Family-Friendly Policies in North Carolina

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.