The Washington PostDemocracy Dies in Darkness

The child-care crisis punishes women in health care. Without schools, they'll quit.

Three-fourths of health care workers are women. They can’t keep this up.

Photographs of doctors and nurses, worn to comfort patients while they are dressed in protective gear, hangs on a wall outside the Covid-19 intensive care unit at the United Memorial Medical Center in Houston, June 29.
Photographs of doctors and nurses, worn to comfort patients while they are dressed in protective gear, hangs on a wall outside the Covid-19 intensive care unit at the United Memorial Medical Center in Houston, June 29. (Go Nakamura/Bloomberg)
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Aysha is a nurse practitioner I met during the pandemic who works in a small clinic that provides prenatal care in an underserved neighborhood in New York. It stayed open during the crisis, but her children’s public school did not. So while she worked from 7 a.m. to 3 p.m. during the spring semester, her husband, who works a night shift, helped their 7-year-old and 9-year-old with their online schooling — grabbing naps when he could. When Aysha got home, he slept about three hours, then headed off to work, before starting all over in the morning.

Felicia works as a nurse in a surgical unit in a small hospital on the East Coast. She lives with her rising fourth grader and her mother, who has always provided child care. At the beginning of the pandemic, right before she was deployed to a covid-19 floor, Felicia sent her mom to live in a relative’s basement apartment — but it proved too expensive to maintain two households, and she worried about her kid too much. The local public school mainly provided paper homework packets that her 9-year-old found boring. He spends most of his time alone, in his room; Grandma makes him come out for meals, but she’s not sure what he’s doing in there all the time.

Then there’s me: an obstetrician with four kids, irregular hours and no local family. I have a partner who is working from home, in our three-bedroom apartment in northern Manhattan — meaning the kids are supervised, to the extent that they will probably not burn the house down.

Everywhere I look in the hospital, this is what I see: parents, disproportionately women — we make up about 75 percent of health-care workers — who have done brave and difficult things to be able to come to work for the past few months. Most of us limped through the end of the school year, requesting every emergency favor we had stored up from friends and family to get there. Schools are an important part of the village that helps us raise our kids, along with relatives, babysitters and day care. The pandemic made a substantial part of that village unavailable: schools.

Every parent in this pandemic will tell you that without in-person schools, you can have a job or a child, but — ultimately — not both. And research shows that women bear the lion’s share of the child-care burden that the pandemic has placed squarely on the home. Given the makeup of the health-care profession and the intensity of the jobs, a reckoning is coming if schools remain online-only in the fall. Many health-care providers, especially those who are low-income, may have to quit. And it won’t only be their incomes that suffer. It will be your health care.

I am privileged: I work in a high-paying specialty, and my children go to a private school that is committed to getting kids to class, safely and in person, by the second week of September. But when New York announced that it would be using a hybrid model of education, with only one to three in-person days a week, almost every clinic that I’m in touch with saw a surge of workers requesting temporary leave or giving notice. Those who asked for leave said that if the requests were denied, they might have to walk away. When I mentioned this on social media, one doctor friend of mine responded that 20 percent of her large practice’s clinical support staff had asked for a leave of absence because of child-care issues. Another chimed in to say that at her clinic, the figure was closer to a quarter — with many asking for open-ended leave. If schools stayed closed, this friend was considering leaving, too. (Of course, if people take leave but don’t quit, that still leaves a staffing shortage.) The Center for American Progress has reported that roughly 4.6 million health-care workers — about 30 percent of the total — have children 14 or younger.

Don’t get me wrong. I don’t want to open schools without a safe plan. Most of us in medicine had to work without such a plan during the early part of the pandemic, and we wouldn’t wish it on anyone else. But schools are getting short shrift as a national priority. And if female health-care workers don’t come to work, hospitals can’t function.

Closed cafeterias, ‘recess’ at your desk: School will be weird next fall

Remember those months you spent at home, at catastrophic personal and economic cost? (You may still be there.) All of that was to buy time for policymakers and our medical system — so that anybody who needed a hospital bed would have one, and so that we could set up a system of testing, tracing and isolation. That plan failed for multiple reasons. We ended up doing enough so that we have sufficient ventilators (for now) but not enough to guarantee that we could open the economy, and the schools, safely — and now we can’t say for sure if someone will be staffing those hospital beds.

If schools don’t open in the fall, or if some other child care solution isn’t devised, much of the sacrifice of the spring and summer will have been wasted. One consequence is that a large share of our hospital workers will be in an untenable situation, generated by the government’s failure to set the right priorities and to provide leadership. If female health-care providers are forced to keep juggling tutoring and their jobs, the medical system may not hold. And we need it to hold.

Twitter: @ChaviKar

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