Family and Medical Leave


What It Is

Family and medical leave is leave granted to an employee for the birth, adoption, or fostering of a child; to allow an employee to care for a seriously ill family or household member; or when the employee is seriously ill. The 1993 Family and Medical Leave Act (FMLA) is federal legislation designed to protect workers who need time off to care for a new child, sick family member, or themselves.

This guide will discuss the FMLA and related laws, as well as other forms of family and medical leave policies that help workers balance life and work commitments.


Why It Matters

At minimum, your organization’s family and medical leave policies need to adhere to federal and state law. The larger question at stake with family and medical leave, however, is how best to strike a balance between the organization’s and employee’s needs at critical junctures in the employee’s life.

Federal law requires that new parents be allowed twelve weeks of unpaid leave within a twelve month period without being terminated and without a lapse in benefits for the birth, adoption, or fostering of a child. Employees can also use up to twelve weeks of unpaid leave to care for a seriously ill relative. For the employee to qualify for leave under FMLA, they must have worked for the organization for at least 12 months, a minimum of 1,250 hours, and the organization must have 50 employees or more. FMLA was amended in 2008 and 2010 to allow relatives of service members to take up to 26 weeks of unpaid leave.

These exceptions for small businesses and duration of employment mean that roughly 40% of American workers are not covered under FMLA. Some states have passed laws that expand on FMLA so that more workers have similar protections in their state. For instance, Massachusetts’s Maternity Leave Act allows 8 weeks of unpaid leave without termination in employment for new mothers, thus adding in protections for employees who work at businesses with less than 50 employees. You can find more information about FMLA here, and similar state laws here and here

In addition to FMLA, pregnant workers and workers dealing with their own or a family member’s serious health concern may be covered under the Americans with Disabilities Act and the Pregnancy Discrimination Act. Some states may also have other laws that can function similarly but that are not described in terms of family leave. For instance, Texas state employees can apply for sick pool leave in case of catastrophic illness, which can be used to supplement FMLA leave.

While many people in the business community feared that the 1993 law would negatively impact their bottom line, several studies have since shown that the act has had minimal impact on the business community.[1] Unfortunately, 40 percent of American workers are not covered by the law, and many workers who are covered cannot afford to take unpaid leave. Among industrialized nations, the US has the weakest laws and programs protecting the needs of employed parents and caregivers. It is one of only a handful of countries globally that does not require paid time off of any kind for new parents.[2]

The lack of consistent and affordable family and medical leave in the United States has significant impact on public health, women’s participation in the workforce, and the long-term economic wellbeing of low-income workers in particular. Several studies have shown that children of parents who have been able to care for them longer before returning to work have better overall health and lower infant mortality rates.[3] Reasons for improved health and reduced mortality rates include increased likelihood and duration of breastfeeding, reduced chance of delaying immunizations, and more attention to new infants and possible signs of illness.

Parental leave policies also improve the long-term earnings and employment of women, in particular.[4] In countries with more generous parental leave benefits, the rate at which women participate in the workforce has continued to climb. In the US this number has remained stagnant at 75 percent over the past twenty years, and limiting the workforce in this way has a significant impact on the GDP.[5]

Parents who are forced to quit their jobs rather take a leave of absence to serve as caregivers for young children or sick family members earn less over their lifetime and have a more difficult time re-entering the workforce.[6] One survey of workers who had used FMLA in the previous year found that 1 in 10 had been forced to go on public assistance. For workers earning under $20,000, this number increased to 1 in 5.[7] Though inadequate family leave policies take a larger toll on low-income workers and single parents, the 11 to 15 percent of US workers that receive paid leave through their workplace tend to be higher-income workers.[8]

So what’s a small business to do? Obviously, no business can make up for a lack of good public policy, and even fewer can foot the bill for paid family and medical leave themselves.[9] Yet small and medium business owners are well aware that most of us serve as caregivers at some point in our lives, even if we don’t choose to have children.

The Alfred P. Sloan Foundation’s national studies of workplace practices suggest that “flexibility is a critical component of workplace effectiveness,” laying the groundwork for improved worker productivity, engagement, and commitment to their place of work.[10] Flexibility is arguably most important when employees face major life changes, such as the addition of a new family member and serious illness. Solid leave policies can also reduce the costs of recruitment and retraining associated with turnover that results when workers are forced to quit to care for a child, a relative, or themselves.[11] They can also serve as a way to distinguish your organization from other employers when attracting new talent. We will review some ways to create family and medical leave policies that will help your workers balance their work and life commitments below.


Getting Started

  • Step One: Ensure that your policies meet federal and state minimums.
  • Step Two: Poll your employees.
  • Step Three: Educate your employees.
  • Step Four: Offer paid sick and vacation leave.
  • Step Five: Offer flex-time, self-scheduling, or telecommuting.

Step One: Your company may be exempt under FMLA, but other state and federal laws may apply if an employee becomes seriously ill, has a family member who is ill, or is expecting a new child. This might include laws related to disability, illness, gender discrimination, and pregnancy discrimination. Do your due diligence and ensure that your policies meet these regulatory standards.

Step Two: You could have great family and medical leave policies, but if none of your workforce can use them, they would be for naught. Asking your employees what workplace practices and policies would be helpful to them is a great place to start when drafting a new policy.

Step Three: Employees who are familiar with your policies as well as state and federal law will be in a better position to make sound decisions should they decide to add to their family or if a crisis occurs. They will be in a better position to use resources at their place of work and through other venues, and be able to communicate their needs to you in a timely manner.

Step Four: Accrued vacation and sick leave is often what employees use first when an emergency arises or when they have a new child. Offering paid vacation and sick leave allows you to budget and plan for this time off. Approximately 60% of American workers have access to some kind of paid leave.[12] Consider exceptions to advance notice for vacation leave for emergencies when drafting your policy. Define what those exceptions are. Similarly, sick leave should be permitted when the employee is ill and also when they need to care for a sick household member. Sick and vacation leave are usually positively correlated with tenure, that is, employees who have worked with the organization longer earn more hours per month.

Step Five: Consider allowing employees to work flex-time (work schedules with shifting end and start times), to schedule their own shifts, or to telecommute (work done from home).

These scheduling approaches will not make sense for all kinds of jobs, but may work for most to varying degrees. Engaging in one or more of these arrangements will require clear communication between the employee and supervisor about scheduling needs, as well as work assignments and expectations. Flex-time and telecommuting might be regularized, for instance, to allow an employee to work around a partner or daycare schedule. These options could also be made available on short notice. Allowing occasional telecommuting, for instance, could reduce absenteeism overall. A contagious employee who cannot come into the office may still be well enough to work from home, or could work from home when their sick child cannot attend daycare.


Going Further

  • Step One: Offer unpaid, block leave.
  • Step Two: Extend benefits for duration of unpaid leave.
  • Step Three: Offer reduced-schedule leave.

Step One: Have an official policy of allowing unpaid blocks of leave. Define how often and when the leave can be used. Even if your place of business is exempt under FMLA, FMLA can serve as a guide when drafting your policy.

The birth, adoption, or fostering of a new child are obvious junctures when a family may need time to adjust to new family dynamics, as is serious illness or injury of the employee. You will have to think more carefully about how to define instances in which leave to care for another person is permitted. Consider a dual approach that defines family by relation (parents, siblings, and children, as well as partners) as well as by household (adults and children that reside at the same address). This would likely be flexible enough to accommodate most family structures. It would also allow for leave in instances in which someone lives with a person they are caring for, but are not related to that person in way that a definition of the family that focuses on the nuclear family would capture.

You will also have to consider how often unpaid time off can be used. This could range from every eligible instance to a set amount of time within a twelve-month period. If your goal is to support employees during a crisis, draft your policy in such a way that you are able to consider exceptions that meet the spirit but perhaps not the letter of the policy.

Available statistics on the FMLA and how it is used are good resources for anticipating the potential impacts of offering unpaid leave. For instance, a 2000 survey found that the median length that employees who used FMLA took off was just 10 days.[12]

Step Two: While FMLA is unpaid, covered employers are required to extend benefits through the duration of the unpaid leave. If your place of business offers group health benefits, consider extending benefits during any allowed, unpaid absences. Taking an unpaid leave will be a financial burden for most individuals, but losing insurance benefits or having to pay the full premium under COBRA will make this doubly burdensome. This is especially true if their family is also insured through their group health plan, or if they will lose coverage for childbirth expenses.[13] Since you are unlikely to extend benefits to any temporary workers you hire, keeping employees on leave on your insurance rolls during their leave may also simplify your human resources work.

Step Three: A reduced-schedule leave is a temporary reduction in workload rather than a full-time, block of leave. This could be in place of a full-time leave or in addition to it. For instance, a new parent could take a full-time leave for several weeks, and then slowly increase their hours to return to full time through a reduced-schedule leave. 

You should also consider how to handle benefits for an employee working a reduced-schedule. You might decide to cover benefits for a set period of time during the leave, but then require the employee to pay part of the premium after a certain point. This could be proportional to the hours worked. For instance, an employee returning to work at half-time could be asked to pay half of their insurance premium.


Advanced Steps

  • Step One: Offer some form of paid family and medical leave.
  • Step Two: Subsidize childcare services.
  • Step Three: Create family friendly workspaces.
  • Step Four: Adopt flex-career policies, such as phased retirement and dialing careers up and down.

Step One: Offering some form of paid leave might not entail full pay or pay for the full duration of the leave. In combination with unpaid leave, any paid leave could be a boon to new parents and caregivers. There are a number of ways to achieve this. Directly paying for leave is obviously the most costly. Offering short-term disability insurance, either as a standard or optional part of a benefits package, is a more cost effective way to achieve similar results. Make sure that you and your employees are clear on the eligibility requirements for such plans, what they do and do not provide, and how they would impact enrollment in other group plans.

Step Two: Google might be able to offer on-site childcare, but most organizations are not large enough to do this. However, you may be able to secure a group rate or discount with a nearby daycare service for your employees, or provide vouchers for childcare services.

Step Three: A family friendly workspace could include a number of features. Two options to consider are a lactation room for nursing mothers and allowing mothers to bring infants to work. Lactation rooms do not need to be single purpose, and could include any room that can be made private and has a mini-fridge. A few companies have also started to allow new mothers to bring infants to work. Infants are allowed before the age at which they are likely to be mobile (around six months), when it makes sense for the employee’s particular job. This would require a waiver releasing the organization from blame should the infant be injured at the work site.[14]

Step Four: Flex-careers allow workers to dial their workload up or down depending on their life circumstances. A phased retirement would allow an individual to gradually move out of their work rather than stop all at once, while dialing a career down might make sense during a period of chronic illness.


More Resources

US Department of Labor, Family and Medical Leave

US Department of Labor, Americans with Disabilities Act

US Deparment of Labor, COBRA

US Department of Labor, Bureau of Labor Statistics

Working Mother

When Work Works, Making Work “Work”: New Ideas from the Winners of the Alfred P. Sloan Awards for Business Excellence in Workplace Flexibility

Families and Work Institute

Heather Boushey and Sarah Jane Glynn, The Effects of Paid Family and Medical Leave on Employment Stability and Economic Security

Human Rights Watch, Failing Its Families: Lack of Paid Leave and Work-Family Supports in the US

Inc., How to Create a Maternity Leave Policy

Janet C. Gormick and Marcia K. Meyers, Families That Work: Policies for Reconciling Parenthood and Employment

Green Plus Guide to Flexible Work Options


Glossary of Related Terms

Americans with Disabilities Act (ADA): Passed in 1990, the Americans with Disabilities Act prohibits discrimination against persons with disabilities in employment, transportation, communications, public accommodations, and governmental services. For the purposes of federal non-discrimination laws, a person with a disability is defined as “someone who (1) has a physical or mental impairment that substantially limits one or more ‘major life activities,’ (2) has a record of such an impairment, or (3) is regarded as having such an impairment.”[15] Certain conditions during pregnancy or post-partum may be covered under the ADA.

Blended families: “Blended families” is a term used to describe any number of family configurations of children and parents from different marriages (for example, a blended family could be comprised of a couple, their birth child, and two children from a previous marriage). According to the 2010 US Census data, a majority of households are now blended households.[16]

Block leave: Paid or unpaid leave granted as a block of time, for any reason. Block leave is distinct from intermittent leave, which is the form that most vacation and sick leave takes.

COBRA (Consolidated Omnibus Budget Reconciliation Act): This law allows most individuals to continue their group health benefits after a change in employment status. The individual usually pays the premium in order to continue coverage.

Family and Medical Leave Act (FMLA): Passed in 1993, this law requires that qualifying individuals who work for organizations with more than fifty employees be allowed to take up to twelve weeks unpaid leave during a twelve month period to care for a new child or seriously ill relative without a loss of benefits or employment. The law was expanded in 2008 and 2010 to allow up to twenty-six weeks of leave for family members of injured and ill servicemen and women. Roughly 60% of American workers are covered under FMLA.

Flex-career: “Flex-career” refers to any number of arrangements in which a person’s employment is altered over the long-term to better match their life circumstances. This might include increasing the amount of time worked during periods of good health and vice-versa.

Flex-time: Flex-time is the practice of altering the end and start times of an employee’s workday, usually to meet other scheduling needs. Examples might include shifting work hours to accommodate childcare and school schedules.

Intermittent leave: Leave provided for solitary instances of illness or for other purposes, such as attendance at a funeral. Most sick leave and vacation leave is a form of intermittent leave, though it may be used in blocks. Intermittent leave is distinct from block leave, in which an employee is given a designated block of time off.

Lactation room: Space provided at a place of work to allow a mother to pump breast milk, along with a means of storing the breast milk (freezer or fridge). Lactation rooms allow working mothers to provide their children with breast milk for a longer period of time because they are able to pump milk during work hours. Not being able to breastfeed or pump breast milk for several hours on end is likely to lead to a loss in the ability to breastfeed.

Parental leave, maternity leave, and paternity leave: Leave provided to new parents upon the birth, adoption, or fostering of a new child. Maternity leave might also include the late stages of pregnancy for women.

Phased retirement: The process of gradual retirement, rather than ending a career all at once. This might be done to allow a worker to reduce their workload so that it matches their current capabilities without terminating employment completely, or to allow the organization they work for to transition and train another employee.

Pregnancy Discrimination Act: Passed in 1978, this act prohibits discrimination against pregnant women in any aspect of employment, including hiring, firing, pay, job assignments, layoff, training, benefits, or any other condition of employment.

Reduced schedule leave: This is leave that reduces a worker’s schedule. This usually done to accommodate the addition of a new child, a worker’s illness, or when the worker needs to serve as a caregiver for a relative.

Telecommuting: This is the practice of working from home. Telecommuting can be full- or part-time, regularized or intermittent, depending on the needs of the employer and employee.


[1] A 1998 survey of covered businesses found that 84% reported either no costs or actual cost savings associated with implementing FMLA, while a 2000 survey reported that 90% of businesses reported no or very low costs associated with FMLA. Lauren J. Asher and Donna R. Lenhoff, “Family and Medical Leave: Making Time for Family Is Everyone’s Business,” The Future of Children 11, no. 1 (Summer 2001): 117-118.

[2] Comparisons of parental leave policies internationally available here:; see also: Tara Siegel Bernard, “In Paid Family, U.S. Trails Most of the Globe,” New York Times, 22 February 2013, accessed 25 June 2013,

[3] See, for instance, Human Rights Watch, Failing Its Families: Lack of Paid Leave and Work-Family Supports in the US, 2011, and Sakiko Tanaka, “Parental Leave and Child Health Across OECD Countries,” The Economic Journal 115, no. 501 (February 2005): F7-F28.

[4] Tara Siegel Bernard, “In Paid Family, U.S. Trails Most of the Globe,” New York Times, 22 February 2013, accessed 25 June 2013,

[5] Bryce Covert, “Twenty Years After FMLA, Our Family Policies Are Dragging Us Down,” The Nation, 5 February 2013, accessed 25 June 2013,

[6] A succinct but thorough explanation of the long-term economic impacts of inadequate family leave policies can be found in Heather Boushey and Sarah Jane Glynn, The Effects of Paid Family and Medical Leave on Employment Stability and Economic Security (Center for American Progress, April 2012),

[7] Lauren J. Asher and Donna R. Lenhoff, “Family and Medical Leave: Making Time for Family Is Everyone’s Business,” The Future of Children 11, no. 1 (Summer 2001): 120.

[8] Tara Siegel Bernard, “In Paid Family, U.S. Trails Most of the Globe,” New York Times, 22 February 2013, accessed 25 June 2013,

[9] In Canada, for instance, this is paid largely through a national employment insurance program that workers opt into.

[10] When Work Works, Making Work “Work”: New Ideas from the Winners of the Alfred P. Sloan Awards for Business Excellence in Workplace Flexibility,

[11] Tara Siegel Bernard, “In Paid Family, U.S. Trails Most of the Globe,” New York Times, 22 February 2013, accessed 25 June 2013,

[12] “Access to paid leave, 2011,” Bureau Labor of Statistics, 4 September 2012, accessed 1 July 2013,

[12] Lauren J. Asher and Donna R. Lenhoff, “Family and Medical Leave: Making Time for Family Is Everyone’s Business,” The Future of Children 11, no. 1 (Summer 2001): 118.

[13] The US has exceptionally high childbirth costs, even for women who have insurance. For more information, see: Elisabeth Rosenthal, “American Way of Birth, Costliest in the World,” New York Times, 30 June 2013, accessed 1 July 2013,

[14] For an example of bringing an infant to work, see Stephanie Clifford, “Brave New Policy: Babies in the Office,” Inc., 1 June 2006, accessed 25 June 2013,

[15] Department of Labor, “Americans with Disabilities Act: FAQs,”

[16] Haya El Nasser and Paul Overburg, “Census Tracks 20 Years of Sweeping Change,” USA Today, 10 August 2011, accessed 25 June 2013,


Shannon recently completed a master’s degree in Religious Studies at the University of North Carolina at Chapel Hill. Her research focuses on the religious dimensions of social and environmental justice movements in the twentieth-century American South. Before moving to North Carolina, Shannon...
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