The urgent necessity for paid parental leave

The fight to provide U.S. parents with paid leave, now more than 100 years old, has stalled yet again. Despite widespread public support and strong evidence of its mental and physical health benefits, the United States remains one of just six countries worldwide that do not offer paid parental leave.

“We have this whole abundance of child development research about the importance of early attachment, but our policies aren’t lining up with that,” said Darby Saxbe, PhD, an associate professor of psychology at the University of Southern California who studies family environments and transitions.

President Biden’s Build Back Better Act, passed by the U.S. House of Representatives in November 2021 but now stuck in the Senate, aims to provide 4 weeks of paid family leave to all U.S. employees. Without it, workers are guaranteed only unpaid leave—up to 12 weeks without losing their jobs—through the Family and Medical Leave Act (FMLA), passed in 1993.

But many people can’t afford to take unpaid leave, and about 44% of U.S. workers don’t even qualify for benefits through FMLA, which excludes smaller employers and many part-time workers (Employee and Worksite Perspectives of the Family and Medical Leave Act, Abt Associates, 2020). Nine states and the District of Columbia have established paid family leave programs, typically between 8 and 12 weeks.

Psychologists have built a key part of the multidisciplinary evidence base that shows how beneficial paid leave is for the physical health, mental well-being, and stability of the entire family. Now, psychologists are increasingly working to refine and disseminate those findings to make an impact on both policy­makers and organizations.

“Paid parental leave can reduce financial stress, allow parents to focus on bonding with their child, and increase gender equality when fathers have more time to participate in child care duties,” said psychologist Ashley Schappell D’Inverno, PhD, a behavioral scientist in the Division of Violence Prevention at the Centers for Disease Control and Prevention. “All of these positive effects trickle down to benefit the child and the family as a whole.”

Health benefits of paid leave

The transition to parenthood is a critical juncture that shapes adults’ physical and mental health—including sleep changes, weight gain, hormonal shifts, and mood disorder risk—for years to come (Saxbe, D., et al., American Psychologist, Vol. 73, No. 9, 2018). Paid leave can help parents briefly shift their focus from earning income to bonding with their child and adapting to the demands of parenting.

Plenty of research shows that mothers fare better when they have paid time off after giving birth, including a 51% decrease in the risk of rehospitalization (Jou, J., et al., Maternal and Child Health Journal, Vol. 22, 2018). After Norway replaced its 12-week unpaid leave policy with 16 weeks of paid leave, many facets of new mothers’ health improved, including blood pressure, pain levels, and exercise and smoking behaviors (Bütikofer, A., et al., American Economic Journal: Economic Policy, Vol. 13, No. 1, 2021).

“Even if it goes well, pregnancy and birth is a really serious event. It can be an assault on your body, and you need time to recover,” said Tiffany Green, PhD, an economist and an assistant professor of population health sciences and obstetrics and gynecology at the University of Wisconsin–Madison.

Parental leave policies are also linked with better mental health. Women who aren’t able to take as much time off—especially those who return to work in under 2 months—face more depressive symptoms and more marital and self-esteem problems (Bullinger, L. R., Journal of Health Economics, Vol. 66, 2019; Feldman, R., et al., Journal of Applied Developmental Psychology, Vol. 25, No. 4, 2004). Even 2 to 3 years later, women who took shorter maternity leaves report more psychological distress (Whitehouse, G., et al., Journal of Family Issues, Vol. 34, No. 10, 2013).

Research suggests that underprivileged families may benefit most from parental leave policies, starting with better birth outcomes, including fewer early term births, possibly owing to decreased stress during pregnancy (Stearns, J., Journal of Health Economics, Vol. 43, 2015).

But these families are often ineligible for such benefits because of the limits of the FMLA and inconsistency in state and employer policies. People who get paid leave are much more likely to be affluent, well educated, and White. U.S. Bureau of Labor Statistics data indicate that about 47% of White parents, 41% of Black parents, and just 23% of Hispanic parents have access to paid leave (“Racial and Ethnic Disparities in Access To and Use of Paid Family and Medical Leave,” Monthly Labor Review, 2019). Although factors like higher education levels and socioeconomic status can help buffer against the stressors of parenthood, people of color are more likely to face additional stressors such as racial discrimination.

“We’re essentially taking our most vulnerable new parents and giving them the least access to things like rest, restoration, and support,” Saxbe said.

Not only can parental leave policies bolster physical and mental health among lower-income parents; they can also improve household security. After California passed its paid family leave law, poverty risk among mothers of infants decreased by more than 10% (Stanczyk, A. B., Social Service Review, Vol. 93, No. 2, 2019). Paid leave is also associated with greater relationship stability and may even help reduce intimate partner violence (Petts, R. J., et al., Journal of Social Policy, Vol. 49, No. 4, 2020; Schappell D’Inverno, A., et al., Preventive Medicine, Vol. 114, 2018).

Changes in fathers’ brains

Increasingly, psychologists are studying how offering leave to fathers can benefit the whole family. What they’ve learned about the so-called “fathering brain” provides insight into how parental instincts develop and why family leave is a crucial part of that process.

“Like any kind of learning, a parent’s brain grows and changes with new experiences,” Saxbe said. “We develop responses to our babies because we’re in charge of them, not because moms are perfectly designed to be the primary caregiver.”

An Israeli team collected fMRI data from both same-sex and heterosexual parents one year after their child’s birth, finding that “primary caregiver” gay fathers displayed amygdala activation similar to the mothers in the study, whereas “secondary caregiver” gay fathers had brain activity that more closely resembled heterosexual fathers. These results indicate that brain patterns thought to exhibit emotional attunement in moms can also be seen in dads.

Bonding with an infant during the postpartum period appears to be a key part of that growth. Among all fathers in the study, more time spent on child care predicted more connectivity between the amygdala and the superior temporal sulcus, a key empathy pathway in the brain (Abraham, E., et al., Proceedings of the National Academy of Sciences, Vol. 111, No. 27, 2014).

These findings hold up even when dads don’t self-select but are directed to spend close bonding time with their infants. In a randomized, controlled trial of first-time fathers, those who carried their babies in a soft carrier attached to their bodies showed more amygdala activity when they heard babies crying than those who used a carrier seat (Riem, M. M. E., et al., Psychoneuroendocrinology, Vol. 132, 2021).

“This strongly suggests that it does not matter who you are, but it does matter what you do,” said Marian Bakermans-Kranenburg, PhD, a professor of neurobiological and environmental determinants of parenting and child development at Vrije Universiteit Amsterdam and a principal investigator of the study. “Fathers who have the opportunity to do more will adapt themselves better to parenthood.”

When men take leave, their partners also benefit. Following a Swedish policy reform that increased fathers’ ability to stay home, mothers had fewer physical health complications and were less likely to take prescription medications for anxiety (Persson, P., & Rossin-Slater, M., NBER Working Paper No. 25902, 2019). Saxbe, her graduate student Sofia Cardenas, and their colleagues also found that moms reported less depression and stress, and dads reported less daytime fatigue, when paternity leave was available (Journal of Child and Family Studies, Vol. 30, 2021).

But paid leave is even harder for fathers to obtain, which particularly harms same-sex male couples, who receive less leave than heterosexual or same-sex female couples in many countries (Wong, E., et al., Journal of Social Policy, Vol. 49, No. 3, 2020). Research is scant on how paid leave may function differently for same-sex couples, adoptive parents, and other family arrangements.

Benefits for children

All the mental, physical, and relational benefits adults reap ultimately trickle down to their children. Paid leave is associated with lower infant mortality rates and higher rates of vaccination, especially for families below the poverty line (Khan, M. S., Child and Youth Services Review, Vol. 116, 2020; Choudhury, A. R., & Polachek, S. W., Vaccine, Vol. 39, No. 21, 2021). Women with access to more paid leave also breastfeed more, which can boost a child’s immunity and development (Paid Family Leave: A Crucial Support for Breastfeeding, CLASP). Improvements in child physical health carry through at least until elementary school, according to a cross-sectional study of health outcomes before and after California implemented its paid family leave policy (Lichtman-Sadot, S., & Bell, N. P., Journal of Policy Analysis and Management, Vol. 36, No. 4, 2017).

An abundance of psychology research has demonstrated that parent–child bonding in the first months and years of life is crucial for the development of healthy cognitive, behavioral, and socioemotional skills and can even dictate mental health over the life span (Mikulincer, M., & Shaver, P. R., “Attachment Theory,” in The Cambridge Handbook of Personality Psychology, 2020).

Compared with unpaid leave, paid maternal leave is also associated with a distinct profile of brain activity in infants that may indicate more mature early cognitive functioning. Natalie H. Brito, PhD, an assistant professor of applied psychology at New York University, and her colleagues found that patterns of infant electroencephalogram (EEG) activity were different across paid and unpaid leave groups, even when controlling for income, education, occupation, perceived stress, and other factors. Mothers who took leave also showed less physiological stress and had more sensitive interactions with their infants. The paper is currently in press with Child Development (PsyArXiv Preprints, 2021). “Paid leave was mo犀利士
st likely to predict this pattern of infant brain function over and above everything else,” Brito said.

Differences in early brain activity were also reported among infants in the Baby’s First Years study, an experimental trial of universal basic income for low-income mothers, further suggesting that monetary support can influence early brain development (Troller-Renfree, S. V., et al., Proceedings of the National Academy of Sciences, Vol. 119, No. 5, 2022).

Brito’s research also shows that parents’ paid leave is associated with better language skills in toddlers and fewer infant behavioral problems for mothers with less education (Kozak, K., et al., Infancy, Vol. 26, No. 4, 2021). Further studies suggest that longer maternal leaves are linked to fewer cognitive and behavioral problems, even when controlling for factors like the quality of child care and the home environment (Berger, L. M., et al., The Economic Journal, Vol. 115, No. 501, 2005; Brooks-Gunn, J., et al., Child Development, Vol. 73, No. 4, 2002).

“It’s the resources and the time that families have after childbirth—during one of the most important periods of brain development—that really matter,” Brito said.

Influencing policy

With such a strong evidence base for parental leave, some psychologists are shifting their energy toward research questions with more policy-relevant end points. For Saxbe, that often involves “putting a brain on it”—demonstrating how paid leave can change a parent’s or child’s brain, which may hold more weight with the public than self-report data. It also involves thinking critically about how to quantify the benefits of a universal paid leave policy.

“What do policymakers actually care about? A lot of the time, it’s cost-effectiveness,” she said. For example, can paid leave reduce the rates of chronic stress-related illnesses that cost billions of dollars each year to treat? More collaboration with economists might help quantify outcomes in a way that’s meaningful on a policy level, Saxbe suggests.

Green also recommends the Scholars Strategy Network as a way for researchers to connect directly with civic leaders. “If we can make a case that this is going to benefit society—through reductions in health care costs, more happiness, and retention on the job—those are some of the arguments that might convince policymakers and leaders of organizations,” she said.