(CNN) - Twenty-five years ago today, on February 5, 1993, President Bill Clinton signed the Family and Medical Leave Act. The first and only federal leave legislation in the United States, it guarantees nearly 60% of employees 12 weeks of job-protected unpaid leave to take care of a new baby, a sick relative or their own serious medical condition.
While happy with the new legislation, family leave advocates -- some of whom had spent the better part of a decade fighting for the policy -- didn't consider it an outright victory at the time. The law was better from nothing, yes, but also far from ideal.
It leaves out lots of men and women (it doesn't cover freelancers and those who work at companies with fewer than 50 employees, for example), it offers nothing in the way of income replacement, and the time period is too short, at least compared with more family-friendly countries such as France, the Netherlands and Spain, all of which offer 16 weeks at full wage replacement.
"We always knew that we needed to expand it," said Ellen Bravo, executive director of Family Values @ Work, a network of 27 state coalitions pushing for paid sick days and paid family leave.
Bravo and others advocates have continued the fight, making gains on the state level and encouraging businesses to expand their paid leave policies and offer them to more employees, including men and part-time workers.
They've also turned paid leave into a talking point used by politicians on both sides of the aisle, most recently heard as a pledge from President Donald Trump during last week's State of the Union address.
Even with all these successes, the federal policy has remained unchanged since Clinton signed it a quarter-century ago. The United States still holds the unenviable title of being the only industrialized country that does not offer all of its citizens paid family leave. According to the US Bureau of Labor Statistics, only 14% of civilian workers had access to paid leave in 2016, and that's only thanks to state laws or employer largess.
The current United States family leave policy harms women and men in all stages of life, in myriad ways. In particular, it holds long-lasting consequences for new mothers. Not receiving paid time off holds women back professionally and financially. Limited and unpaid leave also has a less quantifiable, but nevertheless damaging, effect on their mental health.
The fact that most mothers are either receiving no paid leave or not enough paid leave from their employers sends the message that they should be able to cope with what is, for many, impossible. They're forced to choose between professional concerns including job security, professional ambition and paying their bills and personal concerns including adequately recovering from childbirth and caring for -- and bonding with -- their new child.
These conditions can easily lead to a deluge of sorrow and self-doubt and negatively affect how a woman views herself and her life over the long run. Some women internalize the message implied by the US family leave policy and perceive themselves as deficient parents and/or deficient workers as a result. Others make compromises, forced to let go of their career and/or parenting plans because they can't afford it.
"It's a public health emergency that we don't offer more support for parents in this country," said Darby Saxbe, an assistant professor of psychology at the University of Southern California.
Work leave and mental health
Research has connected the dots between inadequate paid leave policies and higher incidences of clinically diagnosable anxiety and depression among women, both during the postpartum period as well as later in life. However, paid leave advocates and experts in maternal mental health believe that many more women experience psychological anguish as a result of these insufficient policies, even if it doesn't land them in a therapist's office or with a Prozac prescription.
"The transition to parenthood is a wild and woolly time. There are biological changes, including changes in hormones, and there's also evidence that the brain experiences some changes, which affect memory and cognition," Saxbe said. "Then there are the changes to self-concept and the reorganizing of your identity to incorporate the new child. And if this weren't enough, the everyday experience of caring for an infant is very demanding and requires a lot of self-regulation. It's taxing for your brain to deal with a completely helpless infant."
Although it's established that new parenthood is an exceptionally challenging time psychologically and physiologically, Saxbe said the experience of being a new parent has been largely understudied.
There has been plenty of research on early parenthood, but it tends to focus on the well-being of the infant. Through that lens, moms are seen only as a means to an end. Academics like herself are now trying to change this paradigm, a movement aided by the presence of more women in charge of issuing research grants.
Lauren Smith Brody, founder and author of "The Fifth Trimester," a book and a consulting agency aimed at bolstering parents in the workplace, said new moms often internalize the pressure to be up and running before they are ready, without realizing it.
"I liken it to how when we first started hearing about eating disorders, and it seemed like you either had one or you didn't. But then people became aware of disordered eating and the fact that just because you weren't in a doctor's office and being treated for it doesn't mean you weren't being damaged by a culture that celebrates being super skinny," Smith Brody explained. "The relationship is the same here. You might not have the diagnosable postpartum anxiety, but you still might be suffering, and if that's acknowledged, it can make you feel less crazy."
For her book, Smith Brody took a survey of more than 700 new moms who worked outside the home and asked them when they felt emotionally back to normal after childbirth. The average answer was 5.8 months, which dovetails with research concluding that six months is the minimum amount of paid leave necessary to protect a mom's mental and physical health.
Having an involved father around for part of this can further protect moms and lead to more equitable parenting arrangements in the long run. Unfortunately, the vast majority of American women have to make do with far less.
'How am I going to move forward?'
Melissa Marion Henriquez, a 38-year-old mother of two in Kalamazoo, Michigan, received no paid leave from her employer with either of her children. She cobbled together short leaves by combining short-term disability payments and vacation time but ultimately took only 12 weeks off with each child, eight weeks of which were partially paid.
"Leaving them at day care that early was traumatic. The day care center had a webcam, and that's how I made it through the workday," Marion Henriquez said. "It was extremely painful. I never had postpartum depression, but I definitely had moments when I said, 'I can't do this.' ... I felt like I was being a bad mom and a bad employee, especially in the first months after their birth, when I had a total lack of confidence. It took two years with each kid before I thought, 'I can handle it.' "
Angela Mavers, a 34-year-old mother of two in Denver -- like many women who spoke for this story -- said that not having access to paid leave has forced her to make career decisions she wouldn't have otherwise made and caused her much anguish. In her case, she put off a career in interior design in order stick with less-satisfying jobs that guaranteed her the income to cover the cost of unpaid leave and day care for her babies.
"I went to school and had big dreams, and those haven't stopped, but I've stopped pursuing those things because of my children and what that entails. It keeps me up at night," Mavers said. "How am I going to move forward in my life?"
For women with pregnancy complications, the long-term effects of not getting paid leave can be dire. Erica Clemmons, a mother of one in Atlanta, has given birth prematurely three times. With the first two, her children died shortly after delivery, and she went back to work a week and a half later. When she got pregnant again a few years later and had another preterm birth, she didn't have much hope.
"(My daughter) went to NICU, and I went on to my room. They told me her lungs collapsed, and I just thought, 'forget it, this baby is going to die,' " Clemmons said. Two weeks later and in need of a paycheck, she was back at work during the day and making visits to her daughter in the evening. The girl survived, but Clemmons struggled to connect with her.
"I was not given the opportunity to bond with my baby, like a mother is supposed to get -- just being able to hold that baby every day and be with that child," she said. "I went through years worrying that child was going to die, because of what happened with the other babies. My daughter has spent a lot of time with my mom, because I was in the mindset that I have to work and make money for my baby. That that was what I was supposed to go and do."
It was only after Clemmons began working in the labor movement and paying attention to paid leave policy that it dawned on her how much emotional damage she experienced by not being able to take time off from work after the birth of her children.
"If I had paid leave with the first and especially the second one, I would have had time to grieve and come to grips with what happened and why it happened. I covered all those feelings and suppressed them so I could go back to work ... and it created a distance in my heart that I am trying to close. If I had time to grieve for my children, it would have been a completely different outcome with (my daughter)," Clemmons said.
"Now, I am trying to be around (my daughter) more, and I am struggling with it. I feel bad as a mother."
Clemmons, now fully aware of the effect paid leave can have on our personal lives and self-perception, advocates for better policies through her work as the state director of the Georgia chapter of 9 to 5, which fights for economic justice for working women.
If she and the many others fighting for just paid leave policies are successful, it will be an end to the ubiquitous and ruinous assumption, implied by our policies, that early parenthood is a period of life that is easy to navigate and should not require special accommodations.
The majority of women around the world live in countries that acknowledge the attendant challenges of this time and provide parents with some support. It's about time American women get to join them.