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Research ArticleLIVED EXPERIENCES – INVITED COMMENTARY

Family-Friendly Policies in North Carolina

Kimberly Montez and Beth Messersmith
North Carolina Medical Journal January 2022, 83 (1) 22-25; DOI: https://doi.org/10.18043/ncm.83.1.22
Kimberly Montez
Pediatrician, Wake Forest School of Medicine and Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina.
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  • For correspondence: kmontez@wakehealth.edu
Beth Messersmith
Senior director, North Carolina chapter, MomsRising, Durham, North Carolina.
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Abstract

Given the extensive research on the impact of paid leave on increased access, decreased disparities, and improvement in health and economic outcomes, passing a universal statewide program that covers all working North Carolinians would promote Healthy North Carolina 2030 targets.

Introduction

When I gave birth to my daughter at 27 weeks, neither my job nor the state I lived in provided paid family and medical leave. Instead of caring for her during our 109-day neonatal intensive care unit stay, while she struggled to breathe on her own and learn how to eat, I returned to work within two weeks due to financial obligations. Working at a federally qualified community health center at the time as a pediatrician, I realized that many of my low-income patients and families, particularly those of color, were also disproportionately impacted by lack of paid leave policies. In my mind, paid leave and other family friendly-policies are urgently needed to address persistent health disparities (K.M.).

For families and the economy to thrive in North Carolina, family-friendly employment policies are critical to ensuring that pregnant and parenting workers have the opportunity to raise healthy children. Family-friendly policies are those that enable workers to balance employment, health, and family life through benefits such as flexibility, finances, time, and other accommodations. A list of representative family-friendly policies and their status in North Carolina is presented in Table 1. Providing supportive working conditions for pregnant individuals and parents not only lays the foundation for child health, well-being, and future success during a critical period of growth and development, it also promotes gender and economic equity by increasing women’s labor force participation rates and reducing poverty [1, 2].

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TABLE 1.

Family-Friendly Policies and their Current Status in North Carolina

Furthermore, employment policies that support working families yield benefits for businesses and the economy across several indicators, including productivity, earnings, recruitment and retention, morale, and improved employee health [3, 4]. Family-friendly policies support multiple Healthy North Carolina 2030 targets, including decreasing the number of people living in poverty, the percentage of children experiencing two or more adverse childhood experiences, and infant mortality [5]. Although each of the family-friendly policies listed in Table 1 is important for family well-being, we will focus on one policy that has extensive and strong evidence: paid family and medical leave.

Paid Leave

The United States is the only well-developed country without a national paid leave program that provides wage replacement to caregivers during an extended time off from work to care for a new biological, adopted, or foster child, or for a personal or family illness. Because no national program exists, states, local governments, and private sector businesses have implemented various paid leave programs, creating a patchwork of coverage that has made paid leave inaccessible to most workers.

Nationally, only 23% of civilian workers have access to paid leave [6]. Although 12 weeks of unpaid leave and job protection are available through the Family and Medical Leave Act, only 56% of US workers qualify [7, 8]. Among those who do, the majority of frontline, low-wage, minoritized workers cannot afford to take unpaid leave, choosing to earn an income rather than take needed time off from work to care for a new child or manage an illness [7]. Furthermore, 1 in 4 individuals returns to work within two weeks of giving birth, which has important implications for the health of the birthing individual and the infant [9]. Lastly, significant perinatal health disparities, or differences in health outcomes by race and ethnicity for mothers and infants, exist in North Carolina. For example, although infant mortality (death before one year of life) is slowly improving over time, North Carolina ranked 42nd in the United States for infant mortality in 2018; additionally, the infant mortality rate for non-Hispanic Black and American Indian or Alaska Native infants was two times higher than that of non-Hispanic White infants [10]. North Carolina rates of preterm birth (born < 37 weeks), low birth weight (born < 5.5 pounds), and maternal mortality (death within one year of delivery) demonstrate similar trends and disparities [11].

Status of Paid Leave in North Carolina

Currently, North Carolina is not among the nine states (California, Colorado, Connecticut, Massachusetts, New Jersey, New York, Oregon, Rhode Island, Washington) that have enacted paid leave laws. However, Governor Roy Cooper signed Executive Order No. 95 in 2019, providing paid parental leave to 56,000 eligible state employees (Table 1). This parental leave policy was later adopted by the majority of Council of State agencies as well as the University of North Carolina Board of Governors, which extended coverage to an additional 30,000 employees. A preliminary report from the North Carolina Office of State Human Resources indicates that after 10 months of program availability, there was a 19% increase in usage of paid parental leave [12], demonstrating increased access and utilization.

Since 2016, at least 22 cities and counties in North Carolina have also enacted paid leave programs for eligible local government employees (data not shown). Paid parental leave for all public school employees modeled after the policy for state employees was included in the North Carolina House 2021 version of the budget and in Governor Cooper’s counteroffer to the final budget proposal, but it was ultimately not included in the final budget that became law. In November 2021, the US House passed four weeks (20 workdays) of paid family and leave for all workers in the United States as part of the Build Back Better Act [13]. This was the first step in creating a federal program to provide paid leave. As of this writing, the package is with the US Senate for consideration.

Benefits of Paid Leave

Because multiple countries and US states have had paid leave programs in place for years, an extensive amount of evidence exists highlighting the health and economic benefits of this policy. Although modern family structures have changed, the research to date has focused on biological parents of opposite sex who are cisgender. Further research is necessary to understand the impact of paid leave on gender-diverse, kinship, and foster families.

Health benefits. Universal paid family and medical leave could build a healthier North Carolina by providing benefits for parents and children that have important public health implications. Research demonstrates that paid leave may address health disparities, given that the strongest improvements are seen for single and low-income mothers who are disproportionally from communities of color [14]. Mothers who take parental leave following the birth of a child have fewer rehospitalizations following delivery; increased rates of breastfeeding initiation and increased duration of breastfeeding; a decrease in postpartum depression, psychological distress, and intimate partner violence; and an increase in engaging in exercise [9, 14].

For fathers who take leave following the birth of a child, there is a reduction in the probability of having obesity; reduced use of public benefits; reduced alcohol consumption; higher engagement with and responsibility for children; decreased divorce rates; and increased involvement in household tasks [15–17]. Paternity leave is also associated with improvements in maternal and child health outcomes, including reduced postpartum health complications and depression, improved sleep, and increased child educational attainment.

Paid leave also benefits children, resulting in decreased rehospitalization after birth; lower rates of adverse childhood experiences, such as child maltreatment—a Healthy North Carolina 2030 target; fewer preterm births; lower rates of low birth weight, infant mortality, and child mortality; as well as increased vaccination rates and attendance at well child visits, and attachment and bonding with parents [9, 14].

A Duke Center for Child and Family Policy study demonstrated that if North Carolina were to implement eight weeks of universal paid leave with 55% wage replacement, seven infant lives per year would be saved, while 12 weeks at 80% wage replacement would save 26 infant lives per year, which would have a significant impact on infant mortality disparities [18]. As such, paid leave aligns with the Healthy North Carolina 2030 target of reducing infant mortality rates.

Economic and business benefits. Research demonstrates that paid leave programs greatly improve economic outcomes for low-income workers, women, and workers of color, as well as for businesses and society as a whole. Women of color are more likely to be the primary breadwinners for their families and be paid low wages compared to other workers [19]. For women, access to paid leave increases labor force participation, hourly wages, lifetime earnings, and retirement security, all of which could generate an additional $500 billion in yearly economic activity in the United States [20]. The increase in breastfeeding initiation and duration afforded by paid leave could add billions of dollars in medical, nonmedical, and premature death savings [21]. Furthermore, parents who take paid leave have reduced food insecurity and risk of poverty, are less likely to receive public assistance a year after their child is born, and have improved economic security [14, 16]. California’s paid leave program demonstrated positive impacts for businesses—increasing productivity, performance, profitability, and employee morale while decreasing employee turnover, which saved recruitment and retention costs [4]. These economic benefits of paid leave for families support the Healthy North Carolina 2030 target of reducing poverty.

Conclusion

North Carolina’s passage of paid parental leave for eligible state governmental employees demonstrates that the state understands the importance of this policy for working families. Given the extensive research on the benefit of paid leave on increased access, decreased disparities, and improvement in health and economic outcomes, passing a universal statewide program that covers all working North Carolinians would promote Healthy North Carolina 2030 targets. Passing additional family-friendly employment policies, as outlined in Table 1, would advance the health and well-being of children and families in North Carolina even further.

Acknowledgments

Disclosure of interests. No interests were disclosed.

  • © 2022 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

References

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Family-Friendly Policies in North Carolina
Kimberly Montez, Beth Messersmith
North Carolina Medical Journal Jan 2022, 83 (1) 22-25; DOI: 10.18043/ncm.83.1.22

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Kimberly Montez, Beth Messersmith
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