President Biden’s Build Back Better Framework, currently in the bill stage, introduces major expansions to U.S. social programs, including those created to assist children and their caregivers. The original bill proposed 12 weeks of paid family leave, which affords compensated time off to care for newborn or adopted children and ill family members. However, after heated contention in the House prior to its passing, this provision was ultimately reduced to four weeks. In January 2022, the bill will be up for a vote in the Senate where it faces an uncertain future — paid family leave could be removed from the final version.
Although 80% of Americans support paid maternity leave, the U.S remains one of the few countries in the world without a federal paid benefit for caregivers. While states could introduce bills that include paid family leave, efforts in Pennsylvania to pass legislation have been unsuccessful thus far.
The benefits of paid family leave are well-established, and include better child and caregiver health outcomes and improvements to the economy through workforce retention. Even its short-term effects are valuable; the policy eases financial stressors, allows birthing people more time to recover, and facilitates infant bonding in new families. However, passing paid family leave is only half the battle; it must also be accessible. Families will not benefit from the policy unless they also know that they are eligible and can easily apply and receive funds in time to cover expenses. This is far from true for the social services aimed at young families that are currently available through federal programs.
Because many Philadelphian families qualify for services that they do not receive, they are unlikely to access a paid family leave policy if it is administered in an unreformed system.
In fact, those living in deep poverty, or in the lower half of families that are eligible for social services, are least likely to access government benefits. Due to a long history of systemic injustice in the United States, families of color are more likely to fall into this group. Reasons for foregone services include lack of information, stigma, and mistrust of government agencies. However, the most common barriers for families are filling out paperwork, traveling to appointments, finding application documents, and recertifying every year. These are administrative burdens: the learning, compliance, and psychological costs associated with accessing benefits within bureaucratic systems. These challenges mean that families who are relatively better-resourced receive benefits more often, while those without this institutional knowledge and persistence are left behind. If applicants do get through the tedious process, benefits often take time before they actually begin and have ongoing requirements. Programs that place more of this arduous work on individuals have less enrollment, especially from already vulnerable groups.
I frequently encounter administrative burdens as a public health nurse in Philadelphia supporting postpartum families and their babies. In my role, I answer clinical questions and connect families to needed resources. During visits, I ask about social determinants of health — for example, a family’s access to food, transportation, and safe housing. I recently received a referral for Rochelle and 1-month-old Tamara, who I met with to talk about early child development and postpartum recovery. Rochelle enjoys watching Tamara grow; her c-section is healing appropriately, and her sister helps by taking her to doctor’s visits. However, she also has challenges; she cannot afford utilities consistently and shows signs of postpartum depression. The only public benefit Rochelle is receiving is Medicaid health insurance, for which she became eligible because of her pregnancy. Under the current federal policy, she will lose coverage 60 days after giving birth. Two months is insufficient to provide recommended clinical care for Rochelle, who has experienced pregnancy-related complications.
Rochelle is among the 23% of Philadelphia families living below the national poverty line. Apart from postpartum Medicaid coverage, she is eligible for most income-based public benefits, including the Special Supplemental Nutrition Program for Women, Infants, and Children, and the Low-Income Home Energy Assistance Program. Rochelle has heard of these programs and thinks they will help but is not currently enrolled. She became discouraged by the compulsory, in-person visits and long lists of required documentation. Rochelle, like one in four U.S women, cannot afford to take unpaid time off postpartum. This has immediate consequences for Rochelle’s recovery and Tamara’s health. For example, although Rochelle wants to continue breastfeeding her daughter, she feels this will be difficult after she promptly returns to work. Rochelle and Tamara are among those who would be most helped by social programs, including paid family leave, if passed. They are also least likely to have access to them due to administrative burdens.
I am optimistic that the United States will retain the four weeks of universal paid family leave provision. This program is long overdue. It has been successfully implemented internationally and has been associated with better health and economic outcomes for young families. However, benefits will almost certainly be inequitably distributed if administered in current systems. This is not inevitable, however, and can be remediated by appropriate policy changes. For example, liberal enrollment periods, online registration, partnerships with local organizations, and combined applications will help ensure that all families receive their payments. These efforts should be targeted at families who are least likely to receive the services they qualify for. Implementing an equitable paid family leave program requires systematic improvements to how families learn about, apply for, and receive benefits. Soon, I hope to meet with new caregivers who can enjoy the first few weeks of their child’s life with fewer worries about necessities. Families like Rochelle's deserve this just as much as everyone else.
STACEY BEVAN is a PhD candidate in Nursing from College Station, TX. Her email is firstname.lastname@example.org.