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Shaylene Costa is a medical assistant who lives in Rhode Island. Dominique Jett is a health-care supervisor in Las Vegas.

Both are Black women, married and employed full time in the health-care industry. Each was thrilled when they found out they were expecting their first child. Both experienced difficult pregnancies and complications at birth.

But once they delivered, their paths diverged: One had paid family and medical leave and one didn’t.

Costa lives in one of eight states (plus the District of Columbia) that guarantee paid family and medical leave to eligible workers. Jett, in Nevada, doesn’t.

The maternal mortality rate for Black women in the United States is higher than in any other developed country and more than twice that of White women. The mortality rate for Black infants in America is an alarming three times as high compared with that of White infants. The highest risks for women occur between seven and 42 days — the time many new mothers, particularly Black women, head back to work because they don’t have access to leave and can’t afford to stay home any longer.

Throughout her first pregnancy in 2010, Costa, who now has two children, said she took comfort knowing that she was eligible for Rhode Island’s public paid leave policy and had a supportive workplace. In Rhode Island, eligible workers can receive partially paid temporary disability and four weeks of paid caregiver insurance for up to 30 weeks. Costa took eight weeks of paid leave to stay home after giving birth to recover, bond, arrange child care, establish a breastfeeding routine without interruption and prepare to return to work.

“My employer allowed me to decide how long to stay home and to return part time for as long as I needed,” she says.

When Jett was pregnant in 2011, her experience was very different.

The United States is the only advanced economy that has no national paid maternity leave policy, so Jett had to rely on a private employer to voluntarily offer it. (Nineteen percent of U.S. workers have access to paid family leave through their employers, with high-income workers more than four times as likely to have access to it than lower-income workers.)

Jett’s baby had jaundice and was born with an open-heart valve — a birth defect that can put strain on the heart and sometimes lead to surgery. Then he developed an infection that required intravenous antibiotics. He spent a week in the neonatal intensive care unit.

Jett struggled with bonding because she wasn’t allowed to hold or breastfeed her baby while he was in the NICU. She needed to heal physically and emotionally but didn’t have the time — something she was constantly stressed about throughout her pregnancy. The two weeks of annual paid time off offered by her company was mostly gone by her due date because she had to use it for doctor’s appointments and other issues while she was pregnant.

The security of Jett’s job was in question as well. She’d been with her employer for only 10 months, two months shy of qualifying for the federal unpaid family medical leave, which would have protected her job for up to 12 weeks. Instead, Jett and her employer established a verbal agreement to hold her position for six weeks. Jett spent five weeks at home with her newborn.

“Being forced back to work before I was ready really added to postpartum depression,” said Jett. “I suffered really bad anxiety and paranoia about someone taking my baby.”

Once she did return to work, she still needed time off to take her son to doctor’s appointments. “I definitely felt slighted,” she said. “I was young and a new mom. My emotions were everywhere. I remember being so on edge just trying to make sure I was doing the right thing and caring for him properly.”

Costa and Jett illustrate why, particularly for Black mothers, researchers and advocates say paid family and medical leave is a critical lifeline. “The portion of Black maternal health issues that are attributable to inability to take time away from work to get prenatal care, postnatal care or insufficient leave after the birth of a child would be addressed by guaranteed access to paid leave,” said Vicki Shabo, a senior fellow for paid leave policy and strategy at the Better Life Lab at New America.

And while Costa did have access to paid leave, experts say it is still far less than what would be considered ideal for maternal and infant health. A report from New America says that “psychological distress was significantly less likely among mothers who took more than 13 weeks of paid leave,” further noting that job-protected paid leave of 40 weeks shows the greatest decrease to infant mortality.

Black parents are less likely to have access to paid parental leave compared with White parents — 40.8 percent of Black parents compared with 47.4 percent of White parents and 23.2 percent of Latino parents. Evidence suggests that when parental leave is paid, Black women take more time off, which leads to financial, mental and physical benefits.

Receiving less than 12 weeks of parental leave increases the likelihood a mother will face symptoms of postpartum depression, according to Sinsi Hernández-Cancio, the vice president for health justice at the National Partnership for Women & Families, a national organization advocating for work-family policy.

“This could be because mothers are juggling employment alongside important physical and emotional changes during this period,” she says.

Going back to work too early is tied to lower breastfeeding rates, too.

The Centers for Disease Control and Prevention reports a disparity of 17 percent in breastfeeding rates between Black and White infants. A primary barrier to breastfeeding for Black women, especially those with lower-income jobs, is a motivation to return to work earlier than women in other racial groups out of economic necessity and not having access to resources.

Research shows that a public paid leave policy can help level the playing field. Before California’s statewide paid leave program was implemented in 2002, Black women took an estimated one week of maternity leave. White women averaged four weeks. After the paid leave policy passed, Black and White mothers both took an average of seven weeks of paid leave. Black women are also more likely to face inflexible work hours and have fewer accommodations for pumping, so having time after birth to establish breastfeeding routines can be critical if the mother wants to pursue breastfeeding.

While on paid leave, Costa said she returned to the hospital several times for breastfeeding support, something that would have been difficult to do if she had immediately returned to work. Jett’s experience with breastfeeding was the opposite. “I nursed for a short time” she said, “but not once I went back to work.”

Costa required additional follow-up and treatment in the weeks after she gave birth because she developed postpartum preeclampsia. Having paid leave meant she had the time to get to the doctor for treatment and care.

She isn’t alone. Black women are at a higher risk for developing life-threatening conditions such as postpartum hemorrhage or preeclampsia, which affects Black women at a rate of 60 percent higher than White women. This can cause seizures, damage to organs and death if not treated right away.

“The health complications of pregnancy don’t just come to an abrupt end after childbirth. While most women are out of the danger zone after the first 42 days, or 6 weeks, they are not in the clear for at least the first year,” said Hernández-Cancio.

Costa required weeks to recover from her postpartum preeclampsia. “I was frustrated that I had to be restricted in mobility and diet after just having had a baby,” she said. But with two months of paid leave, she had the time she needed to heal before returning to work.

Costa is grateful she had the time to establish a breastfeeding routine with both of her children, which has contributed to her becoming a fierce advocate for all women to have access to breastfeeding support. Today, she works as a doula and sits on the board of directors for the Rhode Island Breastfeeding Coalition — a nonprofit that works with hospitals and agencies to improve breastfeeding outcomes. “These programs are especially important for Black women because we have some of the highest mortality rates and the lowest breastfeeding rates,” she says.

A decade after the birth of her first child, Jett realizes that what she most needed and wanted to manage the transition to new motherhood was time. Time to cry, bond and heal. Returning to work so soon, she said, took a toll on her mental health, and she felt robbed of crucial time with her son. But she says it gave her the motivation to finish her education and get a new job with better pay and better benefits. She now works as a supervisor in health-care administration, but she still feels time is never on her side. Between working from home, home-schooling her son during the pandemic and taking care of her family, there’s little time for herself, including taking care of her own health.

“No one cuts Black mothers any slack. We’re supposed to be everything in one without breaking a sweat, Jett said. “It can be exhausting.”

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