By exploring experiences of female participants with young children who received care at a safety-net hospital system during the COVID-19 pandemic, we learned several important lessons. First, lack of childcare exacerbated disruptions in access to healthcare during the COVID-19 pandemic. Second, childcare and parenthood were inextricably linked with participants’ health, in that their health was both driving and impacted by caregiving and household needs. Finally, the interplay of childrearing and household demands with health led to cumulative stressors and increased emotional distress.
For participants in our study, access to healthcare was disrupted not only due to generalizable difficulties obtaining face-to-face appointments during the pandemic, but specifically due to difficulty arranging childcare during health appointments. Similar to findings noted by Henly and Lyons, who explored how low-income mothers of children < 13 years negotiated employment demands and childcare needs in LA County, CA [2], women in our study often relied on informal arrangements for childcare, which were not consistently dependable sources of childcare. Moreover, visitor restriction policies in place during the pandemic exacerbated the limited childcare options that participants faced when arranging healthcare appointments. If their informal childcare arrangements fell through and they could no longer bring their children with them to their appointments, participants were forced to make difficult choices, such as canceling or missing their appointment or putting their child in non-ideal situations. This led to a sense of frustration and, at times, feeling that it was pointless to try to reschedule medical appointments, given that lack of childcare was an ongoing barrier to accessing healthcare.
This finding underscores the need for health systems to acknowledge childcare as a barrier to healthcare, particularly for women with young children in safety-net health systems. At minimum, clinics serving vulnerable populations should ensure that logistical barriers to attending appointments are assessed, including the need and ability to arrange dependent care. After noting that lack of childcare was a major reason for missed and delayed appointments at Parkland, Parkland’s Center for Innovation and Value addressed childcare as a barrier to care through its partnership with community-based organization MIN to provide no-cost on-site childcare during medical appointments. Our next steps will be to evaluate healthcare-related outcomes from this novel service, including whether this intervention has led to a reduction in missed or delayed appointments.
In addition to demonstrating the intersection between childcare and access to healthcare, our findings also suggest that childcare is inextricably linked with participants’ health overall. This may have been especially true for this study’s participants given that they were all women with young children. Many participants noted that household and childcare duties were traditionally women’s responsibilities regardless of whether they had a domestic partner, highlighting the disproportionate caregiving burden for women in the U.S. [13]. Women in our study were unable to optimally address their health issues despite wanting to do so and being motivated to do so, due to the need to manage competing priorities at home, including childcare, often with minimal support. Our findings underscore the need for additional support systems that address family and social context to help patients, especially women with young children, to optimally manage their health [8, 13, 19]. The Parkland-MIN collaboration to subsidize an on-site childcare center provides one example of a social care intervention that provides this additional support in the context of the health system.
For women in our study, the interplay of childcare, household responsibilities and health issues led to cumulative stressors, which was overwhelming and contributed to emotional distress. Prior studies have similarly found that parents have been facing high levels of psychological distress and exhaustion during the COVID-19 pandemic, in part due to prolonged social isolation and increased care demands [13, 20]. Our findings add to this by highlighting the role that managing one’s own physical health plays in exacerbating emotional distress for mothers. Although participants in our study practiced coping skills such as time management or re-prioritizing tasks, they still found it difficult to optimally manage their health issues and felt overwhelmed. This is significant because it suggests that existing resources and strategies to manage distress may be insufficient [9, 20–22]. Our findings demonstrate the additional need for structural support systems to reduce the burden on mothers with young children. This includes not only providing early identification and referrals for mental health services but also advocating for expanded childcare assistance policies, such as childcare subsidies and paid family leave, at the state and federal levels [13, 19].
Limitations of our study include use of convenience sampling, which may have introduced sampling bias such that participants may have been more likely to be included in our study based on unmeasured characteristics. Strengths of this study include the generation of rich, descriptive data and the focus on a vulnerable population subject to health disparities.