Paid family leave policies have the potential to reduce health disparities, yet access to paid leave remains limited and unevenly distributed in the United States. The US is the only OECD country that does not provide paid leave for new parents, and just 8 states and the District of Columbia have passed partially-paid family leave policies.

In a new paper, Julia Goodman of the OHSU-PSU School of Public Health, Will Dow of UC Berkeley, and Holly Elser of Stanford University examine the impact of the 2017 San Francisco Paid Parental Leave Ordinance (PPLO), the first in the US to provide parental leave with full pay. 


The research team drew on two complementary data sources: administrative data from the California Employment Development Department to estimate the effects of the Paid Parental Leave Ordinance on leave-taking, and survey data of new mothers to help understand the remaining barriers to leave-taking. Their findings show that the PPLO moderately increased parental leave uptake among fathers but did not increase leave among mothers.  Limited knowledge and reach of the PPLO likely dampened its potential effects:

  • Men in San Francisco increased their uptake 13 percent more than did men in surrounding counties after the PPLO went into effect, but women’s leave-taking did not change.
  • Lower-income mothers reported less knowledge of their maternity leave benefits than other mothers, and were 48 percentage points less likely to report receiving information from their employers.
  • Fewer than 2 percent of lower-income mothers had accurate information about the PPLO (that is, knew that it includes fathers and ensures full pay for six weeks), despite extensive public outreach.
  • Employers were not a reliable source of information for many workers.
  • Health care providers were the only source of information being used equally by low and high-income women and their use over time increased with both groups.
  • Among women who were employed during pregnancy, only 33 percent of lower-income women were employed in jobs that were covered by the PPLO, compared to 65 percent of higher-income women.

Implications for Policy and Practice

The current policy is not well targeted for low-income working families. A universal policy would be more effective in expanding parental leave among vulnerable workers. The research reveals three ways to structure paid leave to increase uptake:

Expand eligibility: The San Francisco policy has limited impact due to its eligibility restrictions which exclude small employers, independent contractors, and those in the public sector. These exclusions limit the reach of these benefits among low-income workers. Lower-income women were far less likely than their higher-income counterparts to work in jobs or to have partners employed in jobs covered by the PPLO.

Increase education: Many women, particularly lower-income women, had limited knowledge of maternity leave benefits available to them.  More robust outreach would be helpful to increase knowledge of leave benefits as would ensuring that health care providers understand the benefits. In addition, making leave universally available makes it easy for all parents to know they are eligible.

Simplify the program: A less complex policy design and application process would also be helpful, so parents are not required to learn the many nuances of state and local systems. For cities that establish benefits supplementing state policies, like San Francisco, confusion could be reduced by establishing a local office to coordinate applications and benefit payments for all relevant leave policies on behalf of the employee. This would also relieve individual applicants from the burden of figuring out which specific rules apply in their city.

Related Evidence

  • Published July 1, 2020

    Paid family and medical leave has important health benefits for parents and their children, but access to job-protected leave is limited and highly disparate in the United States. Increasingly, state and local governments have established policies such as paid leave to support parents and other caregivers. While these policies have been crucial in enabling more workers to take leave, their effects have been weakened due to only partial coverage of job protection laws. As part of their ongoing work evaluating the 2017 San Francisco Paid Parental Leave Ordinance, investigators Julia M. Goodman (Oregon Health & Science University/Portland State University) and William H. Dow (University of California, Berkeley) published an issue brief examining paid leave protections in the California Bay Area.

    View Evidence

  • Published February 1, 2019

    In a new issue brief examining the 2017 San Francisco Paid Parental Leave Ordinance, Julia M. Goodman, William H. Dow and Holly Elser find little evidence that implementing new paid family leave policies or expanding existing policies negatively affects employers.

    View Evidence

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