Improving Access to Paid Family Leave to Achieve Health Equity
Note: This brief was originally published in May 2021 and released again in February 2023 to include the latest research related to paid family leave and to update the number of states passing and implementing policy related to paid family leave.
The United States is the only country among 41 higher-income nations that does not guarantee any paid leave for new parents or to care for a sick family member.
This issue brief provides background on federal and state paid family leave (PFL) policies, highlights domestic and international research that shows PFL provides a range of benefits, and lays out principles for a universal paid family leave program.
Unpaid leave and employer-provided paid leave are available to some workers but are generally less accessible to workers in low-wage jobs and workers of color. Employer-provided paid family leave is more prevalent among high-paying, professional occupations and within large companies.
Thirty-four percent of U.S. workers in the highest wage brackets have access to paid family leave through their employers, compared to 7 percent of workers in the lowest wage bracket and 6 percent of service workers. This leaves approximately 100 million people, or 80 percent of U.S. workers, without paid time off after birth or adoption.
Key Findings
A growing body of research demonstrates that paid family leave has short- and long-term health benefits:
- Increases the use of parental leave to recover and care for children after childbirth, particularly for mothers with lower levels of education and who are Black or Hispanic.
- Gives parents more time for bonding with a new child, which is key to healthy child development.
- Increases overall breastfeeding duration by nearly 18 days. (Breastfeeding protects against allergies, asthma, sickness, and obesity.)
- Improves rates of on-time vaccinations, with the strongest impact on families below the poverty line.
- Reduces infant hospitalizations and lowers infant mortality rates, particularly in households with lower income.
- Leads to fewer low-birthweight and small-for-gestational-age births, especially for Black mothers.
- Increases parity in the duration of maternity leave taken between White women and women of color.
- Reduces rates of food insecurity in the year following a birth, especially for households with very low food security, which are disproportionately Black or Latinx.
- Improves the physical and mental health of new mothers, with the strongest impacts on single mothers and mothers with lower incomes, who are disproportionately women of color.
- Short-term PFL increases the likelihood that mothers will remain in the labor force after childbirth.
- Paid time off nearly closed the gap in workforce participation between mothers with young children and women without minor children.
- Many employers report that PFL policies level the competitive playing field, especially for smaller employers who are recruiting skilled workers.
Principles for a Paid Family Leave Program for All
Despite the overwhelming benefits of paid family leave, most workers in the United States lack access. No one should be forced to choose between taking care of their family when they need it most or securing a paycheck. Giving all children a healthy start to life should include PFL for all workers and should take into account the following principles:
- Leave should be universally accessible, not tethered to a zip code or where workers are employed.
- Eligibility should extend to independent contractors, gig workers, or employees of any size business.
- Broad eligibility for paid family leave, including: new baby/adoption/foster; care for a family member with a serious health condition; a worker’s own serious health condition; partner in active-duty military, or a survivor of domestic violence.
- The definition of ‘family’ should be broad, including: a child, parent or parent of a spouse or domestic partner, spouse, domestic partner, grandparent, grandchild, sibling, or an individual with whom the covered individual has a significant personal bond that is or is like a family relationship, regardless of biological or legal relationship.
- Like Social Security, a program should be attached to the worker, not the employer.
- The program offers at least 12 weeks, and ideally up to 24 weeks, of leave.
- Wage replacement rates should be progressive (meaning workers in low-wage jobs get a higher percentage of their wages covered) and regularly adjusted for inflation.
- Participants receive full job protection.
- The program provides a streamlined application and claims process. Funds are available for awareness and outreach to key groups that underutilize leave benefits and to businesses to help them comply. Legal advocates and workers’ rights organizations work in tandem with administering agencies to highlight and address noncompliance among businesses and, as needed, take legal actions.
Here's one federal mandate all Americans can love: Workers need paid family leave
The benefits of paid family leave are clear, but 80 percent of U.S. workers don’t have access to it. That means after having a baby, adopting a child, falling ill, or needing to care for a sick parent or child, most people living in America can’t take time off work without risking their income or their health. In an op-ed for USA Today, RWJF Vice President for Policy Avenel Joseph says it’s time to create a policy that reflects the needs of a modern workforce. Universal paid family leave could be the needed change that benefits both the employee and employer while also creating a healthier and more equitable society.
Related Content
Federal Policy Recommendations to Advance Health Equity from the Robert Wood Johnson Foundation
A series of policy briefs include evidence-based recommendations to help people through the immediate health and economic crises and longer-term recommendations to ensure a fair and just opportunity to be as healthy as possible.
1-min read
Child and Family Wellbeing
1-min read
Normalizing Men as Caregivers Helps Families and Society
7-min read