Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2025 Mar 1.
Published in final edited form as: Womens Health Issues. 2023 Nov 17;34(2):115–124. doi: 10.1016/j.whi.2023.10.002

Early Childcare Precarity and Subsequent Maternal Health

Carol Duh-Leong a, Caitlin F Canfield b, Anne E Fuller c, Rachel S Gross a, Nancy E Reichman d
PMCID: PMC10978296  NIHMSID: NIHMS1938050  PMID: 37978038

Abstract

Objective:

We examined prospective associations between early childcare precarity, or the security and reliability of childcare arrangements, and subsequent maternal health.

Study Design:

We conducted a secondary analysis of survey responses from mothers of 2,836 children in the Future of Families and Child Wellbeing study. We assessed the following childcare measures: insecure childcare, insecure childcare with missed work, inadequate childcare, emergency childcare support. We used linear and logistic regression models with robust standard errors to examine associations between these measures when the index child was age 3 and maternal health outcomes (overall health, depression, and parenting stress) later when the child was age 9. We then examined additive experiences of childcare measures across child ages 1 and 3 on maternal health outcomes.

Results:

Early inadequate childcare increased odds of later poor maternal overall health (aOR 1.64, 95% CI: 1.11, 2.41). All early childcare precarity measures increased odds of maternal depression (insecure childcare [aOR 1.64, 95% CI: 1.23, 2.18]; insecure childcare with missed work [aOR 1.58, 95% CI: 1.13, 2.22]; inadequate childcare [aOR 1.75, 95% CI: 1.22, 2.51]). Emergency childcare support decreased odds of adverse maternal health outcomes (poor overall health [aOR 0.65, 95% CI: 0.48, 0.88]; depression [aOR 0.73, 95% CI: 0.54, 0.99]; parenting stress [B −0.45, 95% CI: −0.80, −0.10]). Prolonged experiences had stronger associations with maternal health than shorter experiences.

Conclusion:

Early childcare precarity has long-term adverse associations with maternal health, and emergency childcare support appears favorable for maternal health. These findings highlight childcare precarity as a social determinant of women’s health for researchers, clinicians, and decisionmakers.

Keywords: maternal child health, maternal depression, child care, social support, parenting stress, social determinants of health

INTRODUCTION

Childcare precarity is a state of insecure and unreliable childcare arrangements while parents are working or in school. Among other hardships faced by families with young children, childcare precarity is unique, as it directly interferes with an adult parent’s ability to work or attend school, which can lead to work-family conflict, long-term income instability, and decreased economic opportunities, particularly for those who identify as mothers (Geyer et al., 2015; Grice et al., 2011; Luhr et al., 2022; Müller & Wrohlich, 2020). Studies show that women assume the majority of childcare responsibilities (Petts et al., 2021). Thus, experiences of childcare precarity may take a particular toll on women’s health when persistent childcare-related disruptions to work or school routines upset important daily routines, eventually leading to poor physical and/or mental health outcomes. For example, unstable employment schedules have been associated with lower maternal sleep quality and happiness (K. Harknett et al., 2021); income instability is known to worsen physical and/or mental health (Crear-Perry et al., 2021). Childcare instability — or unstable, fluctuating childcare arrangements — is understood as an important child health issue, with key associations with adverse behavioral health outcomes, poor social adjustment, and child maltreatment risk (Bratsch-Hines et al., 2015; Ha et al., 2015; Pilarz & Hill, 2014). Understanding potential health consequences of the closely adjoining maternal experience of childcare precarity or, conversely, maternal access to emergency childcare support from family or friends would inform strategies to improve women’s health and well-being.

As reflected in ongoing policy debates about parental leave (Goodman et al., 2021) and universal access to pre-kindergarten education (J. L. Reid et al., 2019), childcare needs are greatest prior to school entry at age 5. Problems with childcare arrangements in the preschool years – after infancy but prior to school entry – have been associated with immediate psychological strain, parenting stress, and depressive symptoms, which may be causal or explained by other family instability variables during this period of transitional parenthood when those who identify as mothers may experience conflict from competing responsibilities (Charrois et al., 2017; Johnson & Padilla, 2019; Nærde et al., 2000; Pilarz & Hill, 2017). Whether or not childcare experiences have lasting associations with maternal health even after the peak period of childcare needs has passed—e.g., when children are in school—is poorly understood. Furthermore, existing research does not report whether the kind of dose-response association that exists for other hardships (e.g., the severity of food insecurity corresponds to the severity of negative health outcomes) also exists for childcare precarity (Gross et al., 2018; L. Reid, 2000).

To address these gaps, we use data from a national birth cohort recruited from large cities to investigate prospective associations between early maternal childcare experiences (insecure childcare, insecure childcare with missed work, inadequate childcare, availability of emergency childcare) before school entry when children were age 3 and later maternal health outcomes when children are age 9 (overall health status, depression, and parenting stress). We hypothesized that: 1) increased childcare precarity risk is adversely associated with later maternal health outcomes; 2) access to emergency childcare support is positively associated with maternal health outcomes; and 3) prolonged experiences of childcare precarity are more strongly associated with long-term maternal health outcomes than shorter experiences.

METHODS

Study Design

This was a secondary analysis of data from the Future of Families and Child Wellbeing (FFCWB) study, an ongoing national birth cohort study from 20 large US cities (1998–2000) (Reichman et al., 2001). Leveraging a longitudinal cohort dataset as has been done with similar research questions (Anyigbo et al., 2022; Dauner et al., 2015), we account for temporal ordering by measuring childcare precarity at a developmentally appropriate earlier time point prior to subsequent maternal health outcomes of interest. Specifically, to test the hypothesis of whether childcare precarity experiences when children were age 3 have associations with maternal health outcomes when children are age 9 (a lag of ~6 years), we estimated regression models with conservative robust standard errors. In these models, we adjusted for relevant covariates selected using a comprehensive directed acyclic graph informed by important baseline covariates related to the FFCWB sampling design as well as a careful review of childcare studies (Gordon et al., 2008; Johnson & Padilla, 2019; Pilarz & Hill, 2014, 2017; Reichman et al., 2001).

Participants

The FFCWB study oversampled non-marital births (3:1), a population at increased risk to be at a lower socioeconomic status and with decreased access to social support (Liang et al., 2019; Solomon-Fears, 2014). The original cohort study included 4,898 children largely from socioeconomically disadvantaged groups. Study staff interviewed parents shortly after giving birth (baseline), then re-interviewed parents when children were 1, 3, and 9 years old. Our secondary analysis included self-identified mothers who were primary caregivers for the focal child with complete longitudinal data for our variables (n = 2,836, Figure 1), and we confirmed that baseline characteristics of our sample were similar to the full FFCWB sample (Reichman et al., 2001). The Institutional Review Board at NYU Grossman School of Medicine deemed this study exempt from human subjects review because it was an analysis of publicly available deidentified data.

Figure 1:

Figure 1:

Open in a new tab

Study Flow Chart

Measures

Childcare precarity measures when the child was age 3

To conceptualize our main predictor, we first referenced prior work examining childcare instability, which describes child health outcomes associated with unstable, fluctuating, or multiple childcare arrangements. Our interest was in capturing the adjoining, but distinct, maternal experience of childcare precarity, or feelings of uncertainty, lack of predictability, and insecurity, a concept informed by an interdisciplinary review of literature describing similar experiences of job and economic precarity (Luhr et al., 2022; North, 2021; Parolin & Lee, 2022). We used three assessments of childcare precarity with increasing severity, measured when children were at age 3. These questions were only asked of children in regular childcare, defined in the FFCWB study as being cared for by someone other than a mother or father on a regular basis for 10 or more hours a week.

Insecure childcare:

This question captures childcare that fell through, leaving the participant to scramble for backup childcare arrangements. The survey asked, “Approximately how many times in the past month did you have to make special arrangements because your usual childcare arrangement fell through?” Participants who reported this experience at least once were coded as having insecure childcare. The FFCWS did not collect information on the circumstances for which childcare fell through, such as a parent’s subjective decision to keep a child home due to mild illness vs. a childcare provider’s unreliability.

Insecure childcare with missed work:

This question captures whether insecure childcare was severe enough to result in a participant missing a day of work or training. The survey asked, “How many times in the past month did you miss work or school because your childcare arrangement fell through?” Participants who reported this experience at least once were coded as having insecure childcare with missed work.

Inadequate childcare:

This question captures the highest level of childcare severity, assessing whether or not childcare precarity resulted in interruption or suspension of the participant’s professional trajectory. The survey asked participants whether since their child was age 1, “Have you had to quit a job, school, or training activity because you had problems arranging childcare or keeping a childcare arrangement?” Participants who responded yes were coded as having had inadequate childcare.

Access to emergency childcare support when the child was 3 years old

To assess emergency childcare support, we used a question that captures access to emergency childcare support from informal sources: “If you needed help during the next year, could you count on someone to help you with emergency child care?” If the participant replied yes, they were coded as having emergency childcare support. This question, asked of all participants regardless of whether the child was in childcare, is part of a larger question set in the FFCWB measuring perceived social support (e.g., someone to count on for a $200 loan), which has been consistently associated with positive health outcomes (Dauner et al., 2015; Delaney, 2017).

Reliable childcare is most relevant for parents who are working or in school, but emergency childcare support has been shown to be a key component of a “parental safety net” (K. Harknett & Knab, 2007; K. S. Harknett & Hartnett, 2011). Thus, when examining associations with maternal health outcomes when children were age 9, we assessed emergency childcare support in all families as well as in a subset of participants who ever worked when their children were ages 1,3, or 5. Given that access to emergency childcare support could mitigate childcare precarity, we also explored whether emergency childcare support had a buffering interaction with childcare precarity (i.e., whether it reduced the magnitude of association between childcare precarity and maternal health).

Maternal health measures when the child was age 9

Poor/Fair Overall Maternal Health.

This measure captures self-reported health, which studies have established to be a valid health status indicator for adult population health monitoring to reflect physical health, health care use, and mortality (McGee et al., 1999; Miilunpalo et al., 1997). The survey asked “In general, how is your health?” Participants could respond: 1) Excellent, 2) Very Good, 3) Good, 4) Fair, 5) Poor. Per prior work (McGee et al., 1999; Miilunpalo et al., 1997), we dichotomized overall health at the cutpoint of poor/fair versus all others, and ran sensitivity analyses using a cutpoint of excellent versus all others. This same measure was also assessed in participants when children were age 1, which we used as a covariate in certain models.

Maternal Depression.

Maternal depression was derived from the Composite International Diagnostic Interview (CIDI), a comprehensive, fully structured interview assessing ICD-10 and DSM-IV mental health criteria administered by trained interviewers (Kessler et al., 1998). FFCWB uses the short form, which includes 15 CIDI questions about the prior 12 months. Examples of symptoms surveyed include: losing interest, weight changes, trouble sleeping or concentrating, feeling worthless, and thinking about death. The FFCWB user guide (User Guide, n.d.) recommends two scoring methods based on symptom duration. For our main analyses, we used the “liberal” scoring, which is more sensitive for depression (16.5% score positive for depression with this scoring), and we conducted sensitivity analyses using “conservative” scoring, which is more specific (11.6% score positive for depression with this scoring) (User Guide, n.d.). Maternal depression was also assessed when children were age 1, and we used the short form scoring as a covariate in certain models.

Maternal Parenting Stress.

This measure captures stress triggered by child-rearing tasks. FFCWB used questions derived from the Panel Study of Income Dynamics and the Job Opportunities and Basic Skills Training Program Survey (McGonagle et al., 2012). Participants responded on a 4-point Likert scale (e.g., “not at all true,” “completely true”) to statements such as “Being a parent is harder than I thought it would be” or “I feel trapped by my responsibilities as a parent.” In line with prior work, we reverse coded the items and summed the items so that higher scores represented higher levels of agreement with parenting stress statements (Cooper et al., 2009; Lin & Wiley, 2017). We ran sensitivity analyses using the alternate parenting stress scoring method, which averages the scores from each statement (User Guide, n.d.). In certain models, we additionally adjusted for parenting stress when children were age 1, which was assessed with the same measure but not collected for two of the FFCWB cities at that time point.

Covariates

We tested all factors for multicollinearity by assessing variance inflation factors prior to inclusion in our model. Maternal baseline characteristics, measured at birth, included maternal age (years), race and ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, other), education level (Less than high school, high school graduate, some college, college graduate), family structure (married, cohabiting, parents in a relationship but not cohabiting, no relationship), and income as a percentage of the federal poverty level (categories). Child baseline characteristics included assigned sex at birth, first born and multiple birth status.

Covariates at other timepoints included whether participants ever worked or were in school when their children were age 3 or before age 1 (yes/no). Prior work has also shown that use of childcare centers over individual caregivers led to work absences due to child illnesses, so we adjusted for childcare center use as well the number of childcare arrangements concurrently used when their children were at age 3 to proxy for childcare instability (Gordon et al., 2008).

As per prior relevant research, we controlled for child temperament at age 1 using the mean of the Emotionality, Activity, and Sociability Temperament Survey (Pilarz & Hill, 2014), with higher scores indicating negative emotionality and shyness. This covariate helped account for child-level time-invariant differences that may contribute to both childcare precarity experiences and maternal health.

Finally, as has been done in prior work (Hedges et al., 2021), we ran an additional model that adjusted for the corresponding maternal health outcome measure when their children were age 1, prior to age 3 childcare exposures, to account for time-invariant maternal health characteristics at baseline, in an effort to isolate our estimates to what occurred when their children were between ages 3 and 9 only.

Statistical Analysis

We used Stata/SE version 15 (Stata Corp, College Station, TX) to conduct all analyses. To preserve sample size, we did not use FFCWB weights so that we could include all families with complete longitudinal data.

We first summarized child, maternal, and childcare characteristics. Using unadjusted chi square or independent sample t-tests as appropriate, we tested for statistically significant differences between the sample in and not in regular childcare. For our primary study question, we used logistic and linear regressions as appropriate to estimate adjusted regression models of associations between childcare precarity when children were age 3 and maternal health outcomes when children were age 9. Model 1 controlled for maternal, child, and childcare characteristics. Model 2 added the corresponding maternal health outcome measure when children were age 1, prior to age 3 childcare exposures. We used robust standard errors to account conservatively for potential bias in estimates. We presented estimates as odds ratios (ORs) or unstandardized linear regression coefficients (Bs) with 95% confidence intervals (Cis).

To characterize persistent childcare precarity or support across child ages 1 and 3, we categorized the variables as never (no at both ages 1 and 3; the reference group), age 1 only (yes at age 1, no at age 3), age 3 only (no at age 1, yes at age 3), and both time points (yes at both ages 1 and 3), and estimated adjusted logistic and linear regression models to examine associations between persistent early childcare precarity or emergency childcare support and maternal health outcomes when children were age 9. We ran these analyses using covariates from Model 1 to maximizes cases given that the corresponding parenting stress variable was not measured in all cities when children were age 1, and we ran sensitivity analyses using covariates from Model 2.

To assess cross-sectional relationships when children were age 3, we conducted supplemental analyses examining associations between concurrent measures between childcare measures and maternal health outcomes both measured when children were age 3. We also examined associations between childcare measures when children were age 1 and maternal health outcomes when children were age 9. Supplemental analyses used Model 2 covariates.

RESULTS

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 half (49.5%) self-identified as Black, almost a quarter (24.4%) as Hispanic, and less than a quarter (22.5%) as White. There were subgroup differences across sociodemographics between those whose children were in and not in regular childcare. Participants with children in regular childcare were more likely to be Black (53.3% v. 43.8), less likely to be Hispanic (21.2% v. 29.3), and more likely to have higher levels of education and income. This group was also more likely to not live with a partner (i.e., less likely to be married [24.1% v. 29.0%], less likely to be cohabiting [33.5% v. 38.5%]).

Table 1:

Sample Characteristics

n (%) or mean (SD) Overall Sample1
n=2,836		 In Regular Childcare2
Yes (n = 1,716) No (n=1,120)
Maternal characteristics at baseline (wave 1)
Age in years 25.2 (6.0) 25.0 (5.9) 25.4 (6.1)
Race and ethnicity
 White, non-Hispanic 639 (22.5) 382 (22.3)*** 257 (23.0)***
 Black, non-Hispanic 1,405 (49.5) 914 (53.3)*** 491 (43.8)***
 Hispanic 692 (24.4) 364 (21.2)*** 328 (29.3)***
 Other 100 (3.5) 56 (3.3)*** 44 (3.9)***
Education level
 Less than high school 854 (30.1) 410 (23.9)*** 444 (39.6)***
 High school equivalent 893 (31.5) 553 (32.2)*** 340 (30.4)***
 Some college 744 (26.2) 518 (30.2)*** 226 (20.2)***
 College + 345 (12.2) 235 (13.7)*** 110 (9.8)***
Family structure
 Married 738 (26.0) 413 (24.1)*** 325 (29.0)***
 Cohabiting 1,005 (35.4) 574 (33.5)*** 431 (38.5)***
 Parents together, not cohabiting 761 (26.8) 490 (28.6)*** 271 (24.2)***
 Parents not together 332 (11.7) 239 (13.9)*** 93 (8.3)***
US born 2,444 (86.2) 1,519 (88.5)*** 925 (82.6)***
Income, % federal poverty level
 0–49% 483 (17.0) 252 (14.7)*** 231 (20.6)***
 50–99% 467 (16.5) 255 (14.9)*** 212 (18.9)***
 100–199% 732 (25.8) 440 (25.6)*** 292 (26.1)***
 200–299% 452 (15.9) 300 (17.5)*** 152 (13.6)***
 300% + 702 (24.8) 469 (27.3)*** 233 (20.8)***
Employment/training status at age 3 (wave 3)
 Working for pay 1,358 (47.9) 1,076 (62.7) 282 (25.2)
 Actively seeking work 519 (18.3) 215 (12.5) 304 (27.1)
 In school or training 424 (15.0) 317 (18.5) 107 (9.6)
 None of the above 535 (18.9) 108 (6.3) 427 (38.1)
Child characteristics at baseline (wave 1)
Female 1,361 (48.0) 884 (51.5) 591 (52.8)
First born 1,124 (39.6) 977 (56.9)*** 735 (65.6)***
Multiple birth 57 (2.0) 35 (2.0) 22 (2.0)
Temperament3 2.6 (0.8) 2.5 (0.7) 2.6 (0.8)**
Childcare characteristics at age 3 (wave 3) 4
Childcare center - 829 (48.3) -
Number of current arrangements - 1.2 (0.5) -
Insecure childcare - 478 (27.9) -
Insecure childcare with missed work - 262 (15.3) -
Inadequate childcare - 203 (11.8) -
Emergency childcare support 2,529 (89.2) 1,566 (91.3)*** 963 (86.0)***
Maternal health outcomes at age 9 (wave 5)
Poor/fair health 457 (16.1) 250 (14.6)** 207 (18.5)**
Depression 467 (16.5) 269 (15.7) 198 (17.7)
Parenting stress score5 8.1 (2.7) 8.1 (2.7) 8.1 (2.8)
Open in a new tab

Unadjusted chi square or independent sample t-test as appropriate to compare differences between sample in and not in regular childcare,

**

p<0.01;

***

p<0.001.

1

Full sample includes mother-child dyads in ages 1, 3, and 9 waves with complete data.

2

Sample in childcare includes children regularly cared for by someone other than mother or father on a regular basis for more than 10 hours a week at age 3.

3

Emotionality, Activity, and Sociability Temperament Survey for Children; higher scores indicate more negative emotionality and shyness temperaments.

4

Childcare measures only assessed in the subgroup of children in childcare.

5

The higher the score, the higher level of parenting stress (Mean [SD]).

In the subsample of those with children in childcare, over a quarter (27.9%) had insecure childcare, 15.3% had insecure childcare with missed work, and 11.8% had inadequate childcare. Those with children in regular childcare were more likely to report access to emergency childcare support than those whose children were not in regular childcare (91.3% v. 86.0%).

Early childcare precarity and subsequent maternal health

Participants with early inadequate childcare when their children were age 3, the highest level of childcare precarity, had increased odds of poor/fair overall health when children were age 9 compared to participants without early inadequate childcare even when adjusting for poor/fair overall health when children were age 1 (Model 2: aOR 1.64, 95% CI: 1.11, 2.41). The other two, less severe, childcare precarity measures were not significantly associated with increased odds of poor/fair overall health (Table 2).

Table 2:

Childcare Precarity at Child Age 3 and Maternal Health at Child Age 9

Sample N Poor/Fair Overall Health Odds Ratio aOR (95% CI) Depression Odds Ratio aOR (95% CI) Parenting Stress Score Regression Coefficient B (95% CI)
Model 1 Model 2 Model 1 Model 2 Model 1 Model 25
Insecure childcare1 1716 1.29 0.95, 1.75 1.15 0.84, 1.59 1.69*** 1.27, 2.25 1.64** 1.23, 2.18 0.29* 0.01, 0.58 0.12 −0.16, 0.40
Insecure childcare with missed work2 1716 1.41 0.99, 2.02 1.33 0.90, 1.95 1.69** 1.21, 2.37 1.58** 1.13, 2.22 0.15 −0.20, 0.51 0.01 −0.34, 0.37
Inadequate childcare3 1716 1.68** 1.15, 2.46 1.64* 1.11, 2.41 1.90*** 1.33, 2.70 1.75** 1.22, 2.51 0.48* 0.08, 0.87 0.09 −0.31, 0.48
Emergency childcare support4 (full sample) 2836 0.59*** 0.44, 0.79 0.65** 0.48, 0.88 0.66** 0.49, 0.88 0.73* 0.54, 0.99 −0.55** −0.90, −0.20 −0.45* −0.80, −0.10
Emergency childcare support4 (in childcare only) 1716 0.75 0.48, 1.15 0.83 0.52, 1.31 0.78 0.50, 1.20 0.85 0.55, 1.33 −0.46 −0.93, 0.004 −0.41 −0.86, 0.05
Emergency childcare support4 (ever worked ages 1,3,5) 2701 0.56*** 0.42, 0.76 0.62** 0.45, 0.85 0.64** 0.47, 0.86 0.71* 0.52, 0.97 −0.62** −0.99, −0.26 −0.54** −0.90, −0.18
Open in a new tab

Models examine associations between childcare precarity risk at age 3 and maternal health at age 9. Poor/Fair Overall Health and Depression estimates are odds ratios with 95% confidence intervals (aOR [95% CI]). Parenting stress results are unstandardized coefficients of change in parenting stress scores with 95% confidence intervals (B [95% CI]). Model 1 controls for child sex, firstborn status, temperament, maternal age, race, ethnicity, education level, work/school status, marital status, income, multiple birth, childcare center use, number of concurrent childcare arrangements; Model 2 controls for all variables in Model 1 plus the corresponding maternal health variable at when child was 1.

*

p<0.05;

**

p<0.01;

***

p<0.001

1

Having to make special arrangements at least once over the past month because the child’s usual childcare arrangement fell through.

2

Having to miss work or school at least once over the past month because the child’s usual childcare arrangement fell through.

3

Having to quit a job, school, or training activity due to problems arranging childcare or keeping a childcare arrangement.

4

Having someone to count on to help with emergency childcare over the next year.

5

Parenting stress not assessed in 2 cities at age 1; n=2,467 for full sample and n=1,513 for sample in childcare; n= 2,348 for sample ever worked when child aged 1, 3, or 5.

All early childcare precarity measures were associated with increased odds of maternal depression (Model 2: insecure childcare [aOR 1.64, 95% CI: 1.23, 2.18]; insecure childcare with missed work [aOR 1.58, 95% CI: 1.13, 2.22]; inadequate childcare [aOR 1.75, 95% CI: 1.22, 2.51]).

Early insecure childcare was associated with greater parenting stress scores later on when controlling for maternal and child characteristics (Model 1: B +0.29 score; 95% CI: 0.01, 0.58), but not when controlling for prior levels of parenting stress when children were age 1 (Model 2: B +0.12 score, 95% CI: −0.16, 0.40). Early inadequate childcare, the highest level of childcare precarity, was again associated with greater parenting stress scores later on when controlling for maternal and child characteristics (Model 1: B +0.48 score; 95% CI: 0.08, 0.87), but not when controlling for prior levels of parenting stress when children were age 1 (Model 2: B +0.09 score, 95% CI: −0.31, 0.48). We did not detect associations between early insecure childcare with missed work and later parenting stress scores.

Access to emergency childcare support and subsequent maternal health

In the full sample, emergency childcare support had protective associations with all subsequent maternal health outcomes (Model 2: poor/fair overall health [aOR 0.65, 95% CI: 0.48, 0.88]; depression [aOR 0.73, 95% CI: 0.54, 0.99]; parenting stress [B −0.45 score, 95% CI: −0.80, −0.10]). In the sample of participants with children in regular childcare, the corresponding associations were of a smaller magnitude but no longer significant (Table 2). When estimated in a sample of participants who ever worked when their children were aged 1, 3, or 5 (n=2,701, 95.2% of the full sample), emergency childcare support had protective associations with all subsequent maternal health outcomes (Model 2: poor/fair overall health [aOR 0.62, 95% CI: 0.45, 0.85]; depression [aOR 0.71, 95% CI: 0.52, 0.97]; parenting stress [B −0.54 score, 95% CI: −0.90, −0.18]). Analyses exploring whether there was a buffering interaction between emergency childcare support and childcare precarity did not yield meaningfully significant findings (data not shown).

Additive experiences when children were ages 1 and 3 and subsequent maternal health

Across our three childcare precarity variables, persistent exposure at when children were both ages 1 and 3 approximately tripled the odds of depression compared to no childcare precarity at either time point (Model 1: insecure childcare [aOR 2.82, 95% CI: 1.65, 4.84]; insecure childcare with missed work [aOR 3.57, 95% CI: 1.73, 7.39]; inadequate childcare [aOR 3.54, 95% CI: 1.86, 6.72]). We found no additive associations between childcare precarity and poor/fair overall health or parenting stress (Table 3).

Table 3:

Additive Effects of Childcare Experiences Across Child Ages 1 and 3 on Maternal Health Outcomes at Child Age 9

Insecure Childcare (n=1,037)
Age 1 Age 3 n Poor/Fair Overall Health Odds Ratio aOR (95% CI) Depression Odds Ratio aOR (95% CI) Parenting Stress Score Regression Coefficient B (95% CI)
No No 553 REFERENCE REFERENCE REFERENCE
Yes No 167 1.21 (0.69, 2.11) 1.67 (1.01, 2.77)* 0.57 (0.12, 1.02)*
No Yes 205 1.22 (0.74, 2.02) 1.91 (1.21, 3.01)** 0.49 (0.05, 0.94)*
Yes Yes 112 1.30 (0.70, 2.41) 2.82 (1.65, 4.84)*** 0.52 (−0.05, 1.08)
Insecure Childcare with Missed Work (n=1,037)
Age 1 Age 3 n Poor/Fair Overall Health Depression Parenting Stress Score
No No 777 REFERENCE REFERENCE REFERENCE
Yes No 89 1.23 (0.62, 2.47) 1.42 (0.77, 2.60) 0.66 (0.08, 1.24)*
No Yes 128 1.10 (0.61, 1.96) 1.37 (0.82, 2.31) −0.03 (−0.56, 0.51)
Yes Yes 43 0.67 (0.25, 1.81) 3.57 (1.73, 7.39)** 0.32 (−0.51, 1.16)
Inadequate Chidcare (n= 1,037)
Age 1 Age 3 n Poor/Fair Overall Health Depression Parenting Stress Score
No No 839 REFERENCE REFERENCE REFERENCE
Yes No 87 0.77 (0.36, 1.65) 1.57 (0.88, 2.82) 0.06 (−0.55, 0.69)
No Yes 67 2.28 (1.19, 4.37)* 2.79 (1.58, 4.94)*** 0.85 (0.18, 1.52)*
Yes Yes 44 1.65 (0.76, 3.61) 3.54 (1.86, 6.72)*** 0.48 (−0.35, 1.31)
Emergency Chidcare Support (n=2,839)
Age 1 Age 3 n Poor/Fair Overall Health Depression Parenting Stress Score
No No 109 REFERENCE REFERENCE REFERENCE
Yes No 190 0.81 (0.48, 1.38) 1.03 (0.59, 1.80) −0.26 (−0.94, 0.42)
No Yes 167 0.72 (0.42, 1.25) 0.90 (0.50, 1.62) −0.45 (−1.13, 0.23)
Yes Yes 2,373 0.48 (0.31, 0.74)** 0.63 (0.39, 1.01) −0.75 (−1.29, −0.20)**
Open in a new tab

Maternal health outcomes measured at child age 9. Poor/Fair Overall Health and Depression estimates are odds ratios with 95% confidence intervals (aOR [95% CI]). Parenting stress results are unstandardized coefficients of change in parenting stress scores with 95% confidence intervals (B [95% CI]). Model controls for child sex, firstborn status, temperament, maternal age, race, ethnicity, education level, work/school status, marital status, income, multiple birth, childcare center use, and number of concurrent childcare arrangements.

*

p<0.05;

**

p<0.01;

***

p<0.001

Persistent access to emergency childcare support at when children were both ages 1 and 3 halved the odds of having poor/fair overall health (Model 1: aOR 0.48, 95% CI: 0.31, 0.74) and decreased parenting stress (Model 1: B = −0.75 score, 95% CI: −1.29, −0.20) compared to not having emergency childcare support at either time point. We found no additive protective associations between emergency childcare support and maternal depression.

Supplemental and sensitivity analyses

Supplemental Table 1 displays concurrent associations between experiences of childcare precarity and maternal health outcomes when children were age 3. In comparison to our main findings in Table 2, where we did not detect strong associations with parenting stress, some childcare precarity measures were associated with increased parenting stress scores concurrently, even when adjusting for parenting stress scores when children were age 1.

Supplemental Table 2 displays similar or diminished relationships between childcare measures when children were age 1 and maternal health outcomes when children were age 9. The only statistically significant association was between inadequate childcare when children were age 1 and maternal depression when children were age 9.

Sensitivity analyses using alternate cutoffs for maternal overall health (excellent v. all others), depression (using the conservative cutoff), parenting stress (alternate scoring method), and additive effects (using Model 2 covariates with decreased power) all yielded findings that supported interpretations of our main results (data not shown).

DISCUSSION

In a national US birth cohort from large cities, we found significant and robust associations between early childcare precarity and maternal health outcomes approximately 6 years later, which have not been described before. These findings suggest that policies to increase access to reliable, secure childcare and emergency childcare supports could improve the health of mothers of young children. We categorized levels of childcare precarity (i.e., insecure, insecure with missed work, inadequate), as often is done for food insecurity (e.g., food insecure, food insecure with hunger) (Blumberg et al., 1999). This categorization, which acknowledges that families experience varying levels of hardship, also demonstrates that increased severity may be associated with poorer health outcomes and indicates that childcare precarity is a social determinant of women’s health.

Our finding that early inadequate childcare was associated with increased odds of poor/fair maternal health later on extends literature showing associations between other experiences of social determinants of health and poorer overall health (e.g., food insecurity (Hager et al., 2010; Stuff et al., 2004), housing disrepair (Adamkiewicz et al., 2014)). Furthermore, prolonged access to emergency childcare support had protective and additive effects on overall health later on: participants with emergency childcare support when children were both ages 1 and 3 had half the odds of poor/fair health compared to participants who had no emergency childcare support when children were either age. To our knowledge, this is one of the first studies to find associations between childcare experiences with long-term overall maternal health, prompting future studies to elucidate potential pathways from experiencing childcare precarity to potentially curtailing work or training, reducing income, increasing stress, and compromising overall women’s health (Chatterji et al., 2013).

All childcare precarity measures we considered were associated with subsequent maternal depression. Maternal depression is a common, chronic source of disability that is also likely a vehicle for the intergenerational transmission of poverty-related toxic stress (Letourneau et al., 2019; Schor, 2018; Wachs et al., 2009). A prior study found associations between perceptions of stable childcare access and decreased odds of maternal depression when children were preschool-aged, but not between an increased number of childcare arrangements and concurrent maternal depression (Johnson & Padilla, 2019). Our findings reinforce that it is the participant’s experiences of childcare precarity rather than the actual arrangement – which may reflect maternal cultural and personal preferences – that likely contribute to maternal depression. Our findings also suggest that the most notable associations with childcare precarity may be long-term in the setting of persistent experiences of managing conflicts between work and family. Supplemental analyses showed that experiences of inadequate childcare starting when children were age 1 were associated with maternal depression when children were age 9, showing potentially enduring effects of childcare precarity on maternal mental health. Future studies should elucidate vulnerable stages of parenthood when systemic efforts to deliver childcare support may optimize long-term maternal mental health.

While depression captures overall feelings of dysphoria or anhedonia, parenting stress stems specifically from parenting (e.g., “I feel trapped by my responsibilities as a parent”). While we found strong associations between early childcare precarity and later maternal depression, associations with parenting stress were less consistent. Early insecure and inadequate childcare, but not insecure childcare with missed work, had associations with parenting stress scores; none of these estimates were significant after adjusting for parenting stress at 1 year. Our measure of parenting stress was not available for two of the FFCWB cities when children were age 1, which potentially limited our ability to detect associations in those models. However, this finding is consistent with prior research showing that associations between childcare precarity and parenting stress do not hold up when adjusting for prior stress, perhaps because participants experiencing stress to begin with are also more likely to experience childcare precarity (Pilarz & Hill, 2017). In supplemental analyses, we found that all experiences of childcare precarity were associated with parenting stress concurrently when children were age 3, which may indicate that parenting stress may dissipate over time as concentrated childcare needs decrease. The ability to follow families more intensely and reevaluate childcare supports at various stages may yield valuable information on the extent of childcare supports needed across childhood, informing interventions to optimize family health.

We found that emergency childcare support had favorable associations with all subsequent maternal health outcomes in the full sample. These findings reinforce an accumulating body of evidence showing that access to social support is a matter of public health (Balaji et al., 2007). Participants parenting on their own, who make up the majority of our sample, may also particularly benefit from robust social support networks. However, as reflected in the regular childcare sample where associations were similar in direction and magnitude but no longer significant, access to emergency childcare may be helpful as a short-term solution but not an adequate substitute for ongoing reliable childcare essential for a parent to successfully engage in employment or training. The sample who ever worked when children were ages 1, 3, 5 (the vast majority) did show benefits from emergency childcare support, suggesting that the presence of this informal safety net does likely benefit most participants who are attempting to work or go to school. We did not detect statistical interaction when exploring whether emergency childcare support buffered effects of childcare precarity. However, future studies should consider intentionally powering their samples to examine additional subgroup analyses by income, race, or types of social support specifically as a strength-based approach.

Limitations include study design, sampling, unmeasured variable bias, and loss to follow-up. FFCWB is a prospective observational study and causality cannot be established. FFCWB also oversampled non-marital births with the intention of generating data on an understudied socioeconomically disadvantaged population. Yet, childcare precarity likely has health impacts across socioeconomic strata, as highlighted in parenting studies during the COVID-19 pandemic (Petts et al., 2021). In analyses examining childcare experiences across timepoints when children were ages 1 and 3, a few of the subgroups were below 50 participants and estimates were less precise with large confidence intervals. These analyses were likely underpowered to detect associations for mothers experiencing precarity consistently when their children were ages 1 and 3. In light of limited US data available to study long-term outcomes of childcare precarity, new prospective studies involving larger and more diverse cohorts are needed. FFCWB also only asks about childcare precarity for children regularly cared for by someone else at the time of the survey, omitting participants who may have used regular care in early childhood but not at the time of the survey. While we were able to examine the effects of emergency childcare support on all participants, experiences of childcare precarity were only assessed in participants who had children in regular childcare at the time. The FFCWS also did not include information on why childcare fell through, which may depend on subjective parental judgment (e.g., mild illnesses) rather than provider reliability. However, our decision to control for childcare type or child temperament may have tempered this potential bias. Finally, loss to follow-up is also a limitation, although our overall sample characteristics are similar to the FFCWB baseline, suggesting minimal bias owing to attrition.

IMPLICATIONS FOR PRACTICE AND POLICY

Overall, our study findings leverage a life course framework to suggest that experiences of early childhood precarity may be followed by persistent or even mounting adverse maternal health associations over time. Findings from this study support primary care efforts to screen for childcare precarity (Chung et al., 2016; Sokol et al., 2019), as well integration of maternal-child health care system linkages to harmonize access to child and maternal community and health resources (Ronis et al., 2022). For public policy stakeholders looking to ameliorate structural inequities and bolster maternal economic opportunity, this work supports collaboratives such as the New York City Economic Development Corporation’s Childcare Innovation Lab, which links city economic well-being to high quality, affordable, early childcare access (Points, 2023). These observational findings also prompt future studies to test the potential positive long-term health effects of strategies such as flexible parental leave that can be taken in the first few years after childbirth to respond to ongoing childcare needs, provision of employer-sponsored onsite childcare to support options for work-life integration (French et al., 2022), and universal access to pre-kindergarten on maternal health and well-being.

CONCLUSION

Findings from this study suggest that early childcare precarity has persistent adverse associations with maternal health over time and that emergency childcare support, reflective of informal social support networks that can be further bolstered by intervention and policy, appears to be favorable for maternal health. More broadly, the findings contribute to accumulating evidence that material hardships experienced by those who identify as participants with young children may have specific and additive long-term adverse effects on women’s health.

Supplementary Material

1

Funding Statement:

This work was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, under award numbers 2KL2TR001446-06 (Dr. Duh-Leong) and U3DMD32755 (Dr. Reichman); the U.S. Department of Health and Human Services/Health Resources and Service Administration under award numbers UA6MC32492 (Dr. Duh-Leong, Life Course Intervention Research Network) and U3DMD32755 (Dr. Reichman); and the Robert Wood Johnson Foundation through its support of the Child Health Institute of New Jersey under grant number 74260 (Dr. Reichman). The funders/sponsors had no role in the design or conduct of the study.

Biographies

Carol Duh-Leong, MD, MPP is an Assistant Professor of Pediatrics at NYU Grossman School of Medicine. Her research interests include applying a life course framework towards understanding the social context of early maternal-child health and its long-term contribution to health and well-being.

Caitlin F. Canfield, PhD is an Assistant Professor of Pediatrics at NYU Grossman School of Medicine. Her research interests include individual differences in children’s development, including the influences of social policy, community assets, family strengths, and internal characteristics like temperament.

Anne E. Fuller, MD, MS is an Assistant Professor of Pediatrics at McMaster University. Her research interests include income-related inequities in family health, and building knowledge to support clinical and policy-level interventions to reduce inequities.

Rachel S. Gross, MD, MS is an Assistant Professor of Pediatrics at NYU Grossman School of Medicine. Her research interests include examining how poverty-related risks like material hardships and high psychosocial stressors influence disparities in obesity and children’s health.

Nancy E. Reichman, PhD is a Professor of Pediatrics at Robert Wood Johnson Medical School. Her research interests include understanding linkages between socioeconomic status and health as well as effects of public policies on child and family well-being.

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Conflicts of Interest: The authors have no conflicts of interest nor financial relationships relevant to this article to disclose.

REFERENCES

  1. Adamkiewicz G, Spengler JD, Harley AE, Stoddard A, Yang M, Alvarez-Reeves M, & Sorensen G (2014). Environmental Conditions in Low-Income Urban Housing: Clustering and Associations With Self-Reported Health. American Journal of Public Health, 104(9), 1650–1656. 10.2105/AJPH.2013.301253 [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Anyigbo C, Jimenez ME, & Sosnowski DW (2022). Association Between Adverse Childhood Experiences at Age 5 Years and Healthcare Utilization at Age 9 Years. The Journal of Pediatrics, 246, 227–234.e2. 10.1016/j.jpeds.2022.04.006 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Balaji AB, Claussen AH, Smith DC, Visser SN, Morales MJ, & Perou R (2007). Social Support Networks and Maternal Mental Health and Well-Being. Journal of Women’s Health, 16(10), 1386–1396. 10.1089/jwh.2007.CDC10 [DOI] [PubMed] [Google Scholar]
  4. Blumberg SJ, Bialostosky K, Hamilton WL, & Briefel RR (1999). The effectiveness of a short form of the Household Food Security Scale. American Journal of Public Health, 89(8), 1231–1234. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bratsch-Hines ME, Mokrova I, & Vernon-Feagans L (2015). Child care instability from 6 to 36 months and the social adjustment of children in prekindergarten. Early Childhood Research Quarterly, 30, 106–116. 10.1016/j.ecresq.2014.09.002 [DOI] [Google Scholar]
  6. Charrois J, Côté SM, Japel C, Séguin JR, Paquin S, Tremblay RE, & Herba CM (2017). Child-care quality moderates the association between maternal depression and children’s behavioural outcome. Journal of Child Psychology and Psychiatry, 58(11), 1210–1218. 10.1111/jcpp.12764 [DOI] [PubMed] [Google Scholar]
  7. Chatterji P, Markowitz S, & Brooks-Gunn J (2013). Effects of early maternal employment on maternal health and well-being. Journal of Population Economics, 26(1), 285–301. 10.1007/s00148-012-0437-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Chung EK, Siegel BS, Garg A, Conroy K, Gross RS, Long DA, Lewis G, Osman CJ, Jo Messito M, Wade R, Shonna Yin H, Cox J, & Fierman AH (2016). Screening for social determinants of health among children and families living in poverty: A guide for clinicians. Current Problems in Pediatric and Adolescent Health Care, 46(5), 135–153. 10.1016/j.cppeds.2016.02.004 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Cooper CE, McLanahan SS, Meadows SO, & Brooks-Gunn J (2009). Family Structure Transitions and Maternal Parenting Stress. Journal of Marriage and Family, 71(3), 558–574. 10.1111/j.1741-3737.2009.00619.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Crear-Perry J, Correa-de-Araujo R, Lewis Johnson T, McLemore MR, Neilson E, & Wallace M (2021). Social and Structural Determinants of Health Inequities in Maternal Health. Journal of Women’s Health, 30(2), 230–235. 10.1089/jwh.2020.8882 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Dauner KN, Wilmot NA, & Schultz JF (2015). Investigating the temporal relationship between individual-level social capital and health in fragile families. BMC Public Health, 15(1), 1130. 10.1186/s12889-015-2437-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Delaney ME (2017). The Relationship Between Counseling, Social Support, and Depression in Mothers of Fragile Families. Journal of Mental Health Counseling, 39(4), 320–334. 10.17744/mehc.39.4.04 [DOI] [Google Scholar]
  13. Fragile families and child wellbeing study: Data and documentation. (n.d.). Princeton University. Retrieved September 8, 2022, from https://fragilefamilies.princeton.edu/documentation [Google Scholar]
  14. French VA, Werner JL, Feng EJH, Latimer RA, Wolff SF, & Wieneke CL (2022). Provision of Onsite Childcare in US Academic Health Centers: What Factors Make a Difference? Women’s Health Issues: Official Publication of the Jacobs Institute of Women’s Health, 32(1), 74–79. 10.1016/j.whi.2021.08.005 [DOI] [PubMed] [Google Scholar]
  15. Geyer J, Haan P, & Wrohlich K (2015). The effects of family policy on maternal labor supply: Combining evidence from a structural model and a quasi-experimental approach. Labour Economics, 36, 84–98. 10.1016/j.labeco.2015.07.001 [DOI] [Google Scholar]
  16. Goodman JM, Williams C, & Dow WH (2021). Racial/Ethnic Inequities in Paid Parental Leave Access. Health Equity, 5(1), 738–749. 10.1089/heq.2021.0001 [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Gordon RA, Kaestner R, & Korenman S (2008). Child Care and Work Absences: Trade-Offs by Type of Care. Journal of Marriage and Family, 70(1), 239–254. 10.1111/j.1741-3737.2007.00475.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Grice MM, McGovern PM, Alexander BH, Ukestad L, & Hellerstedt W (2011). Balancing work and family after childbirth: A longitudinal analysis. Women’s Health Issues: Official Publication of the Jacobs Institute of Women’s Health, 21(1), 19–27. 10.1016/j.whi.2010.08.003 [DOI] [PubMed] [Google Scholar]
  19. Gross RS, Mendelsohn AL, & Messito MJ (2018). Additive effects of household food insecurity during pregnancy and infancy on maternal infant feeding styles and practices. Appetite, 130, 20–28. 10.1016/j.appet.2018.07.016 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Ha Y, Collins ME, & Martino D (2015). Child care burden and the risk of child maltreatment among low-income working families. Children and Youth Services Review, 59, 19–27. 10.1016/j.childyouth.2015.10.008 [DOI] [Google Scholar]
  21. Hager ER, Quigg AM, Black MM, Coleman SM, Heeren T, Rose-Jacobs R, Cook JT, Cuba S. A. E. de, Casey PH, Chilton M, Cutts DB, Meyers AF, & Frank DA (2010). Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics, 126(1), e26–e32. 10.1542/peds.2009-3146 [DOI] [PubMed] [Google Scholar]
  22. Harknett K, & Knab J (2007). More Kin, Less Support: Multipartnered Fertility and Perceived Support Among Mothers. Journal of Marriage and Family, 69(1), 237–253. 10.1111/j.1741-3737.2006.00356.x [DOI] [Google Scholar]
  23. Harknett KS, & Hartnett CS (2011). Who Lacks Support and Why? An Examination of Mothers’ Personal Safety Nets. Journal of Marriage and Family, 73(4), 861–875. 10.1111/j.1741-3737.2011.00852.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Harknett K, Schneider D, & Irwin V (2021). Improving health and economic security by reducing work schedule uncertainty. Proceedings of the National Academy of Sciences of the United States of America, 118(42), e2107828118. 10.1073/pnas.2107828118 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Hedges A, Corman H, Noonan K, & Reichman NE (2021). Gestational Age at Term and Educational Outcomes at Age Nine. Pediatrics, 148(2), e2020021287. 10.1542/peds.2020-021287 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Johnson AD, & Padilla CM (2019). Childcare Instability and Maternal Depressive Symptoms: Exploring New Avenues for Supporting Maternal Mental Health. Academic Pediatrics, 19(1), 18–26. 10.1016/j.acap.2018.05.006 [DOI] [PubMed] [Google Scholar]
  27. Kessler RC, Andrews G, Mroczek D, Ustun B, & Wittchen H-U (1998). The World Health Organization Composite International Diagnostic Interview short-form (CIDI-SF). International Journal of Methods in Psychiatric Research, 7(4), 171–185. 10.1002/mpr.47 [DOI] [Google Scholar]
  28. Letourneau N, Dewey D, Kaplan BJ, Ntanda H, Novick J, Thomas JC, Deane AJ, Leung B, Pon K, Giesbrecht GF, & Team, the Ap. S. (2019). Intergenerational transmission of adverse childhood experiences via maternal depression and anxiety and moderation by child sex. Journal of Developmental Origins of Health and Disease, 10(1), 88–99. 10.1017/S2040174418000648 [DOI] [PubMed] [Google Scholar]
  29. Liang LA, Berger U, & Brand C (2019). Psychosocial factors associated with symptoms of depression, anxiety and stress among single mothers with young children: A population-based study. Journal of Affective Disorders, 242, 255–264. 10.1016/j.jad.2018.08.013 [DOI] [PubMed] [Google Scholar]
  30. Lin C-H, & Wiley AR (2017). The relationship of relative child care and parenting behaviors in fragile families. Children and Youth Services Review, 82, 130–138. 10.1016/j.childyouth.2017.09.022 [DOI] [Google Scholar]
  31. Luhr S, Schneider D, & Harknett K (2022). Parenting Without Predictability: Precarious Schedules, Parental Strain, and Work-Life Conflict. RSF: The Russell Sage Foundation Journal of the Social Sciences, 8(5), 24–44. 10.7758/RSF.2022.8.5.02 [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. McGee DL, Liao Y, Cao G, & Cooper RS (1999). Self-reported Health Status and Mortality in a Multiethnic US Cohort. American Journal of Epidemiology, 149(1), 41–46. 10.1093/oxfordjournals.aje.a009725 [DOI] [PubMed] [Google Scholar]
  33. McGonagle KA, Schoeni RF, Sastry N, & Freedman VA (2012). The Panel Study of Income Dynamics: Overview, Recent Innovations, and Potential for Life Course Research. Longitudinal and Life Course Studies, 3(2), 188. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Miilunpalo S, Vuori I, Oja P, Pasanen M, & Urponen H (1997). Self-rated health status as a health measure: The predictive value of self-reported health status on the use of physician services and on mortality in the working-age population. Journal of Clinical Epidemiology, 50(5), 517–528. 10.1016/S0895-4356(97)00045-0 [DOI] [PubMed] [Google Scholar]
  35. Müller K-U, & Wrohlich K (2020). Does subsidized care for toddlers increase maternal labor supply? Evidence from a large-scale expansion of early childcare. Labour Economics, 62, 101776. 10.1016/j.labeco.2019.101776 [DOI] [Google Scholar]
  36. Nærde A, Tambs K, Mathiesen KS, Dalgard OS, & Samuelsen SO (2000). Symptoms of anxiety and depression among mothers of pre-school children: Effect of chronic strain related to children and child care-taking. Journal of Affective Disorders, 58(3), 181–199. 10.1016/S0165-0327(99)00119-6 [DOI] [PubMed] [Google Scholar]
  37. North A (2021, March 25). The precarious state of American child care. Vox. https://www.vox.com/2021/3/25/22345214/child-care-covid-19-daycare-american-rescue-plan [Google Scholar]
  38. Parolin Z, & Lee EK (2022). Economic Precarity among Single Parents in the United States during the COVID-19 Pandemic. The Annals of the American Academy of Political and Social Science, 702(1), 206–223. 10.1177/00027162221122682 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Petts RJ, Carlson DL, & Pepin JR (2021). A gendered pandemic: Childcare, homeschooling, and parents’ employment during COVID-19. Gender, Work & Organization, 28(S2), 515–534. 10.1111/gwao.12614 [DOI] [Google Scholar]
  40. Pilarz AR, & Hill HD (2014). Unstable and Multiple Child Care Arrangements and Young Children’s Behavior. Early Childhood Research Quarterly, 29(4), 471–483. 10.1016/j.ecresq.2014.05.007 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Pilarz AR, & Hill HD (2017). Child-Care Instability and Behavior Problems: Does Parenting Stress Mediate the Relationship? Journal of Marriage and the Family, 79(5), 1353–1368. 10.1111/jomf.12420 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Points D (2023). Toward a Working Future (Childcare Innovation Lab, Women.Nyc). New York City Economic Development Corporation. https://edc.nyc/sites/default/files/2023-03/Childcare-Toolkit.pdf [Google Scholar]
  43. Reichman NE, Teitler JO, Garfinkel I, & McLanahan SS (2001). Fragile Families: Sample and design. Children and Youth Services Review, 23(4), 303–326. 10.1016/S0190-7409(01)00141-4 [DOI] [Google Scholar]
  44. Reid JL, Melvin SA, Kagan SL, & Brooks-Gunn J (2019). Building a unified system for universal Pre-K: The case of New York City. Children and Youth Services Review, 100, 191–205. 10.1016/j.childyouth.2019.02.030 [DOI] [Google Scholar]
  45. Reid L (2000). The Consequences of Food Insecurity for Child Well-Being: An Analysis of Children’s School Achievement, Psychological Well-Being, and Health. Northwestern University/University of Chicago Joint Center for Poverty Research, JCPR Working Papers. [Google Scholar]
  46. Ronis SD, Masotya M, Birkby GM, & Stange KC (2022). Screening Families in Primary Care for Social and Economic Needs: Patients’ Urgency and Activation for Social Care Navigation. American Journal of Preventive Medicine, 63(3 Suppl 2), S122–S130. 10.1016/j.amepre.2022.03.036 [DOI] [PubMed] [Google Scholar]
  47. Schor EL (2018). Maternal Depression Screening as an Opening to Address Social Determinants of Children’s Health. JAMA Pediatrics, 172(8), 717–719. 10.1001/jamapediatrics.2018.1038 [DOI] [PubMed] [Google Scholar]
  48. Sokol R, Austin A, Chandler C, Byrum E, Bousquette J, Lancaster C, Doss G, Dotson A, Urbaeva V, Singichetti B, Brevard K, Wright ST, Lanier P, & Shanahan M (2019). Screening Children for Social Determinants of Health: A Systematic Review. Pediatrics, 144(4). 10.1542/peds.2019-1622 [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Solomon-Fears C (2014). Nonmarital Births: An Overview. Congressional Research Service. [Google Scholar]
  50. Stuff JE, Casey PH, Szeto KL, Gossett JM, Robbins JM, Simpson PM, Connell C, & Bogle ML (2004). Household Food Insecurity Is Associated with Adult Health Status. The Journal of Nutrition, 134(9), 2330–2335. 10.1093/jn/134.9.2330 [DOI] [PubMed] [Google Scholar]
  51. Wachs TD, Black MM, & Engle PL (2009). Maternal Depression: A Global Threat to Children’s Health, Development, and Behavior and to Human Rights. Child Development Perspectives, 3(1), 51–59. 10.1111/j.1750-8606.2008.00077.x [DOI] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

1
NIHMS1938050-supplement-1.pdf (80KB, pdf)

RESOURCES