Paid family leave

Evidence Rating  
Scientifically Supported
Evidence rating: Scientifically Supported

Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.

Health Factors  
Decision Makers

Paid family leave (PFL) provides employees with paid time off for circumstances such as a recent birth or adoption, a parent or spouse with a serious medical condition, or a sick child. Some employers allow the use of other paid time off, such as sick leave, for these purposes rather than designating family leave; some employers also offer maternity and paternity leave. PFL may be provided by employers or via state-level programs. State programs vary in the amount of benefit and maximum length of leave provided, and whether leave is job protected1. PFL is distinct from the federal Family and Medical Leave Act (FMLA), which provides eligible employees with at least 12 work weeks of job-protected leave without pay2.

Expected Beneficial Outcomes (Rated)

  • Increased labor force participation

  • Increased use of parental leave

  • Improved health outcomes

Other Potential Beneficial Outcomes

  • Improved mental health

  • Increased preventive care

  • Increased breastfeeding rates

  • Improved birth outcomes

  • Reduced infant mortality

  • Improved well-being

  • Improved economic security

Evidence of Effectiveness

There is strong evidence that short-term paid family leave (PFL) policies in the US increase the likelihood that mothers remain in the labor force after child birth3, 4, 5, particularly mothers without bachelor’s degrees4. PFL improves child and family health outcomes6, 7, 8, 9, 10. It also increases use of parental leave to recover and care for children after birth3, 6, 11, particularly for mothers with lower levels of education and mothers who are black or Hispanic5.

Paid maternity leave appears to reduce the likelihood of low birthweight babies and pre-term birth12. Expansion of paid maternity and parental leave can increase breastfeeding initiation and duration9, 13, 14, 15. Employed mothers who have a longer delay returning to work after giving birth may experience fewer depressive symptoms than those who return to work earlier9, 10. Taking paid maternity leave may also decrease the risk of re-hospitalization for mothers and infants, and increase mothers’ exercise levels and improve their stress management7.

An analysis of California’s statewide PFL program indicates children born after program implementation have better health outcomes in elementary school, particularly those from less advantaged backgrounds, than children born prior to program introduction8. Another study of the program suggests it may reduce nursing home use among the elderly16.

Paid leave can improve child6, 17 and family health and well-being, and contribute to greater family economic security17. Such leave is associated with improved mental health in those caring for family members with special health care needs18. Access to paid leave can increase the likelihood of parents taking leave when their children have health problems15, 19, especially in families with children with special health care needs20. Paid parental leave may also increase access to immunizations and other preventive care15, and may reduce child abuse21.

Early assessments of statewide paid leave policies in California and New Jersey suggest little impact on employers6 and increased hiring and mobility among young women22, but also potential for small decreases in employment and hiring1 and increased unemployment among young women23. Studies of leave in other countries suggest that leaves shorter than one year appear to increase employment but longer leave times decrease mothers’ wages and employment in the long-term6.

Individuals with the lowest incomes may take shorter leaves7, 24 and be less likely to take any leave than parents with higher incomes7, 25. Studies of California’s PFL program suggest fathers of infants are more likely to take leave when PFL is available26, though fathers may be less likely to take their full leave than mothers25.

In other developed nations, access to paid, job-protected parental leave has been shown to reduce infant and child mortality27, 28, with longer durations resulting in greater reductions in death among infants and young children29.

Impact on Disparities

Likely to decrease disparities

Implementation Examples

Legislation guarantees paid leave for eligible employees in California, New Jersey, New York, and Rhode Island and several cities across the country, including New York City and San Francisco30, 31. Washington state and Washington DC’s programs will go into effect in 202030, and the program in Massachusetts will begin paying leave benefits in 202132. State legislation pre-empts local laws related to leave in 13 states33.

Five states (California, New Jersey, New York, Rhode Island, and Hawaii) also provide paid maternity leave through state-level Temporary Disability Insurance programs34.

The US is the only OECD country that does not provide paid parental leave35.

Implementation Resources

NCSL-PFL resources - National Conference of State Legislatures (NCSL). Paid family leave resources.

NCSL-State leave laws - National Conference of State Legislatures (NCSL). State family medical leave laws.

CA EDD-Family leave - State of California Employment Development Department (EDD). Paid family leave.

NJ LWD-Family leave - State of New Jersey Department of Labor and Workforce Development (LWD). Family leave insurance.

RI TDI-Paid leave - Rhode Island Temporary Disability Program (RI TDI). RI paid leave.

LAW-Resources - Legal Aid at Work (LAW). Work & family. San Francisco, CA.


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1 Urban-Isaacs 2017 - Isaacs J, Healy O, Peters HE. Paid family leave in the United States: Time for a new national policy. Washington, DC: The Urban Institute; 2017.

2 US DOL-FMLA - US Department of Labor (US DOL). Family and Medical Leave Act (FMLA).

3 Baum 2016* - Baum CL, Ruhm CJ. The effects of paid family leave in California on labor market outcomes. Journal of Policy Analysis and Management. 2016;35(2):333-356.

4 Byker 2016* - Byker TS. Paid parental leave laws in the United States: Does short-duration leave affect women’s labor-force attachment? American Economic Review. 2016;106(5):242-246.

5 Rossin-Slater 2013* - Rossin-Slater M, Ruhm C, Waldfogel J. The effects of California’s paid family leave program on mothers' leave-taking and subsequent labor market outcomes. Journal of Policy Analysis and Management. 2013;32(2):224-45.

6 Rossin-Slater 2018* - Rossin-Slater M. Maternity and family leave policy. In: Averett SL, Argys LM, Hoffman SD, ed. The Oxford Handbook of Women and the Economy. New York: Oxford University Press; 2018.

7 Jou 2018* - Jou J, Kozhimannil KB, Abraham JM, Blewett LA, McGovern PM. Paid maternity leave in the United States: Associations with maternal and infant health. Maternal and Child Health Journal. 2018;22(2):216-225.

8 Lichtman-Sadot 2017* - Lichtman-Sadot S, Bell NP. Child health in elementary school following California’s paid family leave program. Journal of Policy Analysis and Management. 2017;36(4):790-827.

9 Borrell 2014* - Borrell C, Palencia L, Muntaner C, et al. Influence of macrosocial policies on women's health and gender inequalities in health. Epidemiologic Reviews. 2014;36(1):31-48.

10 Chatterji 2012* - Chatterji P, Markowitz S. Family leave after childbirth and the mental health of new mothers. Journal of Mental Health Policy and Economics. 2012;15(2):61-76.

11 McGovern 2000* - McGovern P, Dowd B, Gjerdingen D, et al. The determinants of time off work after childbirth. Journal of Health Politics, Policy and Law. 2000;25(3):527-64.

12 Stearns 2015* - Stearns J. The effects of paid maternity leave: Evidence from Temporary Disability Insurance. Journal of Health Economics. 2015;43:85-102.

13 Mirkovic 2016* - Mirkovic KR, Perrine CG, Scanlon KS. Paid maternity leave and breastfeeding outcomes. Birth. 2016;43(3):233-239.

14 Huang 2015c* - Huang R, Yang M. Paid maternity leave and breastfeeding practice before and after California’s implementation of the nation’s first paid family leave program. Economics & Human Biology. 2015;16:45-59.

15 Heymann 2013* - Heymann J, Earle A, McNeill K. The impact of labor policies on the health of young children in the context of economic globalization. Annual Review of Public Health. 2013;34:355-72.

16 Arora 2018 - Arora K, Wolf DA. Does paid family leave reduce nursing home use? The California experience. Journal of Policy Analysis and Management. 2018;37(1):38-62.

17 Schuster 2009 - Schuster MA, Chung PJ, Elliott MN, et al. Perceived effects of leave from work and the role of paid leave among parents of children with special health care needs. American Journal of Public Health. 2009;99(4):698-705.

18 Earle 2011 - Earle A, Heymann J. Protecting the health of employees caring for family members with special health care needs. Social Science & Medicine. 2011;73(1):68-78.

19 Heymann 1999 - Heymann SJ, Toomey S, Furstenberg F. Working parents: What factors are involved in their ability to take time off from work when their children are sick? Archives of Pediatrics and Adolescent Medicine. 1999;153(8):870-74.

20 Chung 2007 - Chung PJ, Garfield CF, Elliott MN, et al. Need for and use of family leave among parents of children with special health care needs. Pediatrics. 2007;119(5):e1047-55.

21 Klevens 2016* - Klevens J, Luo F, Xu L, Peterson C, Latzman NE. Paid family leave’s effect on hospital admissions for pediatric abusive head trauma. Injury Prevention. 2016;22(6):442-445.

22 Curtis 2016* - Curtis EM, Hirsch BT, Schroeder MC. Evaluating workplace mandates with flows versus stocks: An application to California paid family leave. Southern Economic Journal. 2016;83(2):501-26.

23 Das 2015* - Das T, Polachek SW. Unanticipated effects of California’s paid family leave program. Contemporary Economic Policy. 2015;33(4):619-635.

24 Evans 2007 - Evans PM. Comparative perspectives on changes to Canada’s paid parental leave: Implications for class and gender. International Journal of Social Welfare. 2007;16(2):119-28.

25 Bana 2018 - Bana S, Bedard K, Rossin-Slater M. Trends and disparities in leave use under California’s paid family leave program: New evidence from administrative data. AEA Papers and Proceedings. 2018;108:388-391.

26 Bartel 2018 - Bartel AP, Rossin-Slater M, Ruhm CJ, Stearns J, Waldfogel J. Paid family leave, fathers’ leave-taking, and leave-sharing in dual-earner households. Journal of Policy Analysis and Management. 2018;37(1):10-37.

27 Heymann 2011 - Heymann J, Raub A, Earle A. Creating and using new data sources to analyze the relationship between social policy and global health: The case of maternal leave. Public Health Reports. 2011;126(Suppl 3):127-34.

28 Tanaka 2005* - Tanaka S. Parental leave and child health across OECD countries. Economic Journal. 2005;115(501):F7-F28.

29 Ruhm 2000* - Ruhm CJ. Parental leave and child health. Journal of Health Economics. 2000;19(6):931-60.

30 NCSL-PFL resources - National Conference of State Legislatures (NCSL). Paid family leave resources.

31 LAW-Resources - Legal Aid at Work (LAW). Work & family. San Francisco, CA.

32 MA-Leave - Commonwealth of Massachusetts. Massachusetts law about employment leave.

33 Grassroots Change - Grassroots Change: Connecting for better health. Preemption Watch.

34 NPWF-TDI - National Partnership for Women & Families (NPWF). Existing Temporary Disability Insurance (TDI) Programs. 2015.

35 Adema 2016* - Adema W, Clarke C, Frey V. Paid parental leave and other supports for parents with young children: The United States in international comparison. International Social Security Review. 2016;69(2):29-51.

Date Last Updated