Division of General Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York, New York.
Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York, New York.
Womens Health Issues. 2024 Mar-Apr;34(2):115-124. doi: 10.1016/j.whi.2023.10.002. Epub 2023 Nov 17.
We examined prospective associations between early childcare precarity, or the security and reliability of childcare arrangements, and subsequent maternal health.
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, and 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.
Early inadequate childcare was associated with higher odds of later poor maternal overall health (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.11-2.41). All early childcare precarity measures were associated with higher 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]; and inadequate childcare [aOR, 1.75; 95% CI, 1.22-2.51]). Emergency childcare support was associated with lower odds of adverse maternal health outcomes (poor overall health [aOR, 0.65; 95% CI, 0.48 to 0.88]; depression [aOR, 0.73; 95% CI, 0.54 to 0.99]; and parenting stress [B -0.45; 95% CI, -0.80 to -0.10]). Prolonged experiences had stronger associations with maternal health than shorter experiences.
Early childcare precarity has long-term adverse associations with maternal health, and emergency childcare support seems to be favorable for maternal health. These findings highlight childcare precarity as a social determinant of women's health for researchers, clinicians, and decision-makers.
我们研究了早期儿童保育不稳定（即儿童保育安排的安全性和可靠性）与随后的产妇健康之间的前瞻性关联。
我们对未来家庭和儿童福利研究中 2836 名儿童的母亲的调查回复进行了二次分析。我们评估了以下儿童保育措施：不安全的儿童保育、因儿童保育不安全而错过工作、儿童保育不足和紧急儿童保育支持。当指数儿童年龄为 3 岁时，我们使用具有稳健标准误差的线性和逻辑回归模型来检查这些措施与儿童 9 岁时的母亲健康结果（整体健康、抑郁和育儿压力）之间的关联。然后，我们检查了儿童年龄为 1 岁和 3 岁时跨儿童保育措施的累积经验对母亲健康结果的影响。
早期儿童保育不足与母亲后期整体健康状况较差的几率较高相关（调整后的优势比 [aOR]，1.64；95%置信区间 [CI]，1.11-2.41）。所有早期儿童保育不稳定措施都与母亲抑郁的几率较高相关（不安全的儿童保育 [aOR，1.64；95% CI，1.23-2.18]；不安全的儿童保育和错过工作 [aOR，1.58；95% CI，1.13-2.22]；和儿童保育不足 [aOR，1.75；95% CI，1.22-2.51]）。紧急儿童保育支持与不良产妇健康结果的几率较低相关（整体健康状况不佳 [aOR，0.65；95% CI，0.48-0.88]；抑郁 [aOR，0.73；95% CI，0.54-0.99]；和育儿压力 [B-0.45；95% CI，-0.80 至 -0.10]）。长期的经验与母亲健康的关联比短期的经验更强。
早期儿童保育不稳定与产妇健康有长期的不利关联，紧急儿童保育支持似乎对产妇健康有利。这些发现突显了儿童保育不稳定作为研究人员、临床医生和决策者的女性健康的社会决定因素。
