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Paid Parental Leave

Statement of Policy

The health and economic benefits of paid parental leave are well documented. The American College of Obstetricians and Gynecologists (ACOG) endorses paid parental leave as essential. Paid parental leave includes maintenance of full benefits and 100% of pay for at least eight weeks.

Those who choose to have children should not face discrimination, and discrimination on the basis of pregnancy is explicitly prohibited (1, 2). Workers who choose to have children are no less committed to the workplace and training environment as those who do not choose to have children. Workers eligible for paid parental leave include workers who are pregnant, their partners, a surrogate, and parents of a newly adopted child.

The recognized benefits of paid parental leave include decreased infant and childhood mortality, decreased infant and birthing parent rehospitalization rates, decreased post-partum depression and intimate partner violence, improved infant attachment and child development, improved exercise ability and stress management for the birth parent, improved breastfeeding initiation and continuation, improved worker morale and retention, and increased income over time (3-11). Paid parental leave supports the parent-child dyad while also benefiting the employer in decreasing worker turnover, increasing productivity, and encouraging the worker to return to the workplace (12, 13). Individuals of lower socioeconomic status generally do not have access to paid parental leave, and the benefits of parental leave are hypothesized to be greater in disadvantaged groups (6, 11). All employed persons should have the time and support to experience the benefits of paid parental leave.

Implementation of equitable parental leave policies in Graduate Medical Education Programs is recommended. By necessity, policies may vary depending upon the number of trainees in a program and resources available to the department. Minimum guidelines are listed below.

The following guidelines are proposed to serve as a framework for paid parental leave policies for all employees:

  • Paid parental leave for at least 8 weeks, separate from vacation and sick time for new parents
  • Paid parental leave is taken after the birth of the child, to care for a newly adopted child, or because of placement of the child with the worker for adoption
  • Use of paid parental leave should not be considered when making decisions regarding benefits, promotion, tenure or continued employment.
  • The employee should inform their appropriate team members or administration of the pregnancy or anticipated adoption date in a timely fashion, with the understanding that adjustments may be needed for unanticipated events.

The following guidelines are proposed for parental leave for physicians and physicians in training:

  • Medical schools, residency and fellowship training programs, medical specialty boards, the Accreditation Council for Graduate Medical Education, and medical practices should incorporate paid parental leave policies as part of the physician’s standard benefit package.
  • Paid and unpaid parental leave policies should be explicitly included in employment contracts and should be part of the standard benefits package
  • Physicians in training should not be required to use vacation days for parental leave or give up vacation days because they have utilized parental leave
  • Physicians in training should not be required to make up call shifts as a consequences of taking parental leave. Call requirements should be proportionate to the number of days available to work. GME programs and their departments should explore ways to cover unfilled call shifts with advanced practice providers or other non-GME physicians.
  • Coverage by trainees above their baseline annual call requirements should be appropriately compensated.
  • ACGME duty hours requirements for all trainees should be maintained.
  • The trainee and program director should meet to review the impact of parental leave on completion of the program, potential need for an extension of training, and the impact on eligibility for the board certification examination. This information should be used to plan subsequent training and graduated date determination.
  • In settings where training is based on ‘rotations’, adjustments and flexibility to reassign rotations in light of clinical, patient care, education and procedural experience preservation for all impacted trainees should be identified as early as possible prior to the paid parental leave.
  • Procedure volume and competency based progress should be used to determine eligibility for clinical practice.

ACOG recommends that all workplaces and training environments, including medical training programs, adopt policies to promote supportive environments for new parents. ACOG opposes any punitive measures directed at workers who choose to have children. Neither they nor their colleagues should be subject to an excessive call burden or forfeit core training experience.

References

  1. U.S. Equal Employment Opportunity Commission. The Pregnancy Discrimination Act of 1978. Accessed November 9, 2023. https://www.eeoc.gov/statutes/pregnancy-discrimination-act-1978.

  2. State of California, Civil Rights Department. Legal records and reports. Fair Employment and Housing Act. Accessed November 9, 2023. https://calcivilrights.ca.gov/LegalRecords/.

  3. Ruhm CJ. Parental leave and child health. J Health Econ 2000;19:931-60. doi: 10.1016/s0167-6296(00)00047-3.

  4. Berger LM, Hill J, Waldfogel J. Maternity leave, early maternal employment and child health and development in the US. Econ J 2005;115:F29-47. doi: 10.1111/j.0013-0133.2005.00971.x.

  5. Gault B, Hartmann H, Hegewisch A, Milli J, Reichlin L. Paid parental leave in the United States: what the data tell us about access, usage, and economic and health benefits. Institute for Women's Policy Research; 2014. Accessed November 9, 2023. https://iwpr.org/wp-content/uploads/2020/09/B334-Paid-Parental-Leave-in-the-United-States.pdf.

  6. Rossin M. The effects of maternity leave on children's birth and infant health outcomes in the United States. J Health Econ 2011;30:221-39. doi: 10.1016/j.jhealeco.2011.01.005.

  7. Burtle A, Bezruchka S. Population health and paid parental leave: what the United States can learn from two decades of research. Healthcare (Basel) 2016;4:30. doi: 10.3390/healthcare4020030

  8. Van Niel MS, Bhatia R, Riano NS, de Faria L, Catapano-Friedman L, Ravven S, et al. The impact of paid maternity leave on the mental and physical health of mothers and children: a review of the literature and policy implications. Harv Rev Psychiatry 2020;28:113-26. doi: 10.1097/HRP.0000000000000246.

  9. Jou J, Kozhimannil KB, Abraham JM, Blewett LA, McGovern PM. Paid maternity leave in the United States: associations with maternal and infant health. Matern Child Health J 2018;22:216-25. doi: 10.1007/s10995-017-2393-x.

  10. Whitney MD, Holbrook C, Alvarado L, Boyd S. Length of maternity leave impact on mental and physical health of mothers and infants, a systematic review and meta-analysis. Matern Child Health J 2023;27:1308-23. doi: 10.1007/s10995-022-03524-0.

  11. Montoya-Williams D, Passarella M, Lorch SA. The impact of paid family leave in the United States on birth outcomes and mortality in the first year of life. Health Serv Res 2020;55(suppl 2):807-14. doi: 10.1111/1475-6773.13288

  12. Council of Economic Advisors. The economics of paid and unpaid leave. Executive Office of the President; 2014. Accessed November 9, 2023. https://obamawhitehouse.archives.gov/sites/default/files/docs/leave_report_final.pdf.

  13. Baughman R, DiNardi D, Holtz‐Eakin D. Productivity and wage effects of “family‐friendly” fringe benefits. Int J Manpow 2003;24:247-59. doi: 10.1108/01437720310479723.

  14. Dex S, Smith C. The nature and pattern of family-friendly employment policies in Britain. Policy Press; Joseph Rowntree Foundation; 2002. Accessed November 9, 2023. https://www.jrf.org.uk/sites/default/files/jrf/migrated/files/jr116-family-friendly-employment.pdf.

  15. U.S. Department of Labor, Wage and Hour Division. Family and Medical Leave Act. Accessed November 9, 2023. https://www.dol.gov/agencies/whd/fmla.

Approved by the Executive Board July 2016
Amended and Reaffirmed July 2019
Amended August 2020
Amended November 2023