Unintended Perinatal Health Consequences Associated With a Swedish Family Policy

Area of Science:

• Public Health
• Health Policy
• Reproductive Health

Background:

• Swedish "speed premium" policies in 1980 and 1986 aimed to protect parental leave benefits for shorter birth intervals.
• These policies may have indirectly encouraged shorter birth spacing and older maternal age, known risk factors for adverse perinatal outcomes.

Purpose of the Study:

• To evaluate the association between the 1980 and 1986 Swedish speed premium policies and perinatal health outcomes.

Main Methods:

• Cross-sectional study using Swedish Medical Birth Register data from 1974-1991 (1,762,784 singleton births).
• Interrupted time series analysis with segmented logistic regression to assess odds of preterm birth, low birth weight, small for gestational age (SGA) at preterm, and stillbirth.
• Subgroup analyses were conducted by maternal origin.

Main Results:

• The 1980 policy was associated with a 0.3% monthly increase in preterm birth odds (OR, 1.0029).
• Following the 1986 policy relaxation, preterm birth odds decreased by 0.5% monthly (OR, 0.9951).
• Low birth weight followed a similar pattern; SGA at preterm decreased post-1980, while stillbirths showed no significant change. Changes were primarily observed in births to Swedish- and Nordic-born mothers.

Conclusions:

• The speed premium policies, despite economic benefits, were associated with adverse perinatal health outcomes, notably preterm births.
• Family policies require careful design, considering potential unintended consequences on fertility behaviors and perinatal health.
• A "Health in All Policies" approach is recommended for family policy development.