Relative measures of effects can be misleading

How America’s ‘childcare expenses’ are driving women out of the workforce

When looking at the unemployment rate in the United States, it is easy to misconstrue the low number as meaning that a high percentage of Americans are working stable jobs. Not only does the number include a significant portion of part-time workers, but it also does not include those who have completely dropped out of the workforce. These are people who do not even want to try and find a job right now. One of the groups that fall under this category are moms who could not find affordable childcare for their kid.

Trends in Female Employment

Interestingly, the number of women that are actively looking for a job, or working, is going through a two-decade decline. And we are still going downward. It is also the same time when the cost of childcare began to increase. Is there are a relation between these two trends, or is it a mere coincidence?

A study from a student at Princeton University analyzed the trend of women’s unemployment, starting in 1985 and continuing to 2011. The years were chosen because the mid-1980s represents a time when women were entering the workforce in huge numbers. And by the 1990s, we were at a stage where female participation in the workforce was at its highest level. But now there are many other first-world nations that are surpassed the United States for the percentage of women who are in the workforce.

For the United States, the peak came around 1995, and it has been steadily declining ever since. It is not a huge decline, but it is a decline nonetheless. In contrast, countries such as Canada, Germany, Spain, United Kingdom, Australia, Japan, Netherlands, and Italy have all experienced steady increases. Each country had some blips, where the percentage went down, but the general trend is still an upward one.

Cost of Child Care

Between 1990 and 2010, the cost of childcare went up by 32 percent. In comparison, wages stagnated for most types of workers. That means the average lower to middle-class family experienced a situation where it was costing them more money every few years to get quality child care, but they were still being paid roughly the same amount of money as before.

The Princeton study discovered that since 1995, a roughly five percent decrease in total employment for women has taken place because of childcare expenses. And a roughly thirteen percent decline exists among working mothers with children under the age of five. The data shows that mothers with young children do not find it financially feasible to have a full-time job and put their child in daycare. It saves the family money to have one parent working, while the other stays home.

Many families attempt to find informal arrangements, such as friends or relatives looking after kids while they work. But those are not possible for every family, which is why we are seeing a steady decline in female participation in the workforce. Until the cost of childcare is controlled, or wages rise with respect to inflation, there will be little change in the trend.

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What is a Guideline?

Despite being widely used, particularly in healthcare, guidelines are not well understood by many. Therefore, this blog post will attempt to shed some light on this increasingly prominent aspect of evidence-based healthcare.

Misconceptions of a Guideline

First of all, there are many misconceptions surrounding guidelines so let’s begin by dispelling the myths:

1. The purpose of guidelines is just to dictate the clinical management of diseases

While guidelines are used by healthcare professionals as a way to inform them about how to care for patients with specific conditions, guidelines cover a much greater scope. In healthcare, the term ‘guideline’ encompasses recommendations on everything from clinical practice and the governance and prescription of medications, to public health interventions and social care services and provisions. [3]

2. Guidelines are developed for and used solely by healthcare practitioners

This is perhaps the commonest misconception regarding guidelines and, in actual fact, it couldn’t be further from the truth. Given that guidelines exist for a vast array of topics, it shouldn’t come as a surprise that guidelines are developed for and used by local authorities, schools, national organisations and even patients and their families to name but a few. All the more so, many guideline publications, such as those developed by NICE, are intended to be jargon-free to encourage use by laypeople – particularly patients – to inform their decisions.

3. Guidelines are a set of rules

It is important to understand that guidelines are not designed to be used like a cookbook. One formula does not work for everybody. Hence, in some circumstances, the purpose guidelines aim to serve is to make adaptable recommendations.

So what exactly is a Guideline?

Now that we have established what a guideline is not, let’s consider what a guideline is.

The Merriam Webster dictionary definition for the word is “an indication or outline of policy or conduct”. [2] In healthcare, the term describes a set of systematically developed statements that aim to fulfil various objectives. [1]

Primarily, they provide users quick access to concise chunks of relevant evidence. Just think of the sheer volume of research conducted every year. It is simply unrealistic to expect healthcare practitioners to sift through every study, judge its value and decide whether it should be applied in patient care. Hence, guidelines aid healthcare professionals and patients in the decision-making processes involved at various stages in care. Moreover, they can help to protect against needless, ineffective and/or unusual interventions. Overall, the objective is to improve the consistency and outcomes of care. [4]

As a result, guidelines are an invaluable part of healthcare. However, not all guidelines are created equal! The value of a guideline depends on the quality of the evidence on which it is based, its relevance and applicability to clinical practice, and its consideration of patient preferences. In other words, the best guidelines are developed through a rigorous evidence-based approach.

As the incorporation of guidelines into everyday practice becomes commonplace, it is crucial that all involved in the provision and delivery of healthcare, as well as those on the receiving end of care, understand what guidelines are – and are not. Equally, we must bear in mind that, unless guidelines are critically assessed and used appropriately, instead of benefiting patients, practitioners and healthcare systems, they have the potential to cause them harm.

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Subgroup analyses may be misleading

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