Last year, as Hillary Clinton awaited the birth of her first granddaughter, Charlotte, a nurse at New York City’s Lenox Hill Hospital thanked her for promoting paid family leave.

“She sees first-hand what it means for herself and her colleagues and the working parents she takes care of,” Clinton said, recalling the encounter Monday in her first major economic speech this election cycle.

The memory illustrated what has thus far been a central message of Clinton’s campaign: So-called “women’s issues” are economic issues, and they intensify for millions of workers after those life-shaking trips to the maternity ward.

In her sprawling speech, which touched on Wall Street and Internet competition and the sharing economy, Clinton dedicated more than 1,000 words to burdens disproportionately carried by women -- a rarity in the context of policy addresses from front-running presidential candidates.

She called fair pay, flexible scheduling, paid family leave and earned sick days “essential to our competitiveness and growth.”

She told the stories of a single mother balancing full-time work and community college, highlighting the need for affordable childcare, and a grandmother who watches children for a living but can barely afford to fill her prescriptions, highlighting the weak financial rewards for providing it.

And she mentioned the disparity that makes all this even tougher for female workers nationwide: American women, on average, make 78 cents for every dollar earned by men. Women of color, Clinton added, make even less. The number, compared to white men’s earnings, dwindles to 64 cents for black women, the National Women’s Law Center reports, and 56 cents for Hispanic women.

“Another key ingredient of strong growth that often goes overlooked and undervalued: Breaking down barriers so more Americans can participate more fully in the workforce, especially women,” she said. “We are in a global competition and we can’t afford to leave talent on the sidelines.”

Over the last four decades, the number of female breadwinners in the U.S. has more than tripled. This trend generated $3.5 trillion of economic growth, Clinton said -- but progress is stalling.

Full-time employment increased from 28.6 percent of all women in 1979 to 43.6 percent in 2007 before declining to 40.7 percent in 2012, according to the the Center for American Progress.

The reasons are complicated, and research suggests no one policy fix can vanquish social deterrents like, say, the well-documented unconscious biases that seep into hiring and promotion decisions.

An estimated 43 million American workers have no access to paid leave. They’re mostly low-wage workers, already strained when recovering after the birth of a child, for example, or tending to a sick kid. Top earners, on the other hand, tend to receive the benefits through employers, according to a recent survey by the Bureau of Labor Statistics.

The problem compounds for single mothers who lack the benefits. Some economists argue closing the wage gap would lift nearly half out of poverty, according to a report from the Institute for Women’s Policy Research.

“All this lost money adds up,” Clinton said Monday, “and for some women, it’s thousands of dollars every year.”

Advocates say Clinton’s policy prescriptions for gender equality could be a good start for leveling the professional playing field, so long as government mandates don’t make matters worse for working women.

The results are mixed when it comes to paid leave, in particular. The three states that so far offer some form of it -- California, New Jersey and Rhode Island -- are already recording increased wages for mothers of young children.

But evidence from abroad warns about possible, unintended consequences of sweeping reforms. After Chile, for example, required large employers to cover daycare costs, women, whether or not they had children, started seeing lower starting pay.