Qualitative Paid Leave Report 2020: Furthering Our Case for Paid Leave in the United States

Photos submitted anonymously by study participants.

The Report

Our latest report is based on a study we commissioned to examine how lack of paid leave affects the well-being of new mothers and their babies, particularly women working in low-wage jobs, and to amplify the experiences of low-wage working mothers in their own words. By interviewing and surveying 20 women in five states that did not require workers to have access to paid leave, we learned about how mothers navigate the experiences, demands and joys of motherhood.

Overall, the participants in the study grappled with the following experiences:

Navigating work schedules, including leave and flex time policies.

How the women perceived that work was impacting both mothers’ and babies’ nutrition and feeding, health care and childcare.

• Changes in the women's original plans of working (both during their last trimester of pregnancy and postpartum), and why these changes occurred.

• The impacts these changes had on the women and their families.

This report is complementary to our 2019 report, The First 1,000 Days: The Case for Paid Leave in America. It adds human voices and experiences to a vital policy issue. Examining 20 case studies, this report unearthed moving stories that are representative of the trends we discovered in our 2019 report.

Download the report here.

Brianna's Story

Watch Brianna, one of the study participants, talk about her experience of navigating pregnancy and having her first baby without access to paid leave.

Why we are making the case for paid leave (especially now)

1,000 Days works to improve and advocate for the health of mothers and children during the 1,000-day window from pregnancy to age two. We believe all children deserve a healthy first 1,000 days and the opportunity to achieve their full potential. Through our advocacy work, we articulate the benefits of paid family and medical leave in the United States.

The COVID-19 pandemic has underscored the need for paid leave and the disparities in who has access to it. Many essential workers are also low-wage workers, which means they have less access to affordable, quality health care. Many of these workers are unable to take paid time off from their job, and in the age of a viral pandemic, that threatens public health and community well-being.

A lack of paid leave for low-wage working women causes disruptions in women’s connections to the labor force and their employer, often leading to financial hardships and career disruptions. Paid leave allows parents, particularly women (as the primary caretaker), to avoid having to choose between caring for their families and preserving or gaining financial stability. Making paid leave broadly available is especially helpful for minority women, those with lower education attainment and unmarried women to be able to afford to take the leave they need while working in jobs that do not offer more benefits (e.g., paid time off/sick days/vacation days).

Paid leave is the biggest obstacle to working women in the U.S. in the 1000-day window.

For many women and children in the United States, a healthy first 1,000 days is out of reach. The U.S. is one of the only countries in the world that does not guarantee paid leave to new parents, and, consequently, the U.S. has one of the highest rates of infant mortality of all advanced economies, with more than 22,000 babies dying before their first birthday. The 1,000 days between a woman’s pregnancy and her child’s second birth is a time of tremendous potential and enormous vulnerability. Paid leave is imperative for the health of moms and babies, societies and communities.

Because the U.S. does not have a national paid family and medical leave policy to allow workers to care for themselves during pregnancy or postpartum or to bond with a newborn in early stages of infancy, it too often falls on employers to make these determinations. Most women in our sample reported having postpartum needs, like a change in schedule or time off, taking time to pump, and more frequent breaks, that impacted their work. Lack of paid leave for low-wage working women causes disruptions in women’s connections to the labor force and their employer, leading to financial hardships and career disruptions.

Almost a third of the mothers in our sample reported that employers were not understanding of all their postpartum needs, most commonly needing more time off.

Paid leave can reduce racial and ethnic health disparities in the U.S.

Being pregnant and giving birth are fraught with risk for women of color. Women of color have a higher risk of maternal morbidity and mortality. Black infants are more than twice as likely to die before their first birthday as non-Hispanic white infants, and American Indian and Alaska Native infants are nearly twice as likely to die as those who are non-Hispanic white. What’s more, Black women are dying from pregnancy-related causes at more than three times the rate of white women, and American Indian and Alaska Native women are dying at 2.5 times the rate. Both study participants who reported they did not receive high-quality care are women of color, which is in line with prior research related to disparities in receiving health care.

Inclusive and comprehensive paid family leave policies can reduce the inequities in access to paid leave, helping to bridge the racial and ethnic disparities in overall maternal and child health outcomes. Financial worry tops the list for low-wage mothers concerned about work and taking leave time to have and care for their baby. Some of the mothers in our study said their timeline for returning to work was driven by the financial stress of lack of paid maternity leave.

Mothers from racial and ethnic minority groups, as well as mothers with lower educational attainment or mothers who are unmarried, are less likely to take unpaid leave because in many cases they cannot afford it. No one should have to choose between their health and their paycheck.

Moms shouldn’t have to be superheroes.

Women need time off from work to care for their newborns, establish breastfeeding, develop strong emotional bonds with their babies, attend medical appointments and adjust to their new caregiving responsibilities. Just as importantly, women also need time to let their bodies heal and recover from childbirth – especially if they had a C-section or medically complicated birth.

Returning to work too soon after delivery can stress a woman’s body and impede her healing process, whereas access to paid leave can help facilitate recovery. A study from Australia found that the country’s universal paid parental leave program (18 weeks of leave at the minimum wage rate) benefited women who were economically disadvantaged.

All but one of the mothers in our study needed to take unpaid time off postpartum. The mother who didn't take unpaid leave returned to work the day after giving birth.

Paid leave saves lives.

The Centers for Disease Control estimates that 700 women die every year in the U.S. from pregnancy-related complications. Pregnancy complications can affect the mother’s health, the baby’s health or both, and even healthy women can experience complications.

Paid leave has the potential to play an especially critical role for the parents of babies born prematurely and those in the neonatal intensive care unit, whose development and health are shown to improve with parental presence. A study of leave-taking in the U.S. found at 21 months postpartum, infants had a 47 percent reduction in re-hospitalization when mothers took paid maternity leave.

Providing 12 weeks of paid leave in the U.S. could result in nearly 600 fewer infant deaths per year.

Brittany's Story

Watch Brittany, one of the study participants, talk about the financial burden not having paid leave was for her and her family.

What can you do to make paid leave a public health imperative?

Take Action. Tell your representatives that we need paid leave for all women and children in their first 1,000 days.

Tell your Story. Share your paid leave story and amplify the voices of women lacking paid leave by reposting their stories. Remember to tag us on Facebook (@1000Days) and Instagram (@first1000days).

Donate to our Cause. Your donations enable us to continue our advocacy work and fight for moms, babies and families in the critical 1,000-day window.

State Sheets on Paid Leave

The links below take you to state sheets for each state included in our study:






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Visit us at thousanddays.org to learn more.