Will it ever change? Lack of parental leave and its detrimental effects on maternal well-being

Days before beginning the second post-graduate year of my psychiatry residency, I learned I was pregnant with my first child. I assumed I would have sufficient paid family leave the same way I wrongly assumed most women in America did. Instead, I was dismayed to learn the unfortunate truth that paid family leave is under no national regulations and all but non-existent for most of the country (in 2021, only 23% of civilian employees in the US were eligible for paid family leave).¹ Even the laws on unpaid leave do not apply to a large portion of the population.

Other than a few Pacific Island nations, the United States and Papua New Guinea are the only countries without a paid maternity leave policy.² It wasn’t until the Family and Medical Leave Act (FMLA) of 1993 that US employees had any legally protected time off for medical or family reasons. FMLA mandated that employers provide their employees unpaid leave of up to 12 weeks and guaranteed that they could not be terminated during this time.³ Although a step in the right direction, FMLA has failed to cast a wide enough net. To qualify you must work 25+ hours per week for a company with 50+ employees for at least one year.³ These requirements exclude 40% of the American workforce.⁴ Some states have passed their own paid leave laws rather than waiting for the Federal Government to enact a policy. Eight states (CA, CT, MA, NJ, NY, RI, VA, and WA) and Washington D.C. have active paid family medical leave laws.⁵ Additionally, five states (CO, DE, MD, NH, and OR) have programs set to take effect in 2023–2026.⁵ Of the active programs, six provide 12 weeks of parental leave, one provides eight weeks, and one provides five weeks.⁵

The vast majority of US residents (82%) support paid maternity leave in concept.⁶ Paid family leave also enjoys broad support across party lines with 80% of Democrats and 73% of Republicans in favour.⁴ If most US citizens and a bipartisan coalition support it, why has universal paid family leave not yet occurred? The question is: Who will pay? Most who support paid family leave believe employers should bear the cost, about 12% believe the federal government should pay, and about 10% argue it should be paid by the state governments.⁶ Of the previously mentioned states with paid leave legislation, employees pay the premium in five of the programs (CA, CT, NJ, NY, and RI) and only Washington D.C.’s program requires the employer to pay the premium.⁵ The rest have a percentage of the premium covered by the employer and the remainder by the employee.⁵

While the cost of a paid leave program is a legitimate concern, more concerning should be the direct and indirect costs of not implementing a policy. We know that paid maternity leave is associated with economic growth and lower employee turnover. But, even more important than this, are the effects of paid maternity leave on mothers and children.

The literature is absolutely clear—paid maternity leave overwhelmingly benefits the mental and physical health of mothers and their children in the short run and over their lifetimes. Paid maternity leave is associated with lower rates of postpartum depression (PPD),⁷ a well-documented cause of mothers’ disability and even suicide, with potentially devastating effects on their children. Having a depressed, dysfunctional, or deceased mother is an adverse childhood experience, which we now know will negatively influence a child’s physical and mental health over a lifetime whether it is recognized or not. Women who take any duration of paid leave are also less likely to be re-hospitalized in the year after giving birth and are nearly twice as likely to successfully manage stress.⁷ There is a correlation between increased duration of paid leave and decreased infant and child mortality including decreased re-hospitalization of infants in the first year and increased compliance with the medical advice of paediatricians and adherence to the recommended immunization schedule.⁷ Paid maternity leave also increases the likelihood of breastfeeding for the recommended six months which has a litany of proven health benefits to both mother and child.⁷ Despite all of this, one in four new mothers return to work within two weeks of giving birth because, financially, they have no choice.⁴

We should all be outraged by the negative effects of the lack of paid leave on the well-being of families, peers, patients, the community, and our society at large. This topic has been discussed in our country for decades, but it is particularly timely now. The US is in the midst of a maternal mortality crisis and a year out from Roe v Wade being overturned. Even prior to the overturn of Roe v Wade, states advocating for the most restrictions on abortion insisted that they intended to step forward to provide additional support for pregnant women, especially those with unplanned pregnancies, for example, by expanding Medicaid. Yet, there has been very little discussion about revisiting policies on paid maternity leave and no national progress made. If our nation’s children are truly the priority, there should be serious momentum behind finally passing a national paid maternity leave policy. More women, especially those with fewer resources, will be becoming mothers, whether they want to or not, and they need all the support we can give them. Working mothers in our country don’t just want paid maternity leave, we, including myself, need it. Our children need it. Our families need it. Our country needs it. This is where the legislative energy should be going. Thirty years of no national progress is unacceptable; now is the time.

Declaration of interests

None to declare.