Minimum wages and maternal health in the U.S.

Project Summary/Abstract The United States is experiencing a maternal health crisis, with high rates of severe maternal morbidity (SMM) and other pregnancy-related health problems and rising rates of pre-pregnancy health conditions. Furthermore, a legacy of structural racism and discrimination has led to substantial and persistent racial disparities in SMM and other adverse maternal health outcomes. In addition to the health impact on women, maternal morbidity imposes substantial cost burdens on families and society. Social determinants of health play a significant role in maternal health, with economically disadvantaged women having lower access to care, increased exposure to health risks, and poorer health outcomes before and during pregnancy. Yet there is very limited understanding of whether economic policies aimed at increasing incomes of families can be part of an effective strategy for improving maternal health and reducing disparities. Researchers have estimated that implementing a $15 federal minimum wage (MW) by 2025, as is currently being debated in Congress, would increase the earnings of 32 million workers and lift nearly four million people out of poverty. Because they are overrepresented among lower wage workers, women and people of color could disproportionately benefit. This study examines the role of the MW as a potentially powerful tool for addressing the maternal health crisis in the U.S. In lieu of any federal MW changes since 2009, many states have taken the lead in implementing their own MW increases, with 30 states having higher MW rates than the 2019 federal rate, compared to only 10 in 2010. Although these changes are likely consequential for lower-income and minority women, there is scant evidence on how the MW affects their reproductive and maternal health. Moreover, as the labor market impacts of MW are not uniform across populations, assessing potential heterogeneity is critical for quantifying effects on maternal health disparities. The overall objective of this project is to assess how state MW policies affect maternal health, as well potentially important intermediate outcomes that may lie on the causal pathway. Our multidisciplinary team will leverage recent methodological advances in the quasi-experimental evaluation of staggered policy interventions to estimate causal effects of MW increases on SMM and other pregnancy- related outcomes. We will also explore important outcomes that represent potential intermediary mechanisms linking MW to maternal morbidity outcomes, including changes in household income and employment, health care coverage, health care utilization, health behaviors, and pre-pregnancy health outcomes. Finally, we will examine how the MW affects health care costs associated with pregnancy and delivery. Throughout, we will explore potential heterogeneous effects to better understand how MWs affect health disparities. This research addresses a critically important and potentially very impactful policy-relevant question that has significant implications for mothers, their children, and their families.