The COVID-19 pandemic has increased the need for paid leave and resurfaced the difficulties workers face trying to balance work and care. Nearly every worker will need time off from work for family or health reasons, but the US stands out among wealthy nations in its lack of universal access to paid family and medical leave.

This brief uses nationally representative data from the December 2021 round of the Urban Institute’s Well-Being and Basic Needs Survey to examine patterns in access to paid family and medical leave among workers ages 18 to 64. We find significant disparities in paid leave access and greater levels of material hardship among workers without paid leave:

• In December 2021, about 67 percent of workers who were not self-employed reported they could take paid leave for their own illness, while 54 percent could take paid family leave for the birth or adoption of a child or to care for an ill family member. Approximately 30 percent reported not having or not knowing if they had access to any form of paid leave.

• Access to paid leave is highly skewed toward adults with higher incomes, with college degrees, and who work full time.

• Hispanic/Latinx and Black workers are less likely to have access to paid leave than white workers (58 percent, 67 percent, and 72 percent, respectively).

• Access to paid leave for the birth or adoption of a new child is limited and poorly targeted, with women ages 18 to 34 reporting the lowest rates of access (45 percent).

• Many workers who reported access to paid leave were limited to two weeks of leave or less, suggesting they may be relying on paid sick leave for their care needs and do not have access to comprehensive paid family and medical leave lasting several weeks or months.

• Workers without access to paid leave are more likely than workers with paid leave to be uninsured and have difficulty paying for an emergency expense or basic needs, such as food, housing, and health care.

These gaps in access leave many working adults with the fewest resources at risk of losing wages or their job when they confront a health crisis, have a baby, or care for a seriously ill family member. As federal and state policymakers consider new paid family and medical leave programs, options to reduce disparities include broadening worker coverage and eligibility, progressive wage replacement, job protections, and stronger worker outreach and education efforts.