The Full Family Journey, From Fertility to Postpartum.

The United States has no federal paid family leave. The Family and Medical Leave Act of 1993 guarantees 12 weeks of unpaid leave — but only for workers at companies with 50 or more employees, and only if they can afford to go without a paycheck. For most American families, that is not leave. It is a legal fiction.

Family Forward advocates for a federally guaranteed, state-administered paid leave insurance program — funded through shared employer and employee payroll contributions, modeled on Virginia's landmark 2026 law. Our near-term standard: 12 weeks of paid leave for birthing and primary parents, 6 weeks for non-birthing partners and fathers, at 80–90% wage replacement. For lower-income families, we advocate for 90% replacement to make leave genuinely usable — not just technically available.

Non-transferable partner leave is a critical design feature. In countries where fathers must use their leave or lose it, uptake rises dramatically — and the long-term wage gap for mothers narrows. Policy design is not a detail. It determines outcomes.

American families now spend up to $36,000 a year on childcare for a single child. That's not a budget line — it's a barrier. Research from the U.S. Department of Labor shows that a 10% rise in median childcare prices leads to a measurable drop in maternal employment, with the highest-cost counties seeing maternal employment fall by 4 percentage points. Parents — disproportionately mothers — aren't leaving the workforce because they want to. They're leaving because we've built a system that makes staying impossible.

Among mothers under 30, 69% say they won't have another child. In 2019, that number was 35%. One in three cite the combination of needing to work and being unable to afford care. Only 3% of American companies currently offer any childcare subsidy. That number isn't a market outcome — it's a policy failure that mandates can fix, and that leading employers like Cakes Body (covering up to $3,000/month per employee from day one, with a team of 30) are already choosing to solve.

Family Forward advocates for federal childcare mandates paired with proximity care requirements. Subsidy alone isn't enough — proximity to one's child supports breastfeeding, secure attachment, and the daily rhythms that keep families intact.

A tax deduction reduces taxable income — which means it only helps if you have enough taxable income to offset. The families paying 20%, 30%, even 40% of what they earn for care are precisely the families a deduction fails. That's not a design flaw. That's a design choice. And it's one we can undo.

Childcare now consumes roughly one-fifth of household income for the average American family. In high-cost markets, a single infant in full-time center care exceeds $19,000 per year. When both parents work — and for single parents, always — childcare isn't a discretionary expense. It's the precondition for employment. A tax structure that treats it otherwise is an active barrier, dressed up as policy.

Family Forward advocates for fully refundable federal childcare tax credits that reach every family at every income level, scaled per child, with no income floor — paired with employer incentives, transparency requirements, and federal investment in the childcare workforce itself.

1 in 6 couples experience infertility. A single IVF cycle costs between $15,000 and $30,000. Only 21 states require any insurance coverage for fertility treatments. For most American families, the decision to pursue fertility treatment is not a medical decision — it is a financial one.

A tax deduction does not help a family who cannot afford the cost upfront. Family Forward advocates for a federal insurance mandate covering the full fertility journey — IVF, egg freezing, assisted reproduction, and surrogacy-related costs — with no marriage requirement and no income ceiling.

We also advocate for dedicated coverage for pregnancy and fertility loss — miscarriage, stillbirth, and failed cycles — including paid grief leave and mental health support. These losses are medical events. They deserve to be treated as such.

The current U.S. standard for postpartum care is a single clinical visit at 6 weeks after birth. In the weeks between hospital discharge and that appointment — when postpartum complications peak, when breastfeeding challenges are most acute, when postpartum depression most often goes undetected — mothers in America receive no professional contact whatsoever.

Every other high-income country in the world provides universal at-home postnatal visits. The Netherlands sends a midwife for 3–4 visits of up to 8 hours each in the first week. Japan provides 16 weeks of universal postpartum care, with up to a year of support for complex cases. France provides between 1–4 fully covered home visits based on need. The United States provides none of these as a standard.

1 in 5 mothers experience postpartum mood disorders. The majority go untreated — not by choice, but because treatment is inaccessible, unaffordable, or buried behind prior authorization requirements. Family Forward advocates for comprehensive postpartum coverage with no barriers and universal screening at three points: 2 weeks, 6 weeks, and 6 months postpartum.