NEW YORK – On a Saturday morning last May, Ms Julia Sachdev, a mother of a two-year-old and four-year-old, woke up to an e-mail from her children’s pre-school.

The school, which her children adored and had been in operation for more than 50 years, announced that it would be closing in a month.

In the following days, she and her husband scrambled to find an alternative that was a reasonable driving distance from their home. Most of the places they reached out to had long waiting lists. Some never even called them back.

“It was so stressful,” said Ms Sachdev. “There was this suffocating anxiety that ruled my day. I couldn’t concentrate on other things. It kept me up at night.”

The Sachdevs’ experience is far from unique.

For years, American parents – regardless of family roles, paid work status, geography or income – have struggled to find and maintain stable childcare. Research shows that roughly half of Americans live in childcare deserts, meaning that they have limited or no access to care.

In September, federal relief funding put in place to support more than 220,000 childcare programmes during the pandemic expired abruptly. This steep drop-off in investment, which has been termed a childcare cliff, is projected to lead to the closing of thousands of pre-schools and childcare centres around the United States.

The situation has been getting steadily worse for years and it is now reaching a pivotal moment.

As thousands of American families face the daunting prospect of losing their childcare, Congress has the opportunity to take immediate action to help alleviate their burden.

People know inadequate childcare is an economic issue, costing states, families and businesses billions of dollars every year. They know it is a gender issue that contributes to a widening pay gap.

But here is another critical consideration worth pushing for: the US’ inadequate childcare system is also a healthcare issue.

For years, parents, particularly mothers, have been shouldering the burden of the childcare shortage, assuming additional caretaking responsibilities and shelling out untenable amounts of money to cover the increasing costs of outside care.

And it is a worry that, as people begin to see the fallout from this latest wave of disruption, the thin lifelines holding families together and safeguarding the well-being of parents may snap.

It is well documented that stress wreaks havoc on health.

Decades of research have linked chronic stress to increased long-term risks for heart disease, diabetes and autoimmune disorders. Stress is also a key component underlying the onset and maintenance of mental illness.

Research from the pandemic – when families across the world suddenly lost access to childcare – continues to suggest links between the additional load of caregiving responsibility and mental health disorders such as anxiety and depression, especially for mothers. And inadequate childcare intensifies other stressors affecting health as well.

Most obvious, of course, is financial stress.

For many American parents, the cost of childcare is crushing and contributes to financial instability and hardship. Missed or interrupted work because of inadequate childcare can also add to financial stress.

The task of finding care can also increase parents’ mental labour load, which can erode psychological health, particularly for mothers. Dwindling childcare options mean that parents may have to travel farther from home to find care, or they may have to rely on an inconsistent patchwork of babysitters and family members to find coverage.

And when one childcare centre closes or one babysitter cancels, the burden of finding an alternative falls to the parents.

When polled, over half of parents who paid for care said that it would take them at least one month to find a comparable, affordable childcare alternative if their current programme closed.

Unpredictability itself is a source of stress. Childcare precarity – a state of insecure and unreliable childcare – has been linked to negative mental health outcomes for mothers for at least six years afterwards.

For many families, stressors do not disappear the moment they secure care.

Take the Sachdevs’ case again. In the end, they found another pre-school for their children, but it did not have the same learning environment as their previous school, and they did not know the community there.

“We just went with a place that had an available spot,” said Ms Sachdev. “And then we had more anxiety for months over whether it was the best place for our kid.”

But while precarity can have negative health effects, the opposite is also true.

Research has shown that the perception of stable childcare access decreases the risk of maternal depression, underscoring why researchers think lack of childcare should be considered a social determinant of health.

Because of unsustainable funding, many childcare centres have struggled to maintain full manpower. Shoestring budgets can also mean fewer high-quality educational programmes and less one-on-one attention for children.

Worse, the parents likely to experience the worst impacts of the childcare cliff are people of colour and low-wage workers, who are already at the highest risk for stress-related illness.

“These are communities and individuals that don’t have the luxury to say, ‘I guess I’m going to have to stay home’ or ‘I guess I’m going to have to get a nanny,’” said Dr Karen Sheffield-Abdullah, who studies health equity, stress and anxiety at the University of North Carolina, Chapel Hill. “When there is no alternative or Plan B, it can feel hopeless.”

It is also expected that the American workforce at large will begin to see not only increased absenteeism related to caregiving responsibilities, but also mental health issues and burnout related to childcare gaps, a consequence well documented for farm families, healthcare workers and other professions.

It is time to acknowledge that childcare is directly tied to health.

It is time to appreciate that stable, affordable, accessible, high-quality childcare is preventive medicine for decreasing long-term health risks. It is time to value care workers and early childhood educators for the crucial services they provide.

It is time to view immediate federal investment in childcare as a key part of the solution to address the growing mental health crisis.

It is time to fight for permanent federal investment in childcare as a critical expenditure, with an exponential effect on the health of Americans for generations to come.

It is time to accept that childcare is healthcare. NYTIMES

• Molly Dickens is a physiologist who studies stress and the founder of the Maternal Stress Project. Lucy Hutner is a reproductive psychiatrist and a co-founder of Phoebe, a mental health platform for parents.