Rural New Mexicans Need Paid Leave to Navigate Long Distances to Health Care Services

New Mexico's lawmakers will soon consider legislation creating a statewide paid family and medical leave program. The legislature's deliberations will follow up on thoughtful analysis by a 2022 paid family and medical leave task force composed of researchers, advocacy organizations, labor unions, and business leaders.

As policymakers' discussions and decision-making get underway, policymakers should note new data showing that rural people in New Mexico – who make up about one-third of the state's population – have a particular need for paid family and medical leave.

A state paid leave program would build on recent policy advances in New Mexico aimed at reducing health and economic disparities and supporting healthy families. Last November, voters approved a ballot measure guaranteeing the state's residents a constitutional right to early childhood education; New Mexico is the first state in the country to take this historic step.

New Mexico also recently joined more than a dozen states and two dozen cities in guaranteeing workers the right to earn paid sick days; New Mexico is only one of two largely rural states with a paid sick time requirement.

Paid family and medical leave – which covers longer periods of time away from work for serious personal health and family caregiving needs, including for parents caring for newborn, newly adopted or newly placed foster children – complements both child care and paid sick days in promoting workers' and families' health and economic stability, reducing health and economic disparities, advancing gender and racial equity, and building a more robust and productive workforce. Businesses benefit from both of these interventions as well.

Access to Paid Leave

In New Mexico, job-protected unpaid leave is available and accessible to only 34 percent of workers, according to researchers from Brandeis University. And without paid family leave through their jobs, which just 21 percent of people in the Mountain West have according to the U.S. Bureau of Labor Statistics, parents must leave newborns and newly adopted children too soon, and family members must struggle to find or provide care for loved ones. Paid medical leave is also rare, which means that many seriously ill or injured workers must return to work too soon after a serious health issue if they’re able to take workplace leave at all, or might leave their jobs altogether.

Rural workers have even less access to both employer-provided paid family leave and paid sick leave than workers in metropolitan areas because the types of jobs that are most prevalent in rural communities are less likely than others to offer paid leave benefits. Rural New Mexico's largest and fastest-growing industries, including farming, construction, accommodation and food services, and transportation and warehousing, are industries in which workers are unlikely to have paid family leave.

Rural workers also have reduced access to job-protected unpaid leave through the Family and Medical Leave Act of 1993 (FMLA) because they tend to work for smaller employers and are more likely to work part-time.

Lack of access to paid leave can force impossible choices between keeping a job, feeding a family, and getting or helping a loved one to get the health care they need. New Mexico's high poverty rate means even greater hardships for many workers and families when a family or medical need arises.

Distances to Hospital-Based Health Care Services

In late 2022, the Better Life Lab at New America released a report, Health, Work, and Care in Rural America, tying together new analyses of rural disparities in access to paid leave and new calculations demonstrating the long and disparate distances that rural people must travel to seek specific types of hospital-based health care services. We found that people in rural communities across the United States must travel an average of three to five times as far as people in urban areas to receive hospital-based care. [1]

New state data analysis augments our national findings: People in rural New Mexico must travel three to four times further, on average, for every type of hospital-based health service we examined than people in urban areas of the state. The distance disparities are greatest for parents and caregivers of babies in the NICU or receiving other neonatal care: Rural NICU services are an average of 113 miles from rural census tracts but only 28 miles from urban areas. Hospital-based pediatrics care is 56 miles from rural census tracts, but just 17 miles from urban ones. Cancer treatment is also an average of more than 50 miles away from rural areas in New Mexico, compared to 18 miles from urban areas.

New Mexico's Native Americans and people in areas of persistent poverty – who, nationally, are also less likely to have paid leave – tend to live in rural communities that are even further from hospital-based care than New Mexico's rural communities overall.

New Mexicans who live in rural census tracts with high concentrations of people in persistent poverty face average distances to care in excess of 40 miles for obstetrics care and cancer screening, 60 miles for pediatric care and cancer treatment, and they are nearly 115 miles, on average, from the nearest NICU. Rural New Mexico census tracts where Native Americans are concentrated are also more than 40 miles from obstetrics care and cancer screening, 65 to 76 miles from pediatric care, cancer treatment and cardiac care, and a stunning 118 miles, on average, from the nearest NICU. [2]

Implications: Comprehensive Paid Leave Will Strengthen Rural New Mexico

A growing body of research shows that paid leave contributes to improved health outcomes as well as workforce retention for new parents and caregivers; higher earnings for mothers; positive impacts for businesses; and, as a result, improves the potential for economic growth.

New Mexico's paid leave proposal should include program elements similar to many of the programs in 11 other states and the District of Columbia. Rural workers would benefit most from high levels of wage replacement for lower income people, family caregiving coverage that includes an extended set of loved ones, and job protection for all workers using paid family and medical leave.

Hannah Friedman, a doctoral candidate in the Department of Health Policy and Management at the Gillings School of Global Public Health and The Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, provided the New Mexico hospital-distance data analysis used in this blog.

[1] Distances to hospital-based health care services are measured from the middle of each census tract. Census tracts are classified as rural or metropolitan using RUCA codes. Data on hospital services is from the American Hospital Association Survey. Files used for mapping are from the National Historical Geographic Information System. For more information on our methodology, please see descriptions in Health, Work, and Care in Rural America.

[2] Census tracts in this subgroup analysis are those that fall into the top 10 percent of census tracts nationwide with concentrations of Native American/Pacific Islanders and the top 10 percent of census tracts nationwide for people in persistent poverty (which is defined as 20 percent or higher poverty rate in each of four decennial censuses). For more information, please see the methodology in Health, Work, and Care in Rural America.