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Title V Technical Assistance Meeting

 When Access to Childcare Impacts a Woman’s Ability to Care for Herself

How Lack of Child Care Can Endanger the Health of Mothers

By Andrea Palmer
Illinois Department of Public Health – Maternal and Child Health

"Ann," an African-American woman in her early 30s, went to the emergency room 10 weeks after having a healthy baby experiencing shortness of breath and swelling in her legs. At the hospital, she was diagnosed with a severe cardiac disease and was instructed to follow up with a cardiologist in the next 10 days.

About two weeks later, Ann went to the cardiologist, bringing her newborn with her. Her cardiologist, having noticed Ann had gained weight since her visit to the emergency room, ordered lab work and sent her home to wait for the results. The following day, the nurse from the cardiologist's office called Ann to say her lab results showed that her condition was life-threatening and that she should go to the emergency room right away for further evaluation. Ann declined.

The nurse called Ann back an hour later to check on her and learned that Ann's symptoms were worsening.  The nurse told Ann to go to the emergency room immediately. Ann responded that she couldn't because she had no one to watch her baby. She planned to take her meds and "see" if she felt better. Within a couple of hours, Ann was brought into the emergency room in critical condition. She passed away that night.

According to the Healthy People 2020 national benchmarks, "access to comprehensive, quality health care services is important for promoting and maintaining health." Healthy People 2020 identifies multiple barriers to access including the high cost of care, inadequate or no insurance, lack of availability of services, and lack of culturally competent care.[i] One rarely identified barrier to health care that affects many women of childbearing age is the lack of child care. The Illinois Department of Public Health's  Maternal and Child Health Services Title V program is looking at the impact of lack of childcare for prenatal care and childbirth on health outcomes, in collaboration with the Illinois Department of Human Services Child Care Assistance program, the University of Illinois School of Public Health, and Access Health Network's Westside Healthy Start program, as part of the AMCHP Infant Mortality CoIIN Social Determinants of Health Initiative (SDoH CoIIN).

In a recent focus group with Illinois' Westside Healthy Start program case managers, we learned that women, particularly those with young children, "constantly" express a concern about their ability to find child care for medical appointments.

According to the administrators of Illinois' Administrative Perinatal Centers, (10 highly-resourced birthing hospitals – each serving as a hub for consultation, training, technical assistance, and support to a network of birthing hospitals), it's common knowledge that the lack of child care for childbirth is an issue for many mothers. They report that women often arrive at the hospital to deliver their babies with their other young children in tow, stating that "someone is coming to get them soon." According to the Administrators, "soon" can be a few minutes or a few hours.

At a recent Westside Healthy Start Community Action Network meeting, after hearing an update on this work, a young woman approached Illinois' maternal and child health director and expressed that she was glad that Illinois was looking into the impact of child care on access to health services. She described her own serious health condition, which requires frequent ultrasounds and hospital visits for pain management. She indicated that she often has to make the decision to stay home and bear the pain so severe she can't sit up, because she has no one to care for her four- and five-year-olds. She thanked us and said that there are many other women like her who feel like they have no voice. Illinois is inviting her to represent the state on the SDoH CoIIN team.

One challenge Illinois faces is quantifying the scope of the problem. Anecdotally, "everyone" knows that the lack of child care is a barrier to access to health care. But what does that mean? Next steps include developing a conceptual map that outlines the linkage between the availability of childcare and improved health outcomes, identifying strategies for quantifying the breadth of the issue, and brainstorming potential solutions.

This article was a collaborative effort by the Illinois Social Determinants of Health CoIIN. The members include 

  • Andrea Palmer, Illinois Department of Public Health – Maternal and Child Health
  • Timika Anderson Reeves, Access Community Health Network, West Side Healthy Start Project Director
  • Arden Handler, University of Illinois School of Public Health – School of Public Health
  • Barb Payne, Illinois Department of Human Services – Child Care Assistance Program
  • Shannon Lightner, Illinois Department of Public Health – Office of Women's Health
  • Kelly Vrablic – Illinois Department of Public Health –Maternal and Child Health
  • Roselyn Harris – Illinois Department of Human Services- Child Care Assistance Program
  • Amanda Bennett, Centers for Disease Control and Prevention – Senior Epidemiologist
  • Ashley Horne, Council of State and Territorial Epidemiologist (CSTE) Fellow

 [1] ODPHP. (2018, May 21). Access to Health Services. Retrieved from Healthy People 2020: