Abstract
This survey study evaluates childcare-related employment disruptions before and after COVID-19, accounting for child special health care needs status and sociodemographic factors.
Parents and caregivers have struggled to arrange childcare throughout the COVID-19 pandemic,1 and early evidence suggests negative effects on caregiver employment.2 However, analyses have not compared pre–COVID-19 and post–COVID-19 periods or stratified estimates by children’s health care needs. Forgoing employment is more common among caregivers of children with special health care needs (CSHCN).3 We estimate childcare-related employment disruptions before and after COVID-19, accounting for CSHCN status and sociodemographic factors.
Methods
The study sample consisted of 49 546 children 5 years and younger in the 2016 to 2020 waves of the National Survey of Children’s Health, a nationally representative US-based survey.4 The 2020 wave was fielded from July 2020 to January 2021, after the COVID-19 pandemic began in the US. We estimated the yearly percentage of CSHCN and non-CSHCN with a family member who “during the past 12 months…[had] to quit a job, not take a job, or greatly change [their] job because of problems with child care for this child.”4 Although the 12-month period covers time prior to COVID-19, we expect any bias would be toward the null. We compared estimates for 2020 with 2019 and with pooled 2016 to 2019 estimates using adjusted Wald tests.
We then assessed whether caregivers of CSHCN had greater childcare-related employment disruption using a multivariable logistic model. Covariates were survey year and social and demographic factors hypothesized to affect caregiver employment, childcare needs, and childcare access.1 We hypothesized that odds of childcare-related employment disruption would be higher in 2020 and among caregivers of CSHCN and that CSHCN would see greater increases in odds of disruption during 2020 than non-CSHCN. We estimated adjusted odds ratios (aORs) and 95% CIs and defined statistical significance as a 2-sided P < .05. Stata version 16.1 (StataCorp) was used for all analyses. The University of North Carolina Institutional Review Board deemed this study exempt from review.
Results
In 2020, 12.6% (95% CI, 11.2-14.1) of all children 5 years and younger had caregivers with a childcare-related employment disruption (Figure 1), which was larger than 9.4% (95% CI, 8.0-10.9) of children in 2019 (P = .002) and 8.9% (95% CI, 8.3-9.6) of children in the pooled 2016 to 2019 sample (P < .001). Nearly one-quarter of CSHCN had caregivers with childcare-related employment disruption in 2020 (24.8%; 95% CI, 19.3-31.3), which was larger than the 11.1% (95% CI, 9.7-12.6) of non-CSHCN in 2020 (P < .001), not significantly different from CSHCN in 2019 (17.7%; 95% CI, 13.3-23.3; P = .08), and larger than the pooled 2016 to 2019 estimate for CSHCN (17.8%; 95% CI, 15.5-20.3; P = .03).
Figure 1. Childcare-Related Employment Disruption in 2020.
The estimated percentage of US children with caregivers experiencing an employment disruption because of childcare is shown by year and child special health care needs (CSHCN) status. A total of 48 805 records were included after removing 741 records with missing values for any variable (listwise deletion). Horizontal dashed lines show the pooled 2016 to 2019 estimate for CSHCN, non-CSHCN, and overall. Estimates and 95% CIs are adjusted for the complex survey design. Error bars indicate 95% CIs.
After adjusting for potential confounders, CSHCN had 2.7-fold higher odds of having a caregiver with employment disruption than non-CSHCN (aOR, 2.73; 95% CI, 2.25-3.31; P < .001), while, in 2020, children overall had 1.4-fold higher odds than in 2019 (aOR, 1.41; 95% CI, 1.13-1.76; P = .002) (Figure 2). The interaction of 2020 and CSHCN status was not significant (aOR, 1.06; 95% CI, 0.71-1.60; P = .75). Male respondent sex was associated with lower odds of childcare-related employment disruption. Children 2 years or younger as well as Black, Asian, or multiracial children had higher odds of having a caregiver with employment disruption, as did those living in low-income families and in families not headed by 2 married parents.
Figure 2. Associations With Childcare-Related Employment Disruptions.
Adjusted odds ratios (aORs) and 95% CIs were estimated with multivariable logistic regression, adjusting for all other variables, the complex survey design, and the multiply imputed family income estimates. A total of 48 018 records were included after removing 1528 records with missing values for any variable (listwise deletion). For each variable, the modal category was taken as the base level and is indicated by an aOR of 1. CSCHN indicates children with special health care needs; FPL, federal poverty limit.
aP < .01.
bEach parent/caregiver reported their child’s race and ethnicity and could select multiple races. The other category includes American Indian and Alaska Native (all years) and the option “some other race alone” (included on the 2016 to 2018 forms).
cP < .05.
Discussion
Childcare-related employment disruption increased by approximately one-third in 2020 and was higher among caregivers for CSHCN, low-income families, and children from racial and ethnic minority groups. Parents’ job loss can lead to loss of insurance coverage for their children5 and may be directly detrimental to children’s health.6 Without increased access to childcare, caregivers may struggle to meet the basic human and health care needs of their children.
References
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