To ensure child wellbeing for all children, we need to provide different levels of support based on the intensity of need. There are some supports all families need, but a subset of families will need additional help, with a smaller group of families having severe difficulties needing therapeutic support, and a few families needing intensive long-term support.
You could envision this as a pyramid.
I have been reflecting on the universal supports available in New Zealand compared to what is available in North Carolina. There are three programs that comprise the bulk of universal support to new parents in New Zealand: Paid parental leave, maternity care, and the well-child visits conducted by nurses. How do these resources impact the wellbeing of children?
Currently, New Zealand provides 22 weeks of paid parental leave to build strong attachments. Strong parent-child bonds can mitigate the risk caused by adverse childhood events, buffering children from the risks to their overall health and wellbeing caused by toxic stress and trauma. New Zealand is adding on weeks, increasing the time to 26 weeks starting in July. In North Carolina, if you work for Durham county where I come from, you get 12 weeks paid leave (thanks to the strong commitment to preventing ACEs (Adverse Child Experiences) of the Durham County Commissioners). If you work for the state of NC, you get eight weeks paid leave if you were the birth parent, and four weeks if you are otherwise a new parent and you work for the right part of state government - not every part of the North Carolina government adopted this policy. This seems very skimpy compared to 26 weeks until you dig a little into the math. Leave in NC is at your typical wage; in New Zealand, while on parental leave you are paid at most $585.80 NZ/week. For 26 weeks, that would be the equivalent of $9,630 US dollars for half a year, which is about 20% of the average New Zealand salary. Every new parent in New Zealand knows they will have support, but it isn’t keeping them at the same salary level they were previously, and there is stress from that financial pinch. However, those who take leave (including additional unpaid leave) are guaranteed the ability to return to their job after a year. In NC, if you are lucky enough to work for the government or a private employer who gives you some paid family leave, you don’t end up with the stress of fewer resources in the time you can take off, but the length of time is shorter. And most employers follow the standard set of policies by FMLA which is they only guarantee you can return to an equivalent position for 12 weeks, so taking an additional unpaid leave might not be approved. Just when you are getting used to your new family member and getting to keep your job and your livelihood, you go back to work sleep-deprived and either ask your extended family/network to watch the little one or start using child care.
What about support around the pregnancy and through the birth process?
In New Zealand, everyone is entitled to a lead maternity carer (typically a midwife, but you can pick a specialist doctor instead). This person not only provides your prenatal care and helps with the birth, but they also follow up with you weekly until the child is 6 weeks old. You are then transitioned to the Tamariki Ora well-child visits provided by a nurse. This includes five visits in the first year followed by three additional visits before age four and a half. The visits include assessments of the child as well as interventions to help the family and health education. The assessments of the child include growth and developmental milestones as well as vision and hearing checks. The family is offered support with smoking cessation, talked to about the impact of family violence on babies, and given community resources. The nurse provides education about the benefits of breastfeeding, immunization, safe sleeping, parenting tips, and injury prevention information. These two programs together are provided in the home--like Family Connects-Durham on steroids.
Family Connects-Durham provides one to three home visits with a nurse sometime around when the baby is three weeks old. The nurses do similar assessments and connect families to local resources or encourage them to follow up with their primary medical home. Family Connects-Durham identified that 94% of families have at least one area of need after their children are born and have seen great benefit from the lighter touch they provide. The New Zealand model provides time to build a relationship with a new parent and time to help the family successfully get started with the support they need. And yet, even with all this support offered, 20%-25% of infants in New Zealand don’t get all of their core well-child visits.
As a parent and as a professional who provided in-home parenting coaching in Durham for over a decade, I am empathetic to families who don’t always show up when they said they would. For families with multiple and complex needs, being home for this visit may be forgotten in the chaos of unmet needs, dismissed as less important than another commitment, or just hard to attend because other things took longer than expected. Understanding professionals will keep following up and give families another chance to get support. We have to make sure that full caseloads and full calendars don’t result in giving up on families who struggle to make their appointments.
The universal supports in New Zealand are truly universal—everyone has paid family leave and the right to return to their position up to a year later, everyone has access to a midwife (or some form of lead maternity care) and everyone has multiple Tamariki Ora well-child visits. In North Carolina, you might have paid family leave and a job held for you or you might not depending on your employer; you may have a visit from a Family Durham-Connects nurse depending on where you live. By providing a strong base of the pyramid to all new families, New Zealand creates a tightly knit safety net so families can support their children’s strong attachments and healthy development. With these supports, children are more likely to be on track in developing the initial physical, social, and language skills they need to progress through life. In North Carolina, the universal safety net has bigger holes where more families might potentially fall through.