Improving Access to Paid Family Leave to Achieve Health Equity

How the United States can advance health equity by guaranteeing all people have access to paid family leave.

A family on a city street.

The United States is the only country among 41 higher-income nations that does not guarantee any paid leave for new parents or to care for a sick family member.


This issue brief provides background on federal and state paid family leave (PFL) policies, highlights domestic and international research that shows PFL provides a range of benefits, and lays out principles for a universal paid family leave program.

Unpaid leave and employer-provided paid leave are available to some workers but are generally less accessible to workers in low-wage jobs and workers of color. Employer-provided paid family leave is more prevalent among high-paying, professional occupations and within large companies.

Thirty-four percent of U.S. workers in the highest wage brackets have access to paid family leave through their employers, compared to 7 percent of workers in the lowest wage bracket and 6 percent of service workers. This leaves approximately 100 million people, or 80 percent of U.S. workers, without paid time off after birth or adoption.


Key Findings

A growing body of research demonstrates that paid family leave has short- and long-term health benefits:

Principles for a Paid Family Leave Program for All

Despite the overwhelming benefits of paid family leave, most workers in the United States lack access. No one should be forced to choose between taking care of their family when they need it most or securing a paycheck. Giving all children a healthy start to life should include PFL for all workers and should take into account the following principles:

  • Leave should be universally accessible, not tethered to a zip code or where workers are employed.
  • Eligibility should extend to independent contractors, gig workers, or employees of any size business.
  • Broad eligibility for paid family leave, including: new baby/adoption/foster; care for a family member with a serious health condition; a worker’s own serious health condition; partner in active-duty military, or a survivor of domestic violence.
  •  The definition of ‘family’ should be broad, including: a child, parent or parent of a spouse or domestic partner, spouse, domestic partner, grandparent, grandchild, sibling, or an individual with whom the covered individual has a significant personal bond that is or is like a family relationship, regardless of biological or legal relationship.
  • Like Social Security, a program should be attached to the worker, not the employer.
  • The program offers at least 12 weeks, and ideally up to 24 weeks, of leave.
  • Wage replacement rates should be progressive (meaning workers in low-wage jobs get a higher percentage of their wages covered) and regularly adjusted for inflation.
  • Participants receive full job protection.
  • The program provides a streamlined application and claims process. Funds are available for awareness and outreach to key groups that underutilize leave benefits and to businesses to help them comply. Legal advocates and workers’ rights organizations work in tandem with administering agencies to highlight and address noncompliance among businesses and, as needed, take legal actions.  

Federal Policy Recommendations to Advance Health Equity from RWJF

A series of policy briefs include evidence-based recommendations to help people through the immediate health and economic crises and longer-term recommendations to ensure a fair and just opportunity to be as healthy as possible.

Related Resources

Paid leave and child care are fundamental to recovery—One step to ensuring the U.S. economy and families will recover from this crisis and thrive is guaranteeing paid leave and access to quality, affordable child care.

COVID recovery requires addressing economic inequities—To become a society in which health prospers, we need to move from a mindset of health being simply about the choices we make as individuals, to a recognition that health is about the communities in which we live and the policies that shape the living conditions in those places.

National Partnership for Women and Families’ Resources on Paid Leave—Background on federal and state paid family leave policies and proposals, as well as research on paid family leave.

Urban Institute’s Research on Paid Family, Medical, and Sick Leave—A collection of research on paid family leave from the Urban Institute.