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Explaining the Positive Relationship Between State-Level Paid Family Leave and Mental Health

Explaining the Positive Relationship Between State-Level Paid Family Leave and Mental Health

Paid Family Leave, Q&A Update

The HHS Office on Women’s Health (OWH) recently released a study that examined the relationship between paid family leave (PFL) and mental health. The study, published on November 8, 2022 in the journal Community, Work & Family, found that PFL programs may make it easier to take longer leave after giving birth, which could result in better outcomes for mental health among postpartum women. This Q & A explains the research study and what it means.

What is paid family leave (PFL)?

PFL is a state program that provides partial wage replacement to parents to care for their babies. While programs vary by state, PFL is often coupled with temporary disability leave, giving eligible employees paid time off to physically recover and bond with their babies.

How does PFL differ from the Family Medical Leave Act and maternity/paternity leave programs?

The Family Medical Leave Act, or FMLA, is a federal law that provides job protected unpaid leave for eligible workers up to 12 weeks while they bond with a new child, care for sick family member, or take personal medical leave. FMLA, however, does not provide wage replacement. Some PFL programs do not offer job protection, so many people rely on both PFL and FMLA.

PFL is also different from maternity or paternity leave. PFL is a state-mandated law while maternity and paternity leave programs are not state law and are typically provided at an employer’s discretion. Employers may choose to provide maternal or paternity leave to their employees as a benefit. Maternity and paternity leave programs may vary between employers.

Which states currently offer PFL? What states are the focus of the study?

Currently, eleven states and the District of Columbia have PFL programs.

PFL programs are active in California, Massachusetts, New Jersey, New York, Rhode Island, Washington, the District of Columbia, and Connecticut. Programs in Oregon, Colorado, Maryland, and Delaware have been approved but have yet to go into effect.

It is important to note that benefits may differ from state to state. The article focuses on California, New Jersey, New York, and Rhode Island because those were the states that had active PFL programs at the beginning of the study.

According to the study, what is the connection between PFL and mental health?

As part of the study, Pregnancy Risk Assessment Monitoring System (PRAMS) survey data was analyzed to determine if women with paid leave experienced better mental health outcomes. PRAMS survey data assessed the relationship between paid leave and self-reported feelings of depression following birth. The data revealed that women who participated in state PFL programs were significantly less likely to report feelings of depression following birth and were less likely to be diagnosed with postpartum depression. Focus groups were also conducted to obtain information on themes related to postpartum physical and mental health and perceived impacts of PFL. Input from the focus groups indicated some benefits of PFL allowed postpartum mothers more time at home to engage in behaviors that were good for their mental health, such as moms’ groups, therapy, and sleep. It was further noted that PFL created work-related boundaries and reduced both separation and financial anxiety.

Many women in the study indicated they were screened for postpartum depression during their doctor’s appointments in the eight weeks following birth. However, the study found that women who did not have access to PFL were less likely to attend their eight-week postpartum appointment. These appointments are opportunities for women to get connected to mental health support through their health provider’s office.

Are there other benefits to PFL?

The study found that PFL supports physical health by facilitating access to postpartum medical care and giving women more time to physically recover, exercise, and eat right. Women who take PFL are more likely to breastfeed their babies and for longer periods of time and are more likely to make it to all well-baby appointments.

Additionally, the study indicated that women take more time-off of work when the leave is paid due to greater financial security and the feeling that the leave is more accepted by employers. With this additional time, women reported that they were able to better access mental health services, sleep more, establish breastfeeding, and bond with their babies. Women also reported improved financial security and better work boundaries with paid leave compared to unpaid leave.

How does this study build on HHS previous work?

This study builds upon previous research by the HHS Assistant Secretary for Planning and Evaluation (ASPE) on the impact of family leave and related policies.

What are some resources for women who may be experiencing postpartum depression?

If you or someone you know is experiencing feelings of depression following birth (postpartum depression), it is important to talk with your health care provider. Depression during and after pregnancy is common and treatable.

You can also get more information connecting with the resources below:

The National Maternal Mental Health Hotline funded by the Health Resources and Services Administration (HRSA) provides 24/7, free, confidential support, resources and referrals to any pregnant and postpartum mothers facing mental health challenges and their loved ones. The service is available via phone and text in English or Spanish.

  • Call or text 1-833-943-5746 (1-833-9-HELP4MOMS).
  • TTY users can use a preferred relay service or dial 711 and then 1-833-943-5746.

HHS Office on Women’s Health (OWH) Postpartum Depression provides information on the symptoms of postpartum depression and how to help.

National Institutes of Health (NIH) Perinatal Depression provides information on postpartum depression and describes treatment options.

NIH Mom’s Mental Health Matters provides answers to frequently asked questions about depression and anxiety during and after birth and treatments.

Centers for Disease Control and Prevention (CDC) Depression During and After Pregnancy provides information on the symptoms of postpartum depression differs from general depression and community resources on mental health.

National Suicide Prevention Lifeline funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) provides counseling and support 24 hours a day, 7 days a week. All calls are confidential.

Ways to Connect the Lifeline: