Despite spending more than $111 billion on maternal and infant health care per year, the U.S. ranks last among high-income nations in maternal mortality rates. A closer look at the data shows that Black women lead these numbers: Black women are two to three times more likely than White women to die in childbirth or from pregnancy-related complications.
Solving the maternal mortality crisis among Black women is essential for bringing down America’s shamefully high maternal mortality rate. One place to start is with federally mandated, paid maternity leave.
The U.S. is the only high-income nation to not guarantee any form of paid maternity leave. Only 20% of private sector workers had access to paid family leave in 2020 to care for a new child or a family member, and only 42% of private sector workers had access to short-term disability insurance in 2020 to recover from an illness or injury. Just 8% of workers in the bottom wage quartile had access to paid family leave in 2020, with Black and Hispanic people being less likely to work in jobs with access to paid leave.
But the postpartum period is crucial for maternal health. In the U.S., 40% percent of maternal deaths occur in the six weeks following labor. Almost 20% occur between six weeks postpartum and one year. Paid leave is essential for allowing mothers to take the necessary time to recover from childbirth.
The data bear this out. A study comparing paid and unpaid leave policies in Australia, Sweden, Norway, the U.S., Canada and Lebanon found that longer paid leave policies are associated with better maternal health outcomes. Another study examined the effects of replacing 12 weeks of unpaid leave in Norway with 16 weeks of paid leave, and found long-term improvements in mothers’ health after the introduction of paid leave, especially among low-income women. Data specific to the U.S. are limited, because paid leave here is rare and most studies have focused on its effects on women’s careers or infant health, rather than on women’s health. Nonetheless, a study in California showed an improvement in new mothers’ mental health after paid leave went into effect there in 2004.
Without paid leave, mothers often return to work before they are healthy enough to do so, resulting in a ripple effect of postpartum health complications. Twenty-three percent of employed women in the U.S. return to work within 10 days of giving birth. This leaves little time for medical appointments. Typical postpartum care in the U.S. includes just one checkup around six weeks after giving birth, and as many as 40% of women miss even this appointment.
While the 1993 Family and Medical Leave Act guaranteed 12 weeks of unpaid leave to certain workers, only 56% of workers qualify, and unpaid leave often goes unused. Not surprisingly, two-thirds of workers who take unpaid leave report having trouble making ends meet, and 27% return to work early as a result. This burden falls especially hard on Black mothers. Four out of five are breadwinners; what are breadwinners and their families supposed to live on while they take FMLA?
Unpaid leave policies were written to support an outdated idea of a family — one in which the father supports everyone. But that’s not how most families look today. Failure to recognize this undermines maternal health, especially in Black and brown communities, and is one of the reasons the U.S. is the most dangerous rich country in which to give birth.
Several options for robust paid leave policies are currently on the table, from the Senate’s FAMILY Act to the Biden administration’s American Families Plan. The FAMILY Act would create a national insurance program to allow all workers, regardless of company size, to take up to 12 weeks of leave while earning 66% of monthly wages. Similarly, the American Families Plan includes a provision that would establish a 12-week national paid leave program.
Twelve weeks may not sound like much to readers in other countries — the OECD average is 16 weeks of paid maternity leave, and that’s not including several additional weeks of paid leave that can be taken by either parent. But 12 weeks would be a leap forward for the U.S., and new mothers need at minimum 12 weeks of parental leave to allow for healing from childbirth and bonding with their babies.
Paid leave would not, on its own, solve the Black maternal mortality crisis. We also need other solutions, such as those in the Black Maternal Health Momnibus Act of 2021, which would, among other reforms, address provider discrimination within the health care system, provide funding for community-based organizations to increase access to midwives and doulas, improve telehealth options, and expand the perinatal workforce. To coordinate all these efforts and support a comprehensive solution — there are more than a dozen related bills in Congress right now — the Biden-Harris administration should create an Office of Sexual and Reproductive Health and Wellbeing within the White House.
The lack of paid maternity leave is often portrayed as a gender equality issue or an employee retention issue. But we should not forget that, most fundamentally, it is a health issue: Paid leave saves lives.
This article was written by Dr. Joia Crear-Perry for Bloomberg. She is the founder and president of the National Birth Equity Collaborative, which works to optimize Black maternal and infant health.