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Quick Facts on Paid Family and Medical Leave

The United States urgently needs a comprehensive paid family and medical leave program that will boost the health and economic well-being of American workers and families.

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A COVID-19 patient, trying to recover at home, grabs fresh air on the front stoop of her home in Brooklyn, New York, on November 20, 2020. (Getty/Andrew Lichtenstein)
A COVID-19 patient, trying to recover at home, grabs fresh air on the front stoop of her home in Brooklyn, New York, on November 20, 2020. (Getty/Andrew Lichtenstein)

Illness can strike at any time—and for workers without access to paid leave, they often must choose between recovering their health and keeping their job or between caring for a loved one and securing their next paycheck. As the coronavirus pandemic has made even clearer, workers should have access to comprehensive paid family and medical leave to care for themselves or a loved one without being faced with this impossible choice.

While Congress addressed this need amid the pandemic by providing temporary emergency paid sick leave and emergency paid child care leave to some workers, the United States still lacks a permanent and comprehensive paid family and medical leave policy. This makes the United States the only industrialized nation in the world to not guarantee any paid leave for workers. It is time to change the status quo. Policymakers must act now to ensure that all workers have access to paid family and medical leave. This fact sheet provides key data on the need for, and widespread support of, a comprehensive paid family and medical leave policy.

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Who has access to paid family and medical leave?

  • Only 20 percent of private sector workers had access to paid family leave in 2020 to care for a new child or a family member.
  • Only 42 percent of private sector workers had access to short-term disability insurance in 2020 to recover from an illness or injury.
  • Low-wage workers are less likely to have access to different forms of paid leave. For example, just 8 percent of workers in the bottom wage quartile—who on average earn less than $14 an hour—had access to paid family leave in 2020.
  • Black and Hispanic workers are less likely than white, non-Hispanic workers to have access to paid family and medical leave.
  • After the Federal Employee Paid Leave Act went into effect on October 1, 2020, an estimated 2 million federal employees now have access to 12 weeks of paid parental leave.

State paid leave programs

Workers in California, New Jersey, Rhode Island, New York, Washington state, the District of Columbia, and Massachusetts have access to paid family and medical leave through their state or district’s program. In 2002, California became the first state to pass a paid family leave program, building on its temporary disability insurance (TDI) program. California’s example was followed by three more states that also had TDI programs: New Jersey in 2008, Rhode Island in 2013, and New York in 2016. Recently, states without TDI programs have implemented new paid family and medical leave programs. Washington state, the District of Columbia, and Massachusetts, for example, now provide benefits to workers, and Connecticut, Oregon, and Colorado plan to implement benefits in the next few years. In November 2020, Colorado became the first state to pass a paid family and medical leave program through a ballot measure.

While the state paid leave programs vary in the duration of leave provided and other design elements, all nine states plus the District of Columbia provide paid leave for comprehensive reasons, including medical leave, family caregiving, and parental leave. Evidence has shown that these state programs expand paid leave access to millions of workers, improving their health and economic security.

What can workers use paid leave for?

Workers and their families experience myriad life events that require paid leave. For short-term medical needs such as a temporary illness or doctor’s appointment, an earned paid sick leave law will allow workers to care for their own health or a sick loved one. For more serious medical or family caregiving needs, workers need access to long-term paid family and medical leave.

A comprehensive paid family and medical leave policy would guarantee leave for workers to care for a new child, recover from a serious health condition, care for a seriously ill family member, or address needs arising from a family member’s military service deployment. In the spring of 2020, Congress passed temporary emergency paid leave in response to the pandemic that is limited to uses related to COVID-19. It provided 80 hours of emergency paid sick leave and 12 weeks of emergency leave to care for a child whose school or place of care is closed. That law expired on December 31, 2020, and was replaced with a voluntary tax credit.

Workers’ use of leave under the 1993 Family and Medical Leave Act (FMLA)—which guarantees eligible workers 12 weeks of leave (or 26 weeks of leave to care for military service members) but not pay—provides useful data on the reasons why workers need long-term paid leave. Among workers who took leave for a qualifying FMLA reason, 51 percent used leave for their own illness; 25 percent to care for a new child; and 19 percent to care for an immediate family member who was ill.*

How does paid leave improve workers’, families’, and public health?

Paid family and medical leave offers wide-ranging benefits for individual and public health outcomes. For example, paid medical leave allows workers to pursue necessary medical treatment earlier and to manage ongoing treatment. A study of cancer patients and survivors found that those who had access to paid family and medical leave were better able to complete their treatment and manage symptoms and side effects. Paid medical leave is especially important now that an estimated 10 percent of Americans who contracted COVID-19 will become so-called long-haulers, or those who experience debilitating and persistent symptoms long after their initial diagnosis. Furthermore, having access to paid medical leave has led workers to experience less stress from financial insecurity during a health shock. As paid medical leave improves workers’ overall health outcomes, it could also reduce disability leave durations and overall health care spending.

While its benefits reach every worker and family, paid leave is particularly critical for parents. For example, paid leave helps parents establish a strong bond with new children and is proven to increase rates and duration of breastfeeding; improve on-time vaccination rates; reduce infant hospital admissions; and improve health outcomes of elementary school children.

For birthing parents, taking paid maternity leave leads to lower rates of postpartum depression and improved physical health. Paid parental leave is also critical to help eliminate maternal health disparities, which are particularly devastating for Black women. California’s paid family leave program, for example, increased leave-taking among fathers with new children, contributing to their greater involvement in caring for children later in life.

What are the costs to workers, their families, and the U.S. economy of not having paid leave?

Workers without access to paid family and medical leave are at serious risk of losing their income or job if they or their family fall ill or need to care for a new child. This harms families’ economic security as well as U.S. labor force participation and economic growth.

  • Workers and their families lose $22.5 billion in wages each year due to a lack of paid family and medical leave, according to original CAP analysis.
  • Two-thirds of workers who received partial or no pay while on leave reported financial difficulty in making ends meet.
  • Working adults aged 21 to 64 lose an estimated $9,578 in wages after taking 12 weeks of unpaid leave. This equates to families losing 58 percent of their quarterly income. For Black, Asian, and Hispanic families, the percent of household income lost due to unpaid leave is even greater.
  • For women who are primary or co-breadwinners in their families—64.2 percent of mothers in 2017—and who also perform the majority of caregiving, the lack of paid leave risks their family’s economic security.

Providing workers with paid leave is proven to improve the labor force participation, earnings, and economic security of all workers, especially women.

  • Access to paid leave is estimated to increase mothers’ labor force participation by approximately 20 percent during the first year following their child’s birth.
  • California’s paid leave program increased the average income of mothers with a 1-year-old child by $3,407 and reduced their risk of dropping below the poverty line by 10.2 percent.
  • Caregivers also saw an increase in their labor force participation under California’s paid leave program: 8 percent in the short run—2003 to 2006—and 14 percent in the long run—2003 to 2011.

How does paid family and medical leave affect businesses?

Opponents of paid leave laws inaccurately assume such programs would harm businesses. In fact, paid family and medical leave is good for businesses—especially small businesses—and has garnered wide support among business groups.

  • A study of California’s paid family leave program found that the vast majority of California employers reported a positive or neutral effect on employee productivity (89 percent) as well as profitability and performance (91 percent). Similarly, 87 percent of employers reported no added costs due to the paid family leave program, and 9 percent of employers reported cost savings.
  • In New Jersey, the majority of small, medium, and large businesses say they have had no difficulty adjusting to the paid family leave law.
  • An analysis of employers in California found no evidence of higher wage costs or increased employee turnover when employees took paid family leave.

Small businesses overwhelmingly support a national paid family and medical leave program, which they have found can make the benefit affordable, reduce business costs, increase their competitiveness, and allow small-business owners themselves to take paid leave.

  • Only 13 percent of small businesses with fewer than 50 employees offer employer-provided paid family leave, half the rate among employers with 100 or more employees (26 percent).
  • A poll commissioned by CAP and Small Business Majority found that 70 percent of small-business owners with fewer than 100 employees support a national paid family and medical leave insurance program.
  • Similar polling from 2020, commissioned by the Paid Leave for All campaign in partnership with Main Street Alliance, found that 64 percent of small-business owners with fewer than 50 employees support a national policy for paid family and medical leave.


With more than three-quarters of voters supporting permanent paid family and medical leave—and with the support of President Joe Biden as part of his “Build Back Better” plan—now is the time to ensure paid leave for all. One current congressional proposal, the Family and Medical Insurance Leave (FAMILY) Act, builds on state evidence to create a comprehensive paid family and medical leave program that will meet the needs of American workers and families.  Policymakers must pass a permanent paid family and medical leave law—such as the FAMILY Act—to advance racial and gender equity and ensure the health and economic security of workers, their families, and the entire U.S. economy.

Diana Boesch is a policy analyst for women’s economic security with the Women’s Initiative at the Center for American Progress.

The authors would like to thank Shilpa Phadke, Sarah Jane Glynn, and Jocelyn Frye for their contributions to this column.

Author’s note: * An additional 5 percent of employees took leave to care for a nonimmediate family member with an illness, a purpose not covered by the FMLA.

The positions of American Progress, and our policy experts, are independent, and the findings and conclusions presented are those of American Progress alone. A full list of supporters is available here. American Progress would like to acknowledge the many generous supporters who make our work possible.


Diana Boesch

Policy Analyst, Women’s Economic Security

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Rachel Bryan of the International Brotherhood of Electrical Workers holds a sign next to the podium in front of the Lincoln Memorial on the anniversary of the Women's March, January 2018. (Getty/J.M. Giordano)

Advancing gender equality is critical to the success of families, communities, and the nation. As country celebrates the progress it has made thus far—including historic firsts such as the elevation of Vice President Kamala Harris as the first woman, Black person, and Indian American person to serve in the second-highest office in the land—it’s also clear that the work to achieve equity, fairness, and justice for all women is far from done. Too many women—across race, ethnicity, sexual orientation, gender identity, disability status, and economic level—still face obstacles that limit their opportunities, impede their progress, and interfere with their ability to lead healthy and productive lives. The Biden-Harris administration and all policymakers must advance concrete solutions to address these problems at all levels—whether it’s the gender wage gap, racism in maternal health care, lack of access to reproductive health care, increasing rates of gender-based violence, or the double standards deployed to hamstring women of color in positions of power. Only then can the country make meaningful progress for women—and all people.


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