“You’ve got some guts starting your residency pregnant!” I was that intern.

It was June 2011. A few months earlier, on Match Day—the day when the National Residency Matching Program releases results to applicants seeking residency in a specialty of their choice in the U.S.—I had found out that I’d gotten into my first-choice hospital residency program in pediatrics. I started my residency four months pregnant, and one of my attendings was not going to let me forget it. It was not a wise decision to start my residency pregnant, she told me, especially with my husband residing thousands of miles away.

Amara showed up five days late and two days prior to Thanksgiving Day after what seemed like eternal labor. But nothing prepared me for the months that followed her birth, worsened by the fact that I had not accrued enough hours to qualify for Family Medical Leave of Absence (FMLA). Eventually, my residency coordinator was able to advocate for me, and I received a consolation prize of about five weeks of leave, but it was unpaid.

The United States is one of only seven countries that does not provide nationally mandated maternal leave. The other six are countries in the Pacific: Micronesia, the Marshall Islands, Nauru, Palau, Papua New Guinea, and Tonga. Across all the other countries, the average paid maternal leave is twenty-nine weeks or about seven months. Read that again. According to the World Population Review, leave policies range from twelve weeks in Mexico to thirty-six weeks in Japan, thirty-nine weeks in the United Kingdom, and up to eighty-five weeks in Estonia. In America, however, most women have no choice but to return to work a few weeks—and in many cases, days—after birthing a child.

Why does this matter? Research shows that when women have paid maternal leave, both the mother and infant are less likely to be re-hospitalized, and there are greater chances of positive maternal behaviors like stress management and exercise. When mothers are able to stay home with paid maternal leave, they are also more likely to breastfeed. Mothers who breastfeed have less incidence of postpartum depression and anxiety, and breastfeeding leads to improved cognitive development of the infant. This allows the child to reach their maximum potential in education and earnings, which leads to long-term economic growth. It gets better. There are direct benefits of paid maternity leave for the economy, with a huge return on investment.

Employees in organizations that offer paid leave have decreased stress and more loyalty, and they are less likely to be absent from work. A U.S. analysis showed that “organizations pay an average of $6.87 weekly per employee per worker for the leave policies, but on average gain $12.32 of value from increased productivity and reduced turnover per worker per week.”

The stakes are high. When our nation does not mandate paid leave, we risk not only adverse maternal and child outcomes but also familial and generational poverty and increased health burden and costs. In 2015, the U.S. Department of Labor issued a report titled “The Cost of Doing Nothing,” which estimated that if women aged 25 to 54 had participated in the workforce to the extent that other countries with paid leave policies do, it would have led to an additional $500 billion to our country’s economic activity. What we have instead is a patchwork of solutions in just a handful of states, only a few of which—California, Massachusetts, New York, New Jersey, Colorado, and DC—offer paid leave.

After Amara’s birth, I went on to have two more children: our second daughter in 2014 and our COVID baby, a boy. As with Amara, I only received a few weeks off with our second child. There was a remarkable difference when I received twelve weeks of partially paid leave for our third child. But even there, it was only partially paid, and I only received anything at all because I had accumulated some weeks from the parental leave that the hospital system offered as well as from my paid time off that I had intentionally saved.

The question of whether paid maternal leave should be funded by the government, the employer, or as an employee contribution is something that needs to be settled, and implementing these policies will still leave us with some unknowns at first. For instance, it is important to note that there are disparities in the effect of paid maternal leave on women in under-resourced communities as well as women who identify as Black. The reasons for this are unclear. In these communities, it appears that some women do not immediately take paid maternal leave because of fear of job loss, limited awareness, and inequitable access to information on the employee’s rights with regard to paid leave.

Where there are unknowns, we can learn from other industrialized countries that have successfully implemented paid leave policies. But what is not acceptable is turning our backs on this any longer. If you do not identify as a woman, you likely have a mother, a female co-worker, or a female family member. This affects you somehow. It is time that we act and protect the lives of our women and children.

Amaka Nnamani is a pediatrician.