Midway through her maternity leave, Jaclyn Cohen collapsed into a heap on the floor. She gave birth to a healthy boy six weeks before—after a traumatic 60 hours of labor, which was followed by a series of post-birth complications, including an MRSA infection in her breast.

“I did not know how much healing time I needed,” Cohen, 35, recalls of the initial period after she and her husband, Josh, brought baby Avi to their home in Seattle. “I did not recognize any of my needs. It was just, ‘Let me make sure this tiny newborn does not die.’”

By the time Josh had to pull her off the floor, Cohen was contemplating her own death and even harbored flickering thoughts of harming her baby.

Her husband recognized that she was suffering from classic symptoms of postpartum depression, which affects about one in nine new mothers. So he encouraged her to seek mental health care and summoned family and friends to circle the wagons. Gradually, the crippling cloud cover lifted from Cohen’s mind and body.

Recognizing how crucial her three paid months off from work were for her recovery, Cohen, who is a rabbi with a zeal for social justice, became an activist in the growing movement calling for the United States to end its lonely status as the only developed nation in the world that still lacks a national paid family leave policy.

The 1993 Family and Medical Leave Act has proved woefully inadequate. It ensures job protection for those taking up to 12 weeks of leave to care for a new child, family member, or personal health condition. But it doesn’t guarantee pay during a leave, and it fails to cover about 40 percent of private-sector workers. As a result, the FMLA has benefited mostly college-educated women. Those women are more likely to meet the law’s eligibility requirements, including having logged at least 1,250 hours for a company with 50 or more employees during the 12 months before their leave. (College-educated women also have a greater chance of being among the approximately one in seven private-industry workers whose employers offer paid leave.) Meanwhile, nearly half of those who are eligible for protection under the FMLA say that they simply can’t afford to take time off work.

Even for new moms who can afford to go without pay for three months, it’s often not enough time. Economic- and health-based research indicates that six months is a more optimal amount of time for new parents to take off from work. But on average, American women take 10 weeks of maternity leave, whether paid or unpaid.

“I truly believe that paid leave was the difference between life and death for me,” says Cohen, who now lives in Los Angeles. Noting that one-quarter of American mothers are back on the job within a mere two weeks of giving birth, she continues, “If I’d had to go back to work because of the pressure of needing that income, I’m actually pretty certain that I would have tried to harm myself.”

Throughout decades of fighting for federal and state paid family leave policies, advocates have promoted the economic benefits of paid leave, such as improved labor-force participation and earning potential among mothers, along with boosted business productivity and reduced turnover.

Darby Saxbe, an associate professor of psychology at the University of Southern California, argues that advocates and researchers should also consider these policies’ potential impact on the overall health and well-being of parents and their children. She is the lead author of a recent paper in American Psychologist in which she characterizes the transition to parenthood as a critical window in adults’ lives, during which their physical and mental health are at risk of falling into a long negative trajectory. The arrival of a child, whether biological or adopted, may drive changes in the immune and inflammatory functions among parents while remolding their neurons and key structures of their brains. Many adults experience their first major episode of depression after becoming a parent, an outcome that increases their chances of suffering from future episodes. Interpersonal conflict often complicates marriages after a new addition, with fights primed to erupt over who forgot to pack enough onesies, not to mention big-ticket items like finances and the division of parental labor. One long-term study of married couples found that the birth of their first child prompted a sudden drop in marital satisfaction, one that tended to persist for years.

The new baby-driven hormonal changes in both men and women, including adoptive parents, combined with greatly reduced opportunities to exercise, can prompt unhealthy weight gain. This “inflection point for body weight trajectories,” Saxbe writes in her paper, may eventually lead to a lifetime of obesity, which is in turn associated with an increased risk of cardiovascular disease, cancer, and diabetes. When Tanya Whippie adopted 2-year-old twin girls from Latvia in 2015, she was able to cobble together three months of paid and unpaid time off from her job as a project manager for the federal government. But she found she still had little breathing room as a new single mom. “The times I had available became solely available for surviving and not anything else,” she recalls. “I definitely did not make it to the gym.” Two years passed before she was able to see a doctor for herself. By then, she had gained weight and developed high blood pressure—concerning news, given a family history of strokes.

Federally backed paid time off after the arrival of a child, Saxbe posits, could serve as an invaluable buffer against such deleterious effects. Healthier, happier moms and dads are in a better position to bond with their babies. That benefits infants over the course of their lives, as secure attachment is associated with a host of long-term benefits. “It’s rare that a single policy can prevent mental health problems and improve child welfare and improve physical health outcomes,” Saxbe says, reiterating what she testified to the Los Angeles City Council during a hearing this year about the city’s proposed expansion of paid family leave.

Black Infant Mortality

Rokeshia Ashley touches her nose to teach her baby, Emery, different parts of the body. Ashley dealt with a series of complications during pregnancy and delivery of Emery about a year ago. Ashley knew she was at a higher risk as a black mother. (Zhihan Huang / Missourian via AP)

“In the US in general there’s just an underinvestment in social policies and programs that target the early-life environment,” says Arijit Nandi, an associate professor in the Centre on Population Dynamics at McGill University in Montreal. “This is despite a growing consensus that the first 1,000 days of life are a critical period in development that helps to define health and well-being over the life course.”

In 2002, California became the first state to pass a paid family leave policy, which provides six weeks of partial pay. Since then, New Jersey, Rhode Island, and New York have joined the club, and recent bills have extended benefits in the District of Columbia, Washington, Massachusetts, and Connecticut. (Like the FMLA, these policies apply broadly to various caregiving duties, as well as personal illness.) California Governor Gavin Newsom, who has called on his state to expand its policy to include six months of paid leave, recently signed a bill extending the current policy to eight weeks.

These state policies, which generally offer four to 12 weeks of partial wage replacement and are available the vast majority of residents, have offered investigators a rich opportunity to study the impact of paid leave. So far, research suggests that if such state policies provide benefits to a broad enough swath of the population, they hold considerable potential as equalizers of some of the nation’s most egregious racial and socioeconomic disparities. The United States’ frighteningly high infant mortality rate is driven almost entirely by poor birth outcomes among low-income women and is characterized by disparate statistics on the basis of race. The babies of African American women are more than twice as likely to die during the first year of life than those born to white women.

Researchers believe that implementation of the FMLA cut the national infant mortality rate by 10 percent. However, given the legislation’s limited reach, this benefit occurred solely among the babies of college-educated, married women. According to one recent analysis, transforming the FMLA to a paid policy would lead to an annual reduction of nearly 600 deaths during American infants’ first year.

Research also suggests that paid family leave can help address the rising crisis of maternal death in the United States, which is concentrated among African American mothers and may be driven in part by what is known as allostatic load, or the totality of stress and its wear and tear on the body.

“If we don’t craft a paid family leave policy that addresses the needs of people of color and those of lower socioeconomic status, this would actually exacerbate the economic, racial, and health inequities that already exist,” says Fabiola Santiago, a campaign manager at the advocacy group PL+US (Paid Leave for the United States).

The overall impact of paid leave policies on health appears to be profound. The implementation of California’s existing family leave policy, one study found, was associated with improved health among children in early grade school, including lower rates of obesity, ADHD, ear infections and hearing problems, in particular among children of lower-income parents. Researchers theorize that these positive outcomes were a result of reduced stress among pregnant women, higher breastfeeding rates, and parents’ improved overall care of their newborns.

NICU Babies

One in eight babies are born prematurely and require time in the NICU. An expanded paid family leave policy would give parents the time to tend to and care for their infant. (AP Photo / The Commercial Appeal, Karen Pulfer Focht)

The American Academy of Pediatrics recommends that women exclusively breastfeed their infants for six months, given the associated health benefits for both. Investigators found that mothers who took longer periods of paid leave in California and New Jersey were more likely to follow this breastfeeding guideline.

For every additional week up to about 12 weeks that mothers took off work under New Jersey’s family leave plan, their risk of postpartum depression declined. Paid time off also provides parents with the flexibility to take their new baby to routine medical visits, helping to ensure adherence to recommended vaccination schedules. Such space to attend to a newborn’s medical care is particularly critical for parents of the one in eight infants who are born prematurely and require time in the NICU.

The California policy also appears to have protected children against extreme abuse: It was associated with a decline in the rate of hospital admissions for severe head trauma among children younger than 2 years old.

National paid family leave legislation enjoys wide bipartisan support among voters; even President Trump acknowledged its importance in his February State of the Union. That month, presidential candidate Senator Kirsten Gillibrand of New York and Connecticut’s Representative Rosa DeLauro, both Democrats, reintroduced to Congress the Family Act, which would essentially transform the FMLA by providing a paid entitlement through a new payroll tax.

Gillibrand FAMILY Act

Sen. Kirsten Gillibrand speaks during the Senate Democrats' news conference to unveil the Family Act on March 14, 2017, which would provide workers with 12 weeks of partially paid leave. (Photo By Bill Clark / CQ Roll Call)

“As a mother with two sons, I know firsthand how important it is for an infant’s development to have their parent with them in those first few months,” Gillibrand says. “Paid leave would have important health benefits for all Americans.”

Many of her Senate colleagues also running for president also support the Family Act, including Bernie Sanders, Elizabeth Warren, Kamala Harris, Cory Booker, and Amy Klobuchar. But given the Republican control of the Senate and the White House, the Family Act is unlikely to pass in the near term. Republican Senators Marco Rubio, Jodi Ernst, and Mike Lee, along with Ivanka Trump, have instead backed legislation that would allow Americans to finance paid leave after the birth or adoption of a child by borrowing from their future Social Security benefits.

The liberal arguments for an increase in taxes to fund paid family leave policies ask voters and policy-makers to shift away from the individualistic American mindset in favor of a more collectivist approach to cultivating a thriving and equitable society. “Every baby is not just the property of one individual person,” says Saxbe. “The fact that you have to be fortunate in order to have the opportunity to care for a baby is kind of shocking when you think about how important the health of our babies is to our entire society and economy.”

“We have to look at this as investing in the people who work for us,” says Cohen. “And if we don’t make that shift, then we’re just screwing ourselves over in the long term.”