Paid family leave

There is strong evidence that short-term paid family leave (PFL) policies in the U.S. increase the likelihood that mothers remain in the labor force after childbirth (Baum 2016, Byker 2016, Rossin-Slater 2013), particularly mothers without bachelor’s degrees (Byker 2016). PFL improves child and family health outcomes (Rossin-Slater 2018, Jou 2018, Lichtman-Sadot 2017, Stearns 2015, Borrell 2014, Chatterji 2012). It also increases use of parental leave to recover and care for children after birth (Rossin-Slater 2018, Baum 2016, McGovern 2000), particularly for mothers with lower levels of education and mothers who are Black or Hispanic (Rossin-Slater 2013).

Paid family or maternity leave appears to reduce the likelihood of low birthweight births and pre-term birth (Stearns 2015), particularly among unmarried mothers and Black mothers (Stearns 2015), and can increase use of postpartum care, particularly for women of color (Steenland 2021). Expansion of paid maternity and parental leave can increase breastfeeding initiation and duration (Hamilton-Byker 2021, Mirkovic 2016, Huang 2015c, Borrell 2014, Heymann 2013), though its effects may be concentrated in those already most likely to breastfeed, such as married, higher income, and older mothers (Hamad 2019a). However, one study of New York State’s paid family leave program suggests it may increase breastfeeding rates among Black women (Dennison 2022). Access to paid family leave may improve mothers’ mental health (Bullinger 2019, Jou 2018), and those mothers who have a longer delay returning to work after giving birth may experience fewer depressive symptoms than those who return to work earlier (Borrell 2014, Chatterji 2012). Taking paid maternity leave may also decrease the risk of hospitalization for mothers (Jou 2018) and infants (Pihl 2019, Jou 2018), and may increase mothers’ exercise levels. International evidence suggests PFL may improve mental and physical health outcomes for mothers when fathers are able to take leave as well (NBER-Persson 2019).

Paid leave can improve child (Rossin-Slater 2018, Schuster 2009) and family health and well-being, and contribute to greater family economic security (Schuster 2009). An analysis of California’s statewide PFL program indicates children born after the program was implemented have better health outcomes in elementary school, particularly children from less advantaged backgrounds, than children born prior to program introduction (Lichtman-Sadot 2017). PFL is associated with improved mental health in those caring for family members with special health care needs (Earle 2011) and may reduce nursing home use among the elderly (Arora 2018). Access to paid leave can increase the likelihood of parents taking leave when their children have health problems (Heymann 2013, Heymann 1999), especially in families with children with special health care needs (Chung 2007). Paid parental leave may also increase access to immunizations and other preventive care (Choudhury 2021, Heymann 2013), and may reduce child abuse (Klevens 2016).

Early assessments of statewide paid leave programs in California and New Jersey suggest little impact on employers (Rossin-Slater 2018, Bedard 2016) and such programs may decrease turnover (Bedard 2016). Programs may increase labor force participation (Das 2015), hiring, and mobility among young women (Curtis 2016), but also have potential for small decreases in employment and hiring (Urban-Isaacs 2017) and some increased unemployment, perhaps due to firms shifting hiring away from young women to men and older women (Das 2015). Higher benefit levels may increase individuals’ leave duration as well as the likelihood that they are employed one year after taking leave (Bedard 2016). International evidence from OECD countries suggests paid leave, in combination with other supportive programs including child care, increases women’s labor force participation (Adema 2016). Leaves shorter than one year may increase women’s employment rates for several years after childbirth, though leaves longer than a year may harm women’s employment, earnings and career advancement (Rossin-Slater 2018). Similarly, in other high-income countries, access to paid, job-protected parental leave has been shown to increase infant and child health (Nandi 2019) and reduce infant and child mortality (Nandi 2019, Heymann 2011, Tanaka 2005), with longer leave durations resulting in greater reductions in death among infants and young children (Ruhm 2000).

While PFL can increase men taking leave (Bartel 2018, Bedard 2016, Baum 2016), particularly job protected leave (CLASP-Goldman 2020), fathers appear to be less likely to take their full leave than mothers (Dennison 2022a, Bana 2018, Bedard 2016). International evidence from OECD countries suggests that gender neutral paid parental leave does not appear to increase leave for new fathers but paid paternal leave with high wage replacement rates does (Nandi 2019).

Evidence related to the use of PFL to care for older adults is limited, but one study of California’s PFL suggests it may increase employment among female caregivers 45-54 with earnings just above the poverty line and those with higher education levels. however, it does not appear to increase employment among those with lower levels of education and who live below the poverty line, perhaps because the wage replacement rate is too low. PFL alone may not mitigate the stress of ongoing and multiple care duties (Kang 2019).

Barriers to taking paid family leave include lack of awareness of the program, misconceptions about whether a worker qualifies, the complexity of the application process, lack of job protection, employers discouraging leave-taking or providing incorrect information, insufficient benefit levels, insufficient flexibility for intermittent leave (for caregivers of older individuals), and lack of enforcement of leave-taking rights (Urban-Peters 2021).

Experts suggest that the U.S. create a publicly-administered paid leave program with a progressive benefit structure and inclusive coverage, with additional policies supporting workers’ access to leave and public education and community engagement on the program, in addition to child care policy reform (Gates 2020). Leave benefits should include caregiving for older adults (Gates 2020, Chen 2016).

Paid family leave has the potential to decrease disparities in women’s economic conditions and health outcomes (Nandi 2019, Bullinger 2019, Jou 2018, Baum 2016, Borrell 2014, Chatterji 2012, Schuster 2009), particularly for mothers with low incomes (Stanczyk 2019), women of color (Steenland 2021, Stearns 2015, Rossin-Slater 2013), and those with less education, (Stanczyk 2019, Byker 2016). Creating a comprehensive national paid family leave policy is also a suggested strategy to reduce disparities in income, health, and access to leave for workers across racial and economic groups (Urban-Boyens 2022a, Hamilton-Byker 2021, CLASP-Maye 2021, CLASP-Gupta 2020, Montez 2020a, Urban-Jacobs 2020, Chen 2016, Jou 2018).

Paid family leave used following a birth may reduce poverty and increase income for mothers, particularly single mothers with lower incomes and less education (Stanczyk 2019), and can increase return to work after having a child rather than dropping out of the labor force (Baum 2016), particularly among women with less education (Byker 2016). State PFL programs can increase use of leave after having a child, especially among women with less education, women of color, (Rossin-Slater 2013) and women with lower incomes (Dennison 2022a) and may close the gap in amount of leave taken between Black and white mothers (Rossin-Slater 2013). PFL can help create workplace cultures that are more female-friendly by increasing the number of women in leadership (NBER-Bennett 2020).

Paid family leave has the potential to increase gender equity by increasing men’s participation at home (Montez 2020a), but so far women are more likely to take PFL (Hamilton-Byker 2021) and fathers are less likely to take their full leave allotment (Dennison 2022a, Bana 2018, Bedard 2016), which could exacerbate the earnings gap between genders (Hamilton-Byker 2021). International evidence indicates availability of PFL increases the use of leave for both men & women (Bedard 2016).

In New York State, men and women with lower incomes were more likely to take PFL when the state-wide program was introduced, perhaps due to lack of paid leave from their employers. Employees of color and those with lower incomes were more likely to take the full 8 weeks of PFL available, possibly due to the high costs of child care upon returning to work (Dennison 2022a).

Current programs have room for improvement. D.C.’s program saw uneven take up rates in its first 18 months, with equal numbers of whites and Blacks making claims, despite Blacks being the largest group in D.C., and higher rates of denials in majority Black wards (CLASP-Baldino 2022). In California, workers with the lowest earnings may take shorter leaves (Bedard 2016) and are also the least likely to take any leave (Bana 2018), and the program may not be generous enough to benefit caregivers of older adults living below the poverty line and those with lower levels of education (Kang 2019). More general evidence from the U.S. and Canada on maternity and parental leave suggests individuals with the lowest incomes may take shorter leaves (Jou 2018, Evans 2007) and be less likely to take any leave than parents with higher incomes (Bana 2018, Jou 2018).

Black women and lower- and middle-income women are less likely to take maternity leave, paid or unpaid (Jou 2018). Black and Latina women are also more likely to be providing high intensity caregiving for parents (Estrada 2022) due to higher rates of chronic disease and an increased likelihood of living in multigenerational households (Montez 2020a), and as such have more negative health, economic/financial, and employment consequences due to providing uncompensated care. These conditions perpetuate a cycle of disadvantage among families historically prevented from building generational wealth by structurally racist policies and practices (Estrada 2022). During the COVID-19 pandemic, workers from groups marginalized in U.S. society were more likely to miss work, and to go without pay due to the lack of paid leave, including workers with low incomes, people of color, women, and families with children. Additionally, women were disproportionately responsible for child care and other family obligations, and their absences were the least likely to be paid. The lack of universal paid leave combined with the COVID-19 pandemic compounded economic and health disparities between families with high incomes and most other families (Urban-Boyens 2022a).

The Family and Medical Leave Act (FMLA) provides unpaid, job protected leave, but unpaid leave does not appear to provide the same potential health and economic benefits as paid leave. Evidence from FMLA suggests unpaid maternity leave may actually increase disparities, as its benefits are concentrated among those who can afford to take it (Nandi 2019).

To create more equitable paid family leave, experts suggest programs include job protection (Urban-Boyens 2022a, CLASP-Goldman 2020, NPWF 2018), anti-discrimination and anti-retaliation provisions (NPWF 2018), progressive wage replacement (Urban-Boyens 2022a, NPWF 2018), and at least 12 weeks of leave (NPWF 2018). Programs should cover part-time and gig workers, include all firms no matter their size, and have broad coverage and eligibility requirements (Urban-Boyens 2022a). Programs should also tie paid leave to the worker and their work and earnings history, rather than a specific job or employer (NPWF 2018) and should include education and outreach about the program and benefits, and enforcement provisions (CLASP-Maye 2021, NPWF 2018). A permanent federal program could also include clauses to expand reasons for leave (such as child care) and length of leave in case of future public health emergencies such as that presented by the COVID-19 pandemic (Urban-Boyens 2022a). For example, California and Rhode Island could immediately provide coverage to workers, before federal emergency paid leave programs began (Urban-Boyens 2020).

Programs that built the U.S. middle class excluded families of color, limiting their ability to build wealth through homeownership and access to banking institutions, and programs lowering the cost of college (NPWF 2018). State marginalization of Black workers also meant they were largely excluded from social welfare programs (Rodems 2016). Today, workers of color are generally paid less and are more likely to be in low-wage jobs that don’t offer benefits such as leave (NPWF 2018). Black and Hispanic women specifically are less likely to hold jobs with paid leave due to occupational segregation and previous policy choices benefiting workers who are salaried or in professional fields (Goodman 2021). All this leaves workers of color particularly vulnerable when needing leave, with little in the way of savings or assets to rely on if leave is unpaid (NPWF 2018).

Legislative origins for paid family leave in the U.S. started with paid maternity leave, which first began in the 1978 Pregnancy Discrimination Act, which prohibited discrimination related to pregnancy and childbirth (OAH-Sholar 2016) and provided wage replacement through temporary disability insurance. This policy increased labor force participation among pregnant women and women with young children (Bhatt 2015). In the mid-1980s, bills were introduced to provide unpaid, job-protected leave, but these were not enacted. Opponents successfully pushed for companies with fewer than 15 employees to be excluded and reduced the unpaid leave available from 44 weeks per year to 36 weeks over a two-year period. Advocates for retirees successfully expanded leave eligibility to include caring for a spouse or elderly parent. Congress passed the Family and Medical Leave Act (FMLA) in 1990 and 1992, but it was vetoed both times by President George H.W. Bush, who did not support requiring businesses to provide paid leave (OAH-Sholar 2016). In 1993, the FMLA was signed into law by President Bill Clinton. It allows for 12 weeks of unpaid leave per year and does not cover all workers (NPWF 2018). Limited expansions to FMLA since 1993 include coverage for spouses in same-sex marriages.

Approximately 60 percent of low wage workers do not qualify for FMLA, including many women, people of color, single parents, and part time workers (CLASP-Maye 2021). Women of color have less access to leave than white women and are generally paid less even when they do have leave (Goodman 2021). Households of color are also more likely to be multi-generational, entailing additional care burdens (NPWF 2018) and Black women have higher rates of pregnancy complications and mortality, making their lack of access to paid parental leave particularly concerning.

Discriminatory policies and systems have resulted in a low-wage work force largely made up of women, people of color, and immigrants (Brookings-Ross 2019). Workers with the greatest needs have the lowest access to paid leave (Urban-Boyens 2022): low wage workers (Hamilton-Byker 2021, CLASP-Maye 2021a, Brookings-Sawhill 2019), women (Brookings-Sawhill 2019), people of color (Urban-Boyens 2022, CLASP-Baldino 2022, Hamilton-Byker 2021), part time workers (Brookings-Sawhill 2019), and single parents (Hamilton-Byker 2021) are significantly less likely to have access to paid family leave, and structural and historic racial inequities in U.S. economic systems mean that Black, Hispanic, Native American, and Pacific Islander workers are significantly less likely to have access to any leave (Joshi 2020). Most of these workers cannot take necessary leave due to being unable to afford lost wages (Hamilton-Byker 2021, CLASP-Maye 2021, Joshi 2020). Those without paid leave are more likely to be uninsured, have trouble paying bills such as rent and utilities, and have unmet medical needs (Urban-Boyens 2022). Only 23 percent of private-sector workers have access to PFL (US BLS-PFL 2021), and only 6 percent of low wage workers do (US BLS-TED PFL 2022).

The lack of supportive policies in the U.S., including paid family leave, has negative impacts on caregivers, most often women. Such impacts include reduced labor force participation and harms to economic well-being, including the ability to build wealth, advance a career, own a home, and save for retirement, which is associated with worse physical and mental health (Urban-Peters 2021). While gender differences in access to paid leave may be attributable to women’s higher likelihood of working in part time jobs (Brookings-Sawhill 2019), this occupational segregation may be due to previous systematic efforts to “protect women” through their exclusion from large swathes of the workforce (Bhatt 2015). Caregiving has traditionally fallen to women, limiting their ability to work and advance in careers. These barriers continue for working women today (Montez 2020a), with women giving up paid work to provide informal care for children or other family members (Kang 2019), a pattern exacerbated during the COVID-19 pandemic when school closures and family care needs led over 800,000 women to leave the labor force within 6 months (CLASP-Gupta 2020). Lack of leave likely increases vulnerability (Gates 2020) alongside the U.S. child care crisis, limited publicly-funded pre-K, and removal of reproductive rights (NPR-Treisman 2022).

In recent decades, local paid sick leave laws have been a subject of state-level policy preemption. Lawmakers have used state-level preemptions as a tool of structural racism, preventing the expansion of local policies that could reduce racial inequality (Melton-Fant 2022). However, state or federal preemption can be used to protect and expand local policies that reduce health inequities, as in the case of civil rights laws (Carr 2020).

Some states offer greater unpaid leave than the FMLA or versions of paid leave, with 50-100% of wage replacement. The 12 weeks allowed under the FMLA fails to meet the International Labor Organization’s recommended standard for maternity protection, which is 14 weeks of leave for new mothers with at least two-thirds of wage replacement (ILO-Addati 2014). The U.S. remains the only OECD nation without a national paid family leave policy (Glass 2016, OAH-Sholar 2016).

Many countries in the global North and South had enacted national paid maternity leave policies by 1925 (Son 2021). Parental leave policies are designed to reduce financial and opportunity costs of parenthood and work-family conflict which threatens parents’ emotional and financial well-being (Glass 2016). A study of OECD countries finds that a stronger package of national policies supporting working parents, specifically paid leave and work flexibility, is associated with greater emotional well-being among parents (Glass 2016). Lack of investment in children and parents leaves the United States falling behind the rest of the OECD based on social and economic indicators (Adema 2016).

• Who doesn’t have access to paid family leave in your community? Are there specific groups or industries that are most in need but lacking access?
• How do preemption laws impact your ability to implement paid family leave?
• Who is opposed to paid family leave expansion and what is at the root of that opposition? What role can public health play in (re)framing the discussion?
• What community partners can assist in efforts to expand paid family leave? Is there a history of labor organizing or labor partners in your community who could be involved?
• If you have paid leave laws in place, do the laws include job protection? Are all types of workers eligible? Are different industries or business sizes exempt from participating?

Legislation guarantees paid leave for eligible employees in California, Connecticut, Massachusetts, New Jersey, New York, Rhode Island, Washington, and Washington, D.C. (NCSL-State leave laws, NPWF 2018, ABB-US PFL laws). Paid family leave laws have also been passed in Oregon, Colorado, Delaware, and Maryland (NCSL-State leave laws) and will begin paying benefits over the next several years: Oregon in 2023 (OR-PL), Colorado in 2023 (CO-FAMLI), and Delaware and Maryland in 2023 (DE-PL, LWP-MA leave). Georgia, New Hampshire, and South Carolina offer paid parental leave to state employees (NCSL-State leave laws). The U.S. is the only OECD country that does not provide paid parental leave (Adema 2016). As of 2019, state legislation pre-empts local laws requiring employers to provide paid family leave in Alabama, Arkansas, Florida, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, and Wisconsin (EPI-Preemption).

‡ Resources with a focus on equity.

ABB-US PFL laws - A Better Balance (ABB). Comparative chart of paid family and medical leave laws in the United States. 2022.

AIC-PFL - All-In Cities, an Initiative of PolicyLink. All-In Cities Policy Toolkit: Paid family leave (PFL).

BPC-PFL 2022 - Bipartisan Policy Center (BPC). State paid family leave laws across the U.S. 2022.

CLASP-Baldino 2022^‡ - Baldino N, Perez R. Early lessons from DC’s paid leave program. Washington, D.C.: Center for Law and Social Policy (CLASP); 2022.

FVW-Paid leave resources and toolkit - Family Values @ Work (FVW). Guides and resources.

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NCSL-State leave laws - National Conference of State Legislatures (NCSL). State family medical leave laws.

* Journal subscription may be required for access.

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NCSL-State leave laws - National Conference of State Legislatures (NCSL). State family medical leave laws.

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