Relationship of Paternity Status and Infant Mortality Before and After Welfare Reform

BACKGROUND: The 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) streamlined paternity establishment and reporting and introduced strong child support and enforcement laws. OBJECTIVE: To examine the effects of paternity status on infant mortality (IM) before (1993-1998) and after (1999-2004) PRWORA implementation. METHODS: Analysis of linked birth/infant death singleton data (N= 130,004) from the City of Milwaukee, WI from 1993 to 2004. Models were estimated using logistic regression and adjusted for important covariates (e.g., demographics, smoking, maternal conditions, gestation age). Paternity status measures included unmarried with paternity statement (UPS), court-established paternity (UCEP), no father on record (UNFR), and married with father on record (MFR). RESULTS: Percent of births decreased among UNFR, but increased among UPS and UCEP between pre and post years. Unmarried black women with NFR had 51% lower adjusted odds of IM in pre (OR 0.49 [0.33-0.72]) but not post-PRWORA period. Between the two periods, the likelihood of IM decreased by 11% and 18% among UPS and UCEP, respectively. Prenatal smoking and gestational diabetes were significantly associated with increased IM during post but not PRWORA period. CONCLUSIONS: Findings suggest that establishment of paternity had a protective effect against IM before and after PRWORA. However, IM was significantly lower for unmarried black women with NFR before but not after PRWORA. IMPLICATIONS: Policies and programs that promote paternity establishment and paternal involvement (e.g. fatherhood initiatives, job training, and child support) may help reduce IM. A better understanding of paternal factors and specific welfare changes that influenced IM is needed.