By Diane Harris

This report explores the difficult choices Southern workers often face when serious illness, caregiving, childbirth, or family loss occur. Based on interviews with 10 workers, Inaccessible and Costly finds that limited access to paid family and medical leave means too many workers fear retaliation, return to work too soon, lose wages, fall into debt, or are pushed out of jobs altogether.

The report argues that these harms deepen poverty and inequity, especially for women of color, and calls for worker-centered paid leave policies that include job protection, anti-retaliation measures, strong wage replacement, inclusive family definitions as well as paid sick days, and bereavement leave.

Since the report was originally published, Southern states have made important progress on paid family and medical leave. In March 2026, Virginia’s General Assembly passed a comprehensive paid family and medical leave policy, and Tennessee’s legislature expanded the state’s public-sector paid parental leave policy.

In July 2026, Inaccessible and Costly was updated to reflect these historic developments, including measures taken in Virginia following the passage of the state’s paid family and medical leave law earlier this year.