Paid Family Leave Policies and Population Health

A crying employee of Walmart who has personal problems, stands outside store.

Available evidence suggests that the introduction of paid family leave for up to one year may yield child and maternal health benefits in the short and long run.


What's the Issue?

A large body of evidence documents that the early life environment affects people’s health and economic outcomes throughout the life cycle. Coupled with the fact that the United States has relatively poor infant health ratings, particularly for preterm births and infant mortality, this research suggests that early childhood interventions may be beneficial for population health and the economy as a whole. One such intervention is paid family leave (PFL), which allows workers to take time off to care for newborn children or ill family members.

  • The United States has no federal PFL legislation. The 1993 Family and Medical Leave Act provides unpaid leave, but only about 60 percent of private-sector workers are eligible, and of those, 46 percent report struggling to afford unpaid time off.
  • The United States is the only one of the 35 Organization for Economic Cooperation and Development (OECD) countries that does not offer paid leave to new mothers, and one of the eight OECD countries that do not provide paid leave to fathers. 
  • 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 from it.
  • Studies on PFL in the United States and other developed countries indicate short- and long-term health benefits of leave taking for children and mothers, such as a decreased incidence of low birth weight and preterm births, increased breast-feeding, reduced rates of hospitalizations among infants, and improved maternal health.
  • Research on PFL in Canada and Europe suggests decreasing marginal health benefits from increasing paid leave entitlements beyond 6–12 months.

This brief outlines the PFL policy landscape in the United States and the ways in which PFL may affect population health. It discusses empirical research on the effects of PFL on child and parental health, both in the United States and in other countries. It concludes by exploring the policy implications of this research and commenting on additional research that is needed to better understand the health effects of PFL.

What's Next?

Despite the wealth of existing research on PFL, important knowledge gaps remain. First, we know little about the health effects of PFL on parents—especially fathers. Second, nearly all of the current research focuses on leave surrounding the birth of a child. There is almost no evidence on how leave taken to care for an ill family member affects population health. Third, more research is needed to understand how PFL legislation affects 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 benefit packages, hiring practices, or other aspects of jobs.

Finally, there is little evidence of the health effects of specific PFL features—the length of leave, the level of wage replacement, or whether employees get job protection while on leave. One study shows that a higher weekly benefit amount for CA-PFL did not increase leave duration, but might promote job continuity and future program participation (or paid leave taking) among high-earning mothers. Similar research on the health effects of different leave features might help inform PFL policy structure. This type of research may be possible as the newly enacted state PFL laws take effect in the coming years or as additional states pass their own PFL programs.


As coronavirus spreads, the bill for our public health failures is due

Richard Besser, MD, president and CEO of RWJF and former acting director of the CDC, pens an Op-Ed in The Washington Post on the health equity issues raised by the Coronavirus, such as paid leave.

Read the Op-Ed