Kansas Breastfeeding Coalition Issues Public Comment on Labor Department Notice

WASHINGTON, Sept. 17 -- Brenda Bandy, executive director of the Kansas Breastfeeding Coalition, Manhattan, has issued a public comment on behalf of the board on the Department of Labor notice entitled "Request for Information: Paid Leave". The comment was written and posted on Sept. 14, 2020:

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The Kansas Breastfeeding Coalition (KBC) is writing to comment on the request for information (RFI) issued by the Women's Bureau of the U.S. Department of Labor (DOL) on July 16, 2020. As an organization dedicated to promote, support and protect breastfeeding, we are committed to policies that ensure workers the ability to care for themselves and their families without sacrificing their economic security.

The KBC strives to support the more than 90% of Kansas families who choose to breastfeeding. The evidence is clear that having time to establish breastfeeding in the early days and weeks after birth is one of the best strategies to support these breastfeeding families. Therefore, one of our policy priorities is paid family and medical leave. Research shows paid family and medical leave can improve economic and health outcomes for families across Kansas. Paid family leave improves maternal and child health outcomes, including increased breastfeeding rates and duration. The impact is larger for disadvantaged workers. The KBC believes the implementation of paid family and medical leave is vital for our state and nation.

The RFI notice indicates that DOL seeks to "gather information concerning the effectiveness of current state- and employer-provided paid leave programs, and how access or lack of access to paid leave programs impacts America's workers and their families," in order to "identify promising practices related to eligibility requirements, related costs, and administrative models of existing paid leave programs." Although it is not mentioned in the RFI, there is already a vast wealth of information demonstrating the effects of not having paid family and medical leave and the benefits of state programs that provide it.

DOL itself enabled several valuable studies on paid leave program design and implementation through the innovative Paid Leave Analysis Grant Program administered by the Women's Bureau, and the Chief Evaluation Office-funded Worker Leave studies. The overwhelming weight of the research is clear: the private sector as a whole has failed to solve the paid leave crisis faced by America's workers, and publicly funded social insurance represents the only viable path forward.

The following is drawn from the position statement adopted by the Board of Directors of the United States Breastfeeding Committee (USBC) on July 11, 2016.

I. Paid Family and Medical Leave Must Work for All Workers

At some point in their lives, nearly every working person will welcome a new child, deal with their own serious health issue or need to provide care to a seriously ill, injured or disabled loved one. Yet despite progress, most people still do not have the security they need to take time away from their jobs. Millions of people are forced to choose between their wages and their ability to care for themselves or their families. Just 19 percent of the workforce has paid family leave through their employers, and only 40 percent has personal medical leave through an employer-provided disability program./1

The reality is especially stark for people of color and low-wage workers, who face the greatest disparities in their ability to access and afford leave. The lack of paid leave costs U.S. workers and their families $22.5 billion each year in lost wages alone./2

Evidence from the states with paid leave programs has shown that in order to truly meet the needs of working people, a paid family and medical leave program must meet certain basic standards. It must be comprehensive by allowing leave for all FMLA-covered events, particularly as our nation ages and the shortage of paid caregivers means more working people are called upon to care for their family members. It must provide the same amount of leave regardless of a worker's gender. It must replace individuals' wages at an adequate level so that people can actually afford to take time off, as well as a meaningful duration of leave, so that people have enough time to meet their family or medical needs. It must allow leave to care for an inclusive range of family members in order to adequately reflect the way our families really look - particularly for families of color, immigrant families, and the LGBTQ community. It must guarantee job protection so that people can take the time off they need without having to worry if their job will still be there for them when they return. And it must be funded affordably and sustainably, without cutting other essential programs that working people need.

In addition, the RFI describes family leave as leave to "[care] for the employee's spouse, child, or parent who has a serious health condition." By limiting its request to only ask about spouses, children, and parents, the RFI misses the reality of caregiving - namely, that families come in all shapes and sizes, and that caregiving transcends the boundaries of blood, age, and legal formality. According to the most recent DOL-commissioned study of the Family and Medical Leave Act, nearly one in five leaves taken for family caregiving purposes is to care for an individual not covered under the FMLA's limited definition of "family member."/3

All nine states (including the District of Columbia) that have enacted paid leave allow leave to care for a more inclusive range of family members that more accurately reflects the lived realities of workers and their families. This restrictive definition of "family" especially leaves out single-parent and blended families, families headed by same-sex couples, chosen families, and multi-generational families. These families and their stories are essential to the inquiry on which DOL is embarking.

Paid family leave to support family bonding and caregiving allos women to successfully combine their reproductive role and employment, and to prevent unequal treatment in the workplace. Paid family and medical leave provides crucial protections to preserve the health of both mother and child, as well as to provide job security, maintenance of wages and benefits, and the right to resume paid employment. Additionally, paid family and medical leave is linked to increased employee retention, reduced employee turnover and worker replacement costs for employers, increased worker productivity, reduced healthcare costs, and a reduced need for public assistance.

All major medical authorities recommend exclusive breastfeeding for the first six months of life, followed by continued breastfeeding until at least one year of age. While 4 out 5 of babies born in the United States start out breastfeeding, six in ten breastfeeding mothers stop breastfeeding earlier than they intend. By six months of age, only 24.9 percent of U.S. infants are exclusively breastfed. A major barrier to breastfeeding in the United States is the social and economic pressure for women to return to paid employment soon after birth. More than half of mothers enter or return to the labor force before their children turn one year old with as many as one in four women returning within two weeks of giving birth. Research shows a relationship between a woman's decision to start and continue breastfeeding and the length of maternity leave she has. Mothers who return to work before six weeks postpartum are over three times more likely to stop breastfeeding than women who did not return to work. Research also shows that mothers who return to full-time employment shortly after giving birth are less likely to breastfeed as long as they intend. In California, access to paid family leave doubled the median duration of breastfeeding for all new mothers who used the state's paid family leave law during the six years after it went into effect. Increasing access to paid family leave is especially crucial among low wage and vulnerable populations. Only 15 percent of workers in the United States have access to paid family leave. Among low-wage workers (those in the lowest 25 percent of wage earners), this number drops to 6 percent. Further, there are significant disparities in access to paid family leave between racial groups. At the same time, disparities in breastfeeding outcomes between racial groups persist. In 2012, 66 percent of black infants had ever been breastfed, compared to 83 percent of white infants.

The United States currently ranks 57th globally in infant mortality and 48th in maternal mortality. In both developed and developing countries, paid maternity leave has been found to be associated with significantly lower neonatal, infant, and child mortality rates. Newborns whose mothers take longer leaves are more likely to be taken for well-baby check-ups and more likely to be breastfed. Men who take two or more weeks off after the birth of a child are more involved in the direct care of their children nine months later than fathers who take no leave.

Maternity protection has been a core issue for the International Labor Organization (ILO), recognizing that expectant and breastfeeding mothers require protection to ensure adequate time to give birth, recover, and breastfeed their children. Current ILO Conventions call for a period of maternity leave of no less than 14 weeks (Convention No. 183, Article 4(1)), with cash benefits at no less than two-thirds of the woman's previous earnings (Convention No. 183, Article 6(3)), provided through compulsory social insurance or public funds (Convention No. 183 Article 6(8)). These Conventions apply to all employed women including those in atypical forms of dependent work such as part-time, informal, casual, or seasonal; contractual, remote, or piecework; or self-employed.

II. A Publicly Run Paid Leave Program Is the Best Option for Workers and Businesses

Paid family and medical leave has been shown to reap significant benefits for employers in the forms of worker retention, productivity, loyalty, morale, and competitiveness. As a testament to these benefits, over the past few years, over one hundred large brand-name businesses have introduced or expanded their paid leave policies to recognize the needs of their workforce and the benefits to their bottom line. Yet even with these developments, access to paid leave remains critically low, and has improved at a glacial pace for the majority of workers. Nationwide, only 18 percent of private sector workers have access to paid family leave through their employers, and only 42 percent have employer-provided short-term disability insurance. These numbers become even more dismal when exploring workers with the lowest wages, part-time workers, and small business employees - the very workers who would benefit the most from paid leave. In fact, access to paid family leave for the lowest-income workers has increased by just 2 percentage points in the last 7 years, to a paltry 5 percent in 2019,/4 even after the enactment in 2017 of tax credits intended to incentivize employers to offer paid leave. These low access rates and minimal progress prove that private sector policies alone are insufficient to solve our nation's paid leave crisis. Too few businesses are adopting paid leave policies, and those that do often limit access to only their highest paid, white collar employees.

Fortunately, a more universal model already exists and is proven to work. Nine states, including the District of Columbia, have enacted paid family and medical leave social insurance programs. Under this model, employees and/or employers contribute a small percentage of wages into a public fund, out of which benefits are paid as a percentage of an employee's wages. This ensures that employees can access leave regardless of their employer, position, or part-time/full-time status - meaning that the workers most in need of leave can access it. It also eliminates employers' large up-front costs of providing paid leave out of their own pockets - especially important for small businesses, who otherwise might not be able to afford this benefit, making it harder to compete with large businesses for the best employees. Polls of small businesses repeatedly demonstrate overwhelming support for a national paid leave policy structured as social insurance, and hundreds of small businesses have endorsed federal paid family and medical leave legislation.

III. Research Demonstrates the Clear Benefits of Public Paid Leave Programs for Workers and Businesses

Research from these programs has demonstrated that working families with paid leave are more economically secure and more able to manage work and family responsibilities. Parents in California and Rhode Island reported that paid leave improved their ability to arrange child care./5

State paid leave programs improve the labor force participation of family caregivers,/6 reduce the likelihood that new mothers will fall into poverty,/7 and increase household incomes./8

The research also shows wide-ranging impacts on public health When workers do not have the leave they need -- most often because they could not afford unpaid leave -- they may defer or forego necessary medical treatment./9

Paid medical leave has been shown to help cancer patients manage their treatment and side effects./10

For babies and young children, paid leave provides time to establish a strong bond with parents during the first months of life, increases rates and duration of breastfeeding,/11 supports fathers' involvement in care,/12 improves rates of on-time vaccination,/13 reduces infant hospital admissions,/14 and reduces probabilities of having ADHD, hearing problems or recurrent ear infections./15

Paid leave may also help prevent child maltreatment by reducing risk factors, such as family and maternal stress and depression./16

Paid leave reduces the odds of a new mother experiencing symptoms of postpartum depression/17 and is associated with improvements in new mothers' health./18

In California, implementing paid family leave was linked to an 11 percent relative decline in elderly nursing home usage./19

Meanwhile, employers have adapted well to state paid leave programs. The vast majority of California employers reported a positive or neutral effect on employee productivity, profitability and performance./20

The California Society for Human Resource Management, a group of human resources professionals that initially opposed California's paid family leave law, declared that the law is less onerous than expected, and few businesses in their research reported challenges resulting from workers taking leave./21

In New Jersey, the majority of both small and large businesses say they have adjusted easily./22

Just one year after implementation of New York's paid family leave program, 93 percent of employers were in compliance with the new law./23

Additionally, state paid leave programs provide a model that works for small businesses. The majority of small business owners support the creation of family and medical leave insurance programs at the state and federal levels, as these programs make the benefit affordable, reduce business costs, increase their competitiveness and can allow small business owners themselves to take paid leave when the need arises./24

In California, although most employers of all sizes report positive or neutral outcomes associated with paid leave, small businesses reported more positive or neutral outcomes than large businesses in profitability, productivity, retention and employee morale./25

A New Jersey survey found that, regardless of size, New Jersey businesses say they have had little trouble adjusting to the state's law./26

Finally, paid leave boosts employee morale and reduces costly turnover. In California, virtually all employers (99 percent) report that the state's program had positive or neutral effects on employee morale and 87 percent say that the state program had not increased costs. Sixty percent report coordinating their benefits with the state's paid family leave insurance system - which likely results in ongoing cost savings./27

Firm-level analysis of employers in California before and after paid family leave was implemented confirmed that for the average firm, wage costs had not increased and turnover rates had decreased./28

Workers in lower quality jobs who used the state paid leave program reported returning to work nearly 10 percent more than workers who did not use the program./29

Women who take a paid leave are 93 percent more likely to be in the workforce nine to 12 months after giving birth than women who take no leave./30

In multiple studies, New Jersey employers have noted that the state's paid leave program is beneficial for employees and manageable for employers./31

The evidence is overwhelming: paid leave is a win-win for workers and businesses, and the most equitable, sustainable model for paid leave is a national, publicly run social insurance program that builds on the innovation that states have pioneered.

We appreciate the opportunity to submit this comment. If you have any questions, please contact Brenda Bandy, Executive Director at [email protected] .

Sincerely,

Board of Directors

Kansas Breastfeeding Coalition

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Footnotes:

1/ U.S. Bureau of Labor Statistics. (2019, September). National Compensation Survey: Employee Benefits in the United States, March 2019 (Table 16, Table 31). Retrieved 27 August 2020, from https://www.bls.gov/ncs/ebs/benefits/2019/employee-benefits-in-the-united-states-march-2019.pdf

2/ Glynn, S. J. (2020, January 21). The Rising Cost of Inaction on Work-Family Policies. Retrieved 27 August 2020 from Center for American Progress website: https://www.americanprogress.org/issues/women/news/2020/01/21/479555/rising-cost-inaction-work-family-policies/

3/ Brown, S., Herr, J., Roy, R., & Klerman, J. A. (2020, July). Employee and Worksite Perspectives of the Family and Medical Leave Act: Supplemental Results from the 2018 Surveys (Exhibit B4-3). Retrieved 27 August 2020, from U.S. Department of Labor website: https://www.dol.gov/sites/dolgov/files/OASP/evaluation/pdf/WHD_FMLA2018SurveyResults_Appendices_Aug2020.pdf

4/ See note 1; U.S. Bureau of Labor Statistics. (2012). National Compensation Survey: Employee Benefits in the United States, March 2012 (Table 32). Retrieved August 27 2020, from https://www.bls.gov/ncs/ebs/benefits/2012/ebbl0050.pdf

5/ Appelbaum, E., & Milkman, R. (2013). Unfinished Business: Paid Family Leave in California and the Future of U.S. Work-Family Policy. Ithaca, NY: Cornell University Press; Silver, B., Mederer, H., & Djurdjevic, E. (2015). Launching the Rhode Island Temporary Caregiver Insurance Program (TCI): Employee Experiences One Year Later. Rhode Island Department of Labor and Training and University of Rhode Island. Retrieved 27 August 2020, from https://web.uri.edu/ssirep/files/RI-Paid-Leave-Final-Report-April-2016.pdf

6/ Saad-Lessler, J., & Bahn, K. (2017, September 27). The Importance of Paid Leave for Caregivers. Retrieved 27 August 2020, from Center for American Progress website: https://www.americanprogress.org/issues/women/reports/2017/09/27/439684/importance-paid-leavecaregivers/

7/ Stanczyk, A. (2019). Does Paid Family Leave Improve Household Economic Security Following a Birth? Evidence from California. Social Service Review, 93(2), 262-304. DOI: 10.1086/703138

8/ Ibid.

9/ See Brown, S., Herr, J., Roy, R., & Klerman, J. A. (2020, July). Employee and Worksite Perspectives of the Family and Medical Leave Act: Results from the 2018 Surveys, pp. 45-46. Retrieved 27 August 2020, from U.S. Department of Labor website: https://www.dol.gov/sites/dolgov/files/OASP/evaluation/pdf/WHD_FMLA2018SurveyResults_FinalReport_Aug2020.pdf

10/ Harrington, E., & McInturff, B. (2017). Key Findings -- National Surveys of Cancer Patients, Survivors, and Caregivers. American Cancer Society Cancer Action Network Publication. Retrieved 27 August 2020, from: https://www.fightcancer.org/sites/default/files/ACS%20CAN%20Paid%20Leave%20Surveys%20Key%20Findings%20Press%20Memo%20FINAL.pdf. The results of this survey strongly suggest that other workers with chronic or serious illnesses will have better access to treatment and care when they are able to take paid time off from work.

11/ Hamad, R., Modrek, S., & White, J. S. (2019). Paid Family Leave Effects on Breastfeeding: A Quasi-Experimental Study of US Policies. American Journal of Public Health. 109(1): 164-166. DOI: 10.2105/AJPH.2018.304693

12/ Lamb, M. (2004). The role of the father in child development, 4th ed. (pp. 1-18, 309-313). Hoboken, NJ: John Wiley & Sons, Inc.; Smith, K. (2015). After the Great Recession, More Married Fathers Providing Child Care. Carsey School of Public Policy. Retrieved 27 August 2020, from https://scholars.unh.edu/cgi/viewcontent.cgi?article=1233&context=carsey

13/ Choudhury, A. R., & Polachek, S. W. (2019, July). The Impact of Paid Family Leave on the Timing of Infant Vaccinations. I. Z. A. Institute of Labor Economics. Retrieved 27 August 2020, from http://ftp.iza.org/dp12483.pdf

14/ Pihl, A. M., & Basso, G. (2018). Did California Paid Family Leave Impact Infant Health? Journal of Policy Analysis and Management. 38(1), 155-180. DOI: 10.1002/pam.22101

15/ Lichtman-Sadot, S., & Pillay Bell, N. (2017). Child Health in Elementary School Following California's Paid Family Leave Program. Journal of Policy Analysis and Management, 36(4), 790-827. DOI: 10.1002/pam.22012

16/ Klevens, J., Luo, F., Xu, L., Peterson, C., Latzman, N. (2016). Paid family leave's effect on hospital admissions for pediatric abusive head trauma. Injury Prevention. 22, 442-445. DOI: 10.1136/injuryprev-2015-041702

17/ Chatterji, P., & Sara Markowitz, S. (2008). Family Leave After Childbirth and the Health of New Mothers. Retrieved 27 August 2020, from National Bureau of Economic Research website: http://www.nber.org/papers/w14156; Kornfeind, K. R., & Sipsma, H. L. (2018). Exploring the Link between Maternity Leave and Postpartum Depression. Women's Health Issues, 28(4), 321-326. DOI: 10.1016/j.whi.2018.03.008

18/ Pal, I. (2016). Work, Family and Social Policy in the United States - Implications for Women's Wages and Wellbeing. Doctoral thesis, Columbia University. DOI: 10.7916/D87W6C74

19/ Arora, K., & Wolf, D. A. (2017, November 3). Does Paid Family Leave Reduce Nursing Home Use? The California Experience. Journal of Policy Analysis and Management, 37(1), 38-62. DOI: 10.1002/pam.22038

20/ Appelbaum, E., & Milkman, R. (2013). Unfinished Business: Paid Family Leave in California and the Future of U.S. Work-Family Policy. Ithaca, NY: Cornell University Press; Bartel, A., Baum, C., Rossin-Slater, M., Ruhm, C., & Waldfogel, J. (2014, June 23). California's Paid Family Leave Law: Lessons from the First Decade. Retrieved 20 August 2019, from U.S. Department of Labor website: http://www.dol.gov/asp/evaluation/reports/PaidLeaveDeliverable.pdf

21/ Redmond, J., & Fkiaras, E. (2010, January). California's Paid Family Leave Act Is Less Onerous Than Predicted. Society for Human Resources Management Publication. Retrieved 27 August 2020, from https://www.sheppardmullin.com/media/article/809_CA%20Paid%20Family%20Leave%20Act%20Is%20Less%20Onerous%20Than%20Predicted.pdf

22/ Ramirez, M. (2012). The Impact of Paid Family Leave on New Jersey Businesses. New Jersey Business and Industry Association and Bloustein School of Planning and Public Policy at Rutgers, The State University of New Jersey Presentation. Retrieved 27 August 2020, from https://bloustein.rutgers.edu/wp-content/uploads/2012/03/Ramirez.pdf

23/ Office of Governor Andrew C. Cuomo. (2019, August 13). New York State Paid Family Leave: 2018 Year in Review. Retrieved 27 August 2020, from https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/PFL_EOYReport_2018_FINAL.pdf

24/ Rouzer, S. (2017, February 7). New Report: Small Business Owners Support Paid Family Leave, FAMILY Act. Retrieved 27 August 2020, from Main Street Alliance website: http://www.mainstreetalliance.org/small_business_owners_support_family_act; Small Business Majority & Center for American Progress. (2017, March 30). Small Businesses Support Paid Family Leave Programs. Retrieved 27 August 2020, from http://www.smallbusinessmajority.org/our-research/workforce/small-businesses-support-paidfamily-leave-programs; Mason, J. (2019, August). Meeting the Promise of Paid Leave: Best Practices in State Paid Leave Implementation. Retrieved 27 August 2020, from http://www.nationalpartnership.org/our-work/resources/economic-justice/paid-leave/meeting-the-promise-of-paid-leave.pdf

25/ Appelbaum, E., & Milkman, R. (2013). Unfinished Business: Paid Family Leave in California and the Future of U.S. Work-Family Policy. Ithaca, NY: Cornell University Press

26/ Ramirez, M. (2012). The Impact of Paid Family Leave on New Jersey Businesses. New Jersey Business and Industry Association and Bloustein School of Planning and Public Policy at Rutgers, The State University of New Jersey Presentation. Retrieved 20 August 2019, from http://bloustein.rutgers.edu/wpcontent/uploads/2012/03/Ramirez.pdf

27/ Appelbaum, E., & Milkman, R. (2013). Unfinished Business: Paid Family Leave in California and the Future of U.S. Work-Family Policy. Ithaca, NY: Cornell University Press

28/ Bedard, K., & Rossin-Slater, M. (2016, October 13). The Economic and Social Impacts of Paid Family Leave in California: Report for the California Employment Development Department. Retrieved 27 August 2020, from https://www.edd.ca.gov/disability/pdf/PFL_Economic_and_Social_Impact_Study.pdf

29/ Appelbaum, E., & Milkman, R. (2013). Unfinished Business: Paid Family Leave in California and the Future of U.S. Work-Family Policy. Ithaca, NY: Cornell University Press

30/ Houser, L., & Vartanian, T. P. (2012, January). Pay Matters: The Positive Economic Impacts of Paid Family Leave for Families, Businesses and the Public. Center for Women and Work at Rutgers The State University of New Jersey Publication. Retrieved 27 August 2020, from https://www.nationalpartnership.org/our-work/resources/economic-justice/other/pay-matters.pdf

31/ Lerner, S., & Appelbaum, E. (2014, June). Business As Usual: New Jersey Employers' Experiences with Family Leave Insurance. Retrieved 27 August 2020, from Center for Economic and Policy Research website: http://www.cepr.net/documents/nj-fli-2014-06.pdf; Mason, J. (2019, August). Meeting the Promise of Paid Leave: Best Practices in State Paid Leave Implementation. Retrieved 27 August 2020, from http://www.nationalpartnership.org/our-work/resources/economic-justice/paid-leave/meeting-the-promise-of-paid-leave.pdf

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The notice can be viewed at: https://beta.regulations.gov/document/DOL-2020-0004-0001

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