A mother who is 25 weeks pregnant arrives at the hospital in labor and delivers a baby girl 24 hours later. The newborn is admitted immediately to the neonatal intensive care unit (NICU), where she stays for 16 weeks before being discharged home. The mother goes back to work after recovering from a cesarean section so she can save some of her parental leave time for when her daughter comes home. As a result, the mother is not able to spend much time with her daughter in the NICU.
This scenario is in stark contrast to what happens in some European countries, where one parent is admitted with the preterm child to the NICU. The parent is able to have hours of skin-to-skin contact with the child and is involved in the newborn’s care instead of sitting next to an incubator for a few hours per week.
The U.S. is the only industrialized country without universal paid family and medical leave (PFML) regardless of financial, racial or ethnic background when adding a new family member or when a close family member becomes sick. This is despite the well-known positive effects on the physical and mental health of infants, children, adolescents and their families.
Paid leave available to mothers in Europe ranges from 14 weeks in Switzerland to 164 weeks in the Slovak Republic, with a European Union average of 63.5 weeks and an average wage replacement percentage between 25% and 100%.
A new AAP policy statement reviews the benefits of PFML and recommends that PFML be available to all families to improve health outcomes and reduce disparities.
The policy Paid Family and Medical Leave, from the Council on Community Pediatrics, Council on Early Childhood, Section on Breastfeeding and Section on Neonatal-Perinatal Medicine, is available at https://doi.org/10.1542/peds.2024-068958 and will be published in the November issue of Pediatrics.
Benefits of PFML
The policy details myriad evidence-based benefits of PFML and family-friendly policies.
Parental presence positively impacts infant and child health, specifically in infants, children and adolescents with special health care needs.
PFML also improves parental health, strengthens parent-child relationships, minimizes health inequities and positively affects the labor market. Studies also show that economic benefits increase with longer periods of leave.
Recommendations
The AAP recommends that PFML be available to all families, which will require action by pediatricians and other health care professionals, public health officials, businesses, nonprofit organizations, and state and federal policymakers.
Federal and state legislation will be needed to finance and deliver a national universal PFML policy.
Federal PFML policies should be available for parents of newborns and adopted and fostered children; workers caring for loved ones who are seriously injured, ill or disabled; and workers with serious health problems. Policies should be accessible and job-protective. They should provide for leaves of at least 12 weeks and longer for medical complexity. Policies should ensure equity and inclusivity and include special considerations and protection for small businesses.
Following are key actions and recommendations for pediatricians.
- Use stories from practice to advocate at the local, state and federals levels for PFML benefits for infants, children, adolescents and young adults with special health care needs.
- Educate and refer families who may be eligible for existing leave policies, and educate families about the benefits of universal PFML so they can advocate on their own behalf.
- Promote research and advocacy on the benefits of PFML.
- Advocate for health care systems to provide robust paid leave benefits for all of their employees.
- Work with institutional training programs to educate residents on the importance of these policies for their patients and themselves, which would improve recruitment and retention of pediatricians with young families.
Dr. Dammann is a lead author of the policy statement and an AAP candidate member.
