Health before pregnancy and eligibility for parental leave benefits: a Swedish total population cohort study

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.