New York’s Paid Family Leave program increased access, promoted health equity, and may reduce health disparities.

Why Paid Family Leave Matters

The United States (US) is an outlier, one of only three countries worldwide that does not provide national paid maternity leave. Currently, only 19% of US employees have paid family leave (PFL) benefits; they tend to be more highly paid employees, with professional or management-level jobs.

As a pediatrician and public health physician, I know no group is more stressed and sleep-deprived than new parents. Use of paid maternity or family leave is consistently associated with improved infant and maternal health, reduced family stress, fewer postpartum depressive symptoms, and increased breastfeeding success and duration.

Path to Enactment of PFL law in New York

In 2016, after many years of advocacy and work by a large, diverse group of stakeholders, organizations, and advocates from the public health, health care, labor, business, academic, and civic communities, and support of elected officials and state agencies, New York (NY) became the fourth US state to enact legislation to create a state PFL program. Since then, interest and support for PFL has increased; and 11 states have state PFL laws. At the federal level, whether to implement a national PFL policy and how to pay for it continues to be debated.  

New York State Paid Family Leave (NY PFL) is an insurance-based program, where the costs are paid by employees through payroll deductions, with rates adjusted each year to match the cost of coverage. Private employers in NY are required to provide PFL coverage, while public employers can opt into NY PFL. The benefits increase over 4 years, and can be used by both parents to bond with a newborn, adopted or foster child; to care for a family member with a serious health condition; or to assist loved ones when a spouse, domestic partner, child, or parent is deployed abroad on active military service. Importantly, NY PFL provides job protection, continued health insurance, and protection from discrimination or retaliation.

For a policy to be of benefit, people need to be aware of it and they must use it. Our new study in the Journal of Public Health Management and Practice shows that enrollment was quick, and that first-year use was relatively high. The state harnessed the collective action of government, the advocates, stakeholders, and organizations to reach out to New Yorkers to raise awareness, inform employers, educate, and empower employees about their rights to this important new benefit.

Utilization and Leave Duration Vary by Employee Demographics and Business Size

In 2018, after NY PFL was in effect, 90% of working New Yorkers were enrolled. PFL utilization was higher by women than men for newborn bonding and family care, and was much lower at businesses with fewer than 50 employees. Leave duration was skewed and differed by employee sex, race, ethnicity, and income. Women were more likely to take PFL and more likely to take the full 8 weeks of NY PFL for newborn bonding than men. But just over one-third of employed women who gave birth in NY used the NY PFL benefit for newborn bonding. Women with lower incomes, and Hispanic, Asian, or other race women were more likely than White women to use the full 8 weeks of leave. As these groups were less likely to have had access to PFL before NY PFL was in effect, laws, like NY PFL, promote health equity and may reduce health disparities.

Recommendations

Worldwide, men are less likely than women to use parental leave and take shorter leaves. As more states pass PFL laws, efforts should include increasing the acceptance, use, duration, and normalization of parental leave by both parents. Additional studies are needed to measure the impact of PFL laws and utilization on health outcomes, health care costs, health equity, and population health. 

Read the Report in the Journal of Public Health Management and Practice:

• First-Year Enrollment and Utilization of New York State Paid Family Leave: 2018

Related Articles:

• Paid Family Leave Policies and Population Health 
• First impressions: Comparing paid family leave programs in their first years: Rhode Island’s first year of paid leave in perspective 
• New York State Paid Family Leave Law Associated with Increased Breastfeeding Among Black Women