872012000100004 22552552

26. Historia de la Ley 20.545, Modifica las normas de protección a la maternidad e incorpora el Permiso Postnatal Parental. Biblioteca del Congreso Nacional de Chile; 2011.

27. Social M de trabajo y previsión. Ley 20.545, Modifica las normas de protección a la maternidad e incorpora el Permiso Posnatal Parental. 2011.

28. WHO. Monitoring, evaluation and review of national health strategies. 2011.

29. SUSESO: Publicaciones—Boletines estadísticos [Internet]. [cited 11 Jul 2018]. Available: http://www.suseso.cl/607/w3-propertyvalue-10362.html

30. Bases de datos Nacimientos—DEIS [Internet]. [cited 11 Jul 2018]. Available: http://www.deis.cl/bases-de-datos-nacimientos/

31. Cabieses B, Cookson R, Espinoza M, Santorelli G, Delgado I. Did socioeconomic inequality in self-reported health in chile fall after the equity-based healthcare reform of 2005? A concentration index decomposition analysis. PLoS One. 2015;10. doi: 10.1371/journal.pone.0138227 26418354

32. Ministerio de Desarrollo Social. Metodología de Diseño Muestral Encuesta de Caracterización Socioeconómica Nacional 2013. 2013.

33. Ministerio de Desarrollo Social [Internet]. Available: http://observatorio.ministeriodesarrollosocial.gob.cl/casen-multidimensional/casen/basedatos.php

34. Alkire S. The missing dimensions of poverty data: Introduction to the special issue. Oxford Dev Stud. 2007;35: 347–359. doi: 10.1080/13600810701701863

35. Ministerio de Desarrollo Social, Observatorio Social. Nueva Metodología de Medición de la Pobreza por Ingresos y Multidimensional [Internet]. 2015. Available: http://observatorio.ministeriodesarrollosocial.gob.cl/documentos/Nueva_Metodologia_de_Medicion_de_Pobreza.pdf

36. Public Health Ontario. Summary Measures of Socioeconomic Inequalities in Health. Toronto, ON: Queen’s Printer for Ontario; 2013.

37. Benach J, Malmusi D, Yasui Y, Martinez JM. A new typology of policies to tackle health inequalities and scenarios of impact based on Rose ‘ s population approach. J Epidemiol Community Heal. 2012;67: 286–91. doi: 10.1136/jech-2011-200363

38. Benach J, Malmusi D, Yasui Y, Martı M, Muntaner C. Beyond Rose’s strategies: a typology of scenarios of policy impact on population health and health inequalities. Int J Heal Serv. 2011;41: 1–9. doi: 10.2190/HS.41.1.a 21319717

39. López MJ, Marí-Dell ‘olmo M, Pérez-Giménez A, Nebot M. Diseños evaluativos en salud pública: aspectos metodológicos Evaluative designs in public health: methodological considerations. Gac Sanit. 2011;25: 9–16. doi: 10.1016/S0213-9111(11)70003-6 22055546