Workplace Benefits and Family Health Care Responsibilities: Key Findings from the 2022 KFF Women’s Health Survey

Key Takeaways

• Less than half of women report that their employer offers paid parental leave such as maternity or paternity leave (43%) or paid family and medical leave which can also be used to take time off to care for a seriously ill family member (44%). A considerably higher share, nearly two-thirds, of women say that their employer offers them paid sick leave (63%). Just 7% of women work for an employer that offers on-site childcare or a childcare subsidy. These estimates are consistently lower for women who work part-time, are self-employed, are low-income, or live in rural areas.
• Among employed parents, more than half of mothers (56%) report they are the ones to care for children when they are sick and cannot attend school, compared to about a fifth of fathers (19%). A substantial share of mothers (24%) and fathers (33%) say they share responsibility with a spouse, partner, or co-parent.
• Compared to 2020, there has been an increase in the share of men reporting that they are usually the ones to care for children when they are sick and cannot attend school, but this activity is still largely done by mothers.
• About half of working parents say they are not paid when they take time off to care for sick kids. Three-quarters (76%) of working mothers with low incomes (below 200% of the federal poverty level) report losing pay when they miss work to care for sick children which is twice the share of those with higher incomes (38%).

Introduction

The persistent challenges that working mothers face in balancing family and work responsibilities were intensified by the COVID pandemic, which exposed the gaps in resources to address the rise in family caregiving needs, a shift to homeschooling, and the dearth of childcare options. While children are now back in the classroom and many workers have returned to offices, the pandemic has left its mark on the challenge of balancing family and workplace responsibilities, particularly for working mothers. For many working women, economic security is strongly connected to workplace benefits such as insurance coverage, paid sick leave, and paid family leave as well as their roles as mothers and the primary managers of their children’s health care.

The 2022 KFF Women’s Health Survey (KWHS) is a nationally representative survey of 5,145 women and 1,225 men ages 18-64 conducted from May 10, 2022, to June 7, 2022. Among several topics related to women’s health and well-being, we asked respondents about employment and family health care needs. This brief highlights how workplace benefits and caring for children’s health care differ by gender and among different subpopulations of women. Data presented in this brief are based on survey respondents’ self-identified gender as “woman” or “man.” We recognize that this approach excludes people who do not identify with either of these categories. We do not have sufficient survey sample size to report on people who are not cisgender. See the Methodology section for more details.

Access to Workplace Benefits

Fewer than half of employed women say their employer offers paid parental leave or paid family and medical leave. So-called “fringe benefits” such as paid leave offer financial security to workers who must balance their personal and family care needs with their work responsibilities. However, just 43% of employed women ages 18-64 say their employer offers paid parental leave and 44% say their employer offers paid family and medical leave. Many more employed women (63%) report that their employer offers paid sick leave (Figure 1).

Fewer than one in ten employed women say their employer offers on-site childcare or a childcare subsidy. As some employers seek to provide more “family-friendly” workplaces, some now offer on-site childcare for workers’ children or subsidies to workers to pay for childcare at another location. This type of benefit may help ease the transition back to work for new parents, reduce the need for extensive commuting, and provide financial support for a service that is consuming an increasing share of workers’ paychecks. However, few (7%) employed women report that their employer offers on-site childcare or a childcare subsidy (Figure 1).

Some women do not know whether their employer offers paid leave and childcare benefits. Benefits are an important component of a worker’s total compensation package, but some women do not know if their employer offers paid parental leave (18%) or paid family and medical leave (17%) (Figure 1). Knowledge of sick leave benefits is higher, with just 7% of women saying they don’t know if their employer offers this benefit. Eleven percent do not know if their employer offers on-site childcare or a childcare subsidy. Women who are employed but don’t have kids at home are more likely than those who have kids to say they don’t know if their employer offers paid family and medical leave (19% vs. 14%, respectively), paid parental leave (22% vs. 12%), and on-site childcare or a childcare subsidy (13% vs. 7%) (data not shown).

Access to these workplace benefits varies widely by employment status, income, geographic location, and educational attainment. Women who work full-time, are not self-employed, and have higher incomes are more likely than their counterparts to say their employer offers any of these paid leave or childcare benefits (Table 1).

For example, approximately seven in ten women who are employed full-time (73%) and women who are not self-employed (69%) report that their employer offers paid sick leave compared to three in ten (31%) who work part-time and about two in ten (18%) who are self-employed. Half of higher-income (>= 200% FPL) employed women (49%) say their employer offers paid family and medical leave compared to one-third (33%) of women who are low-income (< 200% FPL). Employed women with a college degree (52%) are more likely than those with lower educational attainment (36%) to report working for an employer that offers paid parental leave. Four percent of employed women in rural locations work for an employer offering on-site childcare or a childcare subsidy compared to 7% of employed women in urban and suburban areas. Overall, there are fewer differences by race and ethnicity, but a slightly higher share of Black women reported working for an employer that offers paid family and medical leave or paid parental leave.

Impact of Children’s Health Needs on Working Parents

Among working parents, a higher share of mothers than fathers report they are the ones that care for children when they are too sick to attend school. Workplace benefits play an important role in parents’ ability to care for their family’s health care needs while meeting workplace responsibilities. When children have to miss school because they are too sick to attend, working parents must arrange care for their children. Among mothers who work outside the home, over half (56%) say they are the ones who usually take care of children who are sick and cannot go to school, about three times the share of working fathers (19%) (Figure 2). A quarter (24%) of working mothers and one-third of working fathers (33%) say they share this responsibility equally with a spouse, partner, or co-parent. Just 6% of working mothers say their spouse, partner, or co-parent usually takes on this responsibility, whereas this is the most common response among fathers (41%), nearly seven times the rate of mothers. Roughly one in ten mothers (13%) and fathers (8%) say they can call someone else for childcare or their child can stay home alone.

About half of working parents report losing pay when they miss work to care for sick children who can’t go to school. When parents miss work to take care of their sick children, 53% of mothers and 49% of fathers say they are not paid for that time (Figure 3). This has a disproportionate impact on mothers, as they are more likely to be the ones caring for children when they are sick. Considering that nearly 15% of children missed more than a week of school per year due to illness or injury before the pandemic and that the CDC recommends that people stay home for at least five days if testing positive for COVID-1, when children miss school because they are sick, it can have tangible negative economic implications for many working parents, particularly women.

Mothers who have low incomes are more likely than those with higher incomes to report they usually care for children who are sick and cannot attend school as well as lose pay for this time. A larger share of mothers with low incomes (61%) say they are the ones who usually care for children when they are sick compared to mothers with higher incomes (53%) (Figure 4). Working mothers with low incomes are also less likely to report sharing the responsibility with a spouse or partner. Additionally, 76% of mothers with low incomes report losing pay when they miss work to care for sick children, twice the share of those with higher incomes (38%). As discussed earlier, fewer women who have low incomes have a paid sick leave benefit than those who have higher incomes.

Across demographic groups, the majority of employed mothers report that they are usually the ones to take care of kids when they are sick and cannot go to school, and some share this work with a spouse/partner. However, there are differences between groups of women workers in the economic impact of missing work to care for sick kids. A higher share of working mothers who are Black, single, or work part-time report losing pay for this time off (Figure 5). Three-quarters of part-time workers are not paid when they take time off to care for sick kids, compared to 44% of full-time workers.

Since 2020, the share of fathers who say they are the ones who usually care for children when they are sick and cannot attend school has risen. While mothers are much more likely to report that they are the ones who care for young children when they are sick and cannot go to school, the share of fathers who say they are usually the ones to do so has risen in the past two years. In 2022, 19% of fathers say that they usually cared for children when they are too sick to go to school, up from 9% in 2020 (Figure 6). Among mothers however, these rates remained similar between 2020 and 2022 (61% and 56% respectively). The pandemic and the impact of the spread of COVID-19 continues to keep some children out of school and has also changed many employment patterns and workplace dynamics. Many more people work from home at least some of the time, which may have also changed the distribution of childcare responsibilities in some families, with more fathers spending more time at home.

Conclusion

Women comprise at least half of the nation’s workforce, and roughly seven in ten women with children under the age of 18 are in the labor force, yet the United States remains one of the few industrialized nations that does not require paid leave for health-related events including paid parental leave and sick leave. For many women, taking even a month of unpaid leave after childbirth is unaffordable and unattainable. Gaps in these benefits are larger among women who are lower income and those who work part-time.

Absent federal legislation, guaranteed paid leave (including paid sick, family and medical, and parental leave) is at the discretion of the states. In states that do not have paid leave programs or requirements, some employers offer it voluntarily, but workers who could most benefit from it are less likely to be offered these benefits.

Among parents, women continue to be the primary caregivers when their children are sick, and the pandemic has made this issue top of mind for many parents. Some employed mothers share the responsibility of caring for their sick children with their partners, and notably, in the past two years, there has been an increase in the share of fathers who say they usually take care of sick kids who cannot go to school. However, it is still working moms who carry this responsibility in many families. The increase in people working from home since the pandemic’s start could have contributed to a change in the distribution of parental health care responsibilities, but it is too early to tell whether this trend will continue in the years to come.

For many working parents who lack paid leave benefits, caring for kids because they are sick and cannot go to school comes with an economic cost, and many of these costs are borne by working women. For some women, the system is largely working though is still challenging, but for those who are in low-wage jobs or work part-time hours, caring for their family's health without workplace supports can weaken their own and their family’s financial well-being.

Overview

The 2022 KFF Women’s Health Survey is a nationally representative survey of 6,442 people ages 18 to 64, including 5,201 females (self-reported sex at birth) and 1,241 males, conducted from May 10, 2022, to June 7, 2022. The objective of the survey is to help better understand respondents’ experiences with contraception, potential barriers to health care access, and other issues related to reproductive health. The survey was designed and analyzed by researchers at KFF (Kaiser Family Foundation) and fielded online and by telephone by SSRS using its Opinion Panel, supplemented with sample from IPSOS’s KnowledgePanel.

This work was supported in part by Arnold Ventures. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities.

Questionnaire design

KFF developed the survey instrument with SSRS feedback regarding question wording, order, clarity, and other issues pertaining to questionnaire quality. The survey was conducted in English and Spanish. The survey instrument is available upon request.

Sample design

The majority of respondents completed the survey using the SSRS Opinion Panel (n=5,202), a nationally representative probability-based panel where panel members are recruited in one of two ways: (1) through invitations mailed to respondents randomly sampled from an Address-Based Sample (ABS) provided by Marketing Systems Group through the U.S. Postal Service’s Computerized Delivery Sequence. (2) from a dual-framed random digit dial (RDD) sample provided by Marketing Systems Group.

In order to have large enough sample sizes for certain subgroups (females ages 18 to 35, particularly females in the following subgroups: lesbian/gay/bisexual; Asian; Black; Hispanic; Medicaid enrollees; low-income; and rural), an additional 1,240 surveys were conducted using the IPSOS KnowledgePanel, a nationally representative probability-based panel recruited using a stratified ABS design.

Data collection

Web Administration Procedures

The majority of surveys completed using the SSRS Opinion Panel (n=5,056) and all of the surveys completed using the KnowledgePanel (n=1,240) were self-administered web surveys. Panelists were emailed an invitation, which included a unique passcode-embedded link, to complete the survey online. In appreciation for their participation, panelists received a modest incentive in the form of a $5 or $10 electronic gift card. All respondents who did not respond to their first invitation received up to five reminder emails and panelists who had opted into receiving text messages from the SSRS Opinion Panel received text message reminders.

Overall, the median length of the web surveys was 13 minutes.

Phone Administration Procedures

In addition to the self-administered web survey, n=146 surveys were completed by telephone with SSRS Opinion Panelists who are web reluctant. Overall, the median length of the phone surveys was 28 minutes.

Data processing and integration

SSRS implemented several quality assurance procedures in data file preparation and processing. Prior to launching data collection, extensive testing of the survey was completed to ensure it was working as anticipated. After the soft launch, survey data were carefully checked for accuracy, completeness, and non-response to specific questions so that any issues could be identified and resolved prior to the full launch.

The data file programmer implemented a “data cleaning” procedure in which web survey skip patterns were created in order to ensure that all questions had the appropriate numbers of cases. This procedure involved a check of raw data by a program that consisted of instructions derived from the skip patterns designated on the questionnaire. The program confirmed that data were consistent with the definitions of codes and ranges and matched the appropriate bases of all questions. The SSRS team also reviewed preliminary SPSS files and conducted an independent check of all created variables to ensure that all variables were accurately constructed.

As a standard practice, quality checks were incorporated into the survey. Quality control checks for this study included a review of “speeders,” reviewing the internal response rate (number of questions answered divided by the number of questions asked) and open-ended questions. Among all respondents, the vast majority (97%) answered 96% or more of the survey questions they received, with no one completing less than 91% of the administered survey (respondents were informed at the start of the survey that they could skip any question).

Weighting

The data were weighted to represent U.S. adults ages 18 to 64. The data include oversamples of females ages 18 to 35 and females ages 36 to 64. Due to this oversampling, the data were classified into three subgroups: females 18 to 35, females 36 to 64, and males 18 to 64. The weighting consisted of two stages: 1) application of base weights and 2) calibration to population parameters. Each subgroup was calibrated separately, then the groups were put into their proper proportions relative to their size in the population.

Calibration to Population Benchmarks

The sample was balanced to match estimates of each of the three subgroups (females ages 18 to 35, females ages 36 to 64, and males ages 18 to 64) along the following dimensions: age; education (less than a high school graduate, high school graduate, some college, four-year college or more); region (Northeast, Midwest, South, West); and race/ethnicity (White non-Hispanic, Black non-Hispanic, Hispanic-born in U.S., Hispanic-born Outside the U.S., Asian non-Hispanic, Other non-Hispanic). The sample was weighted within race (White, non-Hispanic; Black, non-Hispanic; Hispanic; and Asian) to match population estimates. Benchmark distributions were derived from 2021 Current Population Survey (CPS) data.

Weighting summaries for females ages 18 to 35, females ages 36 to 64, and males ages 18 to 64 are available upon request.

Finally, the three weights were combined, and a final adjustment was made to match the groups to their proper proportions relative to their size in the population (Table 1).

Margin of Sampling Error

The margin of sampling error, including the design effect for subgroups, is presented in Table 2 below. It is important to remember that the sampling fluctuations captured in the margin of error are only one possible source of error in a survey estimate and there may be other unmeasured error in this or any other survey.

KFF Analysis

Researchers at KFF conducted further data analysis using the R survey package, including creating constructed variables, running additional testing for statistical significance, and coding responses to open-ended questions. The survey instrument is available upon request.

Rounding and sample sizes

Some figures in the report do not sum to totals due to rounding. Although overall totals are statistically valid, some breakdowns may not be available due to limited sample sizes or cell sizes. Where the unweighted sample size is less than 100 or where observations are less than 10, figures include the notation “NSD” (Not Sufficient Data).

Statistical significance

All statistical tests are performed at the .05 confidence level. Statistical tests for a given subgroup are tested against the reference group (Ref.) unless otherwise indicated. For example, White is the standard reference for race/ethnicity comparisons and private insurance is the standard reference for types of insurance coverage. Some breakouts by subsets have a large standard error, meaning that sometimes even large differences between estimates are not statistically different.

A note about sex and gender language

Our survey asked respondents which sex they were assigned at birth, on their original birth certificate (male or female). They were then asked what their current gender is (man, woman, transgender, non-binary, or other). Those who identified as transgender men are coded as men and transgender women are coded as women. While we attempted to be as inclusive as possible and recognize the importance of better understanding the health of non-cisgendered people, as is common in many nationally representative surveys, we did not have a sufficient sample size (n >= 100) to report gender breakouts other than men and women with confidence that they reflect the larger non-cisgender population as a whole. The data in our reproductive health reports use the respondent’s sex assigned at birth (inclusive of all genders) to account for reproductive health needs/capacity (e.g., ever been pregnant) while the data in our other survey reports use the respondent’s gender.