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Having a child and early childhood


Where are we now

Most families making less than 200% of the poverty level do not have the combination of supports that they need to thrive, including access to health care, finances, food, housing, and childcare.

For parents of all income levels, carrying and delivering a child will be one of the most significant experiences of their life — but the stresses and burdens are greater for low-income families.

Low-income families struggle to make ends meet. There were 3,605,201 births in the United States in 2020. 42 percent of these were covered by Medicaid. Across all age groups, those most likely to live in poverty are young children. Having a young child is associated with a $14,850 drop in income for households with two adults, and $16,610 for single women. While families may have the lowest incomes during a child’s first five years of life, and also have the highest expenses, as they have grown their family. Mothers often bear the most of this economic burden, with their paid (and unpaid) labor crucial to their family’s stability.

Economic insecurity contributes to poor health outcomes. In part because of our lack of a social safety net, with a focus on healthcare coverage the U.S. has one of the worst maternal mortality rates of any developed nation, more than double that of most other high-income countries. Leading causes of pregnancy-related deaths in the U.S. include cardiovascular issues and hypertension (and in the postpartum period, during which more than half of U.S. pregnancy-related deaths occur, mental health issues become a leading cause). These high-risk conditions, which disproportionately impact women of color and low-income women, can be improved by access to medical care and proper nutrition, among other interventions in a typical treatment plan.

Lack of family support impacts economic productivity — especially for mothers. Furthermore, due in part to lack of access to care supports, women’s labor force participation in the United States has stalled. Finding, securing, and paying for child care is out of reach for as many families. Only 15% of those eligible for child care subsidies receive them, indicating that families are forced to pay out of pocket for child care they cannot afford. An analysis from the Economic Policy Institute demonstrates that if child care was affordable and accessible, the United States would see a gross domestic product (GDP) gain equal to $210.2 billion.

Where we want to be

We have ample evidence that new families need access to health care services and coverage, and wraparound supports — particularly low-income families and families of color. Medicaid, as the payer of almost half of U.S. births, is an ideal “front door” for lowincome families to access not only health care services but also other social services and benefits that they may be eligible for, and existing labor standards that protect them. Access to social benefits such as SNAP and WIC, and access to FMLA and break time for nursing can support a healthier pregnancy and postpartum period for mothers, and have long-term positive benefits for children. This can form the basis for other Federal opportunities for improving maternal health, educational, and other outcomes for families of all income levels.

Where we will start

Through the discovery period (Summer 2022), our team will run a discovery sprint with the goal of conducting research and diligence on this holistic model of care for women and the outcomes for infants on Medicaid. We will conduct two phases of qualitative research, focusing on subject matter experts and care delivery professionals, and on individuals and families. We will map the journey of an individual from pregnancy through to the child’s entrance into public school, identifying specific points at which various factors (rural, income level, race, LGBTQ+) may create inequitable “drop off points,” as well as pain points for birthing parent of a variety of perspectives. We plan to identify up to 3 tactical projects that the Federal Government can pursue to improve the family experience for families with children under the age of 5. We will prioritize projects that are in the control of Federal Government levers of change and can be supported by increased interagency cooperation and coordination.