Paid Family Leave and Infant Neglect: State-Level Trends and Racial Moderators from 2003-2022

Background & Purpose:

Paid family leave (PFL) policies provide critical economic and time support to caregivers during the postpartum period, potentially reducing risk factors associated with infant neglect–a form of maltreatment closely tied to structural poverty and systemic inequities. While emerging evidence links PFL to reduced infant maltreatment, PFL’s relationship with neglect remains unexplored. Further, research has yet to examine whether PFL’s effects depend on the concentration of historically marginalized communities of color, a group traditionally lacking access to paid leave benefits. Thus, we examine whether PFL implementation affects state-level neglect rates from 2003 to 2022 and whether state-level racial composition moderates this relationship, contributing to evidence-based policy solutions that promote racial and economic justice.

Methods:

Using data from the National Child Abuse and Neglect Data System, we constructed a longitudinal panel dataset of 38 U.S. States and Washington, DC, spanning 2003 to 2022. We applied mixed-effects beta regression models to assess the relationship between PFL implementation and infant neglect rates over time. Moderation analyses examined whether state-level proportions of residents identifying as people of color (POC), including Black, American Indian/Alaska Native (AIAN), and Asian American/Pacific Islander (AAPI) populations, influenced this relationship.

Results:

Infant neglect rates increased nationally over the study period; however, states with PFL experienced significantly slower growth in neglect compared to non-PFL states (B=-0.03, SE=0.02, p=.04). While infant neglect rates rose nearly 80% in non-PFL states, rates in PFL states increased by less than 2%. PFL’s effects on neglect were more pronounced in states with higher proportions of residents of color (B=-0.11, SE=0.04, p=.003). Disaggregated analyses suggested that higher shares of Black residents were associated with increased neglect in non-PFL states (B=-0.09, SE=0.04, p=.019) but not in PFL states (B=-0.04, SE=0.05, p=.391), suggesting PFL may buffer risk where systemic disadvantage is more acute. State-level shares of AAPI residents significantly moderated the relationship between PFL and neglect (B=-0.87, SE=0.18, p<.001), such that PFL’s ability to reduce neglect was magnified as the proportion of AAPI residents increased. AIAN representation did not significantly moderate the relationship between PFL implementation and neglect.. These findings suggest that PFL may function as a structural intervention that helps mitigate racial disparities in infant neglect, particularly in diverse states.

Conclusions & Implications:

This study underscores PFL’s potential as a population-level strategy to prevent infant neglect while promoting racial and economic equity. The results point to the urgent need for inclusive, racially responsive, family-supportive policies that address the systemic drivers of neglect. By centering structural determinants and demographic realities, this research contributes to aligning social work science with policy action. Findings may inform ongoing advocacy for federal PFL legislation and bolster implementation science efforts to ensure equitable access across communities.