A good support system is vital during the postpartum period and has been shown to decrease the risk for maternal mental health disorders and increase general maternal wellness. A crucial part of the postpartum support system includes having access to affordable childcare. Childcare access for infants is especially important in the United States (U.S.) because there is currently no mandatory paid maternity leave in the U.S., which increases the need for accessible non-parental childcare. 

Research shows that having access to affordable and quality childcare can have positive benefits on both maternal and child mental health. One study found that having access to childcare protected moms from depressive symptoms. This study also showed that when moms had access to childcare, loss of sleep was less likely to have a direct impact on the risk for maternal depression.1 Another study showed that access to quality childcare buffered children from any negative emotional and behavioral impacts from any existing maternal mental health disorders and other adverse family conditions.2

However, there are multiple barriers to childcare access in the U.S.  

Childcare deserts are prevalent. The U.S. Census Bureau found that one-third of young children are regularly in non-parental childcare.3 A region is defined as a “childcare desert” if there is a ratio of more than three young children for every licensed childcare slot, meaning that parents will most likely have increased difficulty in finding quality childcare. A report from 2018 shows that approximately 50% of Americans live in a “childcare desert”4–meaning that many families have to deal with the stress of limited childcare access.  

Another barrier to childcare is the high cost of childcare. According to the U.S. Department of Health and Human Services, “affordable” childcare is generally defined as costing 7% or less of a family’s income5, a threshold not met by center-based daycare centers in any state. According to the U.S. Department of Labor in 2023, the cost of childcare ranges from 8% to almost 20% of a family’s annual income per child, making access to childcare a financial challenge for many families. 6   

As access to childcare is intricately tied to socioeconomic and geographic factors, it is important to note the disparities in access to childcare. Current data show that 60.2% of American Indians/Alaskan Natives (AI/AN) and 57.3% of Latino/Hispanic families live in childcare deserts–disproportionately higher rates than the general population rate of 50.5%.7 It is also estimated that the poverty rate for AI/AN families with children under 5 is 74% higher than the national average,8 amplifying the challenges of AI/AN in accessing childcare. Such disparities in childcare, combined with the already higher prevalence of maternal mental health disorders in AI/AN and Latino/Hispanic populations (30%9 and 40%10, respectively) highlight the need to further research and develop resources that address these stark disparities.   

As psychological stress caused by childcare issues has been identified as one of the strongest predictors of maternal depression,11 the current prevalence of barriers to affordable and accessible childcare greatly increases the risk for postpartum depression in families who have difficulties accessing childcare. It is important to keep this in mind when treating and assessing risk factors for developing a maternal mental health disorder during the postpartum period. While broader policy and systems changes are needed to address the current barriers to childcare, acknowledging and identifying the benefits and consequences of access and barriers to childcare on maternal mental health is a positive first step to highlighting this link.

  1. Armstrong, B., Weaver, R. G., Beets, M. W., Østbye, T., Kravitz, R. M., & Benjamin-Neelon, S. E. (2022). Use of Child Care Attenuates the Link Between Decreased Maternal Sleep and Increased Depressive Symptoms. Journal of developmental and behavioral pediatrics : JDBP, 43(5), e330–e338. https://doi.org/10.1097/DBP.0000000000001048 ↩︎
  2. Goelman, H., Zdaniuk, B., Boyce, W. T., Armstrong, J. M., & Essex, M. J. (2014, July 18). Maternal Mental Health, child care quality, and children’s behavior. Journal of Applied Developmental Psychology. https://www.sciencedirect.com/science/article/abs/pii/S0193397314000574 ↩︎
  3. Laughlin, L. (2013). Who’s Minding the Kids? Child Care Arrangements: Spring 2011. Current Population Reports, P70-135. U.S. Census Bureau, Washington, DC.
  4. Malik, R., Hamm, K., Schochet, L., Novoa, C., Workman, S., & Jessen-Howard, S. (2022, May 20). America’s Child Care Deserts in 2018. Center for American Progress. https://www.americanprogress.org/article/americas-child-care-deserts-2018/ 
  5. Office of Child Care. (2016). Child Care and Development Fund final rule frequently asked questions. U.S. Department of Health and Human Services, Administration for Children and Families. https://www.acf.hhs.gov/occ/faq/child-care-and-development-fund-final-rule-frequently-asked-questions ↩︎
  6. Landivar, L.C., Graf, N.L., and Rayo, G.A. (2023, January). Childcare Prices in Local Areas: Initial Findings from the National Database of Childcare Prices. Women’s Bureau Issue Brief. U.S. Department of Labor, Washington, DC. https://www.dol.gov/sites/dolgov/files/WB/NDCP/WB_IssueBrief-NDCP-final.pdf
  7. Malik, R., Hamm, K., Schochet, L., Novoa, C., Workman, S., & Jessen-Howard, S. (2022, May 20). America’s Child Care Deserts in 2018. Center for American Progress. https://www.americanprogress.org/article/americas-child-care-deserts-2018/ ↩︎
  8. National Indian Child Care Association, “Child Care and Development Fund/Child Care and Development Block Grant,” available at http://docs.wixstatic.com/ugd/f8a7b6_156722f84a3540c2a19c9dd675ff56ee.pd
  9. Heck, J. L. (2021). Postpartum depression in American Indian/Alaska native women. MCN: The American Journal of Maternal/Child Nursing, 46(1), 6-13. https://doi.org/10.1097/nmc.0000000000000671
  10. Ceballos, M., Wallace, G. & Goodwin, G. Postpartum Depression among African-American and Latina Mothers Living in Small Cities, Towns, and Rural Communities. J. Racial and Ethnic Health Disparities 4, 916–927 (2017). https://doi.org/10.1007/s40615-016-0295-z
  11. Beck, C.T. (2001). Predictors of postpartum depression: an update. Nurs Res. 50(5):275–285. ↩︎