Policy Impacts on Maternity Care in the United States and France

Health and financial risks associated with childbirth vary widely depending on the policies in place to support mothers. For many women in the United States, having a baby can lead to financial pressure, too little recovery time, and increased medical concerns. France, meanwhile, takes a more structured approach to maternity care, where postpartum recovery is guaranteed  and supported by law. The differences between the two systems show how policy decisions directly impact women and their families.

France guarantees a minimum of 16 weeks of paid maternity leave for employed women, including six weeks before birth and ten weeks after childbirth [10]. Women can also apply for paid maternity leave extensions if they have a complicated pregnancy, a premature birth, or a complicated birth. Women receive wage replacement funded through national social, ensuring that income does not determine whether a mother can afford to take time away from work.

However, the U.S. remains the only high-income nation without a guaranteed federal paid maternity leave.

About one in four American women return to work within two weeks after giving birth because they cannot afford unpaid leave [1].   The Family and Medical Leave Act also contributes to this gap. Its offer of up to 12 weeks of unpaid leave only applies to workers who have been at their job for at least a year, work at least 1,250 hours annually, and are employed by a company with 50 or more employees [2]. Since this eligibility depends on factors like employer size and length of employment, nearly 44% of women workers are excluded from this protection altogether [2]. As a result, many new mothers must choose between recovering from childbirth and maintaining financial stability. 

These differences in maternity leave affect a lot more than just financial stability. Maternal health outcomes also vary drastically between the two nations. The United States has one of the highest maternal mortality rates compared to other OECD countries, amounting to 22.3 deaths per 100,000 live births in 2022. France’s maternal mortality rate is less than half of that number [7]. Together, France’s system of pair leave and structured postpartum support, including home-visiting services and follow-up with midwives, has been linked to healthier recovery and longer breastfeeding duration. A French longitudinal birth-cohort study found that women who had returned to work after at least 15 weeks postpartum were more likely to breastfeed for six or more months. Ultimately this study found a positive correlation between extended leave and better maternal and infant outcomes [5]. U.S. women, by comparison, often struggle to access care after childbirth.

Nearly 1 in 3 American women skip or delay postpartum medical visits due to cost, job restrictions, or lack of childcare [4].

These gaps show how national policy decisions around maternity leave and postpartum support directly shape women’s health outcomes. 

Support systems during and after birth also look very different. French mothers receive automatic access to midwives, paid pelvic floor rehabilitation, and home nursing visits for newborn care [11]. These services reduce long-term health complications and promote mother’s mental well-being. In the U.S., postpartum support varies widely by insurance coverage, state policy, and hospital systems which results in major inequities in recovery experiences. In the U.S.(2020), the rate of severe maternal morbidity was 139 cases per 10,000 delivery hospitalizations among Black mothers versus 69.9 cases per 10,000 among white mothers [3]. So, low-income women of color bear the greatest burdens, with higher rates of severe maternal morbidity and mortality [3, 9].

Artwork by Shea Davis

Despite these contrasts, the U.S. has seen progress in several areas. 13 states and the District of Columbia now provide mandatory paid family and medical leave laws [8]. This shift suggests that states are increasingly recognizing the importance of parental support in the workplace.  At the federal level, the American Rescue Plan gave states the option to extend postpartum Medicaid and Children’s Health Insurance Program (CHIP) coverage from six weeks to 12 months [6]. By late 2022, more than half of the U.S. states had approved this extension [6]. However, the national system remains inconsistent, leaving many women without necessary support. France’s system demonstrates that when maternal health is treated and a shared societal responsibility, both mothers and the economy benefit. 

The differences between these two countries show how much work remains to build a stronger and fairer system of maternity care in the United States. Choosing between income and postpartum recovery is a policy driven outcome, not a personal failing. Advancing maternal health and economic security in the U.S. will require treating paid maternity leave as a guaranteed protection, rather than a benefit available to only some.  

References

1. A National Imperative | National Partnership for Women & Families. (2023, August 16). National Partnership for Women & Families. https://nationalpartnership.org/report/a-national-imperative-state-disparities-demonstrate-urgent-need-for-federal-paid-family-and-medical-leave-law/

2. Am I Eligible for FMLA Leave? (2024). DOL. https://www.dol.gov/agencies/whd/fmla/am-i-eligible-FMLA-leave

3. America’s Health Rankings | AHR. (2024). America’s Health Rankings. https://www.americashealthrankings.org/learn/reports/maternal-and-infant-health-disparities-data-brief/key-findings-health-outcomes

4. Bellerose, M., Rodriguez, M., & Vivier, P. M. (2022). A systematic review of the qualitative literature on barriers to high‐quality prenatal and postpartum care among low‐income women. Health Services Research, 57(4). https://doi.org/10.1111/1475-6773.14008

5. Castetbon, K., Boudet-Berquier, J., & Salanave, B. (2020). Combining breastfeeding and work: findings from the Epifane population-based birth cohort. BMC Pregnancy and Childbirth, 20(1). https://doi.org/10.1186/s12884-020-2801-x

6. Gordon, S., Whitman, A., Sugar, S., Chen, L., Peters, C., De Lew, N., & Sommers, B. (2023). Medicaid after Pregnancy: State-Level Implications of Extending Postpartum Coverage (2023 Update). https://aspe.hhs.gov/sites/default/files/documents/168cd047bebc0725da3128104ec8fdde/Postpartum-Coverage-Issue-Brief.pdf

7. Harrington, K., & Schuster, L. (2024). Maternal Morbidity and Mortality: Are they really up? And what’s the role of measurement changes, real-world factors, and racism? | Boston Indicators. Bostonindicators.org. https://www.bostonindicators.org/article-pages/2024/june/maternal_morbidity_and_mortality

8. Homepage. (n.d.). MACPAC. https://www.macpac.gov

9. OECD. (2013). OECD Data Explorer. Oecd.org. https://data-explorer.oecd.org

10. Parental leave in France: Paternity and maternity leave in France. (n.d.). Www.oysterhr.com. https://www.oysterhr.com/library/parental-leave-in-france

11. Poland. (2024). Employment, Social Affairs and Inclusion. https://employment-social-affairs.ec.europa.eu/policies-and-activities/moving-working-europe/eu-social-security-coordination/your-social-security-rights/poland_en

12. U.S. Department of Labor. (2025). Family and Medical Leave Act. Dol.gov. https://www.dol.gov/agencies/whd/fmla