The United States is the only country in the 35-member Organization for Economic Cooperation and Development that offers no paid leave to new mothers. The U.S. also has relatively poor infant health ratings, particularly for preterm births and infant mortality.

So why has the federal government been so reluctant to join other industrialized nations in paying new mothers to stay at home so they can nurture and nourish these new citizens?

“There’s opposition from business interests arguing that any type of mandate on employers imposes too large costs, especially for small businesses,” said Stanford Health Policy’s Maya Rossin-Slater. “There’s not much empirical evidence supporting this argument, but I think the strong political opposition from business supporters may be a central reason for a lack of action on the federal level.”

In a policy brief published March 28 in Health Affairs, Rossin-Slater, an assistant professor of health research and policy, lays out the evidence that suggests the introduction of paid family leave (PFL) for up to one year in duration may yield significant child and maternal health benefits, both in the short and long term. Her co-author on the brief is Lindsey Uniat, a predoctoral research fellow at the Stanford Institute for Economic Policy Research.

“Existing research suggests that when leave is paid, take-up rates are higher among low-income and disadvantaged families than when it is unpaid, which enables more families to benefit,” they wrote.

Some of the short- and long-term health benefits include decreased incidence of low birthweight and preterm births, increased breast-feeding, reduced rates of hospitalizations among infants and improved maternal health.

Family and Medical Leave Act

The federal Family and Medical Leave Act (FMLA) of 1993 provides 12 weeks of unpaid, job-protected leave with continued health insurance coverage to attend to a newborn or adopted child, a family member, or an employee’s own serious health condition. There are strict eligibility requirements for the FMLA, such as needing to have worked at least 1,250 hours for an employer with 50 or more employees during the 12 months before the start of the leave.

The most recent data, according to the authors, indicate that only about 60 percent of private-sector workers are eligible for FMLA, and 46 percent of those eligible report not being able to afford taking unpaid time off work.

Six states and the District of Columbia have passed paid family leave policies, and the issue has been receiving attention at both state and federal levels in recent years. California, Hawaii, New Jersey, New York and Rhode Island, as well as Puerto Rico, have State Disability Insurance (SDI), which provides partial wage-replaced leave for workers with temporary disabilities and for mothers preparing for and recovering from childbirth. These policies offer up to six weeks of leave postpartum for vaginal deliveries and eight weeks for C-section deliveries.

“The majority of existing research on the health effects of PFL focuses on children’s outcomes,” the authors write. Earlier work on the impacts of unpaid leave provided through the FMLA shows that it led to small increases in birthweight and large reductions in infant mortality rates.

However, these health benefits were apparent only for children of relatively advantaged mothers, the authors wrote, which is consistent with prior evidence that such mothers were most likely to be eligible for, and able to afford to use, unpaid leave.

“In contrast, mothers and children from less advantaged backgrounds particularly benefit from access to paid leave,” they said, noting that one study showed that the introduction of paid maternity leave through the SDI system in five states led to a reduction in the share of low birthweight and preterm births, especially for unmarried and black mothers.

Rossin-Slater and Uniat believe paid family leave may affect population health through multiple channels:

• Children of parents who take leave may receive more parental care, breast-feeding and immunizations if parents are able to stay home longer after birth;
• Child health may improve from the extra resources that parents get form PFL benefits, such as more nutritious food;
• Infant and long-term health outcomes may improve if PFL access lowers maternal stress during pregnancy, perhaps due to increased financial and job security;
• Taking time off from work without the financial strain may improve the parental bond with the infant — leading to long-term health benefits for the child.

The Labor Market

Finally, existing research indicates that paid family leave may benefit the labor market by leading to fewer high-school dropouts, thus an increase in children’s future wages.

“Several policy takeaways are evidence from the research to date,” the authors wrote. “Paid leave, in contrast to unpaid leave, increases leave usage and duration, especially among disadvantaged parents who are least able to afford unpaid time off.”

More research is needed, they said, to understand how paid family leave legislation could impact employers.

“We know little about how employers deal with work interruptions due to employees’ taking leave or whether employers respond to PFL mandates by changing their own benefits packages, hiring practices, or other aspects of jobs,” they said.