Racial/Gender Disparities in Family and Medical Leave: Empirical Evidence and Policy Implications

Background/Purpose:  Health disparities research often fails to address the policies that maintain the systemic structures that produce inequalities in stressors and opportunities for healthy choices. Policies affect social advantage and disadvantage in communities, which ultimately result in health disparities. Policies that change the systemic structures that produce inequalities in stressors and opportunities can lead to decreased stress and higher social advantage and, in turn, a reduction in health disparities, including racial disparities in maternal and infant health.  Currently, Black women have three times higher maternal mortality than White women. Black babies have two times higher infant mortality, preterm birth, and low birthweight than White babies.

We examine the Family and Medical Leave Act (FMLA), a policy that, if ideally constructed, can work to decrease adverse maternal and infant health outcomes for Black women.

Methods:  Data and Samples: We used data from the Family and Medical Leave Act (FMLA) in 2012 – Employee survey, designed to examine the use of family or medical leave under the FMLA, unmet need for leave, and awareness about the FMLA. The analytic sample for the current study included adults aged 18-49 who were Black, Latino/a, or White (excluding 154 American Indian, Alaska Native, Asian, or other race/ethnicity). The final analytic sample size is thus 1,266.

Measures: For this study, we use three dependent variables:  1) leave needer vs. leave taker/employed only; 2) financial reason for not taking leave and 3) difficulty making ends meeting during leave. In addition, a combination of race/ethnicity and gender was categorized into six groups: Black male, Black female, Latino, Latina, White male, and White female.

We conducted the analysis in a two-step process. First, we analyzed the data to examine racial/gender disparities in unmet need for leave, having a financial reason for not taking leave (among leave “needers”), and having difficulty making ends meet (among leave “takers”). Second, we conducted a policy analysis of FMLA though a critical race theory (CRT) lens to identify gaps and provide policy revisions that place Black women at the center of the policy.

Results: We found that Black women had nearly seven times higher odds of unmet need for FMLA benefits compared to White men, after adjusting for age, marital status, education, family income, and awareness of FMLA.  Among leave “needers,” Black women had similar odds than White men for not taking leave due to a financial reason in the adjusted model.  In contrast, among leave “takers,” Black women had 3.5 higher odds of having difficulty in making ends meet compared with White men in the adjusted model.

Conclusions and Implications:  Our findings show how a lack of access to FMLA or inability to afford unpaid leave leads to increased stress for Black mothers, a known determinant of adverse maternal and infant outcomes, and impacts their opportunities for overall healthy choices.  Designing policies that increase equity for opportunities to make healthy choices and to decrease stress is recommended to close racial disparities in health and is fundamental for the overall health of populations.