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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Breastfeeding.

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Strategy. Paid Family Leave

Approach. Create an employer paid family leave policy to support breastfeeding parents

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Overview. Paid family leave (PFL) provides employees with paid time off for circumstances such as a recent birth or adoption, a parent or spouse with a serious medical condition, or a sick child. Some employers allow the use of other paid time off, such as sick leave, for these purposes rather than designating family leave; some employers also offer maternity and paternity leave. PFL may be provided by employers or via state-level programs. State programs vary in the amount of benefit and maximum length of leave provided, and whether leave is job protected (Urban-Isaacs 2017). PFL is distinct from the federal Family and Medical Leave Act (FMLA), which provides eligible employees with at least 12 work weeks of job-protected leave without pay.[1]

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective. These strategies have been tested in multiple robust studies in a variety of populations and settings with consistently positive results, both on their own and in combination with other strategies. (Clarifying Note: The WWFH database calls this "scientifically supported evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Environmental Health. This strategy improves the impact of physical, chemical, and biological factors in the environment on health.
  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of employers educated about the benefits and requirements of PFL policies for breastfeeding support. (Measures the reach of employer outreach and education efforts.)
  • Number of employees covered by newly adopted employer PFL policies. (Quantifies the scale of expanded PFL access for working parents.)
  • Number of stakeholder groups engaged in advocating for employer PFL policies (e.g., unions, business associations). (Tracks the breadth of coalition-building efforts.)

OUTCOME MEASURES:

  • Number of breastfeeding parents who utilize PFL benefits through their employer. (Measures direct utilization of PFL for breastfeeding purposes.)
  • Number of weeks of PFL taken by employees to support breastfeeding, on average. (Assesses the average duration of leave taken for breastfeeding needs.)
  • Number of employers reporting cost-neutrality or cost-savings associated with PFL for breastfeeding. (Captures the financial feasibility and sustainability of PFL policies.)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of employer PFL policies that meet or exceed evidence-based best practices for breastfeeding support. (Assesses the quality and comprehensiveness of PFL policies.)
  • Percent of PFL-eligible employees who are aware of their breastfeeding-related leave benefits. (Measures effective communication and education about PFL rights.)
  • Percent of frontline managers trained on implementing PFL policies and supporting breastfeeding employees. (Tracks efforts to ensure equitable and consistent PFL access.)

OUTCOME MEASURES:

  • Percent of PFL benefit applications for breastfeeding that are approved on the first attempt. (Assesses the employee-friendliness and efficiency of the PFL process.)
  • Percent of breastfeeding employees who report high satisfaction with their employer's PFL policy. (Measures perceived value and impact of PFL on the employee experience.)
  • Percent of breastfeeding employees who feel PFL improved their ability to meet their breastfeeding goals. (Captures the self-reported benefits of PFL on breastfeeding success.)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of state/local agencies providing technical assistance to employers adopting PFL policies. (Measures the level of public sector support for employer policy change.)
  • Number of media campaigns or public service announcements promoting PFL for breastfeeding. (Assesses efforts to build public awareness and support for the issue.)
  • Number of healthcare providers and health plans educated about PFL benefits for breastfeeding families. (Tracks engagement of key partners in promoting PFL utilization.)

OUTCOME MEASURES:

  • Number of employers reporting improved recruitment and retention of parents after PFL implementation. (Captures the broader workforce and business benefits of family-friendly policies.)
  • Number of employees who maintain breastfeeding for at least 6 months after returning from PFL. (Measures the sustained health impact of PFL on breastfeeding duration.)
  • Number of PFL benefit claims for breastfeeding processed without incident or appeal. (Assesses the efficiency and customer service quality of the PFL system.)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • - Percent of PFL outreach and education materials tailored to the linguistic and cultural needs of the workforce. (Measures the cultural responsiveness and accessibility of PFL information.)
  • - Percent of small businesses and historically disadvantaged firms provided with PFL adoption support. (Assesses targeted assistance to employers facing unique barriers.)
  • - Percent of PFL policies that provide job protection and continuation of health coverage during leave. (Tracks the adoption of policy provisions that promote health equity.)

OUTCOME MEASURES:

  • - Percent reduction in socioeconomic disparities in PFL utilization for breastfeeding. (Measures progress toward equitable access to family leave benefits.)
  • - Percent increase in breastfeeding initiation and 6-month duration rates after PFL policy implementation. (Assesses population-level impact on breastfeeding outcomes.)
  • - Percent of breastfeeding parents who return to the same employer after taking PFL. (Captures the long-term economic security and job stability benefits of PFL policies.)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 U.S. Department of Labor (US DOL). Family and Medical Leave Act (FMLA). https://www.dol.gov/agencies/whd/fmla.

2 Mirkovic KR, Perrine CG, Scanlon KS. Paid maternity leave and breastfeeding outcomes. Birth. 2016;43(3):233-239.

3 Huang R, Yang M. Paid maternity leave and breastfeeding practice before and after California’s implementation of the nation’s first paid family leave program. Economics & Human Biology. 2015;16:45-59.

4 Borrell C, Palencia L, Muntaner C, et al. Influence of macrosocial policies on women's health and gender inequalities in health. Epidemiologic Reviews. 2014;36(1):31-48.

5 Heymann J, Earle A, McNeill K. The impact of labor policies on the health of young children in the context of economic globalization. Annual Review of Public Health. 2013;34:355-72.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.