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Effectiveness of out-of-home day care for disadvantaged families: randomised controlled trial
Tami Toroyan1, Ian Roberts, Ann Oakley
1Public Health Intervention Research Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1B 3DP. tami.toroyan@lshtm.ac.uk
Insights
Providing daycare for disadvantaged families may boost maternal employment but does not increase household income. This suggests daycare alone is insufficient to reduce poverty effectively.
Area of Science:
- Public Health
- Socioeconomic Studies
- Child Development
Background:
- Disadvantaged families often face barriers to employment and financial stability.
- Access to quality childcare is a critical factor influencing parental workforce participation.
- The impact of early childhood interventions on family welfare requires rigorous evaluation.
Purpose of the Study:
- To evaluate the health and welfare effects of providing daycare facilities for young children in disadvantaged families.
- To assess the impact of subsidized daycare on maternal employment and household income.
- To examine the influence of daycare on child health outcomes and healthcare utilization.
Main Methods:
- A randomized controlled trial was conducted at an Early Years daycare centre in Hackney, London.
- 120 mothers and 143 children (6 months to 3.5 years) were randomly assigned to daycare or control groups.
- Maternal employment, household income, child health, and development were tracked over 18 months.
Main Results:
- Mothers in the daycare group showed a trend towards increased paid employment (67% vs 60%), but this was not statistically significant.
- Household income did not significantly increase for families receiving daycare.
- Children in the daycare group experienced higher rates of otitis media with effusion and utilized more health services, though these findings were imprecise.
Conclusions:
- While daycare may facilitate maternal employment, it does not appear to be a sufficient strategy for poverty reduction.
- The study highlights the importance of considering broader economic factors beyond childcare provision when addressing family poverty.
- Random allocation proved effective in rationing and evaluating the daycare intervention due to high demand exceeding supply.
Objective:
To assess the effects of providing daycare facilities for young children on the health and welfare of disadvantaged families.
Design:
Randomised controlled trial. Eligible children from the application list to a daycare facility were randomly allocated to receive a daycare place or not.
Setting:
Early Years daycare centre in Borough of Hackney, London.
Participants:
120 mothers and 143 eligible children (aged between 6 months and 3.5 years).
Intervention:
A place at the centre, which provided high quality day care. Control families used other child care that they secured for themselves.
Main Outcome Measures:
Maternal paid employment, household income, child health and development.
Results:
At 18 months' follow up, 67% of intervention group mothers and 60% of control group mothers were in paid employment (adjusted risk ratio 1.23 (95% confidence interval 0.99 to 1.52)), but were no more likely to have a weekly household income of above pound 200 (risk ratio 0.88 (0.70 to 1.09)). Intervention group children had more otitis media with effusion (risk ratio 1.74 (1.02 to 2.96)) and used more health services (1.58 (1.05 to 2.38)), but both estimates were imprecise.
Conclusion:
The provision of child day care may have increased maternal employment, but it did not seem to increase household income. The results suggest that providing day care may be insufficient as a strategy to reduce poverty. The study shows how random allocation can be used to ration and evaluate interventions where demand exceeds supply.
