The evidence for the impact of paid family leave in the United States reveals that the policy improves a variety of child and family outcomes, but the research only represents a few states. Only California, New Jersey, and Rhode Island have family leave laws that were in effect before 2018, and the causal studies in this review examine only those three states. Other states with paid family leave programs have not implemented them for a sufficient period to study the impacts in a rigorous way. As a result, the majority of reviewed studies assess the efficacy of a paid family leave policy of 6 weeks, corresponding to the duration of California’s paid family leave policy between 2004 and 2020.
Although most countries outside of the United States have implemented paid family leave and many international studies have found positive impacts, the effects of those laws must be considered within the broader context of universal child care, universal health care, and child allowances in some countries.43 Due to these systemic policy differences, examining laws within the US is the best basis for building evidence on the policy’s effectiveness for families in this country.
The research discussed here meets our standards of evidence for being methodologically strong and allowing for causal inference, unless otherwise noted. Each strong causal study reviewed has been assigned a letter, and a complete list of causal studies can be found at the end of this review, along with more details about our standards of evidence and review method. The findings from each strong causal study reviewed align with one of our eight policy goals from Table 1. The Evidence of Effectiveness table displays the findings associated with paid family leave (beneficial, null,iii or detrimental) for each of the strong studies (A through Z) in the causal studies reference list. For each indicator, a study is categorized based on findings for the overall study population; subgroup findings are discussed in the narrative. The Evidence of Effectiveness table also includes our conclusions about the overall impact on each studied policy goal. The assessment of the overall impact for each studied policy goal weighs the timing of publication and relative strength of each study, as well as the size and direction of all measured indicators.
Of the 26 causal studies included in this review, 6 examined how outcomes differed by race or ethnicity (beyond simply presenting summary statistics or controlling for race/ethnicity). Where available, this review presents the analyses’ causal findings for by race and ethnicity. A rigorous evaluation of a policy’s effectiveness should consider whether the policy has equitable impacts and should assess the extent to which a policy reduces or exacerbates pre-existing disparities in economic and social wellbeing.
Table 2: Evidence of Effectiveness for Paid Family Leave by Policy Goal
|Policy Goal||Indicator||Beneficial Impacts||Null Impacts||Detrimental Impacts||Overall Impact on Goal|
|Access to Needed Services||Leave-Taking||B, N, R, W||Positive|
|Receipt of Postpartum Care||Z|
|Parents’ Ability to Work||Labor Force Participation||D, F, Q||Mostly Positive|
|Average Weekly Work Hours||B, N|
|Employment||B, D||N, O||A, F|
|Attachment to Pre-Birth Employer||B, O||A|
|Sufficient Household Resources||Household Income||M||N||Mixed|
|Annual Wage Earnings||A|
|Risk of Poverty||M|
|Reduced Reliance on Public Assistance||V|
|Healthy and Equitable Births||Preterm Births||S||Trending* Null|
|Parental Health and Emotional Wellbeing||Self-Rated Health||P||Positive|
|Maternal Mental Health||C|
|Paternal Mental Health||C|
|Coping With Demands of Parenting||C|
|Psychological Distress||P, T|
|Nurturing and Responsive Child-Parent Relationships||Mothers’ Time Spent With Children on Reading, Outings, Meals||A||C||Mixed|
|Optimal Child Health and Development||Breastfeeding||G, H, K, U||Positive|
|Timely Infant Vaccinations||E|
|School-Aged Child Health||J|
|Allergies (Food and Respiratory)||C|
|Abusive Head Trauma||I|
*Trending indicates that the evidence is from fewer than two strong causal studies or multiple studies that include only one location, author, or data set.
Access to Needed Services
Paid family leave policies lead to increased leave-taking and improved access to postpartum care. Research from California found that the implementation of paid family leave was associated with mothers and fathers taking longer leave and both parents taking leave simultaneously.B,N,R One study found that the policy increased the likelihood of maternal leave-taking by 3.6 percentage pointsN and another study found that leave-taking increased by 5 weeks for mothers, but only 2 or 3 days for fathers.B A separate study found that the policy increased the probability of fathers taking leave by 46 percent, but fathers were still taking only an average of 1.5 weeks out of the 6 weeks that were available at that time in California.R The study noted that mothers took an average of 9 weeks out of the 12 paid weeks available through both Temporary Disability Insurance and paid family leave at that time.R
Research suggests that the effect on leave-taking may be greater for unmarried women and Black women than other groups; one study found that the probability of taking family leave increased by 10.6 percentage points for unmarried mothers and 14. 4 percentage points for Black mothers.N White mothers, meanwhile, saw a statistically insignificant 3 percentage point increase from a rate of 11 percent prior to the policy. However, more research on leave-taking effects by subgroup would be valuable to corroborate these findings, which had fairly large standard errors.
Although the policy has increased the uptake of maternity leave, a policy brief from the University of California at Davis reported that only between 25 and 40 percent of eligible mothers in California took advantage of paid leave benefits approximately 10 years after implementation.31 The study also found that “median earnings of leave takers are an estimated $10,000 higher than the median income for all working women in California” (p. 1).31 Although some of this difference may be attributed to a differential likelihood of eligibility based on income, research also suggests that awareness of eligibility is low: A 2011 study found that only half of eligible adults reported they knew about California’s paid family leave, with lower-wage earners least likely to know about it.6
A 2020 study of San Francisco’s paid leave ordinance corroborated this finding.W The study examined take-up of paid leave in San Francisco compared to surrounding areas in California after San Francisco implemented an expansion to California’s paid leave policy, bringing reimbursement for private sector employees to 100 percent of wages. The authors found that the policy was linked to a 13 percent increase in leave-taking for fathers, but no significant increase for mothers. They noted that 89 percent of women in the sample were already taking about 12 weeks of leave through paid leave and Temporary Disability Insurance, and the ordinance may not have had a significant effect due to low awareness. For example, a survey associated with the study found that less than 2 percent of low-income mothers had accurate information about the new policy. The study found that 61.6 percent of non-Medicaid covered women employed in San Francisco knew about the policy, compared to just 9.7 percent of women covered by Medicaid. Increasing awareness of state and local paid family leave policies could boost participation and allow more families, especially lower earners, to reap the child and parental benefits supported by the evidence, discussed later in this review.
Research from Rhode Island links statewide paid family leave policies to postpartum care access.Z Researchers used data from births in the Ocean State between 2012 and 2016 to examine the impact of the state’s 2014 4-week paid family leave law, as compared to nearby states that did not have a paid family leave program. The study found that the policy led to a 2.2 percentage point increase in women receiving postpartum care, and the effect was greater for women of color (3.4 percentage points for Black, Hispanic, Asian, American Indian, and women of mixed race, compared to 1.5 percentage points for White women). The authors were unable to disaggregate the specific effects for all racial groups as a result of the small state population and resulting insufficient sample sizes.
Parents’ Ability to Work
Overall, research on the impact of paid family leave on mothers’ employment and labor force participation finds mostly positive results. A study of California’s policy found that paid family leave increased the probability of mothers working 1 year after a birth by 12.9 to 18.3 percentage points, depending on how much work experience the mother had before the birth.B Additional research has shown that paid family leave is associated with higher labor force participation among young women.D,F,Q For example, one study of California and New Jersey’s policies found a 5 to 8 percentage point increase in the labor force participation rate of mothers in the months surrounding birth, as well as a significant increase in weeks spent with a job, compared to weeks spent looking for work.D A second study that examined both states also found a positive impact on labor force attachment—in California, the authors found that paid leave reduced labor market exit by 20 percent through 5 years after a birth, and in New Jersey, the effects averaged 46 percent through 5 years.Q The authors found that the effects were concentrated among women with high levels of education.
Another study found that labor force participation increased by 1.4 percentage points for young women in California following the implementation of paid family leave.F The study, however, also reported unanticipated effects of paid family leave: a significantly higher unemployment rate (an additional 1.5 percentage points) and a longer duration of unemployment, at 1.6 weeks longer.F The author speculated that paid family leave may result in higher labor costs, and employers may be less inclined to hire younger women, causing higher unemployment rates in this group. However, this theory was not tested in the study, and other research suggests no such effect on employers.6
In addition to increased labor force participation, two studies on California’s paid family leave program have found that the policy led to mothers working more in years following birth. The first study found that among employed mothers of children age 2, those who had accessiv to paid leave usually worked 5.8 percent more hours compared to a pre-leave baseline relative to mothers in other states.N This study found no significant effect on the likelihood of employment overall. The second study found that a paid family leave policy increased weeks worked and average weekly work hours during the child’s second year by 7.1 weeks and 2.8 hours, respectively, for those who worked at least 20 weeks during their pregnancy.B
One of the largest studies of California’s paid leave policy to date found negative impacts on employment and wages in the long run among first-time mothers who took leave immediately after the policy was implemented in 2004.A The authors found a reduction of 7 percent in maternal employment and an 8 percent drop in wages, 6 to 10 years after giving birth, among women who were eligible for paid leave at the time of their first birth (compared to those who gave birth a few months before policy implementation). However, the authors found that self-employment income offset some of the decrease in wages. The rationale for focusing on first-time mothers was that “the availability of paid leave may…have a greater impact on new mothers than on women who have already established their child care and work routines [because] women learn how to manage motherhood when they have their first child” (p. 16).A The long-run employment findings for all mothers eligible for paid leave were not statistically significant, but employment was 0.2 percentage points lower than expected in the long-run (5 to 11 years after the birth) among this group.
Findings for job continuity, or attachment to the pre-birth employer, are mixed but lean positive. One study examined the impact of benefit levels using a sample of mothers just above and just below the maximum weekly benefit in California (high-earning women), and the authors found that a 10 percent increase in the weekly benefit amount increased the likelihood that a mother would return to her pre-birth employer by up to 5 percent.O A study with a broader sample found a positive and statistically significant 13 percent increase in the likelihood of working at the pre-birth job 1 year after the birth, with a paid family leave policy.B Very small and insignificant effects on job continuity were found in a study of the long-term effects of paid family leave in California, however.A
Sufficient Household Resources
The current evidence suggests that state paid family leave policies have mixed effects on household material wellbeing. A study from California with a large sample found that paid family leave was associated with better economic security for families.M The study found that household income was approximately $3,400 higher (4.1 percent) among families with access to paid family leave relative to those who did not have access, and the effects were greater among married mothers, likely because they tend to take longer leaves than single mothers. The study also showed that families with access to paid leave were 10.2 percent less likely to be in poverty with the greatest effects for less-educated, low-income, single mothers.M
Two studies found statistically insignificant increases in wages as a result of paid family leave. The first, a study on California’s paid family leave program between 1999 and 2010, found that an increase in weekly work hours for mothers who took paid leave led to very small, and statistically insignificant increases in wage income.N A study of post-birth employment outcomes associated with paid family leave found that the program led to a statistically insignificant increase in hourly wages of up to 5 percent at 1 year after birth.B
Other studies demonstrate the potential detrimental effects of paid family leave. The first study found that paid family leave had a detrimental effect on the long-run annual wages of first-time mothers, with a net 10-year loss of $24,000.A Another study, also examining paid leave in California, found that expectant mothers in that state saved about 1.4 fewer months of household income in the year before the birth compared to mothers in other states without a paid leave policy,X possibly because they were anticipating the additional benefits from paid leave. However, this finding was not statistically significant and the author explains that the reduced incentive to save was concentrated among higher-income families.
A study published in 2020 found economic benefits for families in terms of reduced reliance on public assistance.V The author found that residence in a state with paid maternity leavev decreased the use of Temporary Assistance for Needy Families (TANF) by 4.3 percent, and reduced the benefits received per year by $104 per family. The author suggested that substituting paid family leave benefits for TANF funds can be de-stigmatizing because it allows low-income families to participate in an entitlement program rather than a public assistance program. However, the results were only significant for the period before the Great Recession in 2008, and the author cautions that “a sizable group of low-income mothers are better off with TANF than with PFL benefits” (p. 15). Therefore, the implications of the study’s findings may be different depending on each individual family’s overall resources.
A study on food security in California between 1999 and 2007 found that the enactment of a statewide paid family leave policy significantly improved food security for households with infants (under age 1) compared to states without such a policy.Y The author attributed a 2.3 percentage point decrease in food insecurity to the paid leave law, and measured strongest effects for households below 185 percent of the poverty level and households with multiple children. Access to sufficient resources to purchase nutritious food may be one of the mechanisms driving better health outcomes for families in paid leave states, according to the author.
Healthy and Equitable Births
The impact of paid family leave policies on birth outcomes is limited, given that most leave policies aim to affect the period after the child’s birth. However, a study of California’s paid leave policy found that relative to states without the policy, postneonatal mortality (death after the first 28 days of life) decreased by 12 percent following paid family leave’s passage in 2004.S Impacts on preterm births and birthweight did not reach statistical significance. The authors suggest that access to paid leave may improve caregiver behavior during infancy and prevent the major causes of mortality in the first year of life, including accidents.
Parental Health and Emotional Wellbeing
Three studies of California’s policy found that parents’ physical and mental health benefited when parents had access to paid family leave.C,P,T A study on the impact of the California paid family leave policy found that mothers with access to paid family leave were more likely to report having very good or excellent mental health (an 8.6 percentage point increase) and coping well with the day-to-day demands of parenting (a 5.3 percentage point increase).C Effects on paternal mental health were not significant in this study.
Another study found multiple positive impacts on parent health (including mothers and fathers): a significant, 11 percentage point increase in the likelihood of reporting very good or excellent health, a 0.8 point reduction on a 24-point scale of psychological distress, an 8.2 percentage point decline in the risk of being overweight, and a 12 percentage point decline in any alcohol consumption.P Mothers reported greater impacts on distress and overall health, whereas fathers saw greater declines in alcohol consumption.
A third study on parental health found that access to paid leave led to a 27.6 percent decrease in postpartum psychological distress among mothers with infants, as measured by the Kessler Psychological Distress Scale.T In particular, the authors found the strongest reductions in stress for mothers ages 18 to 29 and for single mothers compared to older and married mothers. The authors also noted that the policy may have a stronger effect for Black and Hispanic mothers compared to White mothers based on point estimates, but the confidence intervals for these groups overlapped, precluding a definite conclusion.
Nurturing and Responsive Child-Parent Relationships
Evidence to date suggests that state paid family leave policies may increase the quality of parent-child relationshipsA,C A study that used data from the Survey of Income and Program Participation found that California’s paid family leave policy led to mothers spending more time with their children up to 4 years after the birth; in particular, mothers with access to paid family leave reported reading to their children 2 more times per week, having breakfast with their children 0.7 more times per week, and going on outings with children 1.8 more times per month than mothers who did not have access to paid leave.A A second study also examined reading, and found that parents were 8.2 percentage points more likely to read to their infants 4 or more days per week when they had access to paid leave in California, but this result was not statistically significant.C
Optimal Child Health and Development
Evidence shows that parents with access to paid family leave in California saw improvements in a variety of indicators of their infants’ health and later child health in elementary school. In particular, increases in breastfeeding have been cited in multiple studies.G,H,K
Four studies present evidence that access to paid family leave increases breastfeeding,G,H,K which has been linked in some research to a number of beneficial impacts for infants, including stronger immunity, reduced infections, and reduced infant mortality.32 A study with a very large sample from California and New Jersey showed that paid family leave policies increased the percentage of exclusively breastfed infants at age 6 months by 1.3 percentage points.G The study also found statistically insignificant, but positive effects on any breastfeeding at 6 and 12 months. The authors noted that the relatively small overall effects found may underestimate the true effects among working women, who are more likely to be affected by paid family leave policies, because the sample included both working and non-working women.
A second study found that in California, paid family leave led to a significant 5 percentage point increase in the likelihood of breastfeeding at 6 months; the authors also report an increase in breastfeeding duration of 18 days, but this finding was not significant at the .05 level.K There was no significant overall effect found for breastfeeding initiation, however; the authors suggested that because many women had access to 6 weeks of paid leave through Temporary Disability Insurance, they were already quite likely to initiate breastfeeding prior to the new paid leave policy (85 percent of mothers breastfed). However, the policy had significant effects on breastfeeding initiation among some subgroups. For example, the study found the greatest effects for Black mothers (a 7.5 percentage point increase in the likelihood of breastfeeding at all) and for mothers with incomes below 50 percent of the federal poverty level (a 5 percentage point increase in likelihood of breastfeeding).K Overall, the study found greater effects on breastfeeding for less-advantaged groups, including those with lower education levels.
Two additional studies corroborate these findings, demonstrating that paid family leave increases breastfeeding duration. An additional study from California with a higher-income and less generalizable sample showed that paid family leave led to an increase in any breastfeeding for at least 6 and 9 months that ranged from 10 to 20 percentage points.H A study on paid family leave and breastfeeding duration found a somewhat smaller, but still significant impact.U The author found that the likelihood of breastfeeding for at least 6 months increased by 1.8 percentage points after the passage of California’s paid leave policy. For infants born to families below the poverty line, the impact was 4 percentage points higher than for wealthier families and for infants in poverty living in states other than California.
Beyond breastfeeding, evidence suggests that state paid family leave policies may impact other indicators of health and development. A study of California found that after the paid leave policy went into effect, hospitals saw 6 percent fewer infant admissions overall, and decreased admissions by 33 percent and 15 percent for upper respiratory infections and gastrointestinal diseases, respectively.L Another California study found that infants in families with access to paid family leave were 1.4 to 5 percentage points less likely to receive late vaccinations (measured for vaccines typically given before 6 months old), depending on the specific vaccination. The effect was even stronger for families with low levels of income, with a 5 to 7 percentage point reduction in the likelihood of receiving a late vaccination relative to similar families in states without paid leave.E
A third study revealed that California’s policy boosted the likelihood that a child had very good or excellent health, as reported by their parents, by between 7.4 percentage points.C The study also found a significant reduction in the likelihood of asthma (5 percentage points) for all children ages 0 to 17. Results for food and respiratory allergies were mixed, with mostly null impacts.
Paid family leave also appears to be linked to better child health in elementary school, suggesting that the policy can have long-lasting beneficial impacts beyond the infant years. One study showed that children whose families had access to paid family leave were less likely to be overweight (4.1 percentage points), have ADHD (0.7 percentage points), have hearing problems (2.4 percentage points), and have communication problems (1.1 percentage points), with greater effects seen among boys and among children with lower socioeconomic status for the likelihood of being overweight and having ADHD.J
Finally, a study on paid family leave in California showed that the policy was linked to a significant reduction in the rate of pediatric abusive head trauma in children below age 2.I For children below age 2, paid family leave led to a rate reduction of 2.8 cases per 100,000 children; for children under age 1, the policy led to 5.1 fewer cases per 100,000 children.I The authors suggested that this finding may be driven by reduced maternal stress and better mental health after the introduction of paid leave, a mechanism supported by other studies reviewed.C,P
- For the purpose of their analyses, most studies included in this review defined “access” as “living in a state with a paid family leave policy” and examined outcomes relative to timeframes prior to implementation of the policy, relative to families in states without a paid leave policy, or relative to families without infants or young children. “Having access” does not mean that every family in the treatment sample was eligible for paid leave or received benefits.
- The study included California, Hawaii, New Jersey, New York, and Rhode Island as treatment states because they either had a Temporary Disability Insurance policy that covered pregnancy, or a paid family leave policy, or both.