Secondary Logo

Journal Logo

Scholarly Perspectives

Who Is Caring for Health Care Workers’ Families Amid COVID-19?

Robinson, Londyn J. MD1; Engelson, Brianna J. MD2; Hayes, Sharonne N. MD3

Author Information
doi: 10.1097/ACM.0000000000004022
  • Free

Abstract

If the health care sector had a theme song, it would be “It’s a Man’s Man’s Man’s World” by James Brown and The Famous Flames. 1 The COVID-19 crisis has placed extraordinary burdens on all health care workers (HCWs), trainees, and their families. The goal of this article is to make a plea to expand family-centered policies for HCWs, as parents have experienced increased domestic responsibilities during COVID-19. However, both the burden on women and the exodus of women from the workforce are disproportionate compared with those for men in similar roles. 2 The unequal impact of the pandemic on women, coupled with women comprising a majority of the health care workforce, begs the question: While women are caring for patients during the COVID-19 pandemic, who is caring for them and their families?

Women worldwide spend triple the amount of time on household activities and childcare compared with men. 3 Women also frequently serve as informal, unpaid caregivers for elderly and high-need family members. 4 COVID-19 has only increased domestic and caregiving responsibilities. 5 Due to school and day care closures, parents now must juggle their children’s online curriculum and playtime as well as the household cleaning, meal preparation, and grocery shopping for their home-bound families. These added responsibilities have fallen disproportionately on women’s shoulders. 5

HCWs—75% of whom are women 6—have not been exempt from these added stressors. As a result, many women HCWs have been forced to make difficult decisions as they balance unrivaled childcare and domestic demands with unparalleled professional needs. 7,8 A lack of organizational support for family-centered policies 9 has already contributed to many highly trained women HCWs leaving the workforce. 7

Childcare in the United States

Even before the pandemic, many parents struggled to afford childcare, with full-time care for 1 infant costing an average of $21,700 annually. 10 This cost represents more than one-third of the average resident’s salary. 11 For many essential workers, the cost of childcare actually exceeds their income. Home health aides, for example, earn about $24,200 annually, 12 far less than the cost of care for 1 child in Washington, DC, California, Seattle, and New York. 10 For many women, staying home with their children is more cost-effective than joining the health workforce.

Beyond cost, accessible day care is not available for many families. 13 Childcare deserts are common, especially in rural areas and minority communities; 3 in 5 rural communities and nearly 60% of the Hispanic/Latinx population are in areas with an inadequate number of licensed childcare centers. 13 In addition, many HCWs are forced to find alternative care options on nights and weekends because less than 8% of center-based care providers offer childcare during nonstandard duty hours. 14 As a result, the vast majority of childcare is provided by unpaid caregivers; retired family members and friends provide approximately 50% of childcare. 15

Unfortunately, most older adults are at increased risk for developing serious COVID-19-related complications and have been advised by the Centers for Disease Control and Prevention to limit their contact with those outside their household. 16 This has forced families to make agonizing decisions between allowing grandparents to provide free childcare and finding costly alternative options. The loss of unpaid caregivers has led to an abrupt rise in childcare needs that licensed centers are not able to meet due to COVID-19 regulations. Parents and guardians have been forced to pick up the slack. 17

Fewer Childcare Options During COVID-19

The absence of childcare options before the pandemic, coupled with COVID-19-related school closures, left approximately 3.45 million children of HCWs without care in the spring of 2020. 18 Lack of access to childcare during increased duty hours and school closures was listed as one of the 8 major sources of anxiety for HCWs during the first week of the pandemic. 19 Unfortunately, this lack of childcare options has led to many children of essential workers being left unsupervised while their parents work. 20

The cruel irony of the situation is that, while many HCW parents scramble to find care, most day care centers sit empty, unable to operate due to an inability to pay workers, lack of personal protective equipment (PPE), and little government support. 21 Due to COVID-19 exposure fears and an increased number of parents working from home, many children who typically attended day care have not during the pandemic. In the span of 1 week in mid-March 2020, day care centers lost nearly 70% of their daily attendance and the corresponding revenue. 22

The government encouraged day care centers to apply for relief loans via the Paycheck Protection Program sponsored by the Small Business Administration. Regrettably, only approximately 5% of childcare facilities received this funding. 17 Due to a lack of immediate financial assistance, many childcare centers closed altogether, and even more remain at risk of closure, which will undoubtedly worsen the existing childcare inaccessibility crisis. 23

Worsening Gender Disparities During COVID-19

COVID-19 has only magnified existing gender disparities. Despite the increased domestic and childcare burdens placed on working mothers, most fathers do not perceive differences in work distribution. 24 Single HCW parents, who are more often women and people of color, have no option to share domestic responsibilities. 25 In addition, compared with women, men are paid more, 25 have less risk of furlough, 26 and more often work in occupations that can be transitioned to telecommuting, allowing them to work from home. 26 Even when both members of heterosexual couples work from home, men’s work responsibilities are often prioritized over women’s. 27

Residents are particularly affected by gender disparities. Several surveys have illustrated that women trainees are less likely to have partners who do not work full-time. For example, a 2014 survey of radiation oncology residents with children found that nearly 40% of men had partners who did not work compared with 0% of women. 28 A much larger survey of early career physician recipients of K awards across all specialties had similar findings; men were approximately 4 times more likely to have spouses or domestic partners who were employed part-time or not at all. 29 In the same study, approximately 85% of women had spouses or domestic partners who worked full-time compared with 44% of men. 29

Women physicians also have cautioned women medical students against choosing specialties that are less supportive of starting or growing a family. For example, one-third of general surgery residents reported that they would discourage women medical students from pursuing a surgical career due to “difficulties balancing pregnancy and motherhood with training.” 30 This lack of support has drastic consequences for residents amid COVID-19. Many of these young physicians have reported working without access to childcare, hazard pay, or adequate PPE. 31,32 Even when PPE is available, most women must make do with ill-fitting products designed to fit “standard” male proportions. 33 In addition to being a nuisance, ill-fitting protective gear poses a serious danger for disease transmission. 33

Compared with their women peers, men in academia have increased their scholarly productivity during COVID-19. 34 Already disadvantaged, delayed manuscript preparation, canceled speaking opportunities, and decreased access to mentorship will undoubtedly hinder women’s academic career advancement, possibly erasing decades of recent progress.

Mental Health Effects of Worsening Gender Disparities

Given the numerous ways that COVID-19 has exacerbated existing gender disparities, it is unsurprising that women’s mental health has been more severely affected by the pandemic than men’s. A survey conducted in Wuhan, China, during the earliest stage of the pandemic (January 2020) found that COVID-19 led to a disproportionate increase in depression, anxiety, insomnia, and distress among HCWs, particularly women. 35 As the pandemic progressed, HCWs in the United States experienced similar mental health effects. One study of physician mothers conducted in April 2020 found that more than 40% met the diagnostic criteria for moderate or severe anxiety. 36

In addition, anecdotes from young physicians highlight their exhaustion, feelings of imposter syndrome, self-doubt, inadequacies, and symptoms of posttraumatic stress disorder. 37 An American Enterprise Institute survey of 3,500 adults conducted in May 2020 found that approximately 51% of mothers endorsed feeling depressed at least a few times over the prior week compared with 35% of fathers. 38 That same survey found that COVID-19 is taking a devastating toll on single-parent households; compared with parents in dual-parent households, single parents are experiencing far greater levels of emotional distress, depressed feelings, and incidences of crying throughout the week. 38

The increased stress that the COVID-19 pandemic has placed on HCW parents is likely affecting their children. When parents or guardians have job instability, adverse work conditions, or nonstandard duty hours, their children are more likely to have elevated emotions and increased behavior difficulties. 39 In addition, psychosocial stressors in infancy and early childhood can alter developmental trajectories, increasing later risk for developmental delay, mental health issues, and metabolic diseases. 40

The full impact of COVID-19 on child development cannot be known yet, but some children are more at risk than others. Disabled children are particularly vulnerable, as the relatively few resources available to them before COVID-19 have been upended. 41 Due to school and day care closures, the majority of stress experienced by children during the pandemic must be mitigated solely by parents and guardians. This is taking a toll on the mental and physical health of both children and their families. 42,43 The American Enterprise Institute aptly named its report “The Parents Are Not All Right.” 38 Without assistance, HCWs and their families will continue to suffer.

Government Support for Childcare

Per the National Academies of Sciences, Engineering, and Medicine, public health efforts must address the social determinants of health to increase community resilience to environmental and infectious disasters. 44 This includes access to childcare, according to the American Academy of Family Physicians. 45 Unfortunately, the absence of government-supported childcare 46 has left the United States ill prepared to address the ramifications of school closures due to COVID-19, which has directly impacted frontline HCWs. According to Dr. Walter Gilliam, a professor of child psychiatry and psychology at Yale University, “When doctors and [intensive care unit] nurses and other important workers don’t have child care, people may die.” 47

The lack of a childcare entitlement program in the United States stands in stark contrast to other Organization for Economic Cooperation and Development (OECD) countries, where childcare is often a government-provided service. 48 For example, in March 2020, the government in the United Kingdom mandated that the education sector organize free childcare for essential workers, allowing parents to drop off their children at school while they went to work. 49 In the United States, however, the federal government has yet to enact legislation mandating access to childcare for essential workers, even a year into the pandemic. In addition, the United States is one of only a few countries in the world and the only OECD member without federally mandated paid family leave 50; parental or caregiver leave and assistance for dependent care are entirely at the discretion of individual employers. Government support for the childcare sector and for HCW parents in particular is urgently needed. We call on the American Medical Association, Association of American Medical Colleges (AAMC), and other organizations representing health care professionals to advocate for such support for HCW parents, especially during COVID-19.

Employer Support for Childcare

Benefits for HCWs during the pandemic have varied greatly; some health care organizations have instituted changes to better support their workers, while others have removed benefits. 51 An August 2020 survey of AAMC member institutions found that, among responding organizations, fewer than half provided any childcare assistance before COVID-19. Of those, 62% (18/29) had expanded childcare options during the pandemic. However, of the 27 organizations (46%) that provided no childcare assistance before COVID-19, only 2 expanded their support. 52 Additionally, organizations that created new childcare policies have struggled to implement them. 47,53 These observations suggest that, without government support for childcare—or at a minimum, legislation mandating employer-sponsored childcare—many HCWs will continue to struggle to find adequate and accessible childcare.

Providing childcare options benefits both organizations and their employees. A 2019 report from the Council for a Strong America estimated that employers lose approximately $13 billion annually in potential earnings due to the childcare challenges faced by their workforces. 54 Parents are often forced to leave work early, show up late, or even miss full days of work when they cannot find adequate childcare. 54 Amid COVID-19, these barriers have increased exponentially, and health care organizations that fail to support HCW parents could risk losing these workers altogether.

Unfortunately, there is not a one-size-fits-all solution to childcare provision at the employer level. Organizations must consider their workers’ needs to adequately support them at any time but especially during COVID-19. For example, some HCWs may benefit more from in-home nannying services, while others may prefer day care centers. Flexible structures that incorporate childcare options for disabled children and 24/7 work schedules are vital. Failure to support HCW parents at this time poses a great risk to patient care, as many parents are being forced to choose between staying home to care for their children and going to work to care for their patients. The true impact of this childcare crisis, however, may be going unrecognized or at least unmeasured; only 9 of 59 organizations in the recent AAMC survey cited above reported tracking the effects of childcare availability on rates of employee turnover. 52

While organizations and the government work to develop a more stable system of childcare options, newly formed volunteer groups are offering short-term solutions. 55 Some of these groups, led by health professions students, provide free childcare to essential workers. 56 For example, a group of primarily women medical students (including L.J.R. and B.J.E.) created MN CovidSitters, a nonprofit that uses technology to link student volunteers with HCWs in need of childcare. 57 While these efforts are important, they are a temporary fix to a broken childcare system.

For too long, politicians have assumed that child care and elderly care can be “soaked up” by private citizens—mostly women—effectively providing a huge subsidy to the paid economy. This pandemic should remind us of the true scale of that distortion. 58

Conclusion

James Brown croons, “it wouldn’t be nothing, nothing without a woman or a girl.” 1 Yet, our health care system is failing its women HCWs and, as a result, many plan to leave or have already left health care altogether. Working mothers—particularly trainees, junior faculty, and those from rural and lower socioeconomic areas—are making increasingly desperate calls for additional family support. 7 Without immediate assistance, these HCWs and their families will continue to struggle. Lack of access to affordable childcare is hindering HCWs in doing their jobs, including conducting and publishing academic scholarship. This poses incalculable risks to families, science, and society.

The United States cannot continue to rely on a crumbling childcare infrastructure. COVID-19 should serve as a call to action to all sectors, including the government and private employers, to prioritize and increase support for vulnerable populations like women and children. As a country and a house of medicine, we must care for the families of HCWs while they continue to care for our families.

Acknowledgments:

The authors acknowledge the valuable contributions of April Rowe, administrative assistant in the Department of Cardiovascular Medicine at Mayo Clinic. Londyn J. Robinson and Brianna J. Engelson thank Deborah Powell, MD, dean emeritus and professor of pathology at the University of Minnesota Medical School, who provided valuable mentorship and discussions about gender disparities in academic medicine.

References

1. Brown J, Newsome BJ. It’s A Man’s Man’s Man’s World [audio recording]. 1966.Cincinnati, OH: King Records;.
2. Gupta AH. Why did hundreds of thousands of women drop out of the workforce? New York Times. https://www.nytimes.com/2020/10/03/us/jobs-women-dropping-out-workforce-wage-gap-gender.html. Published October 3, 2020. Accessed February 16, 2021.
3. Samman E, Presler-Marshall E, Jones N, et al. Women’s Work: Mothers, Children and the Global Childcare Crisis. 2016London, UK: Overseas Development Institute; https://www.odi.org/publications/10349-women-s-work-mothers-children-and-global-childcare-crisis. Accessed February 16, 2021.
4. Global Health Workforce Network. Gender equity hub. Delivered by Women, Led by Men: A Gender and Equity Analysis of the Global Health and Social Workforce. 2019Geneva, Switzerland: World Health Organization; https://www.who.int/hrh/resources/health-observer24/en. Accessed February 16, 2021.
5. UN Women. Whose Time to Care? Unpaid Care and Domestic Work During COVID-19. 2020New York, NY: United Nations; https://data.unwomen.org/sites/default/files/inline-files/Whose-time-to-care-brief_0.pdf. Accessed February 10, 2021.
6. Day JC, Christnacht C. Your health care is in women’s hands. United States Census Bureau. https://www.census.gov/library/stories/2019/08/your-health-care-in-womens-hands.html. Published August 14, 2019 Accessed February 16, 2021.
7. Johnson K. Are more women physicians leaving medicine as pandemic surges? Medscape. https://www.medscape.com/viewarticle/941690. Published November 30, 2020 Accessed February 10, 2021.
8. Abelson R. Doctors are calling it quits under stress of the pandemic. New York Times. https://www.nytimes.com/2020/11/15/health/Covid-doctors-nurses-quitting.html. Published November 15, 2020. Accessed February 10, 2021.
9. Glynn SJ, Hamm K. The economics of caregiving for working mothers. Center for American Progress. https://www.americanprogress.org/issues/early-childhood/reports/2019/12/10/478387/economics-caregiving-working-mothers. Published December 10, 2019 Accessed February 16, 2021.
10. Child Care Aware of AmericaThe US and the High Price of Child Care: An Examination of a Broken System. 2019Arlington, VA: Child Care Aware of America; https://info.childcareaware.org/hubfs/2019%20Price%20of%20Care%20State%20Sheets/Final-TheUSandtheHighPriceofChildCare-AnExaminationofaBrokenSystem.pdf. Accessed February 16, 2021.
11. Martin KL. Medscape residents salary & debt report 2020. Medscape. https://www.medscape.com/slideshow/2020-residents-salary-debt-report-6013072. Published August 7, 2020 Accessed February 16, 2021.
12. Home Health Aide Salary. U.S. News and World Report. https://money.usnews.com/careers/best-jobs/home-health-aide/salary. Published 2019 Accessed February 16, 2021.
13. Malik R, Hamm K, Schochet L, Novoa C, Workman S, Jessen-Howard S. America’s child care deserts in 2018. Center for American Progress. https://www.americanprogress.org/issues/early-childhood/reports/2018/12/06/461643/americas-child-care-deserts-2018. Published December 6, 2018 Accessed February 16, 2021.
14. Dobbins D, Lange K, Gardey C, Bump J, Stewart J. It’s About Time! Parents Who Work Nonstandard Hours Face Child Care Challenges. 2019Arlington, VA:: Child Care Aware of America; https://cdn2.hubspot.net/hubfs/3957809/NSH%20Report%202019.pdf. Accessed February 16, 2021.
15. Susman-Stillman A, Banghart P. Demographics of Family, Friend, and Neighbor Child Care in the United States. 2008New York, NY: National Center for Children in Poverty; http://www.nccp.org/publications/pdf/text_835.pdf. Accessed February 16, 2021.
16. Centers for Disease Control and Prevention. Older adults. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html. Published December 13, 2020 Accessed February 16, 2021.
17. Santhanam L. ‘This is not working.’ Parents juggling jobs and childcare under COVID-19 see no good solutions. PBS NewsHour. https://www.pbs.org/newshour/health/this-is-not-working-parents-juggling-jobs-and-child-care-under-covid-19-see-no-good-solutions. Published July 23, 2020 Accessed February 16, 2021.
18. Child Care Aware of America. Child care for essential workers during coronavirus outbreak. https://www.childcareaware.org/coronavirus/child-care-essential-workers-coronavirus-outbreak. Published March 25, 2020 Accessed February 16, 2021.
19. Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA. 2020;323:2133–2134.
20. Khazan O, Harris A. What are parents supposed to do with their kids? The Atlantic. https://www.theatlantic.com/politics/archive/2020/09/limited-child-care-options-essential-workers/615931. Published September 3, 2020 Accessed February 10, 2021.
21. Hurley K. The last daycares standing. CityLab. https://www.citylab.com/equity/2020/03/coronavirus-daycare-closed-home-child-care-business-covid-19/608956. Published March 28, 2020 Accessed February 16, 2021.
22. National Association for the Education of Young Children. National Industry Organizations Call on Congress for $50 Billion in Urgent Stimulus.. https://www.naeyc.org/about-us/news/press-releases/without-immediate-relief. Published May 2020 Accessed February 16, 2021.
23. National Association for the Education of Young Children. Holding on Until Help Comes: A Survey Reveals Child Care’s Fight to Survive. 2020Washington, DC: National Association for the Education of Young Children; https://www.naeyc.org/sites/default/files/globally-shared/downloads/PDFs/our-work/public-policy-advocacy/holding_on_until_help_comes.survey_analysis_july_2020.pdf. Accessed February 10, 2021.
24. Pew Research Center. Raising kids and running a household: How working parents share the load.https://www.pewsocialtrends.org/2015/11/04/raising-kids-and-running-a-household-how-working-parents-share-the-load. Published November 4, 2015 Accessed February 16, 2021.
25. Treadwell HM. Wages and women in health care: The race and gender gap. Am J Public Health. 2019;109:208–209.
26. Alon T, Doepke M, Olmstead-Rumsey J, Tertilt M. The impact of COVID-19 on gender equality. http://faculty.wcas.northwestern.edu/~mdo738/research/COVID19_Gender_March_2020.pdf. Published March 2020 Accessed February 16, 2021.
27. Pew Research Center. Chapter 6: Time in work and leisure, patterns by gender and family structure. In: Modern Parenthood: Roles of Moms and Dads Converge as They Balance Work and Family. https://www.pewsocialtrends.org/2013/03/14/chapter-6-time-in-work-and-leisure-patterns-by-gender-and-family-structure. Published March 14, 2013 Accessed February 16, 2021.
28. Holliday EB, Ahmed AA, Jagsi R, et al. Pregnancy and Parenthood in Radiation Oncology, Views and Experiences Survey (PROVES): Results of a blinded prospective trainee parenting and career development assessment. Int J Radiat Oncol Biol Phys. 2015;92:516–524.
29. Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Ann Intern Med. 2014;160:344–353.
30. Rangel EL, Smink DS, Castillo-Angeles M, et al. Pregnancy and motherhood during surgical training. JAMA Surg. 2018;153:644–652.
31. Salari S. “A terrifying privilege”: Residency during the COVID-19 outbreak. AAMCNews. https://www.aamc.org/news-insights/terrifying-privilege-residency-during-covid-19-outbreak. Published March 24, 2020 Accessed February 16, 2021.
32. Pan D. Young medical residents worry their lives are on the line as they treat coronavirus patients. Boston Globe. https://www.bostonglobe.com/2020/05/09/nation/long-overworked-young-medical-residents-worry-their-lives-are-line-they-treat-coronavirus-patients/?event=event25. Published May 9, 2020 Accessed February 16, 2021.
33. Trades Union Congress. Personal protective equipment and women. https://www.tuc.org.uk/research-analysis/reports/personal-protective-equipment-and-women. Published April 25, 2017 Accessed February 16, 2021.
34. Flaherty C. No room of one’s own. Inside Higher Education. https://www.insidehighered.com/news/2020/04/21/early-journal-submission-data-suggest-covid-19-tanking-womens-research-productivity. Published April 21, 2020 Accessed February 16, 2021.
35. Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3:e203976.
36. Linos E, Halley MC, Sarkar U, et al. Anxiety levels among physician mothers during the COVID-19 pandemic. Am J Psychiatry. 2021;178:203–204.
37. Safdar K, Palazzolo J, Adamy J, Ramachandran S. Young doctors struggle to treat coronavirus patients: ‘We Are Horrified and Scared’. Wall Street Journal. April 29, 2020https://www.wsj.com/amp/articles/young-doctors-struggle-to-treat-coronavirus-patients-we-are-horrified-and-scared-11588171553. Published April 29, 2020 Accessed February 16, 2021.
38. Cox DA, Abrams SJ. The Parents Are Not All Right: The Experiences of Parenting During a Pandemic. 2020Washington, DC: American Enterprise Institute; https://www.aei.org/wp-content/uploads/2020/07/AEI-Parenting-During-a-Pandemic-Survey-Report-1.pdf. Accessed February 16, 2021.
39. Kalil A, Haskins R, Chesters J. Investing in Children: Work, Education, and Social Policy in Two Rich Countries. 2012.Washington, DC: Brookings Institution Press;
40. Barrero-Castillero A, Morton SU, Nelson CA, Smith VC. Psychosocial stress and adversity: Effects from the perinatal period to adulthood. Neoreviews. 2019;20:e686–e696.
41. UNICEF. COVID-19 response: Considerations for children and adults with disabilities. https://www.unicef.org/disabilities/files/COVID-19_response_considerations_for_people_with_disabilities_190320.pdf. Published April 2020 Accessed February 16, 2021.
42. Mental Health America. The mental health of healthcare workers in COVID-19. https://mhanational.org/mental-health-healthcare-workers-covid-19. Accessed February 10, 2021.
43. Leeb RT, Bitsko RH, Radhakrishnan L, Martinez P, Njai R, Holland KM. Mental health–related emergency department visits among children aged <18 years during the COVID-19 pandemic—United States, January 1–October 17, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1675–1680.
44. Snair MR, Altevogt BM, Davis M. Forum on Medical and Public Health Preparedness for Catastrophic Events. In: Institute of Medicine. Regional Disaster Response Coordination to Support Health Outcomes: Summary of a Workshop Series. 2015.Washington, DC: National Academies Press;
45. American Academy of Family Physicians. Advancing Health Equity by Addressing the Social Determinants of Health in Family Medicine (Position Paper). https://www.aafp.org/about/policies/all/social-determinants.html. Published April 2019 Accessed February 16, 2021.
46. U.S. Department of Health and Human Services. Children and Youth Task Force in Disasters: Guidelines for Development. https://www.acf.hhs.gov/ohsepr/preparedness-resiliency/children-youth-task-forces-in-disaster. Published February 8, 2019 Accessed February 16, 2021.
47. Villeneuve M. States scramble to arrange child care for essential workers. U.S. News and World Report. https://www.usnews.com/news/best-states/minnesota/articles/2020-03-29/states-scramble-to-arrange-child-care-for-essential-workers. Published March 29, 2020 Accessed February 16, 2021.
48. Enrolment in Childcare and Pre-school. OECD Family Database. http://www.oecd.org/els/soc/PF3_2_Enrolment_childcare_preschool.pdf. Published May 11, 2019 Accessed February 16, 2021.
49. Working Families. Coronavirus (COVID-19)—What are my rights? https://workingfamilies.org.uk/articles/coronavirus. Published February 11, 2021 Accessed February 16, 2021.
50. Looking after baby: America is the only rich country without a law on paid leave for new parents. The Economist. https://www.economist.com/united-states/2019/07/18/america-is-the-only-rich-country-without-a-law-on-paid-leave-for-new-parents. Published July 18, 2019 Accessed February 16, 2021.
51. Just Capital. The COVID-19 corporate response tracker: How America’s largest employers are treating stakeholders amid the coronavirus crisis. https://justcapital.com/reports/the-covid-19-corporate-response-tracker-how-americas-largest-employers-are-treating-stakeholders-amid-the-coronavirus-crisis. Published May 7, 2020 Accessed February 16, 2021.
52. Association of American Medical Colleges. GBAnalytic #11: Childcare offerings during COVID-19. https://www.aamc.org/media/47646/download. Published August 2020 Accessed February 16, 2021.
53. The Hunt Institute. COVID-19 state child care actions. http://www.hunt-institute.org/covid-19-resources/state-child-care-actions-covid-19. Published 2020 Accessed February 16, 2021.
54. Bishop-Josef S, Beakey C, Watson S, Garrett T. Want to Grow the Economy? Fix the Child Care Crisis. 2019Washington, DC: Council for a Strong America; https://strongnation.s3.amazonaws.com/documents/602/83bb2275-ce07-4d74-bcee-ff6178daf6bd.pdf. Accessed February 16, 2021.
55. Tolentino J. What mutual aid can do during a pandemic The New Yorker. https://www.newyorker.com/magazine/2020/05/18/what-mutual-aid-can-do-during-a-pandemic. Published May 11, 2020 Accessed February 16, 2021.
56. Collaborative Student Volunteer and Service Projects. https://icollaborative.aamc.org/collection/covid-19-student-service-projects. Updated February 2021 Accessed February 16, 2021.
57. Engelson B, Robinson L, Spence Coffey D. Health professional education student volunteerism amid COVID-19: How a diverse, interprofessional team of health students created a volunteer model to support essential workers. NAM Perspectives. Discussion paper. 2020Washington, DC: National Academy of Medicine; https://nam.edu/health-professional-education-student-volunteerism-amid-covid-19. Accessed February 16, 2021.
58. Lewis H. The coronavirus is a disaster for feminism: Pandemics affect men and women differently. The Atlantic. https://www.theatlantic.com/international/archive/2020/03/feminism-womens-rights-coronavirus-covid19/608302. Published March 19, 2020 Accessed February 16, 2021.
Copyright © 2021 by the Association of American Medical Colleges