Abstract
Purpose
Within a multi-state Collaborative Improvement and Innovation Network addressing the social determinants of health during 2017–2020, the Illinois Department of Public Health led an exploratory project to understand how the availability of child care affects maternal health care utilization. The project assessed whether lack of child care was a barrier to perinatal health care utilization and gathered information on health facility practices, resources, and policies related to child care
Description
TWe surveyed (1) birthing hospitals (n = 98), (2) federally qualified health centers (FQHCs) (n = 40), and (3) a convenience sample of postpartum persons (n = 60).
Assessment
Each group reported that child care concerns negatively affect health care utilization (66% of birthing hospitals, 50% of FQHCs, and 32% of postpartum persons). Among postpartum persons, the most common reported reason for missing a visit due to child care issues was “not feeling comfortable leaving my child(ren) in the care of others” (22%). The most common child care resource reported by facilities was “staff watching children” (53% of birthing hospitals, 75% of FQHCs); however, most did not have formal child care policies or dedicated space for children. Fewer than half of FQHCs (43%) discussed child care at the first prenatal visit.
Conclusion
The project prompted the Illinois Title V program to add a child care-related strategy to their 2021–2025 Action Plan, providing opportunity for further examination of practices and policies that could be implemented to reduce child care barriers to perinatal care. Systematically addressing child care in health care settings may improve health care utilization among birthing/postpartum persons.
Significance
What is already known on this subject? Child care is a social determinant of health affecting parents’ ability to seek medical services. Research has shown that child care is an important factor affecting health care utilization during the perinatal period (prenatal, labor and delivery, and postpartum).
What this study adds? The results of this project indicate that lack of child care is a barrier to health care utilization for some Illinois residents who are pregnant or up to one year postpartum. However, child care resources reported by health care facilities were limited and most facilities reported not having formal child care policies in place.
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Data Availability
Data are not available publicly; survey instruments are available from corresponding author upon request.
Code Availability
Available from corresponding author upon request.
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Acknowledgements
The authors would like to thank the 10 perinatal network administrators for facilitating the birthing hospital surveys, the Illinois Primary Health Care Association for facilitating the FQHC survey, and staff members from Access Community Health Network, Champaign-Urbana Public Health District, and Southern Illinois Healthcare Foundation, Inc. for facilitating the survey of postpartum women.
Funding
Funding for this project was provided in whole or in part by the Association of Maternal & Child Health Programs (AMCHP) pursuant to its Cooperative Agreement #UF3MC31237 with the Health Resources and Services Administration (HRSA). This quality improvement project was considered non-research and did not need IDPH Institutional Review Board approval. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
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This manuscript includes six authors, all of whom contributed substantially to this project. Our contributions are as follows: AH: project administration (co-lead); conceptualization (equal); methodology (supporting); formal analysis (lead); writing—original draft (lead); writing- review and editing (equal). TA-R: project administration (co-lead); conceptualization (equal); writing- review and editing (equal). ACB: project administration (supporting); conceptualization (equal); methodology (lead); writing- review and editing (equal). SL: project administration (supporting); conceptualization (equal); writing- review and editing (equal). KDM: project administration (supporting); conceptualization (equal); writing- review and editing (equal). AH: conceptualization (equal); methodology (supporting); writing—original draft (supporting); writing- review and editing (equal). All authors approved the final manuscript as submitted.
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The project did not require approval from the Illinois Department of Public Health’s Institutional Review Board because it was non-research public health practice.
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Holicky, A., Anderson-Reeves, T., Bennett, A.C. et al. Child Care as a Barrier to Perinatal Health Care in Illinois. Matern Child Health J 28, 221–228 (2024). https://doi.org/10.1007/s10995-023-03784-4
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DOI: https://doi.org/10.1007/s10995-023-03784-4