Family support policies and child outcomes: a realist-scoping review^*

* Our research was conducted at the St. Michael’s Hospital, Centre for Research on Inner City Health.

ABSTRACT

Family support policies (FSP) refer to government policies that promote the well-being of families with children (e.g. job-protected paid leave, cash transfers, childcare). We developed an initial conceptual and theoretical framework of FSP and conducted a realist-scoping review to document the state of evidence regarding the influence of FSP on three child outcomes: poverty, development, and health. Based on the contexts and mechanisms through which FSP are hypothesized to affect child outcomes, we constructed a framework to guide a search of five electronic databases (OVID, ProQuest, PubMed, Scopus, and Web of Knowledge). We analysed articles meeting our inclusion criteria (i.e. conceptualized FSP as a function of the welfare state; conceptualized child poverty, development, and health as outcomes; and conducted empirical analyses) in relation to our mechanisms and thematic concerns (context, developmental periods, and differential impacts). A total of 22 studies met our inclusion criteria, which tested 25 independent child outcomes. Our findings identified initial mechanisms that explain the relationship between FSP and child outcomes through (1) increasing parents’ basic capabilities, (2) shaping parents’ childcare options, and (3) influencing parental leave-taking and shifting beliefs about gender relationships in the home and workplace. Future work will be to test these mechanisms and framework through a realist synthesis.

RESUMEN

Las políticas de apoyo a la familia (PAF) se refieren a las políticas gubernamentales que promueven el bienestar de las familias con niños (por ejemplo, bajas pagadas con protección del empleo, transferencias de dinero, guardería). Se desarrolló un marco conceptual y teórico inicial de las PAF y se realizó una revisión realista del alcance para documentar el estado de la evidencia con respecto a la influencia de las PAF en tres variables resultado relacionadas con los niños: pobreza, desarrollo y salud. Basado en los contextos y mecanismos por los cuales las PAF pueden teóricamente afectar los resultados de los niños, se construyó un marco para guiar la búsqueda en cinco bases de datos (OVID, ProQuest, PubMed, Scopus i Web of Knowledge). Se analizaron los artículos que cumplieron nuestros criterios de inclusión (por ejemplo, conceptualización de las PAF en función del estado del bienestar; conceptualización de la pobreza infantil, desarrollo y salud como variables resultado; y que fueran estudios empíricos) en relación a nuestros mecanismos y temática de interés (contexto, periodo de desarrollo e impacto diferencial). Un total de 22 estudios cumplieron nuestros criterios de inclusión, que facilitaron 26 variables de resultados relacionadas con niños independientes. Nuestros resultados identificaron mecanismos iniciales que explicaron la relación entre PAF y las variables resultado relacionadas con los niños a través de (1) aumentar las capacidades básicas de los padres, (2) la conformación de las opciones de cuidado infantil y (3) influenciar en la toma del permiso de paternidad y cambiar las creencias sobre las relaciones de género en casa y en el lugar de trabajo. Futuros estudios tendrán que probar este marco y mecanismos a través de una síntesis realista.

KEYWORDS:

• Family support policy
• child poverty
• child development
• child health
• realism

PALABRAS CLAVE:

• Políticas de apoyo a la familia
• pobreza infantil
• desarrollo infantil
• salud infantil
• realismo

Disclosure statement

No potential conflict of interest was reported by the authors.

The views expressed in this article are the views of the authors and do not necessarily reflect the views of the Ontario Ministry of Health and Long-Term Care.

Notes on contributors

Edwin Ng is an Assistant Professor in the School of Social Work at Renison University College, University of Waterloo. Prior to Renison, he was an ACHIEVE Post-Doctoral Fellow at the Centre for Research on Inner City Health, St. Michael’s Hospital. Edwin earned his BSW and MSW degrees from the Universities of Windsor and Toronto, respectively. He completed his Ph.D. in Social Science and Health in the Dalla Lana School of Public Health, University of Toronto. His primary research integrates political economy and public health. Specifically, his work focuses on how population health and health inequalities are generated and reproduced through democratic politics, social protection policies, and social class relations.

Mireia Julià is Ph.D. researcher at Health Inequalities Research Group (GREDS-EMCONET) at the University Pompeu Fabra (Barcelona, Spain) with a Master in Occupational Health. Her research mainly focuses on social determinants of health, particularly on employment conditions like precarious and informal employment, and health inequalities.

Dr Muntaner has conducted extensive research on health inequalities, relying mostly on primary data collection studies with a focus on work organization and health. Dr Muntaner’s research agenda encompasses evaluation research on employment conditions and health services inequities in Europe, North America, and Latin America.

Dr Patricia O’Campo is Professor of Epidemiology at the Dalla Lana School of Public Health Sciences at the University of Toronto and an adjunct Professor at the Johns Hopkins Bloomberg School of Public Health and holds the Chair of Intersectoral Solutions to Urban Health Problems. Dr O’Campo’s work often focuses on upstream determinants of health, quantifying the impacts of structural issues and social programmes, and working to propose concrete solutions. By repeatedly demonstrating strong connections between social conditions and health, Dr O’Campo is helping to lay the evidence base for and shift the discourse towards big picture solutions to widespread health problems. Over the last two decades she has conducted a number of longitudinal studies and programme evaluations in a variety of areas including mental health, intimate partner violence, children’s well-being, HIV prevention, infant mortality prevention, and homelessness.

Notes

* Our research was conducted at the St. Michael’s Hospital, Centre for Research on Inner City Health.

1. Three policy instruments characterize FSP: in-cash, in-kind, and in-time supports. In-cash supports can made directly (e.g. tax-free monthly payments or paid time off) or indirectly (e.g. tax breaks). In-kind supports include family services such as childcare. In-time supports are accomplished through measures like job-protected leave (e.g. maternity, paternity, and parental leave entitlements).

Additional information

Funding

This research was supported in part by the European Community’s Seventh Framework Programme (FP7/2007–2013) to the SOPHIE Project (Evaluating the Impact of Structural Policies on Health Inequalities and their Social Determinants and Fostering Change) [grant number 278173]. At the time of this study, EN was a Post-Doctoral ACHIEVE Fellow at the Centre for Research on Inner City Health, St. Michael’s Hospital, Toronto, ON. The authors gratefully acknowledge the support of the Canadian Institute for Health Research [grant number 96566], and the Ontario Ministry of Health and Long-Term Care, and the research assistance of Farihah Ali, Aysha Butt, Lauri Kokkinen, and Christiane Mitchell.