Gender Disparities in Active Duty Air Force Parents' Childcare Access: Pre-Pandemic Costs, Utilization, and Career Impacts
Abstract: Past reports indicate that enduring Department of Defense (DoD) childcare shortfalls may disproportionately affect women, but details regarding gender effects are unknown. This exploratory study sought to uncover the military childcare system’s pre-pandemic state by analyzing two Air Force (AF) survey datasets—the 2017 AF Community Feedback Tool and 2020 AF Childcare Survey—to examine gender gaps in active duty AF parents’ childcare access, cost and utilization, and perceptions of childcare impacts on career progression and retention. Results reveal that women—particularly those in the lowest ranks with less time on station—report more difficulties accessing childcare than male counterparts. Furthermore, fathers paid nothing for childcare and relied on spouses for childcare at higher rates, while mothers paid for care, relied on DoD childcare programs, were on DoD waitlists, reported childcare-related career impacts, and reported childcare affected their retention decisions at higher rates. Policy recommendations to improve childcare across the force are discussed.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.