Center for American Progress

Universal Paid Sick Time Would Strengthen Public Health and Benefit Businesses
Report

Universal Paid Sick Time Would Strengthen Public Health and Benefit Businesses

A national, guaranteed right to paid sick time is essential for the well-being of workers and their families and would have profound positive impacts on public health and businesses.

In this article
Image showing a mother wearing a visor as she holds a child, who has a face mask on.
A mother holds her young child during a Lunar New Year Festival on February 5, 2022, in Houston. (Getty/Brandon Bell)

No worker should have to choose between their health or the health of a loved one and their economic security. Yet because there is no federal guarantee to a universal right to paid sick time, millions of workers in the United States must do just that. Paid sick leave alleviates the economic necessity to work and forgo care while sick, which is good for public health, businesses, and the economy alike, while also helping to save lives.

Read more on paid sick time

This issue brief advances the public health and business cases for passing a guaranteed right to paid sick time.

An overview of paid sick time

Paid sick time refers to short-term time off that workers can use when they are sick, injured, or receiving medical treatment.1 Workers may also use their sick time to care for a loved one’s health needs.

While no U.S. federal law generally guarantees the right to paid sick time, 14 states, Washington, D.C., and many cities and counties have state and local paid sick time laws. Still, almost 1 in 4 private sector workers2—about 28 million workers in total3—do not have access to even a single paid sick day. Furthermore, the lowest 10 percent of earners are half as likely to have paid sick time as the private sector workforce as a whole, and part-time workers are much less likely to have paid sick time than full-time workers, with access varying significantly by occupation.4

The evidence is clear that paid sick time not only is good for individual workers but also has widespread benefits for public health while helping businesses and the economy thrive.

The staggered implementation of state and local paid sick leave policies has enabled researchers to study their effects. The evidence is clear that paid sick time not only is good for individual workers but also has widespread benefits for public health while helping businesses and the economy thrive.

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Paid sick time benefits workers’ health

Workers without paid sick leave are more likely than workers with leave to forgo medical care for themselves and for their families.5 Indeed, those with leave can use their paid sick days to receive necessary medical care, including services that prevent, detect, or treat serious diseases; improve long-term health outcomes; and save lives.6 Access to leave is also associated with an increased likelihood of visiting a health care provider, undergoing cancer screening procedures, and receiving flu vaccines.7

For workers with low access to leave and below-average health outcomes, paid sick time’s influence on receiving care is even more critical. For instance, New York City’s paid sick leave policy led to Medicaid beneficiaries’ improved use of primary care clinician visits and preventive health services.8

The importance of paid sick leave for women and their families

Women report lower rates of access to paid sick leave compared with men9 and are overrepresented in low-wage and part-time jobs that are less likely to offer paid sick leave.10 Even within low-wage jobs, gender disparities exist.11

Yet working women most need this benefit, as they bear the brunt of family caregiving responsibilities:12

  • Mothers are nearly three times as likely as fathers to stay home to care for a sick child.13
  • Without paid leave, parents are forced to take off work without pay or to send a sick child to school:
    • In 2022, half of working parents were not paid when they took time off to care for a sick child, with especially high rates for low-income mothers, Black mothers, and single mothers.14
    • Parents without paid sick days are nearly twice as likely as those with paid leave to send a sick child to school or child care, risking children’s health and spreading illness in communities.15
  • Women are more likely than men to go to work when sick or when a child is sick.16

In addition, women need paid sick leave for their own health:

  • State paid sick leave policies reduce the percentage of women reporting fair or poor health and the number of days women report bad physical and mental health.17
  • Women with paid sick leave are more likely to get mammograms.18
  • Paid sick leave policies are shown to reduce gender gaps in access to paid leave,19 demonstrating the importance of a national guaranteed right to paid sick leave for the economic security and health of all women.

Because paid sick time allows workers to receive necessary and timely medical care, workers with paid leave are also less likely to go to the emergency room. Those who are unable to take paid time off may forgo or delay needed medical treatment and recovery time, which can worsen an illness or injury to the point of an emergency room visit. In fact, state-level paid sick time policies were found to reduce the emergency department visit rate by 5.6 percent relative to their average baseline rate before the policies, over the period from 2011 to 2019.20 And among private sector employees in 2008 and 2009, paid sick time coverage for uncovered workers could have prevented 1.3 million emergency room visits yearly.21

These reduced emergency department visits mean both that workers are getting better care and that billions of dollars are being saved in health care costs.

Paid sick time strengthens public health

The impacts of paid sick time not only benefit individual workers and their families—helping to drive down health care costs overall—but can also significantly prevent the spread of infectious disease.

The Centers for Disease Control and Prevention recommends workers stay home when sick to minimize contact and reduce the spread of disease,22 but many workers cannot afford to take time off without pay. Unsurprisingly, then, paid sick time increases the likelihood a worker will stay home when sick, rather than bring illness into the workplace.23 For example, an expanded paid sick leave policy at Olive Garden lowered the share of workers who reported working while sick in the prior month by 15 percentage points.24 And because paid sick time allows workers to stay home, it can reduce the spread of infectious diseases. In fact, state paid sick leave laws reduced infection rates with the flu and similar illnesses by about 11 percent in the first year they were in place—with impacts that only grow over time.25

Paid sick leave and COVID-19

Paid sick leave has been highly effective in reducing the spread of the COVID-19 virus by allowing workers to self-isolate, get tested, and receive vaccinations.26

In 2019, the United States passed the Families First Coronavirus Response Act (FFCRA), which included an emergency sick leave provision. Emergency sick leave through the FFCRA improved rates of self-quarantining and lowered infection rates.27 In states where workers had newly gained access to paid sick time through the policy, there were an estimated 400 fewer confirmed COVID-19 cases per state per day.28 Another study found that the FFCRA was associated with a 50 percent reduction in cases.29 States and cities that had already implemented paid sick leave policies, meanwhile, experienced lower infection rates30 and higher vaccination coverage than those without such policies.31

Simply put, when workers don’t have paid sick time, it both threatens their economic security32 and compromises public health.33 By reducing the number of COVID-19 cases, paid sick leave saved lives and demonstrated the importance of universal paid sick leave in the event of future pandemics.

Certain workers—including low-income and service workers—disproportionately lack access to paid sick time and cannot afford to take unpaid leave.34 Notably, only 38 percent of workers in the lowest 10 percent of earners have any paid sick days.35 And some sectors have below-average rates of access: For example, only 53 percent of leisure and hospitality workers, including food service workers, have paid sick time, compared with 96 percent of those in management, business, or financial occupations.36 Consequently, these workers are particularly likely to go to work sick and transmit disease.37 A survey found that 12 percent of food workers reported having gone to work while experiencing vomiting or diarrhea two or more times in the previous year;38 food service is also the occupation with the highest share of workers going to work with COVID-19 symptoms.39 These workers regularly interact with customers, which has detrimental public health consequences.

Access to paid sick leave varies by occupation

38%

of workers in the lower 10 percent of earners have any paid sick days

53%

of leisure and hospitality workers, including food service workers, have paid sick time

96%

of workers in management, business, or financial occupations have paid sick time

19%

of surveyed home care workers have employer-provided paid sick days

Other low-wage workers report similar experiences: Of surveyed home care workers, only 19 percent were found to have employer-provided paid sick days.40 Importantly, paid leave policies close the coverage gap for low-wage service-sector workers so they can stay home, stay safe, and reduce the spread of illness.41

Paid sick time is good for businesses and the economy

Contrary to some opponents’ claims,42 guaranteeing paid sick leave is good for employers, providing powerful benefits—including for the bottom line—at minimal cost. Depriving workers of this essential right means businesses bear the costs of decreased productivity and higher turnover, which hurts the economy by billions of dollars yearly.43

In particular, paid sick leave benefits businesses in the following ways.

Increases performance and profitability

Paid sick time increases firm performance by facilitating sick workers’ timely recovery and reducing missed workdays due to the spread of illness. Employees who go to work while sick may perform at a lower capacity than usual, resulting in lost productivity for their employer.44 Indeed, staying home prompts a timely recovery and a faster return to work at regular performance, benefiting business’ bottom line. For instance, one recent study shows a 6 percent increase in productivity and a 1.6 percent increase in profitability in states that have adopted paid sick time guarantees.45

Universal paid sick time would … create a more stable and productive workforce and improve workers’ economic security, building a more sustainable and equitable economy.

Paid sick time also reduces business losses from missed workdays due to the spread of illness. One study estimated that by reducing missed worked days related to the spread of influenza-like illness, universal paid sick leave could save employers cumulatively as much as $1.88 billion per year.46

Reduces turnover

Employee turnover imposes high costs on employers due to lost productivity, the need to hire and train new employees, and lower worker morale.47 It typically costs businesses about one-fifth of a worker’s salary to replace a lost worker—costs that compound, especially in lower-wage industries with higher turnover.48

Yet paid sick time reduces turnover and improves the work experience, saving employers money and keeping high-quality workers on the job.49 For instance, during the most intense period of the COVID-19 pandemic, workers without access to paid sick time quit at rates three to four times higher than those with access to paid sick time.50 And for low-wage hourly workers with little job flexibility, paid sick time may even help them stay at a job: A study of Seattle’s paid sick time policy found that it reduced job turnover by 4.7 percent for workers earning low wages in small firms.51

Strengthens the economy overall

The benefits of paid sick leave for businesses and workers also boost the economy overall. Paid leave mitigates the costs of people working sick, reduces labor turnover, increases labor supply, and increases household income. These outcomes, likewise, benefit the labor market: One study finds that private sector employment increased by 1.5 percent in counties that implemented paid sick leave.52 Universal paid sick time would, therefore, create a more stable and productive workforce and improve workers’ economic security, building a more sustainable and equitable economy.

See CAP’s guide to U.S. workplace leave laws

Conclusion

Paid sick time ensures that workers have the flexibility and dignity to take off from work when they or a loved one are sick or need care. To help address current gaps in access, Congress must pass the Healthy Families Act, a proposed national law guaranteeing the right to paid sick time.53 But in the absence of a federal policy, state and local governments must continue to enact their own paid sick time laws to extend coverage—and states that prevent localities from doing so through preemption should remove those barriers.54 At the same time, employers must take the initiative to offer paid sick time to their employees.

In the end, guaranteeing paid sick leave is essential to workers, their families, the economy, and public health, while uplifting women and low-wage workers across the country.

Endnotes

  1. Molly Weston Williamson, “The State of Paid Sick Time in the U.S. in 2023” (Washington: Center for American Progress, 2023), available at https://www.americanprogress.org/article/the-state-of-paid-sick-time-in-the-u-s-in-2023/.
  2. Ibid.
  3. Based on author’s calculations using the National Compensation Survey. See U.S. Census Bureau, “National Compensation Survey: Employee Benefits in the United States, March 2022,” available at https://www.bls.gov/ebs/publications/september-2022-landing-page-employee-benefits-in-the-united-states-march-2022.htm (last accessed May 2023).
  4. Williamson, “The State of Paid Sick Time in the U.S. in 2023.”
  5. LeaAnne DeRigne, Patricia Stoddard-Dare, and Linda Quinn, “Workers Without Paid Sick Leave Less Likely To Take Time Off For Illness Or Injury Compared To Those With Paid Sick Leave,” Health Affairs 35 (3) (2016), available at https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.0965.
  6. LeaAnne DeRigne and others, “Paid sick leave and preventive health care service use among U.S. working adults,” Preventive Medicine 99 (2017): 58–62, available at https://www.sciencedirect.com/science/article/abs/pii/S0091743517300440.
  7. Thomas A. Hegland and Terceira A. Berdahl, “High Job Flexibility And Paid Sick Leave Increase Health Care Access And Use Among US Workers,” Health Affairs 41 (6) (2022), available at https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.01876; Kevin Callison and others, “Cancer Screening after the Adoption of Paid-Sick-Leave Mandates,” The New England Journal of Medicine 388 (9) (2023): 824–832, available at https://www.nejm.org/doi/full/10.1056/NEJMsa2209197; Yusheng Zhai, “Paid sick leave benefits, influenza vaccination, and taking sick days due to influenza-like illness among U.S. workers,” Vaccine 36 (48) (2018): 7316–7323, available at https://pubmed.ncbi.nlm.nih.gov/30361122/.
  8. Hansoo Ko and Sherry A Glied, “Associations Between a New York City Paid Sick Leave Mandate and Health Care Utilization Among Medicaid Beneficiaries in New York City and New York State,” JAMA Health Forum 2 (5) (2021), available at https://jamanetwork.com/journals/jama-health-forum/fullarticle/2779693.
  9. Chantel Boyens, Michael Karpman, and Jack Smalligan, “Access to Paid Leave Is Lowest among Workers with the Greatest Needs” (Washington: Urban Institute, 2022), available at https://www.urban.org/research/publication/access-paid-leave-lowest-among-workers-greatest-needs.
  10. Chabeli Carrazana, “America falls far behind in supporting women with paid sick leave. Will Biden help with a national policy?”, The 19th, January 21, 2021, available at https://19thnews.org/2021/01/paid-sick-leave-biden-administration/#:~:text=In%20August%2C%20DOL%20issued%20updated%20guidelines%20for%20employers,learning%2C%20they%20could%20no%20longer%20access%20the%20benefit.  
  11. Kristen Harknett and Daniel Schneider, “Mandates Narrow Gender Gaps In Paid Sick Leave Coverage For Low-Wage Workers In The US,” Health Affairs 41 (11) (2022): 1575–1582, available at https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2022.00727.
  12. Beth Almeida and Bela Salas-Betsch, “Fact Sheet: The State of Women in the Labor Market in 2023” (Washington: Center for American Progress, 2023), available at https://www.americanprogress.org/article/fact-sheet-the-state-of-women-in-the-labor-market-in-2023/.
  13. Usha Ranji and others, “Workplace Benefits and Family Health Care Responsibilities: Key Findings from the 2022 KFF Women’s Health Survey” (Washington: Kaiser Family Foundation, 2022), available at https://www.kff.org/womens-health-policy/issue-brief/workplace-benefits-and-family-health-care-responsibilities-key-findings-from-the-2022-kff-womens-health-survey/.
  14. Ibid.
  15. Jibum Kim and Tom W. Smith “Paid Sick Days: Attitudes and Experiences” (Chicago: NORC at the University of Chicago, 2010), available at https://search.issuelab.org/resource/paid-sick-days-attitudes-and-experiences.html; Molly Weston Williamson, “We can help battle the ‘tripledemic’ with this commonsense solution,” NBC News, December 17, 2022, available at https://www.nbcnews.com/think/opinion/help-parents-battle-tripledemic-with-paid-sick-time-rcna62101.
  16. Kaitlin Piper and others, “Paid sick days and stay-at-home behavior for influenza,” PLOS One 12 (2) (2017), available at https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0170698.
  17. Meredith Slopen, “The impact of paid sick leave mandates on women’s health,” Social Science & Medicine 323 (2023), available at https://www.sciencedirect.com/science/article/abs/pii/S027795362300196X?via%3Dihub.
  18. Callison and others, “Cancer Screening after the Adoption of Paid-Sick-Leave Mandates.”
  19. Harknett and Schneider, “Mandates Narrow Gender Gaps In Paid Sick Leave Coverage For Low-Wage Workers In The US.”
  20. Yanlei Ma and others, “State Mandatory Paid Sick Leave Associated With A Decline In Emergency Department Use In The US, 2011–19,” Health Affairs 41 (8) (2022), available at https://www.healthaffairs.org/doi/10.1377/hlthaff.2022.00098.
  21. Ibid.
  22. Centers for Disease and Control and Prevention, “Stay Home When You Are Sick,” available at https://www.cdc.gov/flu/business/stay-home-when-sick.htm (last accessed March 2023).
  23. Abay Asfaw, Roger Rosa, and Regina Pana-Cryan, “Potential Economic Benefits of Paid Sick Leave in Reducing Absenteeism Related to the Spread of Influenza-Like Illness,” Journal of Occupational and Environmental Medicine 59 (9) (2017): 822–829, available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649342/; Piper and others, “Paid sick days and stay-at-home behavior for influenza.”
  24. Daniel Schneider, Kristen Harknett, and Elmer Vivas-Portillo, “Olive Garden’s Expansion Of Paid Sick Leave During COVID-19 Reduced The Share Of Employees Working While Sick,” Health Affairs 40 (8) (2021), available at https://doi.org/10.1377/hlthaff.2020.02320.
  25. Stefan Pichler, Katherine Wen, and Nicolas R. Ziebarth, “Positive Health Externalities of Mandating Paid Sick Leave” (Bonn, Germany: IZA Institute of Labor Economics, 2020), available at https://ssrn.com/abstract=3660277.
  26. Stefan Pichler, Katherine Wen, and Nicolas R. Ziebarth, “COVID-19 Emergency Sick Leave Has Helped Flatten The Curve In The United States,” Health Affairs 39 (12) (2020), available at https://doi.org/10.1377/hlthaff.2020.00863.
  27. Martin Andersen and others, “Paid sick-leave and physical mobility: Evidence from the United States during a pandemic” (Cambridge, MA: National Bureau of Economic Research, 2020), available at https://www.nber.org/papers/w27138.
  28. Pichler, Wen, and Ziebarth, “COVID-19 Emergency Sick Leave Has Helped Flatten The Curve In The United States.”
  29. Alison Thompson and others, “Benefits of Paid Sick Leave During the COVID-19 Pandemic” (Toronto: Ontario COVID-19 Science Advisory Table, 2021), available at https://doi.org/10.47326/ocsat.2021.02.25.1.0.
  30. David Naimark and others, “Health and Economic Consequences of Universal Paid Sick Leave Policies During the COVID-19 Pandemic,” medRxiv, January 14, 2022, available at https://doi.org/10.1101/2022.01.13.21268270.
  31. Alina S. Schnake-Mahl and others, “Higher COVID-19 Vaccination And Narrower Disparities In US Cities With Paid Sick Leave Compared To Those Without,” Health Affairs 41 (11) (2022), available at https://doi.org/10.1377/hlthaff.2022.00779.
  32. Michael Sainato, “In a pandemic, US workers without paid medical leave can’t afford a sick day,” The Guardian, July 9, 2021, available at https://www.theguardian.com/us-news/2021/jul/09/pandemic-workers-cant-afford-sick-day.
  33. Diana Boesch, Sarah Jane Glynn, and Shilpa Phadke, “Lack of Paid Leave Risks Public Health During the Coronavirus Outbreak,” Center for American Progress, March 12, 2020, available at https://www.americanprogress.org/article/lack-paid-leave-risks-public-health-coronavirus-outbreak/.
  34. Scott Brown and others, “Employee and Worksite Perspectives of the Family and Medical Leave Act: Results from the 2018 Surveys,” (Rockville, MD: Abt Associates, 2020), available at https://www.dol.gov/sites/dolgov/files/OASP/evaluation/pdf/WHD_FMLA2018SurveyResults_FinalReport_Aug2020.pdf.
  35. U.S. Bureau of Labor Statistics, “National Compensation Survey: Employee Benefits in the United States, March 2022: Table 7. Leave benefits by average wage category, private industry workers, March 2022,” September 2022, Excel file (“private-average-wage-category-2022″), available at https://www.bls.gov/ncs/ebs/benefits/2022/home.htm.
  36. Ibid.
  37. Harknett and Schneider, “Mandates Narrow Gender Gaps In Paid Sick Leave Coverage For Low-Wage Workers In The US.”
  38. Steven Sumner and others, “Factors Associated with Food Workers Working while Experiencing Vomiting or Diarrhea,” Journal of Food Protection 74 (2) (2011): 215–220, available at https://www.cdc.gov/nceh/ehs/ehsnet/Docs/JFP_ill_food_workers.pdf.
  39. Joshua A. Salomon and more, “The US COVID-19 Trends and Impact Survey: Continuous real-time measurement of COVID-19 symptoms, risks, protective behaviors, testing, and vaccination,” Proceedings of the National Academy of Sciences of the United States of America 118 (51) (2021), available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8713763/.
  40. Molly Kinder, “Essential but undervalued: Millions of health care workers aren’t getting the pay or respect they deserve in the COVID-19 pandemic” (Washington: Brookings Institute, 2020), available at https://www.brookings.edu/research/essential-but-undervalued-millions-of-health-care-workers-arent-getting-the-pay-or-respect-they-deserve-in-the-covid-19-pandemic/.
  41. Harknett and Schneider, “Mandates Narrow Gender Gaps In Paid Sick Leave Coverage For Low-Wage Workers In The US”; Catherine Maclean, Stefan Pichler, and Nicolas R. Ziebarth, “Mandated Sick Pay: Coverage, Utilization, and Welfare Effects” (Bonn, Germany: IZA Institute of Labor Economics, 2020), available at https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3573302.
  42. Lisa Nagele-Piazza, “Senate Hears Debate Over Paid-Leave Proposals,” Society for Human Resource Management, May 24, 2021, available at https://www.shrm.org/resourcesandtools/legal-and-compliance/employment-law/pages/senate-hears-debate-over-paid-leave-proposals.aspx.
  43. National Partnership for Women and Families, “Paid Sick Days Are Good for Business” (Washington: 2020), available at https://nationalpartnership.org/wp-content/uploads/2023/02/paid-sick-days-good-for-business-and-workers.pdf; Asfaw, Rosa, and Pana-Cryan, “Potential Economic Benefits of Paid Sick Leave in Reducing Absenteeism Related to the Spread of Influenza-Like Illness”; Piper and others, “Paid sick days and stay-at-home behavior for influenza.”
  44. Ibid.; A Better Balance, “Paid Sick Leave Is Good For Business,” February 23, 2021, available at https://www.abetterbalance.org/resources/sickleavebusinesscase/.
  45. Liangrong Chunyu, Paolo F. Volpin, and Xingchen Zhu, “Do Paid Sick Leave Mandates Increase Productivity?” (2022), https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4096707.
  46. Asfaw, Rosa, and Pana-Cryan, “Potential Economic Benefits of Paid Sick Leave in Reducing Absenteeism Related to the Spread of Influenza-Like Illness.”
  47. National Partnership for Women and Families, “Paid Sick Days Are Good for Business”; A Better Balance, “Paid Sick Leave Is Good For Business.”
  48. Heather Boushey and Sarah Jane Glynn, “There Are Significant Business Costs to Replacing Employees” (Washington: Center for American Progress, 2012), available at https://www.americanprogress.org/article/there-are-significant-business-costs-to-replacing-employees/.
  49. Heather D. Hill, “Paid Sick Leave and Job Stability,” Work and Occupations 40 (2) (2013), available at https://www.researchgate.net/publication/258530501_Paid_Sick_Leave_and_Job_Stability.
  50. Eli M. Rosenberg, “Workers without sick pay or family leave quit during the pandemic more than those who had benefits, House report shows,” NBC News, October 25, 2022, available at https://www.nbcnews.com/business/business-news/workers-paid-leave-quit-often-coronavirus-pandemic-house-report-rcna53751.
  51. Hilary Wething, “Reduced job turnover in small U.S. firms is an overlooked benefit of paid sick leave,” Washington Center for Equitable Growth, July 5, 2022, available at https://equitablegrowth.org/reduced-job-turnover-in-small-u-s-firms-is-an-overlooked-benefit-of-paid-sick-leave/.
  52. Turk Al-Sabah and Paige Ouimet, “For Better or Worse? The Economic Implications of Paid Sick Leave Mandates” (Chapel Hill, NC: Kenan Institute of Private Enterprise, 2021), available at https://ssrn.com/abstract=3953523.
  53. Healthy Families Act, S. 1195, 117th Congress, 1st sess. (April 15, 2021), available at https://www.congress.gov/bill/117th-congress/senate-bill/1195/text.
  54. Temple University Center for Public Health Law Research, “Preemption, Paid Leave, and the Health of America,” Bill of Health, March 16, 2020, available at https://blog.petrieflom.law.harvard.edu/2020/03/16/preemption-paid-leave-and-the-health-of-america/.

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Isabela Salas-Betsch

Research Associate, Women’s Initiative

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