Population Health

May 18, 2023

Pilot project explores equitable access to state’s paid family leave policy for AIAN families

Adult hand squeezing the finger of an infantThe 2023 Washington State Maternal Mortality Review Panel report found that American Indian and Alaska Native (AIAN) people experienced higher maternal mortality rates than any other race or ethnic group in Washington State, with the rate of pregnancy-associated death among non-Hispanic AIAN people was 8.5 times greater than non-Hispanic white people. To better target these disparities, Tess Abrahamson-Richards, a Ph.D. student at the UW School of Social Work and a parent and tribal citizen of the Spokane tribe, is researching birth equity and equitable access to Paid Family Medical Leave (PFML) for AIAN families in Washington.

A paid family leave policy does not exist at the national level, and only 11 states offer their own legislation. WA PFML is Washington State’s Paid Family and Medical Leave and was first introduced in January 2020. WA PFML serves as a resource for one’s own health conditions, which includes caring for a loved one by spending time with a family member on military deployment, or welcoming a new child through birth, adoption, or foster care.

One only has to work in Washington state and meet the 820-hour qualifying requirements to qualify for the program. “[Since WA PFML is] available to all workers who meet those requirements, it has a big potential to address gaps,” said Abrahamson-Richards.

Abrahamson Richards and her research team were awarded a Population Health Initiative Tier 1 Pilot Research Grant in spring quarter 2022 to more deeply explore the potential impact of PFML access for AIAN families. According to the team’s research to date, there is a large gap between earnings for AIAN families and others. The income for many AIAN families is much lower than other groups and this leaves families particularly vulnerable after the birth of a child. Abrahamson-Richards explained, “Many families, mothers especially, have a pretty high level of financial strain and a pretty low level of earnings during that time that they’re trying to survive off of.”

Abrahamson-Richards and her team are specifically looking at birth and bonding leave for families welcoming a new child. Paid family leave has the potential to have a big impact on AIAN families, especially when comparing earnings for AIAN families with White American families. Abrahamson-Richards shared, “…I’m really interested in equitable implementation because a big concern is that the people who will know about it, who will be able to have the resources that they need and the support they need to navigate the application system, people who will feel safe and supported by their employers to use the leave – all those things might correlate with existing privileges and not be as available to more marginalized workers.”

Tribes are sovereign nations so they are one of the only employer types in WA that are not required to opt-in to WA PFML. Due to this option, Abrahamson-Richards and her team first started their research by asking what opt-in looks like for tribes and why. They found that none of Washington’s 29 federally recognized tribes have opted into PFML. “A large number of people who are employed by tribes, primarily Native people, don’t have access to this benefit. The level of paid family leave benefits offered by Tribal employers is different from one Tribal nation to another and is often less than the state PFML program,” explained Abrahamson-Richards.

The Tribes are taking a wait-and-see approach, and state engagement of the Tribes on PFML has been limited. “Washington PFML may or may not be the right option for a Tribe, but our work seeks to put families’ needs and priorities at the center of that discussion, encourage the state to meaningfully consult Tribes, and provide additional data for Tribal leaders to consider as they engage in health policymaking decisions,” said Abrahamson-Richards.

Abrahamson-Richards met with key AIAN maternal and child health partners to investigate what Native community organizations are interested in learning about families’ paid leave access. The team met with groups such as the Native American Women’s Dialogue on Infant Mortality, the American Indian Maternal Health Commission’s Maternal Infant Health Workgroup, and the Urban Indian Health Institute. “Everybody was very enthusiastic about the importance of knowing (about WA PFML). But it was a ‘yes, and…’” said Abrahamson-Richards.

Through their dialogue, the team found that these organizations were seeking answers to more than just paid family leave, “The ways that community partners were talking about what they were interested in knowing… was a lot more broad, about birth justice issues in our community. And so it took a lot of time and thought on my part and in conversation with others, to understand what that meant for shaping the next phase of a research project.” explained Abrahamson-Richards.

In response to those meetings with key AIAN maternal and child health partners, Abrahamson-Richards and her team began to look into background data and prepare for the next quantitative phase of looking at PFML. Yet, they also decided to, as Abrahamson-Richards said, “Consider larger research questions around family’s experiences with paid leave overall, and their connections to colonial historical harms and community strengths, and Indigenous birth justice as a whole.”

The research team has finished meetings and put together findings from other qualitative data collection, and are now working with community partners to share the results from this phase. They want to expand their aim to look more broadly at perinatal health and well-being, and their underlying factors through an Indigenous lens.

Going forward, Abrahamson-Richards plans to continue to work alongside AIAN families and organizations as they improve paid family leave implementation. “[We will] continue to think about how to use available data ethically, and meaningfully for our communities and leverage administrative data for health equity,” concluded Abrahamson-Richards.