Child Care Assistance Research Articles

Payment rates and the stability of subsidized child care: Evidence from Minnesota's child care assistance program

Participation instability has been recognized as a major challenge in state child care subsidy programs and may undermine the benefits of these programs to the children and families they are intended to support. Payment rates – the maximum amounts that state subsidy programs will pay for child care in a given period – directly determine which providers are affordable to subsidized consumers and what schedules of care they can afford. Payment rates also affect the resources available to providers and their incentive to accept subsidies. This study examines the effect of payment rate increases on the stability of participation in child care subsidies and the stability of subsidized care arrangements. We study the impact of a major update to payment rates for the Minnesota Child Care Assistance Program, using monthly child- and provider-level administrative data and a quasi-experimental design. We implement a regression discontinuity design built on the state's method of setting county rates. We find strong evidence that higher subsidy payment rates lead to more stable subsidy participation and care arrangements. Thus, state-determined payment rates are a critical policy lever that affects access to care.

State Social Expenditures and Preterm Birth and Low Birth Weight in the US

Adverse birth outcomes in the US, including preterm birth and low birth weight, are strongly tied to socioeconomic disadvantage and disproportionately impact infants of Black mothers. Increasing investments in social programs represents a potential policy approach to addressing disparities in birth outcomes. To examine state-level associations of government expenditures on social programs with rates of preterm birth and low birth weight both overall and by race. This cross-sectional, ecological study was conducted among liveborn infants in the 50 US states between January 1, 2011, and December 31, 2019. Data analysis was performed from May 2022 to May 2024. Yearly state and local government expenditures per low-income person on social programs in the following categories: state refundable Earned Income Tax Credit; cash assistance; childcare assistance; housing and community development; and public health. Yearly state-level rates of preterm birth (gestational age <37 weeks) and low birth weight (<2500 g). From January 1, 2011, to December 31, 2019, there were 35.1 million live births in the US, of which 3.4 million (9.8%) were preterm and 2.8 million (8.1%) were low birth weight. Median (IQR) state social expenditures per low-income person were $1546 ($1074-$2323). Greater total state social expenditures were associated with lower overall rates of preterm birth (adjusted prevalence ratio [aPR] for every increase of $1000 per low-income person, 0.99; 95% CI, 0.97-0.999) but not with overall rates of low birth weight. In secondary analyses, greater state social expenditures were associated with lower preterm birth rates for infants of Black mothers (aPR, 0.96; 95% CI, 0.92-0.999). Greater state expenditures specifically on cash assistance (aPR, 0.64; 95% CI, 0.43-0.94) and housing and community development (aPR, 0.91; 95% CI, 0.84-0.98) were associated with lower preterm birth rates for infants of Black mothers. In this cross-sectional, ecological study, greater state-level expenditures on social programs were associated with reduced rates of preterm birth, particularly for infants of Black mothers. State and local governments may consider bolstering investments in cash assistance and housing and community development to address maternal and infant health disparities.

Family Structure and Childcare in Sub-Saharan Africa

Extended family members can help women with childcare. Using data from 32 sub-Saharan African countries, we find that the prevalence of nuclear families relative to extended families is increasing over time. The overall share of nuclear families is 56 percent and is higher in rural areas. We then use detailed time-use data on childcare provision from 110 rural villages in the Democratic Republic of the Congo. We find that while women do receive childcare assistance from their extended family, they provide 84 percent of childcare hours. These results highlight the need for formal childcare provision, particularly in rural areas.

Organization and quality of care in childbirth in private for-profit maternity units in France: Risks of the deprofessionalization of midwives

ObjectiveIn France, in 2007–2009, the risk of peripartum maternal mortality, especially the one due to hemorrhage, was higher in the private for-profit maternity units than in university maternity units. Our research, a component of the MATORG project, aimed to characterize the organization of care around childbirth in these private clinics to analyze how it might influence the quality and safety of care. Material and methodsWe conducted a qualitative survey in 2018 in the maternity units of two private for-profit clinics in the Paris region, interviewing 33 staff members (midwives, obstetricians, anesthesiologists, childcare assistants and managers) and observing in the delivery room for 20 days. The perspective of the sociology of organizations guided our data analysis. Findings/resultsOur study distinguished three principal risk factors for the safety of care in maternity clinics. The division of labor among healthcare professionals threatens the maintenance of midwives' competencies and makes it difficult for these clinics to keep midwives on staff. The mode of remuneration of both midwives and obstetricians incentivizes overwork by both, inducing fatigue and decreasing vigilance. Finally the clinical decision-making of some obstetricians is not collegial and creates conflicts with midwives, who criticize the technicization of childbirth. Some demotivated midwives no longer consider themselves responsible for patients' safety. ConclusionsThe organization of work in private maternity units can put the safety of care around childbirth at risk. The division of labor, staff scheduling/planning, and a lack of collegiality in decision-making increase the risk of deprofessionalizing midwives.

Cultural Influences on Maternal and Child Health Practices. Insights from Juang Tribal Community of Odisha

Inside the Juang tribal group, complex interaction exists between cultural influences and the methods that are used to preserve mother and child health. Because of its location in a distant and culturally diverse region, the Juang community has developed its own distinctive customs, beliefs, and practices, all of which have a substantial influence on the health and happiness of mothers and children. This study provides light on the cultural determinants that influence mother and child health outcomes by conducting an in-depth investigation with the community. An investigation of the traditional birth customs, nutritional habits, and indigenous beliefs toward healthcare, and superstitions that are widespread in the Juang tribal group is presented in this research. The availability of contemporary medical services and their usage, and the part that extended families and community support networks play in the provision of maternal and child care assistance. The usage of traditional medications and herbal cures is also investigated, which offers vital insights into the dynamic relationship that exists between traditional and modern approaches to healthcare.

Factors Influencing Parenting Stress in Female Married Nurses with Young Children

This descriptive survey aimed to identify factors influencing parenting stress among female married nurses with young children. Multiple regression analysis were conducted using the data obtained from 132 surveys. The variables influencing parenting stress were found to be, in order, work-family balance (β=-.356, p&lt;.001) and “Me Time” (β=-.195, p=.016), with an explanatory power of 16%. Spousal involvement in childcare did not significantly correlate with parenting stress. However, satisfaction with childcare assistance from sources other than the spouse revealed a significant difference, indicating that having satisfactory childcare support, even if not for the spouse, can reduce parenting stress. Female married nurses with young children require support to secure sufficient “Me Time” between juggling work and family along with childcare. In particular, strengthen the social support system is needed that people can maintain their identity through “Me Time.”

Public Benefit Programs and Differential Associations With Child Maltreatment by Race and Ethnicity

Public benefit programs, including state spending on local, state, and federal-state partnership programs, have consistently been associated with overall reductions in child protective services (CPS) involvement. Inequities in eligibility and access to benefit programs may contribute to varying associations by race and ethnicity. To determine whether associations between state spending on benefit programs and rates of CPS investigations differ by race and ethnicity. This cross-sectional ecological study used repeated state-level measures of child maltreatment from the National Child Abuse and Neglect Data System and population estimates from the US Census Bureau for all Black, Hispanic, and White children. All 50 US states from October 1, 2009, through September 30, 2019 (fiscal years 2010-2019), were included. Data were collected and analyzed from May 13, 2022, to March 2, 2023. Annual state spending on benefit programs per person living below the federal poverty limit, total and by the following subcategories: (1) cash, housing, and in-kind; (2) housing infrastructure; (3) child care assistance; (4) refundable earned income tax credit; and (5) medical assistance programs. Race- and ethnicity-specific rates of CPS investigations. Generalized estimating equations, with repeated measures of states, an interaction between race and spending, and estimated incidence rate ratios (IRRs) and 95% CIs for incremental changes in spending of US $1000 per person living below the federal poverty limit were calculated after adjustment for federal spending, race- and ethnicity-specific child poverty rate, and year. A total of 493 state-year observations were included in the analysis. The association between total spending and CPS investigations differed significantly by race and ethnicity: there was an inverse association between total state spending and CPS investigations for White children (IRR, 0.94 [95% CI, 0.91-0.98]) but not for Black children (IRR, 0.98 [95% CI, 0.94-1.02]) or Hispanic children (IRR, 0.99 [95% CI, 0.95-1.03]) (P = .02 for interaction). Likewise, inverse associations were present for only White children with respect to all subcategories of state spending and differed significantly from Black and Hispanic children for all subcategories except the refundable earned income tax credit (eg, IRR for medical assistance programs for White children, 0.89 [95% CI, 0.82-0.96]; P = .005 for race and spending interaction term). These results raise concerns that benefit programs may add relative advantages for White children compared with Black and Hispanic children and contribute to racial and ethnic disparities in CPS investigations. States' eligibility criteria and distribution practices should be examined to promote equitable effects on adverse child outcomes.

Occupational survey of the educational outputs of the first established program of cardiac technology speciality in the Kingdom of Saudi Arabia (2013–2022): A cross-sectional study

Background The demand for qualified cardiac technology (CT) graduates is increasing in Saudi Arabia. This study aimed to provide the first descriptive occupational survey of the educational outputs of the first established CT speciality program in the Kingdom of Saudi Arabia over the past 10 years. Methods This was a cross-sectional, survey-based study. An online self-administered survey was distributed to all alumni who graduated from the CT program between 2013 and 2022 at the Imam Abdulrahman bin Faisal University (IAU) in the Eastern Province of Saudi Arabia. Results Of the 238 graduates, 164 completed the survey (72.2%). All the respondents (100%) were women, 56% were aged 25–30 years, 58.5% were married, the majority (95.7%) held a bachelor’s degree, and (93.3%) lived in the eastern region. Of the respondents, 33.7% specialised in cardiac catheterisation and 66.3% in echocardiography. Of those, 66.4% were employed, which was similar between both subspecialties and predominantly in the Eastern region (83.9%). A total of 57.9% of participants attributed the reason for unemployment to limited opportunities in the Eastern province (vs. 15.8% across the country). A total of 76.6% of the respondents reported that most job opportunities were in the Central region (Riyadh). The main barriers and limitations to unemployment reported by the alumni were the need for childcare assistance, further training, and poor job search/interview skills. Of the respondents, 42% expressed a desire to change their career path because of limited job opportunities (10.7%) followed by a change in career interest post-graduation (7.9%). Conclusions The employment rate of IAU CT alumni was high (66.4%) and predominantly based in the Eastern region of Saudi Arabia, and 42% expressed a desire to change their career path due to limited regional job opportunities. The findings from this study will help inform the future of speciality across the kingdom and shape the potential for expansion.

Engaging Parents Affected by Mental Health Problems in Pediatric and Gynecologic Practices-Implications of the KID-PROTEKT Study.

Children of parents with mental illness are at higher risk of developing cognitive, mental health or physical health difficulties. Previous studies have described several barriers for reaching parents with mental health problems (MHPs) and their utilization of psychosocial services. We conducted a cluster randomized controlled study in 24 pediatric and gynecologic practices to evaluate KID-PROTEKT, a psychosocial healthcare intervention that comprises a psychosocial assessment to identify families with psychosocial needs and refer them to support services. In this paper, we analyzed whether psychosocially distressed parents with additional MHPs (identified by the PHQ-9 and GAD-7) had higher support needs, could be referred to support and utilized it in comparison to parents with psychosocial burden only. In total, 178 pregnant women and mothers with psychosocial burden were included, of whom 55 had MHPs. Participants with MHPs were distressed in their relationships more often and medical staff rated their level of support needs higher compared to parents without MHPs. There were no significant differences between the groups regarding whether they were referred to support services or utilized the recommended services. All participants were most frequently referred to family or parent counseling/care or childcare assistance. The results indicate that despite existing barriers, parents with MHPs could be reached and identified by the KID-PROTEKT psychosocial assessment. A psychosocial intervention like KID-PROTEKT can help to provide support for mentally ill parents.

Stressors and Silver Linings during COVID-19: Implications for Supporting Families with Young Children in a Post-Pandemic World.

To better understand impacts of the COVID-19pandemic and resulting economic and social disruptions on families, we analyzed qualitative data capturing perspectives from parents of young children. This study analyzes interviews of parents of children aged 1-3.5 years at enrollment, recruited from four primary care systems serving mainly lower-income Hispanic families in Los Angeles, California. Interviews were conducted over 15 months beginning September 2020. Analyses focused on the open-ended question: Please describe in your own words how the COVID-19 pandemic has affected you and your family. We used iterative, multi-step processes to identify emergent qualitative themes. A total of 460 parent responses were collected and coded. Key themes and subthemes were tested for interrater reliability, with Kappa ranging from 0.74 to 0.91. Thematic analysis revealed two groups of responses, one emphasizing stress and one emphasizing "silver linings." Parents cited a range of stressors, from fear of COVID-19 to social isolation. Those emphasizing "silver linings" also referenced formal or informal supports - especially government/community assistance programs and childcare access - that enabled stronger family ties and positive lifestyle modifications. Experiences of families with young children during COVID-19 were not uniform. Economic stability and reliable childcare may be critical mediators of family stress. Results affirm that the pandemic's impacts were distributed through channels largely built on, and possibly exacerbating, existing disparities. For lower-income families with young children, funding for public and private programs that target economic stability and childcare assistance may merit prioritization in future socio-economic disruptions.

Childcare Assistance Not a Major Draw for Most Employees

Employer-provided childcare accommodations by either in-house facilities or subsidies paid to third-party providers can be an expensive employee benefit and may not be considered the most desired accommodation an employer can offer. Changes in employee attitudes toward family and work balance may be a factor. Providing the benefit can cause related financial exposure and lead to resentment from employees who don’t need or want it. Alternative family accommodation of paid leave and flexible scheduling appear more popular. Employers should carefully survey employee attitudes toward the benefit, assess employee composition to determine need and consider alternative accommodations that may be a better fit.

Incidence of commuting accidents among non-physician staff in a large French university hospital centre from 2012 to 2016.

Traffic road crashes are the leading cause of fatal crashes at work. The circumstances of work-related road accidents have been a regular focus of study, but there is still a lack of knowledge about commuting accidents. The aims of this study were to estimate the overall incidence of commuting accidents for non-physician professionals in a major French university hospital, by gender and different professional categories, and to assess its evolution over a 5-year period. A descriptive analysis was performed on 390 commuting accidents from 2012 to 2016 extracted from the university hospital's occupational health service. Incidences of commuting accidents were calculated according to gender, occupational categories, and years. Crude relative risk (RR) for the association of commuting accidents with gender, occupational categories, and year of the accident was also estimated using log-binomial regressions. The annual incidence ranged from 354 to 581 accidents per 100,000 employees. Compared with administrative staff, the relative risk (RR) for commuting accidents for service agents was 1.6 (95% confidence interval (CI): 1.1-2.4) and for auxiliary nurses and childcare assistants was 1.3 (95% CI: 1.0-1.9). Nursing executives had a non-significantly lower RR of 0.6 (95% CI: 0.3-1.5). The increased risk observed for the auxiliary nurses and childcare assistants and for the service agents may be related in part to the fatigue caused by work schedules, long commuting distances, physical work, and psychological burden.

Veteran Caretaker Perspectives of the Need for Childcare Assistance During Health Care Appointments

PurposeIn 2020, Congress passed legislation to establish the national Veterans Child Care Assistance Program (VCAP) targeting eligible veterans receiving care through the Veterans Health Administration (VA). This needs assessment describes the childcare needs of veteran caretakers of young children and explores the implications of inadequate childcare on health care engagement. MethodsSurvey data were collected from 2,000 VA users with dependent children; data were analyzed using standard descriptive statistics. Qualitative data were collected from 19 veterans through focus groups and analyzed using rapid thematic analysis. FindingsMore than 75% of veterans surveyed indicated that they required childcare assistance during health care appointments and 73% reported barriers to finding childcare. Prominent barriers included the high cost of childcare and not having a trusted source of childcare. Nearly 58% of survey respondents reported missed or canceled VA health care appointments due to childcare challenges. Furthermore, 35% of surveyed veterans reported that their children had accompanied them to an appointment in the past year. Among these veterans, 59% brought their children into the exam room. Focus group participants discussed how having children present during their health care appointments hampered communication with health care providers. ConclusionsVeterans report that lack of childcare keeps them from attending and remaining focused on the provider during their health care visits, which could compromise quality of care. As one of the only health systems in the United States that will offer childcare assistance, VCAP presents an opportunity to improve health care access and quality by reducing missed appointments and suboptimal care.

Off to a slow start: which workplace policies can limit gender pay gaps across firm tenure?

Much of the gender pay gap is generated within workplaces, making it paramount to understand which workplace policies effectively address gaps. Our article asks when policies limit gender pay gaps across employee tenure to identify potential temporal weak points. We analyze a representative panel of 10,000 establishments with over 850,000 employees using the 2005–19 waves of German-linked employer–employee data (LIAB). Two key findings emerge. First, a temporal perspective on workplace policies reveals that no policy under study—formalization, identity-based career programs, and child care assistance—reduces gender pay gaps at hire. Instead, policies only address additional disparities that accumulate after hire. Second, only identity-based career programs narrow gender disparities for all women. In contrast, seemingly gender-neutral formalization is insufficient, while providing employer-sponsored child care has mixed effects depending on employees’ education. We conclude by discussing the implications of these findings for organizational policy and future research.

Grandparents’ Retirement and Mother’s Employment Quality: The Mediating Role of Intergenerational Caregiving

The grandparents’ retirement behavior has important support on mother’s employment quality. This paper aims to estimate the influence of grandparents’ retirement behavior on mother’s employment quality, based on the China Family Panel Studies of 2018. The findings reveal a significant enhancement in mother’s employment quality resulting from grandparents’ retirement behavior. The mediating effect of grandparents’ intergenerational caregiving explains approximately 68.77% of this improvement. Furthermore, the positive effect of grandparents’ retirement behavior on mother’s employment quality is more pronounced in families where the grandchild is older and in better health. Notably, the involvement of paternal grandparents yields more favorable outcomes compared to maternal grandparents. Findings from this study suggest that grandparent’s retirement behavior play an important role in mother’s employment quality through the provision of childcare assistance. Moreover, these findings highlight that the effectiveness of such support varies depending on the characteristics of both grandchildren and grandparents.

Intergenerational care support transfer: insights from the generation and gender survey

Understanding intergenerational transfers of childcare is crucial in the context of declining birth rates, changing family structures, and population aging. Informal assistance in childcare is highly significant for many families with young children as it helps them balance their professional and parenting responsibilities. Existing research indicates that support provided by parents to their adult children in childcare positively impacts decisions regarding childbirth and women's participation in the labor market. The aim of this study is to analyze patterns of support transfer between different generations and identify factors influencing intergenerational transfers in Moldova. It is based on data from the "Generations and Gender" (GGS) study conducted in 2020. Thanks to its representative sample, the study encompasses aspects such as intergenerational transfers related to childcare and grandchildren, attitudes toward childcare, and socio-demographic variables. Statistical analysis involves cross-tabulations and logistic regressions to identify factors determining participation/transmission of support in childcare. The research findings demonstrate that grandparents provide significant assistance to their adult children in childcare, particularly during the initial years of the child's life. This support is predominantly received by women with young children and women with higher education with children. Typically, childcare assistance is offered by grandparents approaching pre-retirement and retirement ages. Factors such as children's ages, family size, level of education, and urban residence significantly influence the receipt of childcare assistance. The results underscore the importance of traditional values and societal expectations, providing a nuanced understanding of intergenerational relationships amidst a changing demographic landscape. They could prove valuable for policymakers and developers of programs supporting families with children.

How prenatal cortisol levels relate to grandmother-mother relationships among a cohort of Latina women.

As part of the human reproductive strategy, mothers receive childcare assistance from others. For kin, allomothers are adaptively incentivized to provide assistance due to inclusive fitness benefits. Previous studies across a broad range of populations identify grandmothers as particularly consistent allomothers. Minimal attention has been paid to the possibility that allomothers may begin investing in offspring quality during the prenatal stage of life. Here, we innovate within the area of grandmother allocare research by examining the prenatal stage of life and biopsychosocial mechanisms by which prenatal grandmother effects may be enacted. Data derive from the Mothers' Cultural Experiences study, a cohort of 107 pregnant Latina women in Southern California. At <16 weeks' gestation, we administered questionnaires, collected morning urine samples, and measured cortisol by enzyme-linked immunosorbent assay, correcting for specific gravity. We measured the soon-to-be maternal and paternal grandmothers' relationship quality, social support, frequency of seeing each other, communicating, and geographic proximity to pregnant mothers, that is, their daughters and daughters-in-law. These measures were self-reported by the pregnant mothers. We assessed how grandmother constructs related to the pregnant women's depression, stress, anxiety, and cortisol levels. We observed benefits conferred by maternal grandmothers for mothers' prenatal mental health and lower cortisol levels. Paternal grandmothers also conferred mental health benefits to pregnant daughters-in-law, but higher cortisol levels. Our results suggest that grandmothers, especially maternal grandmothers, are able to improve their inclusive fitness by caring for pregnant daughters, and allomother support may positively impact prenatal health. This work extends the traditional cooperative breeding model by identifying a prenatal grandmother effect, and, by examining a maternal biomarker.

Characteristics of older people who have an intention to work as assistance personnel for long-term care or childcare

Objectives With the rapid progress of aging society and decreasing population, there is a shortage of workers in various areas, which has become a serious problem especially in the welfare field, for long-term care and childcare. As one of the countermeasures, some efforts are being made to hire people who are living independent daily lives, as auxiliary personnel, and have them take charge of non-specialized peripheral work of the facilities. The purpose of this study was to examine the characteristics of older adults who have an intention to work as auxiliary personnel in the welfare field.Methods A self-response questionnaire survey was conducted from October to November 2019 for 374 members of "REPRINTS" who are picture-book reading volunteers, aged 60 years or more, and are living in the capital area. There were 295 valid responses. We performed logistic regression analysis using the presence or absence of intention to work for long-term care assistance and for childcare assistance as the dependent variables. The missing values were supplemented by the multiple imputation method (10 files were created).Results The results of analysis revealed that 24.9% of the respondents had an intention to work for long-term care assistance, and 36.6% for childcare assistance. From the results of logistic regression analysis, it was found that among those intending to work in long-term care assistance, participants involved in lifelong learning activities had significantly higher intention to work (OR: 2.98, 95%CI: 1.40-6.34). Among those intending to work in childcare assistance, those with a high subjective sense of health had a significantly higher intention to work (OR: 2.41, 95%CI: 1.01-5.76).Conclusion The intention of work for childcare assistance was higher than that for long-term care assistance. A notable characteristic of older people willing to work as assistants in the welfare field is that those who participate in lifelong learning activities would be willing to actively work for long-term care assistance, and those with high subjective health would be willing to actively work for childcare assistance. By focusing on the older people with these characteristics, we may be able to contribute to identifying the those among them who want to work as assistant personnel.

Improving participation of under-represented minorities in breast cancer therapeutic trials in a safety-net system.

90 Background: Racial and ethnic minorities remain under-represented in cancer clinical trials. Strategies to improve access and participation of diverse populations in clinical trials is therefore a key step to improve outcomes and eliminate disparities. Methods: Parkland Health (PH) is the safety-net system for Dallas County, Texas, and is affiliated with the UT Southwestern/Harold C. Simmons Comprehensive Cancer Center (SCCC). Trial operations at PH is mainly supported by a dedicated team of SCCC research coordinators. Interventions employed to increase minority access and accruals were focused on optimizing the portfolio, increasing provider awareness, and enhanced screening. A bilingual research patient navigator was also added to the research team to improve patient education and engagement. Transportation and childcare assistance are routinely provided for patients at PH. Accrual data for 2021, compared to 2017-2020, is presented here. Results: The majority (73%) of breast cancer patients at PH are uninsured and 88% belong to racial/ethnic minorities (57% Hispanics, 31% Blacks). Of the 15 therapeutic breast cancer trials open at SCCC in 2021, 12 (80%) were open at PH. The PH breast cancer trial portfolio included 4 cooperative group, 5 industry-sponsored (ISTs), and 3 investigator-initiated studies (IITs). Four trials were in metastatic setting and 8 were in curative intent setting. Four trials required a genomic biomarker. Forty-three patients were enrolled in therapeutic trials at PH in 2021. This represents 10.3% (43/418) of new cases during the same time period. Thirty-two were enrolled in cooperative group studies, 10 in IITs, and 1 in ISTs. The majority (93%) of the trial participants belonged to under-represented minorities. Number of trial participants in 2021 increased by 48% compared to the best year in the past 5 years (29 patients enrolled in 2018). Conclusions: Collaboration between academic institutions and safety-net systems presents a unique opportunity to provide clinical trial options to under-represented minorities. In this setting, interventions to improve trial portfolio, provider awareness, screening process, and patient education, as well as addition of a patient research navigator resulted in a significant increase in the number of minority participants in breast cancer trials at our safety-net hospital.

“Even if I’m undetectable, I just feel like I would die”: a qualitative study to understand the psychological and socioeconomic impacts of the COVID-19 pandemic on women living with HIV (WLWH) in Chicago, IL

BackgroundThe COVID-19 pandemic has affected the health and well-being of people worldwide, yet few studies have qualitatively examined its cumulative effects on ciswomen living with HIV (WLWH). We aimed to explore how the pandemic has impacted WLWH, including challenges related to HIV care, employment, finances, and childcare. We also investigated how HIV status and different psychosocial stressors affected their mental health.MethodsWe performed 25 semi-structured qualitative interviews with WLWH regarding the ways in which COVID-19 impacted their social determinants of health and physical well-being during the pandemic. 19 WLWH who received care at the University of Chicago Medicine (UCM) and 6 women who received care at Howard Brown Health, a federally qualified health center (FQHC) in Chicago, were interviewed remotely from June 2020 to April 2021. All interviews were audio recorded and transcribed. Interviews were thematically analyzed for commonalities regarding HIV-specific and general experiences of WLWH during the pandemic.ResultsThe majority of participants reported COVID-19 impacted their HIV care, such as appointment cancellations and difficulties adhering to antiretroviral therapy. In addition to HIV care obstacles, almost all participants described perceived heightened vulnerability to or fear of COVID-19. The pandemic also affected the socioeconomic well-being of participants, with reported financial strains and employment disruptions. Some mothers took on additional childcare responsibilities, such as homeschooling. Increased mental health concerns and negative psychological effects from the social isolation associated with the pandemic were also experienced by most participants.ConclusionsWe gained invaluable insight into how WLWH were challenged by and adapted to the COVID-19 pandemic, including its destabilizing effects on their HIV care and mental health. Women described how they undertook additional childcare responsibilities during the pandemic and how their HIV status compounded their concerns (e.g., perceived heightened vulnerability to COVID-19). Strategies to better support WLWH in maintaining their overall health throughout the pandemic include childcare assistance, access to affordable mental health services, support groups, and education from HIV care providers. These findings have significant implications for examining future health crises through the perspective of potential gender inequalities.