The stress of child care precarity may affect our health for years
The stress of child care precarity may affect our health for years
Our brains do not like instability, insecurity, unreliability, or uncertainty -- all characteristics of the current American child care system.
Precarity – a state of uncertainty; a feeling that things could get worse; the idea that something in your life could be humming along one day and then the next day… poof… gone.
The unpredictability. The lack of control.
Precarity has those hallmarks of classic psychological stressors – evaluated by our brain the same way a quietly stalking, hungry lion might – triggering the same physical stress response. Modern-day-lions pile up and cause modern-day-human health consequences.
The impact of child care precarity fascinates me for this reason. How the brain perceives the concept that how your children are cared for and by whom can one day be… poof… gone.
The unpredictability. The lack of control. The body’s reaction to that stress.
I have already written about the stress of child care issues and why childcare = healthcare here and here but I wanted to do a deeper exploration on this one specific area of research for a couple of reasons.
One, I think this dive tees up a really fascinating conversation that I had with Siran Cao, CEO and co-founder of Mirza (more on that below and in the next newsletter!) Two, there are so little data1 directly linking potentially stress-related health outcomes with maternal stressors that this one just jumps out as a very cool example.
Now, I must caveat this to say the research is in early days with only a handful of studies (or maybe it's only two?) and I know, I know, I have a tendency to say “we can’t depend on only a single study…” but forgive me on this one. It’s still interesting and I hope these early studies open up more interest (and funding!) to build on the findings with a continued focus on maternal and parental health2.
Also, to note, the studies discussed below3 include data captured before COVID. While I absolutely treasure the natural experiment created by the pandemic shutdown4 – the on/off switch of child care that allowed researchers to tie childcare loss to maternal maternal health – it’s hard to get a clean picture of the nuance in the perception of precarity when an unexpected global pandemic locks your kid out of a (somewhat) functioning childcare system while the rest of the world feels like it is crumbling under your feet. For the solutions stage of this work, we need to understand the nuance.
The stress of child care precarity
Child care precarity is defined as the state of insecure, unreliable, and/or unstable childcare arrangements.
In a recently published study, researchers found negative maternal health outcomes associated with early child care precarity for at least six years. The authors even call for child care precarity to be considered a social determinant of women's health.
Getting into the details, the researchers dug through a national birth cohort data bank from 1998-2000 to assess maternal health outcomes related to varying degrees of precarity and perception of precarity. Data captured included: insecure childcare (“Approximately how many times in the past month did you have to make special arrangements because your usual childcare arrangement fell through?”); insecure childcare with missed work (“How many times in the past month did you miss work or school because your childcare arrangement fell through?”); inadequate child care (“Have you had to quit a job, school, or training activity because you had problems arranging childcare or keeping a childcare arrangement?”); and access to emergency child care (“If you needed help during the next year, could you count on someone to help you with emergency child care?”)
The longitudinal dataset5 (same data captured for the same people at different time points) allowed for a long(ish)-term look at the health consequences, specifically identifying childcare precarity for mothers when their kids were three years old compared to their maternal health metrics when their kids were nine.
Data were also captured when the child was one year old with those data used as a covariate in the statistical models (e.g. are maternal health metrics better or worse around the period of precarity – comparing when kid was nine to when kid was one). Health metrics included: self-reported health (on a five point scale in response to a validated survey question “In general, how is your health?” – with a binary established between the highest response – “excellent” – and lowest two responses – “fair” or “poor”); maternal depression (based on diagnostic interview); and maternal parenting stress – survey questions with 4-point Likert-scale to capture stress related to child-rearing tasks.
KEY FINDINGS:
All measures of childcare precarity were associated with higher odds of maternal depression.
For all three childcare precarity variables, persistent exposure – precarity occurring at both ages one and three – nearly tripled the odds of maternal depression when compared to individuals who did not experience childcare precarity at either time point.
Mothers experiencing the highest level of childcare precarity, early inadequate child care, had higher odds of poor/fair health when children were nine.
Early insecure and early inadequate child care were associated with higher parenting stress scores when children were nine.
And on the positive side!
All negative maternal health outcomes were lower for those with access to emergency childcare support – suggesting a protective association.
Parenting stress decreased and the odds of having poor/fair overall health were halved for individuals who had persistent access to emergency childcare support when kids were one and three years old. This suggests that consistent access to emergency child care support has a protective and additive effect on overall maternal health later.
As a prospective, observational study, the associations reported do not demonstrate causality, and there are other limitations of working with a dataset designed to capture a specific population6. With that said, this study does document important health outcomes that we can bank for assessing the stress related to child care issues when it comes to testing the stressor map.
I also 100% stand behind the authors conclusion that:
“These findings suggest that policies to increase access to reliable, secure child care and emergency child care supports could improve the health of mothers of young children….it suggests future studies should elucidate potential pathways - from experiencing childcare precarity to potentially curtailing work or training, reducing income, increasing stress, and compromising overall women's health”.
Important to note — the data in this study represent families who had children in regular childcare with a focus on precarity related to having that regular childcare fall through. But what happens when mothers7 do not have access to regular childcare to begin with or struggle with securing stable child care that fits their needs?
The stress buffer of having “good choices for care”
A 2019 study throws an extra layer of nuance into the discussion around how our brain processes issues related to child care. This study looked at a different side of precarity — childcare instability – and found that it was not the child care instability, itself, that affected maternal mental health but rather the perception that good options for child care exist.
To get into the details: this study also mined a longitudinal dataset (10,000+ mothers with children born in 2001). Child care needs varied from part-time (at least 10 or more hours per week) to full time care, from center-based care to relatives, from one arrangement to multiple (2+). Maternal depressive symptoms were captured as a health outcome. Maternal parenting stress was factored in as a covariate in the statistical models.
The dimensions of child care instability included: care duration, the number of months the child spent in their longest arrangement, the number of distinct arrangements the child experienced in the 4-year window8.
To test how mothers’ perceptions of available care options corresponded to maternal depressive symptoms, the researchers also included a measure of personal report on whether or not the mother felt that “good choices for care” existed where she lived. The thinking on this was that perception of options could buffer the stress of instability – “if one arrangement falls through, she could theoretically easily secure another”.
KEY FINDINGS:
Maternal parenting stress was associated with high depressive symptoms.
Odds of high depressive symptoms increased 19% for every unit increase on the parenting stress metric.
Mothers who had good choices for care were 22% less likely to report high depressive symptoms. The biggest impacts were for working mothers and single mothers who showed a 29% and 28% reduction (respectively) in the likelihood to report high depressive symptoms.
Importantly – the study captures rates of high maternal depressive symptoms between 23-35%, highlighting the prevalence of depression among mothers of young children and the urgency of solutions to address maternal mental health.
Again, this study is not without its limitations (and more research needs to be done) but what I love about it is that it starts to connect the dots: parental stress load is associated with depressive symptoms BUT the perception of having “good child care options” decreases those negative health outcomes.
This means that perception of good choices in care may operate as a stress buffer – the external stress of child care instability may remain static, but the degree of stress internalization and the resulting health consequences are reduced when filtered through the context of optionality and a sense of control. This may also relate to the stress buffering effect for mothers who have access to emergency child care support in the earlier discussed study. A sense of control in the face of the unpredictability of child care instability may be a counter-balance to that stress response trigger.
On the flip side, I worry that living through a child care crisis – where we finally have national attention on the issue - could be promoting a global sense of child care precarity and insecurity. While I am all about the national attention on this issue, it is important to consider how a 24 hour news cycle with headlines that fuel a negative perception of child care options and a sense of ‘things are getting worse’ may be impacting maternal mental health indirectly. Another reason why doom scrolling is not healthy.
Overall, the authors of the 2019 study conclude:
“If replicated, findings would highlight a previously unconsidered avenue-increasing care accessibility and awareness of available options-for promoting maternal mental health in a population likely to experience depression but unlikely to be treated.”
There it is. They see it too. A solution! Such a simple solution, right? Increasing access to quality child care AND increasing awareness of available options = improved maternal mental health. It’s preventive health care!
Of course, the simplicity of this solution exists in my dreamworld of a functioning society and political landscape that prioritizes children and mothers and women… but, alas… we can dream and continue pushing for change.
To add more fuel to the fire, I spoke with the incredible
, co-founder and CEO of Mirza, a childcare solution that guides working parents through eligibility for government childcare dollars and simplifies that application process. The conversation with Siran was truly eye-opening for me. Her expert view brings in more layers and connections to the child care issues stressor node and adds even more nuance to the stress related to child care precarity and instability in the context of work, pay, gender, and child care subsidies.Stay tuned!
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Not a typo and this footnote has nothing to do with child care or health but I feel like I have to put it out there... I was conditioned as a grad student that the word "data" is plural. There was even a running joke/cautionary tale:
“Grad student gets up to present thesis and starts with a big proclamation: ‘What IS data?’
Advisor responds: ‘A PLURAL WORD!’”
So, yes, you will catch me saying "data are...", “these data”, etc. quite a lot. And every time I write it that way it feels really freaking pretentious but I just can't change my ways. Grad school brain conditioning is real, y'all.
As you might expect, most research available on child care precarity/insecurity/instability focuses on child health and behavior outcomes. NOT parental health. And when the research does capture maternal health, the directionality is usually: maternal stress leads to child care instability or maternal stress affects the children’s experience of that instability. Very rare to find studies that specifically look at how child care instability affects maternal stress. And I say “parental” but its usually centered around mom, because we all know, instability is bad for kids, so it must be the mom's fault.
As a scientist... NOT as a parent.
Demographics for the data curious:
"The overall sample included 2,836 participants; of those, 1,716 participants (60.5%) had children in regular childcare (Table 1). The majority of the sample had a minoritized background; almost one-half (49.5%) self-identified as Black, almost one-quarter (24.4%) as Hispanic, and less than one-quarter (22.5%) as white.
Participants with children in regular childcare were more likely to be Black (53.3% vs. 43.8), less likely to be Hispanic (21.2% vs. 29.3), and more likely to have higher levels of education and income."
The authors note that “The FFCWB also oversampled nonmarital births, with the intention of generating data on an understudied socioeconomically disadvantaged population." However, in my opinion, the “oversampled” population are precisely the communities that deserve more research on these effects.
Why "mothers" and why "maternal health outcomes"? Well... that's a big question.
Short answer -- that is who the researchers studied and the health outcomes captured.
Long answer (in short form) -- we lived in a gendered society that disproportionately lays the burden on mothers when it comes to the labor load associated with finding, arranging, and managing child care.
Even the authors note that this definition may have actually mucked up the results for statistical associations with depression: "many families change arrangements as their children age from 2 years old to 4 years old." Meaning — this metric is not capturing instability but rather a planned change. The distinction is important in the context of stress — yes, a planned change can still be stressful BUT it is happening in a more "controlled" way.