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Paid sick leave helps workers recover from illness and manage care obligations and protects public health. Yet access to paid sick leave remains limited and unequal in the United States. Drawing on surveys of 61,223 service-sector workers collected during the period 2017–21 by the Shift Project, we documented limited access to paid sick leave and stark gender inequality, with women less likely than men to have paid sick leave. Part-time employment and gender segregation by industry subsector each explain part, but not all, of the gender disparity. However, in states and localities that mandate paid sick leave for workers, workers are far more likely to report access to this benefit, and the gender gap is eliminated. Guaranteeing paid sick leave to all workers would offer a range of benefits for workers, employers, and public health while also offering the further benefit of reducing gender inequality.