PolicyLab

We know that improving maternal and child health outcomes in rural communities requires a holistic approach that addresses the social and structural determinants of health. As we mark this year’s National Rural Health Day, PolicyLab is committed to generating the evidence for and advancing a policy agenda that does this by recognizing the critical role that family caregivers play in our society and in the lives of those they care for. The needs of caregivers in rural areas are acute and it’s time for a reinvestment in our social care infrastructure.

Why do we need a caregiving agenda for rural Pennsylvania?

A recently released report by the Surgeon General, Parents Under Pressure, calls attention to the dire state of parental stress and well-being, and the bidirectional relationship between parental mental health and child outcomes. So many of the concerns documented in the Surgeon General’s report—like parental social isolation, financial strain and economic instability, and lack of access to mental and behavioral supports —are felt in unique ways by families living in rural Pennsylvania. For example:

Many rural Pennsylvania caregivers lack access to paid family and medical leave

The disparity between rural and urban workers’ benefits is stark. Rural Pennsylvanians are much more likely to work in small businesses and fall outside the federal Family and Medical Leave Act, leaving them with less access to paid leave. Rural pregnant persons’ odds of reporting access to paid maternity leave are 24% lower than women living in cities. This rural/urban divide in access to paid leave compounds other structural barriers to good health, like transportation and maternal health care access.

Despite the wealth of evidence supporting the intergenerational positive effects of paid family leave, without policy supports, rural pregnant people and caregivers are skipping vital prenatal and postpartum care, and returning to work before they are ready, an action made even more challenging in rural Pennsylvania given the severe shortage of child care slots for infants.

Child care costs and shortages are debilitating for families and hurting rural growth

Quality and safe child care promotes child health and development and is critical to economic stability and vitality. Yet, rural communities nationwide are experiencing a severe and chronic child care shortage due to workforce shortages, low wages and lack of benefits, low profits, and inconsistent enrollment. Rural families spend an average of 12.2% of their income on child care, in comparison to 10.8% for families in metropolitan areas.

Additionally, nearly 40% of rural parents have left the workforce due to difficulty securing child care. Rural families often rely on home-based child care over child care centers, but there has been a significant decline in home-based care in Pennsylvania. Without significant investments in supporting the child care sector, the longevity of Pennsylvania’s small communities that offer families a rural lifestyle is at risk.

Low incomes are hampering family well-being

The lasting effects of intergenerational and concentrated community poverty and lack of material resources during pregnancy and early childhood cannot be overstated. Families in rural Pennsylvania are more likely to be living in poverty or unable to afford the basic cost of living but do not qualify for public assistance (A.L.I.C.E. households).

One in four of Pennsylvania’s rural workers would benefit from increased minimum wage. Direct economic supports, like the Earned Income Tax Credit (EITC) and an expanded Child Tax Credit disproportionally benefit rural families. In Pennsylvania, 40% of children in rural communities—112,000 kids—would benefit from reinstating the expanded Child Tax Credit.

Mental and behavioral health care is challenging to find and afford

Previous PolicyLab research has highlighted how new mothers living in rural Pennsylvania communities experience heightened social isolation due to transportation barriers and lack of community infrastructure (like community centers, libraries, and ‘third places’), affecting both their mental health and their child’s development. Well-documented shortages in health care and mental and behavioral health leave caregivers with few places to turn when they need care, particularly during the critical postpartum period. Given the overlapping maternal health crisis and opioid crisis, communities in rural Pennsylvania are particularly ill-prepared to support pregnant and postpartum people with substance use disorder.

The social infrastructure of rural communities is fraying

Social infrastructure, like churches, libraries, fairgrounds, firehalls, recreational facilities, parks, and playgrounds promote social interaction, community trust, and resource and information sharing. At the local level, these places are where families interact, engage and celebrate. Yet, these places that improve quality of life and well-being are often declining in rural communities.

Policy actions we need now

At PolicyLab, when we discuss the importance of a caregiving agenda, we mean a comprehensive policy agenda that recognizes the needs of caregivers, and in doing so, supports them and their families. Relieving the pressures of parenting and caregiving through coordinated policy efforts would have profound positive effects on rural families and our rural communities.

A policy agenda that would support the needs of rural Pennsylvania caregivers would include:

• paid family and medical leave

• investments in affordable and high-quality child care supports

• increased direct economic supports alongside investments in social programs

• expanded access to mental and behavioral supports for caregivers

• investments in vibrant public spaces and social infrastructure

Most importantly, as policymakers consider strategies to support caregiver well-being in rural Pennsylvania, I encourage them to listen to the voices of those who would benefit the most. Our Rural PA, an atlas created by mothers and caregivers, lifts the voices and lived experiences of our rural caregivers who describe the challenges they face and the investments they want to see in their rural communities. Their stories reinforce the need for widespread and rural-relevant social and physical supports to protect and support caregivers. When these caregiver-focused policies work together, as part of a robust net, they will improve child health and strengthen the future of Pennsylvania’s rural communities.