Mothers of Ill Children

To the Editors:

In his review of Jason DeParle’s American Dream [NYR, December 15, 2005], Christopher Jencks briefly acknowledges that welfare reform has been rough on mothers unable to work regularly, and that the experience of those diverted from enrolling has stayed invisible. We can shed some light on these two groups as we studied poor mothers of chronically ill children in Boston, New York, and San Antonio and analyzed national data sets.

Mothers of ill children are pinned between a rock and a hard place as they cannot both comply with the work requirements and care for their children—either the children become objectively, measurably sicker or these women lose their jobs or have benefits sanctioned because of missing work when children require medical visits or other care. Moreover, the general shortage of child care is aggravated as there are scarcely any facilities willing or competent to care for ill children. When the bill was first scheduled for reauthorization, we urged that care for sick children be counted toward meeting the work requirement—a recommendation that was endorsed by a dozen major medical organizations. The Bush administration is calling instead for an increase in work requirements. About a quarter of TANF families have chronically ill children so this catch-22 has a significant impact.

The mothers of ill children are often ill themselves—about two thirds of the San Antonio group had health problems that interfered with daily living and this proportion was significantly higher in the applicant group. However, those who were working or denied benefits were unlikely to have health insurance—those receiving TANF were most likely to have Medicaid coverage. Other dramatic concerns in these families with ill children include frequent problems paying for heat, food, phone, and housing. Furthermore, the “invisible” applicant group experienced the highest rate of domestic violence, a clear barrier to staying employed.

All agree that the previous welfare system was riddled with problems. However, the “reformed” version has not achieved improvements for poor families, as Jencks describes, and is harshest on those most in need.

Wendy Chavkin, M.D., M.P.H.

Professor of Public Health and Obstetrics-Gynecology

Mailman School of Public Health and College of Physicians and Surgeons at Columbia University

New York City