Life & the Law Maternal & Public Health

Strengthening the Pro-Life Safety Net: Childcare for Pregnant and Parenting Women in Need

Christopher C. Hull, Ph.D.

August 6, 2025

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This is Issue 35 of the American Reports Series.

Executive Summary

Pregnant and parenting women in need (PPWIN) often face barriers to adequate childcare, including but not limited to trust, affordability, availability, location, and hours.

Federal childcare programs collectively invest billions of dollars annually, but parents still report spending 22% of their income on childcare.

Proposals to expand support for PPWIN include allowing federal Temporary Assistance for Needy Families (TANF) and Childcare and Development Block Grant (CCDBG) funds to support nontraditional providers, revising grant guidance to incentivize pilot programs focused on PPWIN, and improving access to Head Start for younger children and underserved families in ways that would support PPWIN in particular.

Careful reform of federal programs serving low-income populations to improve PPWIN access to childcare, alongside a smarter allocation of existing federal resources to childcare focused on the population, could help build a pro-life safety net that meets the needs of expectant and new mothers, including on the critical childcare challenge.

I. Introduction – The Childcare Industry

Childcare services are an essential aid to many working families, supporting parents who must both work to earn a living or are pursuing an education in knowing that their children are safe and happy. It is a diverse industry that offers families a wide variety of childcare options, but can be expensive. In a recent study, surveyed parents reported spending 22% of their income and 29% of their savings on childcare, and 89% said at least one parent had to make at least one major change to his or her work, life, or finances to afford care in 2024.[1]

Unsurprisingly, therefore, childcare affordability is a major concern among families who use it, especially low-income families,[2] and particularly pregnant and parenting women in need (PPWIN).[3] Low-income women with children struggle not only to find available and affordable childcare,[4] but – particularly when pregnant – to find healthcare,[5] adequate income,[6] housing,[7] and trusted support and advice.[8] Even if parents can afford it, the childcare options they find either may not be immediately available[9] or of high quality.[10]^,[11]

Over the years, the federal government has created a variety of programs related to childcare. In 1965, as part of President Lyndon Johnson’s War on Poverty, the federal government created the Head Start program,[12] which delivers child development services in home-based, center-based, or family child care settings.[13] Later, the federal government sponsored childcare to help low-income families move from welfare to employment under the Family Support Act of 1988[14] and the Child Care and Development Block Grant (CCDBG) Act, as modified in 1996.[15]^,[16] While Head Start is a federal grant that goes directly to 1,600 local agencies,[17] the Child Care and Development Fund (CCDF)^[18] is a block grant, authorized under the CCDBG Act, which goes to states, territories, and tribes to support affordable childcare for low-income families.[19] Parents can then choose a childcare option from among a list of those designated providers that meet a state’s health and safety requirements and receive help paying for childcare.[20] In FY 2022, on average per month, about 74% of children receiving childcare assistance through the CCDF were in childcare centers, with only 15% in a family home and 6% in a group home.[21]

In April 2020, when the COVID-19 pandemic led to a shelter-in-place order, around two-thirds of the childcare industry was shut down.[22] Congress responded by passing three COVID-19 relief bills, which included $52 billion in supplemental appropriations to states for childcare between March 2020 and March of 2021, [23] providing a financial boost to the industry until that funding lapsed in 2023.[24]

Despite the federal government’s massive investment in childcare over the decades, the industry still faces challenges. The first is the business model. Since many parents – especially PPWIN – cannot pay the true cost of childcare, providers are forced into a business model where expenses exceed revenue.[25] That loss of revenue affects wages for childcare workers, who made only about $32,719 on average as of May 1, 2025, [26] a compensation that makes it difficult to attract and keep good workers.[27] Childcare is also highly regulated, adding both cost and compliance to the sector’s challenges.[28]

In this context, as noted above, many families find it difficult to afford good childcare. The U.S. Census Bureau reports that childcare ranged from $4,810 to $15,417 a year, soaking up between 8% and 19.3% of median family income per child.[29] Parents can find less expensive options, such as preschool programs, school age programs, or care provided by a family member, friend, or neighbor. But these other options can have long waiting lists, and may have a wide range in quality and limited flexibility.

Having the option to work from home or choose flexible work schedules has been helpful in suiting the preferences of women with children,[30] and likely helps parents manage their complex and expensive childcare challenges.[31] That said, families may still have problems if these new choices reduce their income.[32]

Even if cost is not a factor, there are still issues with supply. A report on data from 2021 shows that the availability of childcare does not meet the demand, as 12.3 million children potentially needed childcare but there were only 8.7 million slots in licensed childcare centers and family child care providers available.[33] As the problems finding childcare mount, some parents, especially mothers,[34] just drop out of the workforce or reduce their work hours until the children are older.[35]

Of particular concern for PPWIN, there is also a serious shortage of childcare for infants and toddlers,[36] especially in rural areas.[37]^,[38] Since young children require more care,[39] the cost is higher.[40]^,[41] Providers need more staff to care for infants and toddlers to ensure their safety and well-being.[42] Thirty-five states and the District of Columbia, for example, have set standards for programs serving infants and toddlers that meet or exceed child-teacher Early Head Start ratio standards for at least one age group.[43] Even leading up to the COVID-19 pandemic, home-based care for children under age three dropped significantly for both state-listed and unlisted unpaid providers from 2012 to 2019.[44] Since then, an annual survey of states has found an 11% decline in licensed family child care programs just from 2019 to 2022.[45] Parents with infants and toddlers are most likely to depend on such family-provided care, according to CCDF regulations.[46] Less than one-fourth of children under age three could be served by the existing licensed childcare providers, according to one 2020 study of 19 states and the District of Columbia.[47]

By contrast, home-based childcare (HBCC) can offer a less expensive and more flexible option for families.[48] Some parents prefer the home-like setting and the smaller number of children served to the larger childcare centers.[49] Home-based providers are also more likely to offer evening and weekend care.[50] In addition, some communities are building networks of family care centers to enable sharing services that can reduce costs and avoid closures.[51] Unfortunately, in spite of these efforts, the availability of home-based care is decreasing: survey data from state licensing agencies in 2019 suggests that more than 97,000 family childcare homes in the U.S. closed between 2005 and 2017, even as overall licensed capacity increased by 7%.[52]^,[53]

Even with the problems in the childcare industry, most families will eventually find a way to meet their childcare needs – but not all. Low-income pregnant and parenting women in need in particular face an uphill battle because they lack many of the personal, social, and financial resources most families rely on to help them take care of their children while they work.[54] Such women are often single parents who are more likely to be poor[55]^,[56] and/or unemployed,[57] thus often lacking the income or benefits needed to cover their cost of living. Less than half of those entitled to child support received the full amount due in the most recent year for which data was available, though that percentage has grown over time.[58] These women often turn to government programs for help, including for childcare.[59] As a result, PPWIN frequently find themselves having to make tough choices about how to care for their children – including sometimes going without food themselves or even struggling with suicidal thoughts.[60] Most grim of all, fully 28% of women who had abortions specifically cited “Can’t afford a baby and child care” as a rationale in one 2005 survey, and 40% cited financial reasons in a 2013 study of data between 2008-2010.[61][62] For these reasons and more, it is unsurprising that, according to a Statista.com analysis, more than 70% of women in the U.S. who had an abortion between 2021 and 2022 had incomes below 200% of the federal poverty level.[63]

II. Helping Pregnant and Parenting Women in Need Meet their Childcare Challenges through Case Management

In 2019, there were 3.4 million women in the labor force who lived below the poverty line.[64] When these women become pregnant, childcare is just one struggle among many as they work to meet their personal, family, and financial needs. If their employment is an entry level job, they will likely not have enough money to meet all their basic needs, such as healthcare, housing, groceries, transportation, along with childcare. They will need help that might include community and government programs, including at the federal level the CCDF, but also Medicaid,[65] Temporary Assistance for Needy Families (TANF),[66] Supplemental Nutrition Assistance Program (SNAP),[67] and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).[68] Qualifying for these programs, however, can take time and still may not move the needle toward independence. Therefore, PPWIN will need someone to help and support them.[69]^,[70]

This is where the aid provided by case managers may help to fill the gap. Case managers help their clients using needs assessments, action plans, and service coordination to solve problems. Case management is used by various organizations and across many disciplines, such as social work, law enforcement, healthcare, and banking.[71] In healthcare, it is a process that helps patients connect with providers, resources, and services to help ensure the best care.

Case management services are successful for several reasons. Case managers are able to engage with their clients in a more personalized way based on trust, which is especially important for PPWIN for whom trusting relationships may be in short supply.[72]^{,[73],[74],[75]} Such services are also often community-based,[76]^,[77],[78] that is, a mobile rather than office-based service, in which the case manager’s contact with the client occurs in a setting such as the client’s workplace, home, or other venue outside of a counseling or care facility.[79] Finally, a system of monitoring and evaluation provides evidence of the degree to which the clients achieved desired outcomes.[80]^,[81]

For instance, Catholic Charities of Fort Worth (CCFW) has developed “Out of Poverty Pathway” programs for low-income individuals – including PPWIN[82]^,[83],[84]– using a case management model to move clients out of poverty.[85] It offers a range of services to help those in need achieve stability and self-sufficiency. Participants in the Padua Pilot, one of CCFW’s most successful Out of Poverty Pathway programs,[86]were 25% more likely to have full-time employment, and had monthly earnings 18% higher, than the control group after two years..[87] Each client is paired with two case managers who work together to develop a plan with action steps.[88] One of the keys to this program is the building of a trusted relationship with the client through regular meetings that assess progress.[89] The goal is for the client to find solutions for their problems and a way up and out of poverty to sustain their progress.[90]

Many other programs like the Padua Pilot also offer case management services. For example, the federal government implemented the Rural Integration Models for Parents and Children to Thrive (Rural IMPACT) Demonstration to provide cross-agency training and technical support for the development of coordinated service delivery to families to reduce childhood poverty in rural areas.[91] Rural IMPACT built on other federal efforts such as Promise Zones,[92] high poverty communities in which the federal government partners with local leaders in an attempt to foster economic activity, improve education, boost public health, bring down crime, and pursue other community priorities. Specifically, Promise Zones let local leaders utilize five AmeriCorps VISTA members in the project’s work, provide access to a liaison to help designees navigate federal programs, provide preferences for certain competitive federal grant programs, and receive technical assistance from participating federal agencies.[93]^,[94]

Thus, case management offers a promising model for serving low-income communities in general. Specifically, effective case management holds out the possibility of helping connect PPWIN to childcare services in the context of a sweep of other issues, maximizing their chance not only of getting access to affordable care for their children, but of meeting their other needs as well. For instance, community-based childcare centers – an alternative model of childcare that offers a range of case management services such as home visiting, prenatal support, and extended hours – have been used successfully in developing countries.[95] Closer to home, the Texas Workforce Commission (TWC) has implemented the Texas Childcare Connection (TX3C), an online resource allowing parents to identify local facilities while also integrating them into TWC’s case management system.[96] Such models suggest that federal resources from existing programs might usefully be redirected to case management services, in particular aimed at connecting PPWIN with childcare in the context of additional help, as laid out in detail in the next section.

III. Using Federal Childcare Policy to Provide Better Solutions for PPWIN

The federal government has been a forerunner in providing childcare assistance to American families for decades. Focusing mainly on the two primary concerns, cost and access, they have implemented programs that help parents overcome these problems.

For PPWIN, whose needs are more complex, federal funding alone may not be enough. However, there are ways for existing federal childcare and other programs to adopt new and tested strategies to redirect their resources in more productive ways and better serve PPWIN. Following is a review of these key federal programs and proposed changes.

The Child Care and Development Block Grant (CCDBG) Act [97] (42 U.S.C. 9857 et seq[98]) authorizes and governs the CCDF,[99] which in turn oversees the subsidies that go to the states.[100] The CCDF is administered by the Office of Child Care (OCC)[101] within the Administration for Children and Families (ACF)[102] at the U.S. Department of Health and Human Services (HHS).[103] The CCDF is the primary federal funding source that helps low-income families find and pay for childcare.[104] CCDBG funding allows each state to design a plan to help low-income households pay for childcare.[105] While federal law limits its own childcare funds to families with an income below 85% of state median income (SMI), states have set income eligibility that ranges from 40%-150% of SMI for a family of three, in three cases using state-only funds beyond those counted toward the CCDF state match to exceed the federal threshold.[106] Currently, states not only determine income eligibility for families subject to the federal limit, but also the degree to which parents must work in order to qualify.[107] For instance, as of 2016, 26 states or territories set a requirement for parents to work at least a certain number of hours to retain eligibility for the program.[108] Similarly, the lead agency – that is, the state, territorial, or tribal entity, or joint interagency office to which a CCDF grant is awarded[109] – sets the subsidy rate paid on behalf of children.[110] States also prioritize some families for assistance,[111] such as those who are homeless or have special needs.

Proposals to improve the CCDF:

Improve affordability by reducing the co-payment from 7% of gross income to 6% or lower for PPWIN through regulation.[112]
Alter the grant criteria to favor childcare providers that serve infants and toddlers of PPWIN, given the above-mentioned shortage of such care, in a way that includes family, friend, and neighbor (FFN)[113] providers, without excluding faith-based options, including potentially modifying the existing CCDF rule at:
- 45 CFR98.16(x) to read, “A description of the supply of child care available regardless of subsidy participation relative to the population of children requiring child care, including care for infants and toddlers, as well as family, friend, and neighbor (FFN) providers, without exclusion of sectarian options…”[114]
- 45 CF 98.16(y)(2) to read, “For families needing infant and toddler care, which…may include additional strategies such as relying more on FFN providers…, without exclusion of sectarian options.”[115]
- 45 CFR98.16(z) to read, “A description of how the Lead Agency will use grants or contracts for direct services to achieve supply building goals for children in underserved geographic areas, infants and toddlers…This must include a description of how the proportion of the shortages for these groups would be filled by contracted or grant funded slots, as well as relying more on family, friend, and neighbor (FFN) providers, and without exclusion of sectarian options …”[116]
- 45 CFR98.16(aa) to read, “A description of how the Lead Agency will improve the quality of child care services for children in underserved geographic areas, infants and toddlers, children with disabilities …., and children who receive care during nontraditional hours, including by relying more on family, friend, and neighbor (FFN) providers, and without exclusion of sectarian options…”[117]
Meet supply needs by using existing resources to provide start up grants, especially for home-based providers serving PPWIN.
Allocate some of states’ CCDBG funds for community and case management initiatives serving PPWIN, evaluate those strategies, and replicate those with the best outcomes.
Require and fund evaluations, surveys, and audits to regularly monitor the outcomes of these programs serving PPWINs, and shift resources towards those that are working.
Include funding for training of PPWIN to become childcare workers, to increase the size of the needed workforce, and thereby, to the extent it increases supply, to reduce childcare costs at the same time.
Require states to use CCDBG funds to support navigators or facilitators who can help HBCC providers navigate approval processes and provide support to help them meet health and safety standards.[118]
Expand the CCDF’s definition of “Parent” in 45 CFR 98.2 to read, “a parent by blood, marriage or adoption and also means a legal guardian, pregnant woman who will have given birth by the time her child would enter care, or other person standing in loco parentis.”[119]
Add to the CCDF’s requirements for eligibility determination in 45 CFR 98.16(h)(4), “Processes to incorporate additional eligible children in the family size in accordance with § 98.21(d), including unborn children of pregnant women who will have been born by the time the child enters the care facility;”[120]
Make the inclusion of newborns and unborn children explicit in the CCDF’s mandate in 45 CFR 98.21(d) that states, “The Lead Agency shall establish policies and processes to incorporate additional eligible children in the family size (g., siblings, newborns, unborn children of pregnant women who will have been born by the time the child enters the care facility, or foster siblings).”[121]
Require states to include in CCDF Plans as spelled out in 45 CFR 98.16(g) a definition of “parent, including whether pregnant women who will have given birth by the time the child enters the care facility are considered parents for purposes of childcare eligibility.”[122]
Include a subsection in 45 CFR 98.16 requiring outreach to PPWIN, for instance, “(ll) A description of how the Lead Agency will provide outreach and services to pregnant and parenting women in need in the subsidy system.”

Head Start is a federal program that prepares young children from low-income families for kindergarten,[123] as noted above. The program fosters development using a wide range of activities including play and learning that build language skills, knowledge of math and science, social skills, management of emotions, and more.[124] Head Start also provides health screening, including vision and dental, and nutritious meals.[125]

The Head Start program is available to children from birth to age five.[126] Head Start Preschool services in particular work with children ages three to five and their families.[127] Early Head Start services, on the other hand, work with families that have children ranging in age from birth to three.[128] Both programs offer child development services in a variety of venues, including center-based, home-based, or family childcare settings.[129] According to Head Start’s website, its programs “operate in every state, many tribal nations, and several U.S. territories.”[130]

Proposals to Improve Head Start:

Change the grantmaking process by directing that future Notices of Funding Opportunities (NOFOs) stipulate that grant decisionmakers will favor:
- Life-affirming support, home-based and family-based care, and faith-based care, especially for PPWIN;
- Case management approaches to meeting PPWIN’s needs, including in childcare; and
- Funding for facilities that serve more PPWIN with infants and toddlers.
Modify the Head Start regulations to:
- Favor life-affirming support for PPWIN, including by:
  - Expanding Head Start’s Services to Enrolled Pregnant Women laid out in 45 CFR Part 1302 Subpart H[131] to include “services that help reduce barriers to healthy maternal and birthing outcomes for each family, including life-affirming counseling and care” in 45 CFR 1302.80(f).[132]
  - Enhancing Head Start’s home-based program option, which is limited to site visits when the parent is home as specified in 45 CFR 1302.35,[133] by modifying the text to promote “the parent’s role as the child’s teacher through experiences focused on the parent-child relationship and, as appropriate, the family’s traditions, culture, values, and beliefs, including life-affirming counseling and care provided to parents before the child’s birth;”[134]
- Broaden home-based and family-based care for PPWIN, including Head Start’s family child care services as described in 45 CFR 1302.23,[135] which are delivered to children primarily in a private home or family-like setting and operate sufficient hours to meet the needs of families,[136]to stipulate that the “program ensures family child care homes are available that can work with expectant parents in advance of the birth of their children to help ensure that their needs will be met and accommodate children and families with disabilities.”[137]
- Add that Head Start’s Recruitment of Children in 45 CFR 1302.13 should apply to “all families with eligible children and/or unborn children who would be eligible after birth,”[138] especially given that Head Start already provides services to enrolled pregnant women as described in 45 CFR Part 1302 Subpart H.[139]
- Make explicit that for the purposes of Early Head Start age requirements in 45 CFR 1302.12(b)(1), “a child must be an infant or a toddler younger than three years old, and an unborn child may be determined as eligible for future care at any point before birth,”[140] given that Head Start’s Eligibility Requirements in 45 CFR 1302.12(c)(1) already state that they apply to a “pregnant woman or a child.”[141]
- Given that Head Start’s Community Assessments in 45 CFR 1302.11(b)(2)(i) already include “eligible children and expectant mothers,”[142] clarify that the assessment should provide relevant demographic data including on “(G) pregnant women.”[143]
- Add to the Head Start Selection Process criteria in 45 CFR 1302.14(a)(1), “family income, whether the child is homeless, whether the child is in foster care, the child’s age, whether the mother is currently expecting…”[144]

Social Services Block Grant (SSBG) is a block grant that has the flexibility to be used with other funding sources to tailor social service programming, especially related to self-sufficiency, reducing dependency, and other social issues that result from lack of support and poverty.[145] This includes childcare, which the program regulations refer to as “Day Care Services – Children.”[146] In FY 2021, 13% of SSBG-supported service recipients, or 2.7 million people, fell into the category of childcare.[147] SSBG funding has been frozen at $1.7 billion for more than 20 years.[148]^,[149] That said, states can also transfer up to 10% of their TANF funding to SSBG.[150] In FY 2018, for instance, states transferred $1.1 billion in TANF funds to SSBG.[151]

Proposals to Improve SSBG:

Encourage state use of SSBG resources spent on childcare expenditures for case management of PPWIN, including helping them find quality, affordable childcare.
Make SSBG funds available to reduce childcare workforce shortages by funding the training of childcare workers, including training PPWIN to become childcare workers.
Change SSBG grantmaking criteria by stipulating in future Notices of Funding Opportunities (NOFOs) that decisionmakers will favor:
- More home-based and family-based options that serve PPWIN, without excluding faith-based options;
- Building the supply of childcare programs for infants and toddlers in areas described as “childcare deserts,”[152] such as rural and tribal areas.[153];
Broaden the SSBG definition of “Day Care Services – Children” in 45 CFR Appendix A to Part 96,[154] which already includes home-based care, to include more family-based and faith-based options that serve PPWIN, as follows: “Day care services for children (including infants, pre-schoolers, and school age children) are services or activities provided in a setting that meets applicable standards of state and local law, in a center or in a home, including both faith-based and family-based care, for a portion of a 24-hour day.”[155]

Temporary Assistance for Needy Families (TANF) Block Grant is a federal program administered by the Administration for Children and Families (ACF). It provides $16.6 billion annually to states and territories to support low-income families with children.[156] It also serves the District of Columbia and Indian tribes.[157]

In FY 2023, states used about $4.1 billion in TANF and related funds on childcare.[158] Specifically, states spent $1.3 billion in federal TANF funds on childcare, and another $2.8 billion from state funds, a significant portion of which is required state spending to qualify for federal TANF grants.[159] In addition, states transferred $1 billion from TANF to the CCDBG program.[160] (Note that under federal law, states are restricted from transferring more than 30% of TANF funding to CCDF.[161]) Finally, states spent $3.1 billion on Pre-Kindergarten/Head Start, drawing down another $80 million in federal TANF funds for that purpose.[162]

Proposals to Improve TANF:

Encourage state use of TANF resources transferred to childcare expenditures for case management of PPWIN, including helping them find quality, affordable childcare.
Add the specification that the regulatory definition of “Qualified State Expenditures” in 45 CFR 260.30 includes spending on “Child care assistance, including to pregnant and parenting women in need”[163];
Expand the meaning of “assistance” in 45 CFR 260.31 by:
- Including explicitly “supportive services such as transportation and child care provided to families who are not employed, including to pregnant and parenting women in need”[164]; and
- Narrowing the exclusion of “case management [and] child care information and referral” services by qualifying, “unless provided to pregnant and parenting women in need,”[165] thereby including as qualified “assistance” financial support for educating PPWIN about childcare options, as well as referring them to those options.

Legislatively, allow states to transfer:
- More than 30% of TANF funds to childcare, provided that it includes services for PPWIN; and/or
- 30% of TANF to the CCDBG program regardless of the amount of funds transferred to SSBG, again provided that the state includes services for PPWIN.

These changes to federal programs, taken together, would constitute a significant step forward in providing childcare support for PPWIN, without requiring additional appropriations from Congress.

IV. Conclusion

Pregnant and parenting women in need often depend on childcare to work and support their families. Despite this critical need, many challenges exist, including affordability, trust, availability, location, and hours.[166] While some families can manage these problems, low-income parents like PPWIN, whose lives are complex and who do not have the resources to meet their personal, family, and financial needs, struggle to find adequate childcare. They need more than a childcare voucher to manage their household and their children while working.

That said, by making changes to care for PPWIN including leveraging the Child Care and Development Fund (CCDF),[167] Head Start including both Head Start Preschool[168] and Early Head Start,[169] the Social Services Block Grant (SSBG) program,[170] and the Temporary Assistance for Needy Families (TANF) program,[171] an administration could meaningfully improve access to trustworthy, affordable childcare for this critical population.

Christopher C. Hull, Ph.D., is the President of Issue Management Inc., a full-service public affairs firm focused on achieving policy results. Dr. Hull holds a Ph.D. with distinction in American Government from Georgetown University, and an undergraduate degree magna cum laude in Comparative Government from Harvard University. He has served as Chief of Staff in the U.S. House of Representatives; the Majority Caucus Staff Director of a State Senate; Executive Vice President of a major national think tank; and Legislative Assistant/Legislative Correspondent in the U.S. Senate. He is the author of Grassroots Rules (Stanford Press, 2007), as well as more than 100 book chapters, peer-reviewed articles, conference papers, and op-eds.

[1] https://www.care.com/c/how-much-does-child-care-cost/

[2] https://www.commerce.gov/news/blog/2024/06/childcare-costs-reduced-work-and-financial-strain-new-estimates-low-income

[3] Note that the “PPWIN” terminology is used by the authors to describe the target population, though it is not currently present in statute or regulation. For instance, at the time of writing, federal regulations including those associated with childcare and related services commonly do not explicitly include pregnant women in definitions of “family” and “parent.” See, e.g., https://www.ecfr.gov/current/title-45/part-98#p-98.2(Parent) and https://www.ecfr.gov/current/title-24/part-5/section-5.403#p-5.403(Family). Likewise, Health and Human Services (HHS) materials instead refer to “pregnant and parenting youth,” terminology that raises inter alia the issue of excluding pregnant and parenting women who do not qualify under state and federal law as “youth.” See https://teenpregnancy.acf.hhs.gov/resources/pregnant-and-parenting-youth and https://www.usich.gov/news-events/news/homelessness-prevention-series-spotlight-family-homelessness. U.S. regulatory definitions of “at risk” similarly often do not explicitly include pregnant women. See, e.g., https://www.ecfr.gov/current/title-24/part-91/section-91.5#p-91.5(At%20risk%20of%20homelessness) and https://www.ecfr.gov/current/title-24/part-578#p-578.3(At%20risk%20of%20homelessness). Recommendations made below would address this shortcoming with respect to the childcare issue, and more specifically to the Child Care and Development Fund regulations (available at https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-98).

[4] https://rapidsurveyproject.com/article/many-families-with-infants-and-toddlers-struggle-to-consistently-access-child-care/

[5] https://pmc.ncbi.nlm.nih.gov/articles/PMC8556621/

[6] Ibid.

[7] https://lozierinstitute.org/strengthening-the-pro-life-safety-net-federal-housing-policy/

[8] https://pmc.ncbi.nlm.nih.gov/articles/PMC9778672/

[9] https://www.uschamber.com/workforce/understanding-americas-labor-shortage-the-scarce-and-costly-childcare-issue

[10] https://acf.gov/sites/default/files/documents/opre/cceepra_access_guidebook_final_213_b508.pdf

[11] https://www.federalregister.gov/documents/2023/04/21/2023-08659/increasing-access-to-high-quality-care-and-supporting-caregivers

[12] https://www.washingtonpost.com/wp-dyn/content/article/2010/11/04/AR2010110403129.html?hpid=moreheadlines

[13] https://acf.gov/ohs/about/head-start

[14] https://www.congress.gov/bill/100th-congress/house-bill/1720

[15] https://www.congress.gov/104/plaws/publ193/PLAW-104publ193.pdf

[16] https://socialwelfare.library.vcu.edu/programs/child-care-the-american-history/

[17] https://www.headstart.gov/about-us/article/about-office-head-start

[18] https://www.ecfr.gov/current/title-45/part-98

[19] https://acf.gov/occ/faq/child-care-and-development-fund-final-rule-frequently-asked-questions

[20] Ibid.

[21] https://acf.gov/occ/data/fy-2022-preliminary-data-table-3

[22] https://journals.sagepub.com/doi/full/10.1177/23780231211032028

[23] The Coronavirus Aid, Relief, and Economic Security (CARES) Act provided $3.5 billion to states for childcare (P.L. 116-136, enacted March 2020); the Coronavirus Response & Relief Supplemental Appropriations (CRRSA) Act provided $10 billion to states in CCDBG resources to prevent, prepare for, and respond to coronavirus, domestically or internationally, in addition to the $5.911 billion in funding for the CCDF in that Fiscal Year, which was also included in the overall bill (P.L. 116-260, enacted December 2020); the American Rescue Plan Act (ARPA) provided $14.99 billion for CCDBG Supplemental Discretionary Funds and $23.975 billion for childcare stabilization grants (P.L. 117-2, enacted March 2021). See, respectively, https://www.congress.gov/116/plaws/publ136/PLAW-116publ136.pdf, https://www.congress.gov/116/plaws/publ260/PLAW-116publ260.pdf, and https://www.congress.gov/117/plaws/publ2/PLAW-117publ2.pdf.

[24] https://bidenwhitehouse.archives.gov/cea/written-materials/2024/06/27/impacts-of-the-expiration-of-federal-child-care-stabilization-funding-and-the-mitigating-effects-of-state-level-stopgap-funding/

[25] https://nhfpi.org/resource/the-fragile-economics-of-the-child-care-sector/

[26] https://www.salary.com/research/salary/posting/child-care-worker-salary

[27] https://acf.gov/sites/default/files/documents/ecd/ece_low_compensation_undermines_quality_report_june_10_2016_508.pdf

[28] https://www.ecodevo.com/childcare-shortages-are-a-workforce-issue/

[29] https://www.census.gov/library/stories/2024/01/rising-child-care-cost.html

[30] https://siepr.stanford.edu/publications/essay/working-home-2025-five-key-facts

[31] https://www.news24.com/life/lifestyle-trends/reduced-costs-on-childcare-transport-and-more-how-hybrid-work-can-be-a-financial-lifeline-20241007

[32] https://www.commerce.gov/news/blog/2024/06/childcare-costs-reduced-work-and-financial-strain-new-estimates-low-income

[33] https://www.childcareaware.org/catalyzing-growth-using-data-to-change-child-care/?utm_campaign=22CatalyzingGrowthReport&utm_source=Media&utm_content=2023_CGReport_FinalRelease_Media_GeneralOutreach#2021DataAnalysisandRecommendations

[34] https://www.americanprogress.org/article/child-care-crisis-keeping-women-workforce/

[35] https://hbr.org/2021/04/childcare-is-a-business-issue

[36] https://kpmg.com/us/en/articles/2024/may-2024-childcare-crisis-state-work-america.html

[37] https://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/rural/nac-rural-child-care-brief-23.pdf

[38] https://lmi.mt.gov/_docs/Publications/EAG-Articles/EAG-0324_Final.pdf

[39] https://www.zerotothree.org/wp-content/uploads/2022/12/Child-Care.pdf

[40] https://worldpopulationreview.com/state-rankings/child-care-costs-by-state

[41] See, e.g., https://home.treasury.gov/system/files/136/The-Economics-of-Childcare-Supply-09-14-final.pdf, pp. 11 and 26.

[42] See, for instance, pg. 3, https://pn3policy.org/wp-content/uploads/2020/07/ER.0920.012A_ChildCareRatios.pdf and pg. 13, https://osse.dc.gov/sites/default/files/dc/sites/osse/page_content/attachments/Modeling%20the%20Cost%20of%20Child%20Care%20in%20the%20District%20of%20Columbia%202024.pdf

[43] https://www.americanprogress.org/article/data-dashboard-an-overview-of-child-care-and-early-learning-in-the-united-states/

[44] https://acf.gov/sites/default/files/documents/opre/NSECE-chartbook-homebased-may-2021.pdf, Figure 3.

[45] https://www.childcareaware.org/catalyzing-growth-using-data-to-change-child-care-2022/

[46] https://childcareta.acf.hhs.gov/sites/default/files/addressing_decreasing_fcc_providers_revised_final.pdf

[47] https://www.americanprogress.org/article/costly-unavailable-america-lacks-sufficient-child-care-supply-infants-toddlers/

[48] https://childcare.gov/consumer-education/family-child-care-homes

[49] Ibid.

[50] https://acf.gov/sites/default/files/documents/opre/factsheet_nonstandard_hours_provision_of_ece_toopre_041715_508.pdf

[51] https://www.ccfp.org/ccfp/the-case-for-home-based-child-care?rq=family%20child%20care

[52] https://acf.gov/occ/news/decreasing-number-family-child-care-providers-united-states

[53] https://childcareta.acf.hhs.gov/sites/default/files/addressing_decreasing_fcc_providers_revised_final.pdf

[54] https://pmc.ncbi.nlm.nih.gov/articles/PMC9073812/

[55] https://www2.census.gov/programs-surveys/demo/tables/p60/280/tableA2_pov_by_family_type.xlsx

[56] https://www.rsfjournal.org/content/7/3/1

[57] https://www.bls.gov/news.release/pdf/famee.pdf

[58] https://www2.census.gov/programs-surveys/demo/tables/families/2022/cps-childsupport/cs01.xlsx

[59] https://acf.gov/occ/data/fy-2021-preliminary-data-table-18

[60] https://pmc.ncbi.nlm.nih.gov/articles/PMC5932102/

[61] https://pmc.ncbi.nlm.nih.gov/articles/PMC3729671/

[62] https://www.guttmacher.org/sites/default/files/pdfs/pubs/psrh/full/3711005.pdf

[63] https://www.statista.com/statistics/656635/abortion-distribution-united-states-by-income-level/

[64] https://www.bls.gov/opub/reports/womens-databook/2021/home.htm

[65] https://www.medicaid.gov/

[66] https://acf.gov/ofa/programs/temporary-assistance-needy-families-tanf

[67] https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program

[68] https://www.fns.usda.gov/wic

[69] https://www.americanprogress.org/article/basic-facts-women-poverty/

[70] https://pmc.ncbi.nlm.nih.gov/articles/PMC9073812/

[71] https://appian.com/learn/topics/case-management/what-is-case-management

[72] https://www.sciencedirect.com/science/article/pii/S0266613821000668

[73] https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-06089-0

[74] https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0685-y

[75] https://www.healthaffairs.org/doi/10.1377/hlthaff.2023.01450

[76] https://pmc.ncbi.nlm.nih.gov/articles/PMC7937223/

[77] https://psycnet.apa.org/record/2012-32980-040

[78] https://www.tandfonline.com/doi/full/10.1080/23311886.2024.2306921

[79] https://pmc.ncbi.nlm.nih.gov/articles/PMC5388031/

[80] https://www.ncbi.nlm.nih.gov/books/NBK571733/

[81] https://www.ncbi.nlm.nih.gov/books/NBK562214/

[82] https://catholiccharitiesfortworth.org/parenting/

[83] https://stbartsfw.org/gabriel-project

[84] https://fwdioc.org/walking-with-moms-in-need

[85] https://catholiccharitiesfortworth.org/out-of-poverty-pathways/

[86] https://catholiccharitiesfortworth.org/new-research-on-why-padua-works/

[87] https://northtexascatholic.org/news/a-better-way-catholic-charities-fort-worths-padua-program-turns-poverty-on-its-head

[88] https://leo.nd.edu/partners-projects/projects/padua/

[89] https://catholiccharitiesfortworth.org/wp-content/uploads/2017/06/Padua-Results-June-2017-Update.pdf

[90] https://www.aei.org/spotlight-panels/what-works-i-want-to-solve-poverty/

[91] https://aspe.hhs.gov/sites/default/files/private/pdf/224826/ImplementationFederalRuralIMPACT.pdf

[92] https://aspe.hhs.gov/sites/default/files/migrated_legacy_files/164871/ImplementationFederalRuralIMPACT.pdf

[93] https://www.hudexchange.info/programs/promise-zones/promise-zones-overview/

[94] https://aspe.hhs.gov/reports/planning-implementation-rural-impact-demonstration

[95] https://pmc.ncbi.nlm.nih.gov/articles/PMC4078044/

[96] https://tx3c.info/

[97] https://acf.gov/occ/law-regulation/child-care-and-development-block-grant-act-ccdbg-2014-plain-language-summary

[98] https://uscode.house.gov/view.xhtml?req=(title:42%20section:9857%20edition:prelim)

[99] https://acf.gov/occ/guide-ccdf-resources

[100] https://acf.gov/sites/default/files/documents/opre/state-2019-ccdf-policies-graphics-dec-2020.pdf

[101] https://acf.gov/occ

[102] https://acf.gov/

[103] https://www.hhs.gov/

[104] https://info.childcareaware.org/hubfs/WhatChangestoCCDFMeanforStates.pdf

[105] https://acf.gov/occ/about/what-we-do

[106] https://acf.gov/sites/default/files/documents/occ/CCDF-Family-Income-Eligibility-Levels-by-State.pdf

[107] https://acf.gov/sites/default/files/documents/opre/ccdf_policies_database_2016_book_of_tables_final_12_05_17_b508.pdf

[108] https://acf.gov/sites/default/files/documents/opre/ccdf_policies_database_2016_book_of_tables_final_12_05_17_b508.pdf

[109] https://www.ecfr.gov/current/title-45/part-98#p-98.2(Lead%20Agency)

[110] https://childcareta.acf.hhs.gov/sites/default/files/new-occ/resource/files/CCDF%20Subsidy%20-%20Paying%20Above%20the%20Private%20Rate.pdf

[111] https://acf.gov/sites/default/files/documents/occ/priorities_report_fy_2020.pdf

[112] A rule from 2024 caps the co-payment amount at 7%. See 45 CFR 98.45(l)(3) at https://www.ecfr.gov/current/title-45/part-98/section-98.45#p-98.45(l)(3). More specifically, see https://www.federalregister.gov/documents/2024/03/01/2024-04139/improving-child-care-access-affordability-and-stability-in-the-child-care-and-development-fund-ccdf (internal citations removed), noting that rule “requires States and Territories to establish co-payment policies for families receiving CCDF assistance to be no more than 7 percent of family income to help ensure family co-payments are not a barrier to accessing child care. HHS established 7 percent of a family’s income as the benchmark for an affordable co-payments in 2016 based on data from the U.S. Census Bureau that showed on average families spent 7 percent of income on child care, but that poor families on average spent approximately four times the share of their income on child care compared to higher income families. According to ACF data, average CCDF co-payments in 11 States exceed 7 percent of family income, 20 States have policies that allow some family co-payments above 7 percent (which can even rise as high as 27 percent of family income), and 16 States do not have clear policies in place to restrict co-payments to any percentage of family income. CCDF family co-payments increased at a rate higher than inflation between 2005-2021, with an average 18 percent increase (after adjusting for inflation) for families during this period.” See also https://acf.gov/occ/faq/2024-ccdf-final-rule for more detail.

[113] https://rapidsurveyproject.com/article/many-families-with-infants-and-toddlers-struggle-to-consistently-access-child-care/

[114] https://www.federalregister.gov/d/2024-04139/p-683

[115] https://www.federalregister.gov/d/2024-04139/p-686

[116] https://www.federalregister.gov/d/2024-04139/p-690

[117] https://www.federalregister.gov/d/2024-04139/p-691

[118] https://www.urban.org/sites/default/files/publication/104165/child-care-subsidies-and-home-based-child-care-providers-expanding-participation_0.pdf

[119] https://www.ecfr.gov/current/title-45/part-98#p-98.2(Parent)

[120] https://www.ecfr.gov/current/title-45/part-98#p-98.16(h)(4)

[121] https://www.ecfr.gov/current/title-45/part-98/section-98.21#p-98.21(d)

[122] https://www.ecfr.gov/current/title-45/part-98#p-98.16(g)

[123] https://www.headstart.gov/programs/article/head-start-programs

[124] https://headstart.gov/interactive-head-start-early-learning-outcomes-framework-ages-birth-five