From the decline in U.S. birth rates starting in 1958 and the introduction of the  birth control pill  in 1960, the Baby Boomer normal distribution curve is  negatively skewed . The trend in birth rates from 1958 to 1961 show a tendency to end late in the decade at approximately 1969, thus returning to pre-WWII levels, with 12 years of rising and 12 years of declining birth rates. Pre-war birth rates were defined as anywhere between 1939 and 1941 by demographers such as the Taeuber's, Philip M. Hauser and  William Fielding Ogburn . [ 272 ]


In 2021, 27.1 million Americans said they were living in a different place than a year before, compared to 29.8 million in 2020. This reflects an 8.4% mover rate, the lowest recorded in more than 70 years. [ 273 ]


Virginia Sterilization Act of 1924


Eugenics , the set of beliefs and practices which aims at improving the  genetic  quality of the  human population , [ 1 ] [ 2 ]  played a significant role in the history and culture of the  United States  from the late 19th century into the mid-20th century. [ 3 ]  The cause became increasingly promoted by intellectuals of the  Progressive Era . [ 4 ] [ 5 ]


While its American practice was ostensibly about improving genetic quality, it has been argued that eugenics was more about preserving the position of the dominant groups in the population. Scholarly research has determined that people who found themselves targets of the eugenics movement were those who were seen as unfit for society—the poor, the disabled, the mentally ill, and specific communities of color—and a disproportionate number of those who fell victim to eugenicists' sterilization initiatives were women who were identified as African American, Asian American, or Native American. [ 6 ] [ 7 ]  As a result, the United States' eugenics movement is now generally associated with racist and  nativist  elements, as the movement was to some extent a reaction to demographic and population changes, as well as concerns over the economy and social well-being, rather than scientific genetics. [ 8 ] [ 7 ]


The American eugenics movement was rooted in the  biological determinist  ideas of  Sir Francis Galton , which originated in the 1880s. In 1883, Galton first used the word eugenics to describe scientifically, the biological improvement of genes in human races and the concept of being "well-born". [ 9 ]   He believed that differences in a person's ability were acquired primarily through genetics and that eugenics could be implemented through  selective breeding  in order for the human race to improve in its overall quality, therefore allowing for humans to direct their own evolution. [ 10 ]  In the US, eugenics was largely supported after the discovery of  Mendel's law  led to a widespread interest in the idea of breeding for specific traits. [ 11 ]  Galton studied the upper classes of Britain, and arrived at the conclusion that their social positions could be attributed to a superior genetic makeup. [ 12 ]  American eugenicists tended to believe in the genetic superiority of  Nordic ,  Germanic , and  Anglo-Saxon  peoples, supported strict immigration and  anti-miscegenation laws , and supported the forcible  sterilization  of the poor, disabled and "immoral." [ 13 ]


The American eugenics movement received extensive funding from various corporate foundations including the  Carnegie Institution ,  Rockefeller Foundation , and the  Harriman  railroad fortune. [ 14 ]  In 1906,  J.H. Kellogg  provided funding to help found the  Race Betterment Foundation  in  Battle Creek, Michigan . [ 12 ]  The  Eugenics Record Office  (ERO) was founded in  Cold Spring Harbor, New York  in 1911 by the renowned biologist  Charles B. Davenport , using money from both the Harriman railroad fortune and the Carnegie Institution. [ 15 ]  As late as the 1920s, the ERO was one of the leading organizations in the American eugenics movement. [ 12 ] [ 16 ]  In years to come, the ERO and the  American Eugenics Society  collected a mass of family  pedigrees  and provided training for eugenics field workers who were sent to analyze individuals at various institutions, such as mental hospitals and orphanage institutions, across the United States. [ 17 ]  Eugenicists such as Davenport, the  psychologist   Henry H. Goddard ,  Harry H. Laughlin , and the  conservationist   Madison Grant  (all of whom were well-respected during their time) began to lobby for various solutions to the problem of the "unfit." [ 15 ]  Davenport favored  immigration restriction  and sterilization as primary methods; Goddard favored segregation in his  The Kallikak Family ; Grant favored all of the above and more, even entertaining the idea of extermination. [ 18 ]


By 1910, there was a large and dynamic network of scientists, reformers, and professionals engaged in national eugenics projects and actively promoting eugenic legislation. The  American Breeder's Association , the first eugenic body in the U.S., expanded in 1906 to include a specific eugenics committee under the direction of Charles B. Davenport. [ 19 ] [ 20 ]  The ABA was formed specifically to "investigate and report on heredity in the human race, and emphasize the value of superior blood and the menace to society of inferior blood." [ 21 ]  Membership included Alexander Graham Bell, [ 22 ]   Stanford  president  David Starr Jordan  and  Luther Burbank . [ 23 ] [ 24 ]  The  American Association for the Study and Prevention of Infant Mortality  was one of the first organizations to begin investigating infant mortality rates in terms of eugenics. [ 25 ]  They promoted government intervention in attempts to promote the health of future citizens. [ 26 ] [ verification needed ]


Several feminist reformers advocated an agenda of eugenic legal reform. The National Federation of Women's Clubs, the  Woman's Christian Temperance Union , and the  National League of Women Voters  were among the variety of state and local feminist organizations that at some point lobbied for eugenic reforms. [ 27 ]  One of the most prominent feminists to champion the eugenic agenda was  Margaret Sanger , the leader of the American  birth control  movement and founder of  Planned Parenthood . Sanger saw birth control as a means to prevent unwanted children from being born into a disadvantaged life, and incorporated the language of eugenics to advance the movement. [ 28 ] [ 29 ]  Sanger also sought to discourage the reproduction of persons who, it was believed, would pass on mental disease or serious physical defects. [ 30 ]  In these cases, she approved of the use of sterilization. [ 28 ]  In Sanger's opinion, it was individual women (if able-bodied) and not the state who should determine whether or not to have a child. [ 31 ] [ 32 ]


In the  Deep South ,  women's associations  played an important role in rallying support for eugenic legal reform. Eugenicists recognized the political and social influence of southern clubwomen in their communities, and used them to help implement eugenics across the region. [ 33 ]  Between 1915 and 1920, federated  women's clubs  in every state of the Deep South had a critical role in establishing public eugenic institutions that were segregated by sex. [ 34 ]  For example, the Legislative Committee of the  Florida  State Federation of Women's Clubs successfully lobbied to institute a eugenic institution for the mentally retarded that was segregated by sex. [ 35 ]  Their aim was to separate mentally retarded men and women in order to prevent them from breeding more "feebleminded" individuals.


Public acceptance in the U.S. led to various state legislatures working to establish eugenic initiatives. Beginning with  Connecticut  in 1896, many states enacted marriage laws with eugenic criteria, prohibiting anyone who was "epileptic,  imbecile  or  feeble-minded " [ 36 ]  from marrying. [ 37 ]  The first state to introduce a compulsory sterilization bill was  Michigan  in 1897 – although the proposed law failed to garner enough votes by legislators to be adopted, it did set the stage for other sterilization bills. [ 38 ]  Eight years later,  Pennsylvania 's state legislators passed a sterilization bill that was vetoed by the governor. [ 39 ]   Indiana  became the first state to enact sterilization legislation in 1907, [ 40 ]  followed closely by  Washington ,  California , and  Connecticut  in 1909. [ 41 ] [ 42 ] [ 43 ]  Sterilization rates across the country were relatively low (California being the sole exception) until the 1927  Supreme Court  case  Buck v. Bell , which upheld under the  U.S. Constitution  the forced sterilization of patients at a  Virginia  home for those who were seen as  mentally retarded . [ 44 ]


In the late 19th century, many scientists, who were concerned about the population leaning too far away from the favored "Anglo-Saxon superiority" due to a rise in immigration from Europe, partnered with other interest groups to implement immigration laws that could be justified on the basis of genetics. [ 45 ]  After the 1890 U.S. census, people began to believe that immigrants who were of Nordic or Anglo-Saxon ancestry were greatly favored over Southern and Eastern Europeans, specifically  Jews  (a  diasporic ,  Middle Eastern  people),  who were seen by some eugenicists, such as  Harry Laughlin , to be genetically inferior. [ 45 ]  During the early 20th century as the United States and Canada began to receive higher numbers of immigrants, influential eugenicists such as  Lothrop Stoddard  and Laughlin (who was appointed as an expert witness for the House Committee on Immigration and Naturalization in 1920) presented arguments that these immigrants would pollute the national gene pool if their numbers went unrestricted. [ 46 ] [ 47 ]


In 1921, a temporary measure was passed to slowdown the open door on immigration. The  Immigration Restriction League  was the first American entity to be closely associated with eugenics and was founded in 1894 by three recent Harvard graduates. The overall goal of the League was to prevent what they perceived as inferior races from diluting "the superior American racial stock" (those who were of the upper-class Anglo-Saxon heritage), and they began working to have stricter anti-immigration  laws in the United States. [ 48 ]  The League lobbied for a  literacy test  for immigrants as they attempted to enter the United States, based on the belief that literacy rates were low among "inferior races". [ 45 ]   Eugenicists believed that immigrants were often   degenerate , had low IQs, and were afflicted with shiftlessness, alcoholism and insubordination. According to Eugenicists, all of these problems were transmitted through genes. Literacy test bills were vetoed by presidents in 1897, 1913 and 1915; eventually,  President Wilson's  second veto was overruled by Congress in 1917. [ 49 ]


With the passage of the  Immigration Act of 1924 , eugenicists for the first time played an important role in the Congressional debate as expert advisers on the threat of "inferior stock" from eastern and southern Europe. [ 50 ] [ 51 ]  The new act, inspired by the eugenic belief in the racial superiority of "old stock" white Americans as members of the " Nordic race " (a form of  white supremacy ), strengthened the position of existing laws prohibiting race-mixing. [ 52 ]  Whereas Anglo-Saxon and Nordic people were seen as the most desirable immigrants, the Chinese and Japanese were seen as the least desirable and were largely banned from entering the U.S as a result of the immigration act. [ 52 ] [ 53 ]  In addition to the immigration act, eugenic considerations also lay behind the adoption of  incest  laws in much of the U.S. and were used to justify many  anti-miscegenation laws . [ 54 ]


Anti-miscegenation laws prohibited interracial marriages. [ 54 ]  The first  anti-miscegenation law  was passed in Virginia in 1661. [ 55 ]  This law not only prohibited marriage between individuals of different races, but it also prohibited ministers from marrying interracial couples. [ 55 ]  Despite a rising number of interracial relationships, more states passed anti-miscegenation laws, over the course of the 17th and 18th centuries. [ 56 ]  At the beginning of the twentieth century, at least twenty-eight states had anti-miscegenation legislation. [ 55 ]  During this time period, the  one-drop rule  emerged, which stated that anyone with a single drop of African blood was considered “black.” [ 57 ]


Anti-miscegenation laws in the United States  made it a crime for individuals to wed someone categorized as belonging to a different race. [ 58 ]  These laws were part of a broader policy of  racial segregation in the United States  to minimize contact between people of different ethnicities. Race laws and practices in the United States were explicitly used as models by the Nazi regime when it developed the  Nuremberg Laws , stripping Jewish citizens of their citizenship. [ 59 ]


This rule is reflected in Virginia’s Racial Integrity Act of 1924. [ 60 ]  This law prohibited miscegenation and defined a white person as having “no trace whatever of any blood other than Caucasian; but persons who have one-sixteenth or less of the blood of the American Indian and have no other non-Caucasic blood shall be deemed to be white persons.” [ 60 ]


This law and other anti-miscegenation legislature were not overturned until 1967 with the  Loving v. Commonwealth of Virginia  decision. [ 61 ]  In 1958, Mildred Jeter, a black woman, and Richard Loving, a white man, were residents of Virginia but were married in Washington, DC. Upon returning to Virginia, they were arrested and charged with violating the anti-miscegenation legislature. [ 55 ]  The case was eventually brought to the United States Supreme Court. In a unanimous decision, the Supreme Court ruled that this legislature violated the Equal Protection Clause of the Fourteenth Amendment. [ 61 ]


Both class and race factored into the eugenic definitions of "fit" and "unfit." By using intelligence testing, American eugenicists asserted that  social mobility  was indicative of one's genetic fitness. [ 62 ]  This reaffirmed the existing  class  and  racial hierarchies  and explained why the upper-to-middle class was predominantly white. Middle-to-upper class status was a marker of "superior strains." [ 35 ]  In contrast, eugenicists believed poverty to be a characteristic of genetic inferiority, which meant that those deemed "unfit" were predominantly of the lower classes. [ 35 ] [ 63 ]


Because class status designated some more fit than others, eugenicists treated upper and lower-class women differently. Positive eugenicists, who promoted procreation among the fittest in society, encouraged middle-class women to bear more children. Between 1900 and 1960, eugenicists appealed to middle class white women to become more "family minded," and to help better the race. [ 64 ]  To this end, eugenicists often denied middle and upper-class women sterilization and  birth control . [ 65 ]  However, since poverty was associated with  prostitution  and "mental idiocy," women of the lower classes were the first to be deemed "unfit" and "promiscuous." [ 35 ]


In the 19th century, based on a view of  Lamarckism , it was believed that the damage done to people by diseases could be inherited and therefore, through eugenics, these diseases could be eradicated. This belief was carried into the 20th century as public health measures were taken to improve health with the hope that such measures would result in better health of future generations. [ citation needed ]


A 1911  Carnegie Institute  report explored eighteen methods for removing defective genetic attributes; the eighth method was  euthanasia . [ 14 ]  Though the most commonly suggested method of euthanasia was to set up local  gas chambers , [ 14 ]  many in the eugenics movement did not believe that Americans were ready to implement a large-scale euthanasia program, so many doctors came up with alternative ways of subtly implementing eugenic euthanasia in various medical institutions. [ 14 ]  For example, a mental institution in  Lincoln, Illinois  fed its incoming patients milk infected with  tuberculosis  (reasoning that genetically fit individuals would be resistant), resulting in 30–40% annual death rates. [ 14 ]  Other doctors practiced euthanasia through various forms of lethal neglect. [ 14 ]


In the 1930s, there was a wave of portrayals of eugenic "mercy killings" in American film, newspapers, and magazines. In 1931, the Illinois  Homeopathic  Medicine Association began lobbying for the right to euthanize "imbeciles" and other defectives. [ 66 ]  A few years later, in 1938, the  Euthanasia Society of America  was founded. [ 67 ]  However, despite this, euthanasia saw marginal support in the U.S., motivating people to turn to forced segregation and sterilization programs as a means for keeping the "unfit" from reproducing. [ 14 ]


Mary deGormo, a former teacher, was the first person to combine ideas about health and intelligence standards with competitions at state fairs, in the form of baby contests. [ 68 ]  She developed the first such contest, the "Scientific Baby Contest" for the Louisiana State Fair in Shreveport, in 1908. [ 69 ]  She saw these contests as a contribution to the "social efficiency" movement, which was advocating for the standardization of all aspects of American life as a means of increasing efficiency. [ 25 ]  DeGarmo was assisted by Doctor Jacob Bodenheimer, a  pediatrician  who helped her develop grading sheets for contestants, which combined physical measurements with standardized measurements of intelligence. [ 70 ]


The contest spread to other U.S. states in the early 20th century. In Indiana, for example,  Ada Estelle Schweitzer , a eugenics advocate and director of the Indiana State Board of Health's Division of Child and Infant Hygiene, organized and supervised the state's Better Baby contests at the  Indiana State Fair  from 1920 to 1932. It was among the fair's most popular events. During the contest's first year at the fair, a total of 78 babies were examined; in 1925 the total reached 885. Contestants peaked at 1,301 infants in 1930, and the following year the number of entrants was capped at 1,200. Although the specific consequences of the contests were difficult to assess, statistics helped to support Schweitzer's claims that the contests helped reduce infant mortality. [ 71 ] [ 72 ]


The contest intended to educate the public about raising healthy children at a time when approximately 10% of children died in their first year of life. [ 73 ]  However, its exclusionary practices reinforced social class and racial discrimination. In Indiana, for example, the contestants were limited to white infants;  African-American  and  immigrant  children were barred from the competition for ribbons and cash prizes. In addition, the scoring was biased toward  white , middle-class babies. [ 74 ] [ 75 ]  The contest procedure included recording each child's health history, as well as evaluations of each contestant's physical and mental health and overall development using medical professionals. Using a process similar to the one introduced at the Louisiana State Fair, and contest guidelines that the AMA and U.S. Children's Bureau recommended, scoring for each contestant began with 1,000 points. Deductions were made for defects, including a child's measurements below a designated average. The contestant with the most points was declared the winner. [ 76 ] [ 72 ] [ 77 ]


Standardization  through scientific judgment was a topic that was very serious in the eyes of the scientific community, but has often been downplayed as just a popular fad or trend. Nevertheless, a lot of time, effort, and money was put into these contests and their scientific backing, which would influence cultural ideas as well as local and state government practices. [ 78 ]


The  National Association for the Advancement of Colored People  promoted eugenics by hosting "Better Baby" contests and the proceeds would go to its anti-lynching campaign. [ 79 ]


First appearing in 1920 at the Kansas Free Fair, "Fitter Families for Future Firesides" competitions continued all the way up to  World War II . Mary T. Watts and Florence Brown Sherbon, [ 81 ] [ 82 ]  both initiators of the Better Baby Contests in Iowa, took the idea of positive eugenics for babies and combined it with a  determinist  concept of  biology  to come up with fitter family competitions. [ 83 ]


There were several different categories that families were judged in: size of the family, overall attractiveness, and health of the family, all of which helped to determine the likelihood of having healthy children. These competitions were simply a continuation of the Better Baby contests that promoted certain physical and mental qualities. [ 84 ] [ 85 ]  At the time, it was believed that certain behavioral qualities were inherited from one's parents. This led to the addition of several judging categories including:  generosity ,  self-sacrificing , and quality of familial bonds. Additionally, there were negative features that were judged:  selfishness ,  jealousy , suspiciousness, high-temperedness, and  cruelty .  Feeblemindedness ,  alcoholism , and  paralysis  were few among other traits that were included as physical traits to be judged when looking at family lineage. [ 86 ]


Doctors and specialists from the community would offer their time to judge these competitions, which were originally sponsored by the Red Cross. [ 86 ]  The winners of these competitions were given a  Bronze Medal  as well as champion cups called "Capper Medals." The cups were named after then-Governor and Senator,  Arthur Capper  and he would present them to "Grade A individuals". [ 87 ]


The perks of entering into the contests were that the competitions provided a way for families to get a free health check-up by a doctor as well as some of the pride and prestige that came from winning the competitions. [ 86 ]


By 1925, the Eugenics Records Office was distributing standardized forms for judging eugenically fit families, which were used in contests in several U.S. states. [ 88 ]


In 1907, Indiana passed the first eugenics-based  compulsory sterilization  law in the world. Thirty U.S. states would soon follow their lead. [ 89 ] [ 90 ]  Although the law was overturned by the  Indiana Supreme Court  in 1921, [ 91 ]  in the 1927 case  Buck v. Bell , the  U.S. Supreme Court  upheld the constitutionality of the  Virginia Sterilization Act of 1924 , allowing for the compulsory sterilization of patients of state mental institutions. [ 92 ]


The number of sterilizations performed per year increased until another Supreme Court case,  Skinner v. Oklahoma , 1942, which ruled that under the 14th Amendment's Equal Protection Clause, laws that permitted the compulsory sterilization of criminals were unconstitutional if these laws treated similar crimes differently. [ 93 ]  Although  Skinner  determined that the right to procreate was a fundamental right under the constitution, the case did not denounce sterilization laws, because its analysis was based on the equal protection of criminal defendants specifically, therefore leaving those seen as "social undesirables"—the poor, the disabled, and various ethnic groups—as targets of compulsory sterilization. [ 6 ]  Therefore, though compulsory sterilization is now considered an abuse of human rights,  Buck v. Bell  has never been overturned, and Virginia specifically did not repeal its sterilization law until 1974. [ 94 ]


Men and women were compulsorily sterilized for different reasons. Men were sterilized to treat their aggression and to eliminate their criminal behavior, while women were sterilized to control the results of their sexuality. [ 95 ]  Since women bore children, eugenicists held women more accountable than men for the reproduction of the less "desirable" members of society. [ 95 ]  Eugenicists therefore predominantly targeted women in their efforts to regulate the birth rate, to "protect" white racial health, and weed out the "defectives" of society. [ 95 ]


The most significant era of  eugenic sterilization  was between 1907 and 1963, when over 64,000 individuals were forcibly sterilized under eugenic legislation in the United States. [ 96 ]  Beginning around 1930, there was a steady increase in the percentage of women sterilized, and in a few states only young women were sterilized. A 1937  Fortune  magazine poll found that 2/3 of respondents supported eugenic sterilization of "mental defectives", 63% supported sterilization of criminals, and only 15% opposed both. [ 97 ] [ 98 ]  From 1930 to the 1960s, sterilizations were performed on many more institutionalized women than men. [ 99 ]  By 1961, 61 percent of the 62,162 total eugenic sterilizations in the United States were performed on women. [ 99 ]  A favorable report on the results of sterilization in  California , the state that conducted the most sterilizations (20,000 of the 60,000 that occurred between 1909 and 1960), [ 23 ]  was published in 1929 in book form by the biologist  Paul Popenoe  and was widely cited by the Nazi government as evidence that wide-reaching sterilization programs were feasible and humane. [ 100 ] [ 101 ]


After World War II, eugenics and eugenic organizations began to revise their standards of reproductive fitness to reflect contemporary social concerns of the later half of the 20th century, notably concerns over welfare, Mexican immigration, overpopulation, civil rights, and sexual revolution, and gave way to what has been termed neo-eugenics. [ 102 ]  Neo-eugenicists like  Clarence Gamble , an affluent researcher at  Harvard Medical school  and a founder of public birth control clinics, revived the eugenics movement in the United States through sterilization. Supporters of this revival of eugenic sterilizations believed that they would bring an end to social issues such as poverty and mental illness while also saving taxpayer money and boost the economy. [ 103 ]  Whereas eugenic sterilization programs before  World War II  were mostly conducted on prisoners or patients in mental hospitals, after the war, compulsory sterilizations were targeted at poor people and minorities. [ 103 ]  As a result of these new sterilization initiatives, though most scholars agree that there were over 64,000 known cases of eugenic sterilization in the U.S. by 1963, no one knows for certain how many compulsory sterilizations occurred between the late 1960s to 1970s, though it is estimated that at least 80,000 may have been conducted. [ 104 ]  A large number of those who were targets of coerced sterilizations in the later half of the century were African American, Hispanic, and Native American women.


Early proponents of the eugenics movement included not only influential white Americans but also several proponent African-American intellectuals such as  W. E. B. Du Bois ,  Thomas Wyatt Turner , and many academics at  Tuskegee University ,  Howard University , and  Hampton University . [ 79 ]  However, unlike many white eugenicists, these black intellectuals believed the best African Americans were as good as the best White Americans, and "The Talented Tenth" of all races should mix. [ 79 ]  Indeed, Du Bois believed "only fit blacks should procreate to eradicate the race's heritage of moral iniquity." [ 105 ]


With the support of leaders like Du Bois, efforts were made in the early 20th century to control the reproduction of the country's black population; one of the most visible initiatives was Margaret Sanger's 1939 proposal,  The Negro Project . [ 15 ]  That year, Sanger,  Florence Rose , her assistant, and Mary Woodward Reinhardt, then secretary of the new  Birth Control Federation of America  (BCFA), drafted a report on "Birth Control and the Negro." [ 15 ]  In this report, they stated that African Americans were the group with "the greatest economic, health and social problems," were largely illiterate and "still breed carelessly and disastrously," a line taken from W.E.B. DuBois' article in the June 1932  Birth Control Review. [ 15 ]  The Project often sought after prominent African-American leaders to spread knowledge regarding birth control and the perceived positive effects it would have on the African-American community, such as poverty and the lack of education. [ 106 ]  Sanger particularly sought out black ministers from the South to serve as leaders in the Project in the hopes of countering any ideas that the project was a strategic attempt to eradicate the black population. [ 15 ]  However, despite Sanger's best efforts, white medical scientists took control over the initiative, and with the Negro Project receiving praise from white leaders and eugenicists, many of Sanger's opponents, both during the creation of the Project and years after, saw her work as an attempt to terminate African Americans. [ 15 ] [ 106 ]


Opposition to initiatives to control reproduction within the African-American community grew in the 1960s, particularly after President  Lyndon B. Johnson , in 1965, announced the establishment of federal funding of birth control used on the poor. [ 45 ]  In the 1960's, many African Americans throughout the country took the government's decision to fund birth-control clinics as an attempt to limit the growth of the black population and along with it, the increased political power that black Americans were fighting to acquire. [ 45 ]  Scholars have stated that African Americans' fear about their reproductive health and ability was rooted in history as under  U.S. slavery , enslaved women were often coerced or forced to have children to increase a plantation owner's wealth. [ 45 ] [ 107 ]  Therefore, many African Americans, particularly those in the  Black Power Movement , saw birth control, and federal support of  the Pill , as equivalent to black genocide, declaring it as such at the 1967 Black Power Conference. [ 45 ]


Federal funding for birth control went alongside family planning initiatives that were a part of state welfare programs. These initiatives, in addition to advocating the use of the Pill, supported sterilization as a means of curbing the number of people receiving welfare and control the reproduction of 'unfit' women. [ 102 ]  The 1950s and 1960s were the height of the sterilization abuse that African-American women as a group experienced at the hands of the white medical establishment. [ 45 ]  During this period, the sterilization of African-American women largely took place in the South and assumed two forms: the sterilization of poor unwed black mothers, and "Mississippi appendectomies." [ 102 ]  Under these "Mississippi appendectomies," women who went to the hospital to give birth, or for some other medical treatment, often found themselves incapable of having more children upon leaving the hospital due to unnecessary hysterectomies performed on them by southern medical students. [ 45 ] [ 108 ]  By the 1970s, the coerced sterilization of women of color spread from the South to the rest of the country through federal family planning and under the guise of voluntary contraceptive surgery as physicians began to require their patients to sign consent forms to surgeries they did not want or understand. [ 102 ]


Though it is unknown the exact number of African American women who were sterilized throughout the country in the 20th century, records from a few states offer some estimates. In the state of North Carolina, which was seen as having the most aggressive eugenics program out of the 32 states that had one, [ 109 ]  during the 45-year reign of the  North Carolina Eugenics Board , from 1929 to 1974, a disproportionate number of those who were targeted for forced or coerced sterilization were black and female, with almost all being poor. [ 110 ]  Of the 7,600 women who were sterilized by the state between the years of 1933 and 1973, about 5,000 were African American. [ 6 ]  In light of this history, North Carolina became the first state to offer compensation to surviving victims of compulsory sterilization. [ 110 ]  Additionally, whereas African Americans made up just over 1% of California's population, they accounted for at least 4% of the total number of sterilization operations conducted by the state between 1909 and 1979. [ 111 ]  Overall, according to one 1989 study, 31.6% of African American women without a high school diploma were sterilized while only 14.5% of white women of the same educational status were sterilized. [ 6 ]


In 1972,  U.S. Senate  committee testimony brought to light that at least 2,000 involuntary sterilizations had been performed on poor black women without their consent or knowledge. [ 112 ]  An investigation revealed that the surgeries were all performed in the South, and were all performed on black women with multiple children who were receiving welfare. [ 112 ]  Testimony revealed that many of these women were threatened with an end to their welfare benefits unless they consented to sterilization. [ 112 ]  These surgeries were instances of sterilization abuse, a term applied to any sterilization performed without the consent or knowledge of the recipient, or in which the recipient is pressured into accepting the surgery. Because the funds used to carry out the surgeries came from the  U.S. Office of Economic Opportunity , the sterilization abuse raised suspicions, especially among members of the black community, that "federal programs were underwriting eugenicists who wanted to impose their views about population quality on minorities and poor women." [ 113 ]


Despite this investigation, it was not until 1973 that the issue of sterilization abuse was brought to media attention. On June 14, 1973, two black girls,  Minnie Lee and Mary Alice Relf , ages fourteen and twelve, respectively, were sterilized without their knowledge in Alabama by the Montgomery Community Action Committee, an OEO-financed organization. [ 102 ] [ 111 ]  The summer of that year, the Relf girls sued the government agencies and individuals responsible for their sterilization. [ 102 ]  As the case was being pursued, it was discovered that the girls' mother, who could not read, unwittingly approved the operations, signing an 'X' on the release forms; Mrs. Relf had believed that she was signing a form authorizing her daughters to receive Depo-Provera injections, a form of birth control. [ 102 ]  In light of the 1974 case of  Relf v. Weinberger , named after Minnie Lee and Mary Alice's older sister, Katie, who had narrowly escaped also being sterilized, the  Department of Health, Education, and Welfare  (HEW) were ordered to establish new guidelines for its government sterilization policy. [ 102 ]  By 1979, the new guidelines finally addressed the concern over informed consent, determined that minors under the age of 21 and those with severe mental impairments who could not give consent would not be sterilized, and articulated the provision that doctors could no longer claim that a woman's refusal to be sterilized would result in her being denied welfare benefits. [ 102 ]


The 20th century demarcated a time in which compulsory sterilization heavily navigated its way into primarily  Latino  communities, against  Latina women . Locations such as  Puerto Rico  and  Los Angeles, California  were found to have had large amounts of their female population coerced into sterilization procedures without quality and necessary  informed consent  nor full awareness of the procedure.


Between the span of the 1930s to the 1970s, nearly one-third of the female population in Puerto Rico was sterilized; at the time, this was the highest rate of sterilization in the world. [ 114 ]  Some viewed sterilization as a means of rectifying the country's poverty and unemployment rates. Following legalization of the procedure in 1937 a U.S. government endorsed initiative saw health department officials advocating for sterilization in rural parts of the island. Sterilized women were also encouraged to join the workforce, in particular the textile and clothing related industries. The procedure was so common that it was often referred to solely as "la operación", garnering a  documentary  referenced by the same name. [ 114 ]  This intentional targeting of Latino communities exemplifies the strategic placement of racial eugenics in modern history. This targeting is also inclusive of those with disabilities and those from marginalized populations, which Puerto Rico is not the only example of this trend.


Eugenics did not serve as the only reason for the disproportionate rates of sterilization in the Puerto Rican community.  Contraceptive trials  were inducted in the 1950s towards Puerto Rican women.  John Rock  and  Gregory Pincus  were the two men spearheading the human trials of  oral contraceptives . In 1954, the decision was made to conduct the clinical experiment in Puerto Rico, citing the island's large network of birth control clinics and lack of anti-birth control laws, which was in contrast to the United States' thorough cultural and religious opposition to the reproductive service. [ 115 ]  The decision to conduct the trials in this community was also motivated by the structural implications of supremacy and colonialism. Rock and Pincus monopolized off of the primarily poor and uneducated background of these women, countering that if they "could follow the Pill regimen, then women anywhere in the world could too." [ 115 ]  These women were purposely ill-informed of the oral contraceptives presence; the researchers only reported that the drug, which was administered at a much higher dosage than what birth control is prescribed at today, was to prevent pregnancy, not that it was tied to a clinical trial in order to jump start oral contraceptive access in America through  FDA  approval.


In California, by the year 1964, a total of 20,108 people were sterilized, making that the largest amount in all of the United States. [ 116 ]  Individuals sterilized were disproportionately Mexican,  Mexican-American , and  Chicana  women. Andrea Estrada, a  UC Santa Barbara  affiliate, said:


Beginning in 1909 and continuing for 70 years, California led the country in the number of sterilization procedures performed on men and women, often without their full knowledge and consent. Approximately 20,000 sterilizations took place in state institutions, comprising one-third of the total number performed in the 32 states where such action was legal. [ 117 ]


In 1966, the case of  Nancy Hernandez  was the first to reach national public attention and resulted in protests on  women's rights  and  reproductive rights  across the country. Her story was published in Rebecca Kluchin's book,  Fit to be Tied: Sterilization and Reproductive Rights in America, 1950-1980 . [ 118 ]


Cases such as  Madrigal v. Quilligan , a class action suit regarding forced or coerced postpartum sterilization of Latina women following cesarean sections, helped bring to light the widespread abuse of sterilization supported by federal funds. The case's plaintiffs were 10 sterilized women of  Los Angeles County Hospital  who elected to come forward with their stories. Although a grim reality,  No más bebés  is a documentary that offers an emotional and candid storytelling of the  Madrigal v. Quilligan  case on behalf of Latina women whom were direct recipients of the coerced sterilization of the Los Angeles' hospital. The judge's ruling sided with the County Hospital, but an aftermath of the case resulted in the accessibility of multiple language informed consent forms.


These stories, among many others, serve as backbones for not only the  reproductive justice  movement that we see today, but a better understanding and recognition of the  Chicana feminism  movement in contrast to  white feminism's  perception of  reproductive rights .


An estimated 40% of Native American women (60,000–70,000 women) and 10% of Native American men in the United States underwent sterilization in the 1970s. [ 119 ]  A General Accounting Office (GAO) report in 1976 found that 3,406 Native American women, 3,000 of which were of childbearing age, [ 120 ]  were sterilized by the  Indian Health Service (IHS)  in Arizona, Oklahoma, New Mexico, and South Dakota from 1973 to 1976. [ 121 ] [ 122 ] [ 123 ]  The GAO report did not conclude any instances of coerced sterilization, but called for the reform of IHS and contract doctors' processes of obtaining informed consent for sterilization procedures. [ 121 ]  The IHS informed consent processes examined by the GAO did not comply with a 1974 ruling of the U.S. District Court that "any individual contemplating sterilization should be advised orally at the outset that at no time could federal benefits be withdrawn because of failure to agree to sterilization." [ 122 ]


In examining individual cases and testimonies of Native American women, scholars have found that IHS and contract physicians recommended sterilization to Native American women as the appropriate form of birth control, failing to present potential alternatives and to explain the irreversible nature of sterilization, and threatened that refusal of the procedure would result in the women losing their children and/or federal benefits. [ 119 ] [ 121 ] [ 122 ]  Scholars also identified language barriers in informed consent processes as the absence of interpreters for Native American women hindered them from fully understanding the sterilization procedure and its implications, in some cases. [ 122 ]  Scholars have cited physicians' individual paternalism and beliefs about the population control of poor communities and welfare recipients and the opportunity for financial gain as possible motivations for performing sterilizations on Native American women. [ 121 ] [ 122 ] [ 123 ]


Native American women and activists mobilized in the 1970s across the United States to combat the coerced sterilization of Native American women and advocate for their reproductive rights, alongside tribal sovereignty, in the  Red Power movement . [ 121 ] [ 122 ]  Some of the most prominent activist organizations established in this decade and active in the Red Power movement and the resistance against coerced sterilization were the American Indian Movement (AIM), United Native Americans, Women of all Red Nations (WARN), the International Indian Treaty Council (IITC), and Indian Women United for Justice, founded by Constance Redbird Pinkerton Uri, a Cherokee-Choctaw physician. [ 121 ] [ 122 ]  Some Native American activists have deemed the coerced sterilization of Native American women a "modern form of genocide," [ 121 ]  and view these sterilizations as a violation of the rights of tribes as sovereign nations. [ 121 ]  Others argue that the sterilization of Native American women is interconnected with colonialist and capitalist motives of corporations and the federal government to acquire land and natural resources, including oil, natural gas, and coal, currently located on Native American reservations. [ 122 ] [ 120 ]  Scholars and Native American activists have situated the forced sterilizations of Native American women within broader histories of colonialism, violations of Native American tribal sovereignty by the federal government, including a long history of the removal of children from Native American women and families, and population control efforts in the United States. [ 119 ] [ 121 ] [ 122 ] [ 123 ]


The 1970s brought new federal legislation enacted by the United States government which addressed issues of informed consent, sterilization, and the treatment of Native American children. The U.S. Department of Health, Education, and Welfare released new regulations in 1979 on informed consent processes for sterilization procedures, including a longer waiting period of 30 days before the procedure, the presentation of alternative methods of birth control to the patient, and clear verbal affirmation that the patient's access to federal benefits or welfare programs would not be revoked if the procedure were refused. [ 121 ]  The  Indian Child Welfare Act  of 1978 officially recognized the significance and value of the extended family in Native American culture, adopting "minimum federal standards for the removal of Indian children to foster or adoptive homes," [ 122 ]  and the central importance of the sovereign tribal governments in decision-making processes surrounding the welfare of Native children. [ 122 ]


Although the eugenics movement in Germany started in the 1890s, it was later partly influenced by the United States.  California eugenicists  began producing literature promoting eugenics and sterilization and sending it overseas to German scientists and medical professionals. [ 14 ]  By 1933, California had subjected more people to forceful sterilization than all other U.S. states combined. The forced sterilization program engineered by the Nazis was partly inspired by California's. [ 124 ]


The  Rockefeller Foundation  helped develop and fund various German eugenics programs, [ 125 ]  including the one that  Josef Mengele  worked in before he went to  Auschwitz . [ 14 ]


Upon returning from Germany in 1934, where more than 5,000 people per month were being forcibly sterilized, the California eugenics leader C. M. Goethe bragged to a colleague:


You will be interested to know that your work has played a powerful part in shaping the opinions of the group of intellectuals who are behind Hitler in this epoch-making program. Everywhere I sensed that their opinions have been tremendously stimulated by American thought ... I want you, my dear friend, to carry this thought with you for the rest of your life, that you have really jolted into action a great government of 60 million people. [ 126 ]


Eugenics researcher  Harry H. Laughlin  often bragged that his  Model Eugenic Sterilization laws  had been implemented in the  1935 Nuremberg racial hygiene laws . [ 127 ]  In 1936, Laughlin was invited to an award ceremony at  Heidelberg University  in Germany (scheduled on the anniversary of the 1934 purge of Jews from the Heidelberg faculty), to receive an honorary doctorate for his work on the "science of racial cleansing". Due to financial limitations, Laughlin was unable to attend the ceremony and had to pick it up from the Rockefeller Institute. Afterward, he proudly shared the award with his colleagues, remarking that he felt that it symbolized the "common understanding of German and American scientists of the nature of eugenics." [ 128 ]


Henry Friedlander  wrote that although the German and American eugenics movements were similar, the U.S. did not follow the same  slippery slope  as Nazi eugenics because American "federalism and political heterogeneity encouraged diversity even with a single movement." In contrast, the German eugenics movement was more centralized and had fewer diverse ideas. [ 129 ]  Unlike the American movement, one publication and one society, the  German Society for Racial Hygiene , represented all German eugenicists in the early 20th century. [ 129 ] [ 130 ]


After 1945 some historians began to try to portray the U.S. eugenics movement as distinct and distant from Nazi eugenics. [ 131 ]


Many of the defendants at the  Nuremberg trials  of 1945 to 1946 attempted to justify their  human-rights  abuses by claiming similarity between the Nazi eugenics programs and the US eugenics programs. [ 132 ]


After the  Second World War , the extreme version of eugenics practiced by the  Nazis  brought the movement into disrepute. However, aspects of the eugenics movement such as forced sterilization were still taking place, just not with as much public visibility as before. [ 133 ]  As technology developed, the field of  genetic engineering  emerged. Instead of sterilizing people to remove traits deemed to be "undesirable", genetic engineering "changes or removes genes to prevent disease or improve the body in some significant way." [ 119 ]


Proponents of genetic engineering cite its ability to cure and prevent life-threatening diseases. Genetic engineering began in the 1970s when scientists began to clone and alter genes. From this, scientists were able to create life-saving health interventions such as human insulin, the first-ever genetically engineered drug. [ 134 ]  Because of this development, over the years scientists were able to create new drugs to treat devastating diseases. For example, in the early 1990s, a group of scientists were able to use a gene-drug to treat severe combined immunodeficiency in a young girl. [ 135 ]


However, genetic engineering also further allows for the practice of eliminating "undesirable traits" within humans and other organisms—for example, with current genetic tests, parents are able to test a fetus for any life-threatening diseases that may affect the child's life and then choose to abort the baby. [ 119 ]  Some fear that this could lead to ethnic cleansing, or alternative form of eugenics. [ 136 ]  The ethical implications of genetic engineering were heavily considered by scientists at the time, and the  Asilomar Conference  was held in 1975 to discuss these concerns and set reasonable, voluntary guidelines that researchers would follow while using DNA technologies. [ 137 ]


Advancements in  prenatal testing  over the past several decades have contributed to an increase in disability-selective abortions, which refers to the termination of pregnancy after a diagnosis of a genetic anomaly before birth. [ 138 ]  In 2007, the  American College of Obstetricians and Gynecologists  (ACOG) began to recommend that all women, regardless of age, should be offered diagnostic genetic testing before 20 weeks gestation. [ 139 ]  Today, prenatal screening for chromosomal abnormalities, including  Down syndrome ,  Edwards syndrome , and  Patau syndrome , is offered as routine healthcare. In the United States, it is estimated that anywhere from 61%-93% of infants with Down syndrome are terminated after a definitive prenatal diagnosis each year. [ 140 ]  Reasons to continue or terminate a pregnancy following a prenatal diagnosis of a genetic abnormality are complex, and often influenced by a combination of social, medical, and ethical considerations.


Defenders of disability-selective abortion suggest that its practice alleviates human suffering and helps parents make informed reproductive decisions. [ 141 ]  This position considers disability-selective abortion as healthcare, intended to prevent pathology and improve quality of life. Proponents also argue that access to disability-selective abortions is essential to protecting women’s bodily autonomy. [ 141 ]  In addition, some support disability-selective abortion on the basis of  procreative beneficence  – the principle of selecting the child with the best-expected life based on available genetic information. [ 142 ]


Opponents of disability-selective abortion argue that the normalization of its practice is inherently imbued with a condescending, eugenic attitude toward disability. [ 143 ]  They suggest that disability-selective abortions are enabled by the normal function view (NFV) of health, which pathologizes disability and assumes that disability is directly correlated with a reduction in health. [ 144 ] [ a ]


The 1978 Federal Sterilization Regulations, created by the  United States Department of Health, Education and Welfare , or HEW (now the  United States Department of Health and Human Services ), outline a variety of prohibited sterilization practices that were often used previously to coerce or force women into sterilization. [ 146 ]  These were intended to prevent such eugenics and neo-eugenics as resulted in the involuntary sterilization of large groups of poor and minority women. Such practices include: not conveying to patients that sterilization is permanent and irreversible, in their own language (including the option to end the process or procedure at any time without conceding any future medical attention or federal benefits, the ability to ask any and all questions about the procedure and its ramifications, the requirement that the consent seeker describes the procedure fully including any and all possible discomforts and/or side-effects and any and all benefits of sterilization); failing to provide alternative information about methods of contraception, family planning, or pregnancy termination that are nonpermanent and/or irreversible (this includes  abortion ); conditioning receiving welfare and/or  Medicaid  benefits by the individual or his/her children on the individuals "consenting" to permanent sterilization; tying elected abortion to compulsory sterilization (cannot receive a sought out abortion without "consenting" to sterilization); using  hysterectomy  as sterilization; and subjecting minors and the mentally incompetent to sterilization. [ 146 ] [ 147 ] [ 79 ]  The regulations also include an extension of the informed consent waiting period from 72 hours to 30 days (with a maximum of 180 days between informed consent and the sterilization procedure). [ 147 ] [ 146 ] [ 79 ]


However, several studies have indicated that the forms are often dense and complex and beyond the literacy aptitude of the average American, and those seeking publicly funded sterilization are more likely to possess below-average literacy skills. [ 148 ]  High levels of misinformation concerning sterilization still exist among individuals who have already undergone sterilization procedures, with permanence being one of the most common gray factors. [ 148 ] [ 149 ]  Additionally, federal enforcement of the requirements of the 1978 Federal Sterilization Regulation is inconsistent and some of the prohibited abuses continue to be pervasive, particularly in underfunded hospitals and lower income patient hospitals and care centers. [ 147 ] [ 79 ]


The compulsory sterilization of American men and women continues to this day. In 2013, it was reported that 148 female prisoners in two California prisons were sterilized between 2006 and 2010 in a supposedly voluntary program, but it was determined that the prisoners did not give consent to the procedures. [ 150 ]


By 1979, California, driven by the eugenic thinking that prisoners were unfit to reproduce, sterilized approximately 20,000 people without their consent. [ 151 ]  This practice legally ended when eugenics laws were repealed in 1979 for California state hospitals and in 2010 for state prisons. [ 152 ]  However, the compulsory sterilization of American men and women continues to this day. Between 2005 and 2011, 148 female prisoners were sterilized in California prisons through tubal ligations without required state approvals. [ 153 ] [ 154 ] [ 155 ]  Former inmates claim that medical staff pressured women who had served multiple prison terms or would be likely to return to prison in the future to be sterilized. [ 156 ]  In September 2014, California enacted Bill SB1135 that bans sterilization in correctional facilities, unless the procedure is required to save an inmate's life. [ 157 ]  Additionally, in 2021, Gavin Newsom, Governor of California, signed a compensation agreement to pay these 148 victims $25,000 each.


Other states have sterilized prisoners in the recent past. In Tennessee, general sessions judge Sam Benningfield signed an order in 2017 allowing inmates to reduce their sentence by 30 days if they undergo voluntary sterilization. [ 158 ]  His goal was to break a “vicious cycle” of repeat drug offenders who were unemployed or could not pay for child support. [ 159 ]  While the order was only in place for two months, 38 men signed up to receive vasectomies and 32 women to receive Nexplanon implants, a birth control device. [ 159 ]  Benningfield claimed this 2017 order was not a eugenics program, writing in a statement that its purpose was to, “protect children and help people in their rehabilitation efforts.” [ 160 ]  However, criminal justice researchers and news outlets continually compared it to previous prisoner sterilization programs based in eugenics and portrayed it as a continuation of the practice of eugenics. John Raphling, a senior researcher on criminal justice for the U.S. Human Rights Watch, told  The Outline  that Benningfield was “coercing poor people to have this procedure to prevent them from reproducing.” [ 160 ]


Sterilization in immigration detention centers


In 2020, forced sterilizations at a U.S. Immigration and Customs Enforcement (ICE) detention center in Ocilla, Georgia amassed national attention. [ 161 ]  Over 50 people detained at the ICE facility, all lower-income immigrant women with minimal understanding of the English language, stated they were pushed to undergo or did undergo medically unnecessary gynecological surgeries including hysterectomies. A Senate briefing on this subject emphasized the “uniform absence of truly informed consent” due in part to language barriers and in part to lack of information provided. [ 162 ]


Modern eugenics and genetic engineering


Human enhancement through genetic alterations is aimed at improving traits considered normal and extinguishing illnesses, defects, and other abnormalities. [ 163 ]  While genome editing is still being heavily researched and developed, the technology could one day be more developed and used to alter human genetics. [ 164 ]  Opponents of human enhancement through genetic engineering assert that the technology is founded in eugenic ideals: to develop superior individuals and extinguish those deemed inferior. [ 163 ]  Supporters claim that this technology is considered reproductive autonomy and will ultimately benefit both individuals and the community.


The objective of  family planning in the United States  is to enable individuals to determine the number and spacing of their children and to select the means by which that target may be achieved.  Doing so can bring many benefits including improved maternal health, the prevention of the spread of  STDs , and decreased infant and child mortality rates. [ 1 ]


Teenage pregnancies are very involved in today's society and because of this the resources that are around for family planning is vital to the survival of these infants.  Federally funded programs such as  Planned Parenthood  are very important in the  family planning  process of adolescents because of the involvement of doctors, gynecologists, or medicine. These family planning practices also help impact the teenager and the infant because of the availability of healthcare and other resources that may otherwise not be offered. [ 2 ]


Title X  of the  Public Health Service Act , [ 3 ]  is a US government program dedicated to providing family planning services for those in need.  But funding for Title X as a percentage of total public funding to family planning client services has steadily declined from 44% of total expenditures in 1980 to 12% in 2006.


Medicaid  has increased from 20% to 71% in the same time. In 2006, Medicaid contributed $1.3 billion to public family planning. [ 4 ]   The 1.9 billion spent on publicly funded family planning in 2008 saved an estimated $7 billion in short term Medicaid costs. [ 5 ]   Such services helped women prevent an estimated 1.94 million unintended pregnancies and 810,000 abortions. [ 5 ]


More than 3 out of 10 women in the U.S. have an abortion by the time they are 45 years old. [ 6 ]


In the United States, contraceptive use saves about $19 billion in direct medical costs each year. [ 7 ]
Despite the availability of highly effective  contraceptives , about half of the pregnancies in the  United States  are  unintended . [ 7 ]  Highly effective contraceptives, such as  IUD  are underused in the United States. [ 5 ]  Increasing use of highly effective contraceptives could help meet the goal set forward in  Healthy People 2020  to decrease unintended pregnancy by 10%. [ 5 ]   Cost to the user is one factor preventing many US women from using more effective contraceptives. [ 5 ]   Making contraceptives available without a copay increases use of highly effective methods, reduces unintended pregnancies, and may be instrumental in achieving the Healthy People 2020 goal. [ 5 ]


The  fathers' rights movement in the United States  is a group that provides fathers with education, support and advocacy on  family law  issues of  child custody , access,  child support ,  domestic violence  and  child abuse . Members protest what they see as evidence of  gender bias  against fathers in the branches and departments of various governments, including the  family courts .


The movement traces its roots to divorce and alimony controversies in the 1960s. Today, the modern fathers' rights movement generally focuses on issues regarding  shared parenting  while providing support and public awareness for fathers and children after a divorce or separation.


Different fathers' rights organizations may also advocate for non-married fathers' rights through lobbying efforts or news media outlets. Other advocacy topics include  gender bias , both culturally and from within the legal system,  visitation ,  adoption ,  maternal gatekeeping  and  parental alienation .


The modern fathers’ rights movement in the US emerged with the founding of Divorce Racket Busters in California in 1960 to protest California's divorce laws, which they claimed discriminated against men in  alimony , child support settlements and in a presumption of maternal custody. The group expanded into other states, changing its name to Divorce Reform in 1961. [ 1 ]  With the increase in divorce rates in the 1960s and 1970s, more local grassroots men’s organizations grew up devoted to divorce reform, [ 1 ]  and by the 1980s, there were a total of more than 200 fathers’ rights groups active in almost every state. [ 2 ]  These groups focused their actions on what they viewed as gender discrimination in family law by engaging in political activities such as  lobbying   state legislatures , filing  class action  suits,  picketing   courthouses , and monitoring judges’ decisions through “court watches”. [ 1 ]  The 1990s saw the emergence of new and larger organizations such as  National Fatherhood Initiative  and the American Fathers Coalition. [ 2 ]  Several unsuccessful efforts were made to found a national organization to which local organizations could belong. As a result, the movement remains mainly a loose coalition of local groups. [ 1 ]


Some states removed decisions of divorce, child custody and child support from Common Law courts and assigned them to courts of equity.  Michael Newdow  contended that the best interest of the child standard, as currently applied by family courts, violated the  equal protection clause  of the  U.S. Constitution . [ 3 ]


Because the amount of federal funding to states depended on the amount of child support collected by the state, members of the fathers' rights movement allege that federal law (Title IV-D of the Social Security Act) discouraged laws creating a rebuttable presumption for  shared parenting . [ 4 ]


Parental rights activists claimed that employees of the Massachusetts Department of Social Services (DSS) removed children from their parents without cause. [ 5 ]  They add that these employees improperly received immunity from the  Massachusetts Supreme Court , [ 6 ]  threatened mothers with the loss of their children to coerce them into divorce [ 7 ]  and to attend support groups. [ 8 ]   They claimed that these support groups served the dual purpose of allowing associates of DSS employees to receive government funding for running the support groups, and allowing the DSS employees to gain information used to remove children. [ 8 ]


Female opponents at legislative hearings alleged harassment and threats of physical harm by advocates, [ 9 ]  while members stated that the  National Organization for Women  and others had possibly fabricated the claims to get attention as part of a plan to paint non-custodial parents as extremists. [ 9 ]


In South Dakota, Senate Bill 74 was signed into law on March 11, 2014 [ 10 ]


In Illinois, the following laws co-authored by  Jeffery M. Leving  were signed into law in 2009:


SB 1628, sponsored by Senator Iris Martinez and in the House by Representative Deborah Mell, accomplished two things: It amended the Paternity Act and other Acts to insure that both parties be informed to their right to  DNA testing  before paternity can be adjudicated either through a voluntary acknowledgment, court proceedings or by an administrative law judge. It also amended the visitation interference section of the Criminal Code and made it a criminal offense to deny the other parent their right to parenting time or custody time. Previously, only visitation interference was a crime. (Signed into law: August 11, 2009)


SB 1590, sponsored by Sen. Pamela Althoff and in the House by Rep. Sandra Pihos, and which passed unanimously, allows children and non-custodial parents to use electronic visitation technologies such as email, telephone, internet and video conferencing. Illinois became the sixth state to pass Virtual Visitation Legislation which could enable  virtual visitation  for incarcerated fathers. (Signed into law: August 11, 2009)


HB 4008, sponsored by Senate by Senator Martinez and Rep. Jehan Gordon, included the paternity provisions of SB 1628. It amended the Paternity Act to ensure that both parties would be clearly informed to their right to DNA testing before a voluntary acknowledgment of paternity is signed or a paternity order is entered. (Signed into law: August 14, 2009)


HB 2266, sponsored by Martinez and Rep. Ken Dunkin, amended the visitation interference section of the Criminal Code with the use of terms used in family cases today (i.e. parenting time and custody time). (Signed into law: August 25, 2009)


Forensic investigator, Zed McLarnon, proved that Massachusetts family courts used phantom clinical evaluations kept in hidden files, secret hearings without the presence of both parents, and doctored of court hearing tapes. [ 11 ]   A father's rights activist appealed to a Massachusetts state legislator who wrote an environmental law (named Anti-Slapp) intended to protect  whistleblowers  from punitive countersuits by corporations and which was rewritten by the Massachusetts Supreme Court to immunize mothers and social workers who file false allegations, noting that fathers have virtually no remedy for false allegations of abuse. [ 12 ]


In 2004, some Massachusetts voters were offered a chance to vote on a non-binding ballot question about creating a legislative presumption for joint physical custody. One such question was "Shall the state representative from this district be instructed to vote in favor of legislation requiring that in all separation and divorce proceedings involving minor children, the court shall uphold the fundamental rights of both parents to the shared physical and legal custody of their children and the children's right to maximize their time with each parent, so far as is practical, unless one parent is found unfit or the parents agree otherwise, subject to the requirements of existing child support and abuse prevention laws?"  Of those voters choosing to answer the above or similar non-binding ballot initiatives, 84.5% approved. [ 13 ]


Fathers' rights activists campaigned to change Wisconsin law, which allowed custodial parents to move up to 150 miles (240 km) away from their prior residence without informing the noncustodial parent, to create a  rebuttable presumption  that moves of greater than 20 miles (32 km) are not in the best interest of the children. [ 14 ]


Members of the fathers' rights movement criticized a 2005  New York Times Sunday Magazine  article that began with the words, “…custody determinations are traditionally based on what’s in ‘the child’s best interest.’ But some fathers are now arguing – and agitating – for rights and interests of their own,” for creating a false  dichotomy  between  children's best interests  and fathers' rights. [ 39 ]


About a Public Broadcasting Services (PBS) documentary about children and divorce, stating members commented that unlike a previous PBS documentary, the show was balanced, but portrayed the movement as promoting conflict, adding that the average viewer did not distinguish conflict in the public sphere from conflict in the home, which could hurt children. [ 40 ]


Members also protested a Boston Globe article about a case in which a father successfully prevented a mother from moving children 70 miles away to another state. According to the campaigners, the article inappropriately linked the mixed feelings of the children to their inability to relocate with their mother and to the shared parenting arrangement rather than to divorce, adding that the reporter questioned the children about their living situation and thus exacerbated the conflicts felt by the children. [ 41 ]


Parental leave  (also known as family leave) is regulated in the United States by  US labor law  and state law. The  Family and Medical Leave Act of 1993  (FMLA) requires 12 weeks of unpaid leave annually for parents of newborn or newly adopted children if they work for a company with 50 or more employees. As of October 1, 2020, the same policy has been extended to caregivers of sick family members, or a partner in direct relation to the birth of the child therefore responsible for the care of the mother. [ 1 ]  Although 12 weeks are allowed to them, on average American fathers only take 10 days off, due to financial need. [ 2 ]  Beginning in 2020, California, New Jersey, and Rhode Island required paid parental leave to employees, including those a part of 50 or less employees. [ 3 ]  There is no paid paternity leave in the United States currently.


That is below the 16-week minimum recommended by the  World Health Organization . [ 4 ]  The United States is the only country among the 38 member  OECD  nations that has not passed laws requiring businesses and corporations to offer paid maternity leave to their employees. [ 5 ]


Between 1961 and 1965, only 14% of mothers participated in the workforce within six months of their child's birth. [ 6 ]  During the same period, only 44% of mothers worked during their pregnancy. [ 7 ]


Until the enactment of FMLA, in 1993, maternity leave coverage was governed by state law, collective bargaining agreements, and employer policies. [ 8 ]  The first set of maternity leave related policies emerged after World War I, when first-wave feminists lobbied for a women's health bill to give grants to states to provide healthcare for women and children. [ 9 ]  By 1969, five states had enacted temporary  disability insurance  laws to protect employees from income loss in the occurrence of a temporary medical disability. [ 10 ]  Under that legislation, new mothers were granted leaves corresponding to the benefits that other employees received for temporary illness or disability. Changes to the federal tax code in 1976 permitted working families with a dependent child to take a tax credit on child care costs. In 1978, the  Pregnancy Discrimination Act  (PDA) prohibited employers from treating a woman unfavorably because of pregnancy, childbirth, or a medical condition related to pregnancy or childbirth. [ 11 ]  A landmark case in 1987,  California Federal Savings and Loan Association v. Guerra , upheld a California law requiring most employers to grant pregnant women four months of unpaid disability leave and the right to return to the same job. [ 12 ]  That state-level trend of maternity leave legislation continued into the 1970s and 1980s where multiple other states passed more explicit recognitions of new mothers' rights to a temporary leave of absence. Ultimately, 12 states and the District of Columbia had implemented measures requiring at least some private sector employers to offer maternity leave packages to its employees. [ 8 ]  Even in the absence of the formal legislation, employees in other states often obtained maternity leave by  collective bargaining . Employees frequently held enough bargaining power to influence employer policies and to negotiate for the inclusion of maternity leave protection.


Despite some localized employees' access to maternity leave, there was growing pressure for national maternity leave legislation in the early 1990s. Many new mothers continued to be excluded from such maternity leave provisions despite growing national demand. Women now enjoyed greater employment opportunities and changing gender norms that encouraged increased labor involvement. That increased  female employment  also extended to mothers, who now were now more likely to engage in the workforce even if they had a young child. The labor participation rate of mothers with children aged less than one rose from 31% in 1976 to 54% in 1992. [ 13 ]  The contribution of women's earnings to her family income rose from 26.6% in 1970 to 36% in 2008. [ 14 ]  In spite of a high labor force participation rate, only an estimated 40% of working women had access to explicit maternity leave protection. That inadequate national coverage provoked intense protest and growing national consensus on the value of maternity leave. Ultimately, the increased salience and galvanized national support prompted the enactment of the  Family and Medical Leave Act of 1993 , mandating maternity leave.


Although the Family and Medical Leave Act required employers to guarantee job-protected, unpaid leave up to 12 weeks after the birth or adoption of a new child, an estimated 41% of employees in the United States were not covered by Act in 2012. [ 15 ]  Nearly two-thirds of mothers had to work during their pregnancies between 2002 and 2008. [ 15 ]  By 2012, only 14% of US fathers had access to paid family leave as an employee benefit. [ 16 ]  About two thirds of employees (68%) had access to paid sick leave, and 38% had access to short-term disability benefits. Prior to the FMLA, the term "family" referred to a nuclear family where with two parents of opposite sex and the "mother" could bear a child. That was the only definition acknowledged by medical and economic research done before the  LGBTQ rights  movement. Only recently have studies caught up to a modern and more inclusive definition for a family.


In the US, parents and family are federally protected under the 1993  Family and Medical Leave Act  (FMLA) [ 17 ]  to go on maternity or family leave after the adoption or birth of a child. [ 18 ]  Under this law, legal parents are protected for up to 12 weeks of unpaid leave (per year). The FMLA ensures the job security of parents/employees but does not protect employees who go on paid leave with their employers. Receiving the correct payment from being on leave is between the firm and the employee. [ 19 ]  However, some states have laws that do protect and guarantee employees for paid family leave (see State Legislation section). Additionally, the FMLA defines "parents" as biological, adoptive, step or foster parent who stood in loco parentis or "in the place of a parent". Parents do not include parents-in-law. [ 20 ]


This paragraph is for employees who are seeking to get paid using their firm's extended policies on leaves. If employees choose to go on maternity or family leave, The Employee's Guide to Family and Medical Leave Act [ 21 ]  states that they can sometimes use their unspent sick time, vacation time, personal time, etc., saved up with their employer at the same time of their FMLA leave so that they continue to get paid. In order to use such leave, "you must follow your employer's normal leave rules such as submitting a leave form or providing advance notice. Even if you don't want to use your paid leave, your employer can require you to use it during your FMLA leave". [ 22 ]


If employees choose to use the FMLA to go on regular unpaid leave without any extended or paid leave, the FMLA has several limiting stipulations and leaves out certain employee's conditions such as temp workers and trans employees, so only certain employees are eligible. In order to receive maternity leave protections under FMLA, employees must: [ 18 ]


The 12 months of employment are not required to be consecutive in order for the employee to qualify for FMLA leave. In general, only employment within seven years is counted unless the break in service is (1) due to an employee's fulfilment of military obligations, or (2) governed by a collective bargaining agreement or other written agreement.


The FMLA is the only law that federally protects American employees who go on maternity or family leave their resumed job security. It was signed into law during President Bill Clinton's first term in 1993 and revised on February 23, 2015 to include same-sex parents and spouses. [ 17 ]  Two other Federal laws, the Pregnancy Discrimination Act [ 24 ]  (PDA) and the Patient Protection and Affordable Care Act's (PPACA, also known as the Affordable Care Act, the ACA or Obamacare) [ 25 ]  amendment of the Fair Labor Standards Act, [ 26 ]  provide some additional protection for parents on the birth of a child. For instance, the PDA upholds maternity leave by arguing that employees who give temporarily disabled folks a disability leave should give pregnant women maternity leave with the same protections and benefits. This PDA is essentially arguing that pregnant women should have rights to the same paid or unpaid leave that temporarily disabled workers are afforded by their employers. If an employer offers this protection to temporarily disabled workers then PDA says that pregnant women should also be protected using the same processes and same benefits. Additionally, in 2014 the PPACA amendment to the Fair Labor Standards Act made it so that all insurance companies had to include maternity coverage in individual insurance plans. Therefore, filling the gap for unemployed women with individual insurance coverage plans to be able to afford the prenatal and postnatal pregnancy care that they need to have a healthy baby. Maternity care came to include: [ 25 ]


These federal laws and amendments have increased accessibility and quality of care for prenatal and postnatal mothers and families. For example, before the Affordable Care Act, only 12% of insurance plans sold in the individual market included maternity coverage. [ 25 ]  Also, according to a journal study on FMLA by researchers at the University of Maryland, [ 27 ]  it was found that mothers who benefitted from FMLA were returned to the same job and sooner than before FMLA thus showing the impact of job stability for mothers. Nonetheless, many employees are still ineligible for the FMLA. According to the Family and Medical Leave Report in 2012, only 59% of American employees were eligible under the FMLA. [ 28 ]  Additionally, employees who returned after FMLA, women exclusively, were given lower wages than the ones to when they left. This comes from the same study by researchers at the University of Maryland, as aforementioned. It should be said that these lower wages may have not been permanent since the study only went to highlight women's experience with maternity leave two years after they leave.


In recent polls from 2017, Democrats and Republicans both are in high support of federal funding for paid maternity and family leave. According to a study done by the Brookings Institution, [ 29 ]  a non-profit think tank in D.C., 71% of Republicans and 83% of Democrats support for a paid leave policy. Although the study did not reach a particular compromise on how the policies should work, who should pay for it, how much, and other concerns that might factor into creating a universal paid parental leave policy, it reached a conclusion. Among the diverse group of researchers with different political and economic views, everyone believed that it is worthwhile to consider a federal paid leave policy. One reason is that the "USis the only advanced country that provides no public support to new parents."


The US does not have a federal paid maternity and family leave act. Some states, however, include paid leave legislation for family members. States like California, New Jersey, and New York have pioneered paid leave legislature in their respective states. Reasons for paid leave might include higher job security for women and to reduce women's need for public assistance. A study by the Institute for Women's Research [ 30 ]  has also shown that paid leave could reduce employer costs and lead to US economic growth. Also, paid family leave has been shown to increase the health of the family by lowering infant mortality rates. [ 31 ]  Paid family leave would also allow low-income families the ability to take care of their family members without having to sacrifice time and money. Reasons for not having a protected paid family leave policy in place might be justified by the fact that there are limited economic resources to sustain a program. [ 32 ]  Additionally, some may disagree with the overreach of the government in taking on the responsibility to keep families afloat on leave. Compared to some other countries, the US remains behind in terms of maternity leave legislature. [ 33 ]


Many states have supplemented these federal regulations and provided more extensive maternity leave benefits, including expanding paid or flexible sick time, expanding access for workers in smaller companies or with less time on the job, right to pump that expands on federal law, and pregnancy accommodations. [ 34 ]


As of 2016, 12 states have enacted no additional laws or programs to support family leave before or after birth. [ 34 ]  Fourteen states, along with the District of Columbia, have addressed eligibility requirements by lowering the firm-size threshold from 50 or more employees down to as low as 10 employees. Seven other states, in addition to the District of Columbia, have adopted more generous maternity leave lengths that allow longer absences for the purpose of child-rearing. Moreover, some states have enacted legislation enhancing the benefits of leave programs.


California, New Jersey, and Rhode Island for instance, operate programs that require private-sector employers to pay their employees who utilize maternity leave at partial replacement rates. [ 35 ]  New York passed paid family leave legislation, which includes maternity leave, in 2016—starting off at 8 weeks and 50% of pay in 2018, and reaching 12 weeks and 67% of pay in 2021. [ 36 ]


Hawaii, Puerto Rico, and the District of Columbia designate childbirth as a temporary disability thus guaranteeing mothers paid maternity leave through  Disability Insurance  (TDI) provisions. [ 37 ]


On December 31, 2019, New Mexico Governor Michelle Lujan Grisham signed an executive order installing paid family leave for state employees, the first such policy in the state. The order, providing 12 weeks of paid family leave for state employees under the Governor's direct purview, became effective January 1, 2020. [ 38 ]


On January 1, 2022 Connecticut enacted the a policy allowing 16 weeks of parental leave per year should any unforeseen changes or issues arise during the birth. [ 39 ]


Currently, Oregon protects 12 weeks of leave for parents following a birth; However, it is unpaid time unless sick days or vacation days are used for it. The state has announced a reformed parental leave law set to be put in place in 2023. The new law promises paid leave following births as well as the ability to be granted an additional 12 week paid leave if there is a complication to the mother as a result of birth, or a complication with the child's health. This new law will be applied to all employers with 25 or more employees. [ 40 ]  Unlike most other state's programs for parental leave, Oregon includes protection for paid paternity leave as well as maternity leave in the new policy. [ 41 ]


As of 2022, California, Colorado, Connecticut, the District of Columbia, Hawaii, Massachusetts, New Jersey, New Mexico, New York, Oregon, Puerto Rico and Washington have all enacted laws requiring paid family and medical leave laws beyond just the basic federal laws. [ 42 ]


The presence of strong labor unions and Democratic control of state houses increases the likelihood that state legislatures support parental leave legislation. [ 43 ]


The Department of Defense has regulated the amount of maternity leave a military member can take. Before February 5, 2016 the leave was six weeks long for active duty members or reservists who had previously done twelve months of active duty time. [ 44 ] [ 45 ]  On January 28, 2016, the Defense Secretary, Ashton Carter, increased the paid maternity leave to twelve weeks for all branches. [ 45 ]  Traditional reservists, however, are given an eighty-four-day excusal, not leave. [ 46 ]


In the United States Air Force AFI36-3003, it is stated that the maternity leave starts after being released from the hospital from giving birth, as also defined for other branches. "Shared benefits" can be created if both parents are active Air Force members. [ 47 ]  Therefore, a sum of up to twelve weeks can be taken by one parent or distributed amongst the two parents. However, two married active-duty members cannot create "shared benefits" in the Army, according to the Army Directive 2016-09 (Maternity Leave Policy). [ 46 ]


There was a stance by the previous secretary of the navy,  Ray Mabus , to increase the maternity leave from six to eighteen weeks for the Navy and Marine Corps beginning on July 2, 2015. [ 48 ]  It was implemented until January 28, 2016, however, it remained eighteen weeks for those who were pregnant previous to and on March 3, 2016. [ 49 ]


It was a significant leap to go from six to twelve weeks of maternity leave. Other benefits have also been increased to improve the lives of those with newborn or newly adopted children. These benefits include an increase of child care hours to fourteen hours a day, and allowing active duty members more ability to family plan by paying for the sperm and egg freezing. [ 45 ]  These decisions were made by the previous Defense Secretary "in an effort to support military families, improve retention and strengthen the force of the future." [ 45 ]


On December 20, 2019, as part of the  National Defense Authorization Act (NDAA) for Fiscal Year 2020 , [ 50 ]  the Federal Employee Paid Leave Act (FEPLA) amended the  Family and Medical Leave Act (FMLA)  to grant federal government employees up to 12 weeks of paid time off for the birth, adoption or foster of a new child. [ 51 ]  The law applies to births or placements occurring on or after October 1, 2020. [ 52 ]


Since the start of President Biden's presidency, the issue of parental leave and improving benefits for parents and children has been a topic of interest for proposals of new legislation, most recently readdressed in his extensive budget plan for government spending in 2024. One theme for President Biden's budget plan is centered around parents and children in the United States, in which Biden proposed for a federally mandated, paid 12 week leave program for employees protected under the current Family and Medical Leave Act, as well as penalty free paid sick days off. [ 53 ]  In this $6.8 trillion budget package, $325 billion would be set aside to be able to fund for this paid time off in replacement of parents taking unpaid leave. [ 54 ]  This is in addition to other key plans for improving a parents ability to support their children through universal pre-k and making other childcare centers such as daycare cheaper, addressing issues debated around  childcare  affordability in the United States with rising costs placing a financial impact on working parents. [ 53 ] [ 55 ]  President Biden's heavy budget proposal for the fiscal year of 2024 has sparked uncertainty, however, about the ability to be passed through the government's split Congress and approval from the Republican House. Even before President Biden officially released his laid out budget, Republican members of Congress were expected to be quick to reject this plan. This is in regards to dealing with the government's debt and raising the  U.S. debt-ceiling ; Biden's budget would increase taxes by 25% for the wealthy and large companies in order to support these programs without federal borrowing, which Biden believes will boost the economy by improving social programs without delving into the government's spending pocket, while the Republican party believes that the government must instead entirely limit spending without taxation to deal with the debt. [ 56 ] [ 54 ]


This is not the first time President Biden or Congress has proposed creating a mandated paid leave program, as there have been many trials and tribulations to get proposed bills off the ground. President Biden reflected similar program goals from his 2024 fiscal budget plan in his 2021  Build Back Better  Plan. In President Biden's Build Back Better Plan, around $200 billion would be put into a paid leave program to allow for paid familial and sick leave for up to 4 weeks, which is revised from the original goal of the bill to have up to 12 weeks of paid leave. [ 57 ]  Nancy Pelosi and fellow Democratic Congress members were key to keeping the bill alive to pass through the House by cutting down the leave time, but drawbacks from the Senate, especially from Senator Joe Manchin, ultimately lead to hesitancies about winning the Senate vote and further discussion about a paid leave program from the Build Back Better plan had ceased. [ 58 ]  Prior to this, Congress members have also proposed paid leave programs such as the Family and Medical Insurance Leave Act throughout the years. [ 59 ]  This program would provide employees with 12 week paid leave, in which they would receive up to 66% of their paycheck. [ 59 ]  Contrasting to President Biden's proposals for paid leave that would fund the program through tax collections, the FAMILY Act would reflect the Social Security model and deduct $2 per week from earnings. [ 59 ]  Further progress for the passing of the FAMILY Act have been unfulfilled.


Longer maternity leave (up to 25 weeks) is associated with a reduction in post-neonatal and child mortality. [ 60 ] [ 15 ]  A 2017 study found that there was almost a 50% reduction in the probability of infant rehospitalization when women took maternity leave that was partially and fully paid. [ 15 ]  According to data from the 2006–2010 U.S. National Survey of Family Growth, paid maternity leave of 3 or more months for employed mothers is associated with a higher chance of the mother starting breastfeeding and breastfeeding her child at six months. [ 61 ]  The American Academy of Pediatrics (AAP) currently recommends six months of breastfeeding exclusively, and continued breastfeeding as foods are introduced for one year for its medical and neurodevelopmental benefits for the child. [ 62 ]  Mothers who are not engaged in employment may be more able to participate in consistent breast-feeding, since maternal employment can interfere with breastfeeding. [ 61 ]  The Center for Disease Control and Prevention states asthma, obesity, Sudden infant death syndrome, type 2 diabetes, gastrointestinal infections, and certain infections are all less likely to occur in breastfed babies. [ 63 ] [ 64 ]  Research suggests that breast-feeding has the ability to yield substantial child health improvements in disease prevention and immune system build-up. [ 65 ]  Moreover, further evidence indicates that maternal care is especially crucial during the first couple of months following child birth, or the time in which American maternity leave is in effect. [ 66 ]  Finally, evidence shows that paid maternity leave plans can increase paternal involvement in child care as shown by California's state paid maternity leave program. [ 67 ]


The medical definition of  postpartum  is the time frame between childbirth and the return of the gestational parent's reproductive organs to their non pregnant state. [ 68 ]  For people that return to work during this postpartum period, the stress of maintaining a balance between their professional and parenting responsibilities has been shown to weaken their immune systems and interact poorly with their psychological state. [ 69 ]  Lower rates of breastfeeding may also have negative effects on the parent's health, as breastfeeding lowers the possibility of breast cancer, ovarian cancer, type 2 diabetes, and heart disease for the parent. [ 63 ]  People of color and people classified as high economic hardship report postpartum symptoms more frequently and for a longer duration than people not in these categories. This trend is observed with both physical and mental health symptoms. [ 70 ]  Parental leave over a longer time period is associated with an increase in the health of both the mother and the child. Paid leave with a duration of over 12 weeks is correlated with a decrease in the risk of infant and parental re-hospitalization. [ 15 ]  According to a study on cisgender mothers of 6-month old infants using data from the National Institute of Child Health and Human Development, mothers who worked more hours experienced higher levels of depressive symptoms and stress due to parenting. They also viewed their personal health as worse when they worked more hours in the time period after childbirth. [ 71 ]  Parental l-infant separation may cause significant  parental stress , depression, and anxiety. Researchers propose paid leave relates to health as it allows women to recover from childbirth and take care of themselves, attend to their infant, visit the hospital for prenatal checkups, wellness, and illness, and manage finances. [ 72 ]


Among other factors, pregnancy can be a cause of depression in women. Postpartum depression usually develops within 4–6 weeks after birth, however delayed postpartum depression can also take up to 18 months to manifest for some women. [ 73 ]  Symptoms of postpartum depression include a loss of interest in activities, difficulty focusing, thinking, making decisions, and remembering things, anxiety, irritation, slowed speaking, physical pains, and feelings of sadness and worthlessness. [ 74 ]  In industrial societies, postpartum depression is considered a major public health concern and affects about 15% of women. Postpartum depression also has negative developmental consequences for the child. [ 75 ]  Research indicates 12 weeks may not be a long enough leave duration for those at risk of developing postpartum depression. [ 76 ]  As stated earlier, it can take up to 18 months to develop postpartum depression and it affects each individuals differently; the limited time frame maternity leave offers isn't substantial enough to address its potential health issues. [ 73 ]  Fewer occurrences of depressive symptoms are correlated to longer maternity leave. [ 69 ]  A study using data from the Early Childhood Longitudinal Study - Birth Cohort indicates there is a lower likelihood of women developing severe depression  and increased overall health if women take longer maternity leave from work. [ 77 ]  In addition, more depressive symptoms occurred in mothers postpartum when the spouse did not take any paternal leave. [ 77 ]  Poor physical health of the mother during the postpartum period is associated with more depressive symptoms, making postnatal health, in addition to employment, a prevalent factor when considering mental health in new mothers. Negative physical health symptoms frequently reported included tiredness, back pain, and back problems. [ 78 ]  Negative physical health symptoms frequently reported included tiredness, back pain, and back problems. Furthermore, postpartum death is a prevalent issue as half of pregnancy-related deaths take place after women give birth. [ 79 ]


These mental health issues have the biggest toll on women from low-income and marginalized communities. There is a sub-facet within the American Rescue Plan Act of 2021 that extends Medicaid care for postpartum related issues. [ 80 ]  This policy reveals how important it is for mothers and their infants to have access to care for maternal mental health. However, it is a separate policy from the FMLA and women will not have extended parental leave in order to focus on their mental health concerns. FMLA provides 12 weeks of unpaid leave, which only further negatively impacts women with low socioeconomic status seeking mental health care.


Five states currently offer paid family leave: California, Massachusetts, Georgia, New Jersey, and Rhode Island. [ 81 ]  In New Jersey, women who took paid leave in the year after giving birth were 40% less likely to receive public aid or food stamps. [ 82 ]  According to a California-based study, 87% of employers reported that the paid leave requirement did not increase costs; 9% note that it saved money due to decreased turnover and other costs. [ 83 ]


In the United States, $40 million is spent annually on the re-hospitalization of preterm infants. In addition, each maternal re-hospitalization adds an extra $1,600-3,000 to the cost of childbirth. Paid maternity leave is associated with increased maternal and neonatal health, so offering paid leave could decrease these costs. [ 15 ]


Though the overall labor force participation has declined since the year 2000, [ 84 ]  some economists argue that paid maternity leave in California has increased labor force participation among mothers. [ 85 ]  Mothers who receive paid maternity leave may be more likely to return to employment later, and then work more hours and earn higher wages. [ 85 ]  There is some evidence that the state paid maternity leave program in California saves businesses from needing to provide their own leave plans and financially stabilizes workers. [ 67 ]


Less favorable maternity leave policies may inhibit a woman's career trajectory and  promotion  prospects. The extended period of absence of such policies often reduces a women's economic status and opportunities. [ 86 ]  During this hiatus, their job skills and experiences may deteriorate thus limiting their potential advancement.