Maura, a mostly stay-at-home mom in Western New York, gave birth to her first child in July 2020. She brought her son with her to her 6-week postpartum visit, but was turned away at the reception desk—COVID-19 policy barred visitors from the office. It was early in the pandemic, vaccines were not yet available, and nobody really knew the risk of COVID-19 to children.

One morning this September, Maura woke up to excruciating abdominal pain and called her doctor’s office, but she was told that the pandemic policy hadn’t changed. No one else was available to watch her fully vaccinated, now-two-year-old child, and by the time her husband arrived home from work, the doctor’s office was closed. Instead, she went to urgent care and was scheduled for an emergency gallbladder removal the next morning.

“It's really impacting care,” said Maura, who prefers to be identified by only her first name. “It feels exclusionary for moms especially since we're more often the primary caregivers.”

Maura asked to be discharged immediately after her surgery since hospital policy did not allow children to visit and she wanted to see her son. Her doctor suggested a follow-up later in the week to address her post-operative pain but she skipped it—no one was available to help her with childcare.

What happened to Maura is not an isolated incident. A 2020 survey found that more than half of cisgender women respondents report forgoing health care because of difficulties with child care. Patients who lack sufficient child care often delay medical appointments, an issue that disproportionately affects cisgender women, single parents, and low-income earners. Mothers of young children list lack of child care as their number one reason for missing appointments.

When barriers to care keep patients out of the doctor’s office, their health conditions worsen and they may experience delays in critical diagnoses. When experts study these barriers to care, they often ask patients about transportation, nutrition, income, and racism, but rarely ask about childcare explicitly. But for anyone with caregiving responsibility, access to child care is a major determinant of health.

The pandemic has exacerbated this barrier to care, both due to a childcare system stretched beyond its limit, and COVID-related restrictions around who can accompany adults to their appointments. Almost three years into the pandemic, many of the policies implemented early in 2020 remain unchanged. A 2022 study of large U.S. hospitals revealed that 65 of the 70 hospitals reviewed still had public-facing visitor restriction policies. These policies, now common across hospitals and doctors’ offices, cater to patients without caretaking responsibilities or those with adequate childcare and flexible work schedules. But for single parents, stay-at-home-parents, hourly workers, and essential workers, these policies may prevent access to care.

And the problem only seems to be getting worse. The U.S. is on track to permanently lose up to 4.5 million childcare slots due to the pandemic, the large majority of which will affect low-income families and people of color.

Doctors can’t solve our nation’s childcare crisis. But they can implement policies that take this unfortunate reality into account, ensuring that patients with caretaking responsibilities can access the care they need with the resources they have. To encourage equitable access to health care, doctor’s office visitor policies should accommodate the constraints of their patients.

Here are our top recommendations for offering inclusive care for patients who are caretakers:

‍1. Offer transparent, accessible, public-facing visitor policies.

‍Patients may preemptively cancel appointments when they assume their children are not allowed in the office—or bring their children with them only to be turned away. Don’t leave your patients guessing. Whatever your visitor policy, make sure it is clear to patients well ahead of their visit.

‍2. If you changed your visitor policies due to COVID-19, consider an update.

‍Many doctors’ offices have updated their visitor policies to once again allow children and other visitors, even if they didn’t earlier on during the pandemic. This reflects the growing understanding of COVID’s limited threat to children, as well as an acknowledgment of the burden of accessing child care for many patients.

‍3. Offer a child-friendly office environment.

‍Patients who bring their children along to their own appointments usually have no other option. And even when office policies allow patients to bring their children, the child can sometimes be an obstacle to receiving attentive care.

Jingfen Guo, assistant professor in the Interior Design Department at the University of Central Oklahoma, and Douglas King, principal with Stantec Design, conducted a pilot study on the patient population at a federally qualified health care center in Chicago that served a large immigrant and refugee population. They found that for 70% of doctor’s visits, patients came with their children—who proved to be a major distraction. Parents lost focus because of  repeated interruptions, decreasing the effectiveness of the visit.

Guo and King proposed that medical offices should offer child-friendly designs and amenities to help preserve the sanctity of the medical visit. Some ideas included putting an activity table in the waiting room and installing a low-hung whiteboard in exam rooms for kids to doodle during their parent’s appointments.

One Medical, which allowed patients to bring their children to appointments throughout the pandemic, offers children-designated areas in all of their locations with toys, books, and stroller parking.

4. Telehealth can help, but it’s not a silver bullet.

Many medical appointments can occur just as effectively over video as they can in person. The rise of telehealth during the pandemic has made it more convenient for patients to access health care.

Increased utilization of telehealth may seem like an unmitigated boon to patients with caretaking responsibilities. But it’s not a replacement for supportive in-office policies.  

5. Offer on-site daycare.

While this may not be practical for smaller offices, some hospitals offer free on-site daycare for patients who need it. In 2020, San Francisco started offering free daycare for healthcare workers to allow them to come to work when other daycares around the city were closed. It was an emergency measure, but hospitals are increasingly offering on-site child care for employees as a way to increase retention.

The infrastructure for on-site child care is there—now we need more people thinking about how to practically extend the service to patients. Doing so could have a dramatic impact on increasing access to health care for cisgender women and others who have caretaking responsibilities.