Our Lack of Paid Leave Is a Public Health Crisis

Studies show having time off to recover, without worrying about money, is key to maternal and infant health, and so much more.

A woman in a head wrap holds a baby in a towel.
Photo illustration by Natalie Matthews-Ramo/Slate. Photo by Andrae Ricketts on Unsplash and Thinkstock.

“My experience of having a child was so destabilizing,” says Clarissa Doutherd, now the executive director of Parent Voices Oakland. “As a new mom running my own business, paid leave was not an option. The pressure to immediately go back to work, for survival, moved to the center, instead of caretaking for my son and ensuring he was healthy.”

Within months of her son’s birth, Doutherd’s independent bookkeeping business had folded and she found herself without a home or stable employment, and with a sick baby. “I couldn’t just bond with my child and I couldn’t take time and enjoy him. It was very isolating. He had many health issues in those early years, and I have no doubt my stress, and inability to be with him was a factor.”

The birth of a child should be filled with excitement and the natural worries that come with caring for a newborn. But for too many families in the United States, this time is weighed by heavy economic burdens. After delivery, parents are torn between providing the best care for their child versus earning money to keep a roof over their head and food on the table. Mothers push through postpartum pain and ignore doctors’ recommendations by returning to work too early. An investigation featured in In These Times found that about 25 percent of women in the U.S. return to work within 10 days of delivery, a time when they are still literally bleeding.

It’s not like this in other countries. Of the 193 countries in the United Nations, the U.S. is one of two (along with Papua New Guinea) that does not provide paid leave for mothers. Brazil provides 17 weeks. Norway provides 25 weeks. The United Kingdom provides 52 weeks—a full year.

Mounting evidence shows the social and economic benefits of paid leave. Paid leave increases women’s labor participation and boosts overall gross domestic product. And paid leave is an urgent health issue. It carries many public health benefits for moms and children, including reducing postpartum depression and improving breastfeeding initiation and duration. Paid leave is an urgent health issue.

In California, where paid leave has been in place since 2004, the duration of breastfeeding doubled for new parents who took leave. According to 1,000 Days, an advocacy organization to ensure women and children have the healthiest first 1,000 days, “exclusive breastfeeding provides babies the perfect nutrition and everything they need for healthy growth and brain development.” The Centers for Disease Control and Prevention reports that breastfeeding reduces risk of obesity, Type 2 diabetes, asthma, and infections in children and protects against ovarian and breast cancer, Type 2 diabetes, and heart disease in women. Breastfeeding not only improves health, it saves money. And, a 2016 study estimated, the U.S. would save $17.2 billion in costs associated with medical expenses and premature deaths, if mothers were able to meet the recommendation to exclusively breastfeed for six months.

And there are benefits to mental health as well. “An adequate paid maternity leave policy would lead to both better mental health outcomes in children and fewer instances of postpartum depression,” according to Erica Komisar, psychoanalyst, parent guidance expert, and author of Being There: Why Prioritizing Motherhood in the First Three Years Matters. “A maternity leave that facilitates a mother’s presence in the early years can have an enormous impact in protecting her children from developing long-term social and emotional disorders.” Komisar argues that maternity leave could be “a preventive measure which might offset massive mental health costs.”  

But the benefits of paid leave are not limited to moms. When dads and nongestational parents take paid leave, evidence shows the whole family benefits. A Swedish study found infants whose fathers did not take paternity leave were less likely to be breastfed at 2,4, and 6 months of age. Longer paternity leave means dads have more time to bond with their child and share household chores and child care, like changing diapers, feedings, and getting up at night. This increased engagement leads to improved health and developmental outcomes for children.

Research shows that paid leave can literally save lives. A 2000 study analyzing data from 16 European countries found that, “a 10-week increase in paid leave is predicted to reduce infant mortality rates by between 2.5% and 3.4%.” These benefits should come as no surprise, because when parents have paid leave, they are more likely to ensure children get timely vaccinations, pediatric visits, and better management of chronic conditions.

Despite the public health benefits of paid leave, and the economic savings it brings for businesses, families, and society, only about 14 percent of U.S. workers currently have access to paid leave. For these reasons, the U.S. needs a national equitable paid leave policy. Equitable means not just any paid leave policy, but job-protected leave with adequate time off, wage replacement that allows low-wage workers to take leave (so they don’t just receive a fraction of their already low income on leave), broad employee eligibility criteria, and a gender-neutral, expansive definition of family.

A prominent argument against paid leave in the U.S. is that paid leave is bad for business, but the evidence shows exactly the opposite. Leave policies have negligible costs and, in fact, benefit businesses both large and small. Businesses gain from increased productivity, employee satisfaction, and employee retention thereby avoiding the sizable cost of finding and training new employees. A survey of California’s employers found that 87 percent reported no cost increase associated with the state’s paid leave program and 9 percent reported cost savings due to reduced turnover and benefit costs.

At the Make Family Leave Not Suck Policy Summit at the MIT Media Lab this weekend, we are hosting more than 60 thought leaders to discuss what policies it would take to ensure all families have access to equitable paid leave. In the process, we are centering traditionally marginalized voices and ideas of low-wage workers and parents of color, who are so often left out of developing solutions to problems that affect them most of all, but also inventors of creative policy solutions.

This is exactly what motivated Doutherd to lead Parent Voices Oakland, a grass-roots organization dedicated to economic and educational justice for families. “In a country with so many resources, I found it unbelievable that there was nearly zero support for a family like mine.” she says. “My experiences have motivated me to organize other parents to advocate for smart policymaking that provides support for children and parents universally.”