Moms Under Pressure: The Surgeon General Advisory on Parental Mental Health Is About Women
Saying the quiet part out loud
The Office of the Surgeon General just released Parents Under Pressure: The U.S. Surgeon General Advisory on the Mental Health and Well-Being of Parents. It calls attention to many factors related to the increasing rates of parental stress, including technology and social media, loneliness, financial pressures, and child and adolescent mental health concerns.
Alongside Dr. Vivek Murthy’s New York Times op-ed, these documents discuss the urgent need to address parent and caregiver mental health and well-being. They also provide important recommendations for improving the lives of American parents at the national, community, and individual level.
I encourage you to read the entire Advisory, as it is a persuasive and necessary call to action for politicians, policy makers, researchers, employers, and anyone who cares about a parent or caregiver (which is everyone). I wholeheartedly endorse the majority of their recommendations and am proud that the office is taking the pressing needs of parents seriously.
However, I want to explicitly acknowledge a truth that the Advisory does not:
This is a public health crisis about mothers.
Now, I am sympathetic to the strategy behind making the Advisory about parenting broadly rather than about mothering specifically. I’m enough of a realist to understand that making something explicitly gendered will turn off a large section of an audience they are hoping to persuade, especially as it relates to their policy recommendations.
At the same time, it’s disingenuous to act as if the stress around parenting affects mothers and fathers equally. News flash: We live in a patriarchal society where men and women are treated differently! And parenting makes these differences even starker.
Caregiving is literally referred to as “women's work,” with fields like nursing, social work, daycare and early childhood education, and elderly care dominated by women. One in four American children do not live with a father figure, and single mothers represent over 80% of single parent households.
Suffice it to say: Any stress related to caregiving disproportionally affects women.
The Advisory cites hundreds of scientific studies that assess aspects of parental stress and health. This is great! However, the text makes pains to be gender-neutral, even when discussing something that the research suggests overwhelmingly affects mothers.
As one egregious example, here’s the paragraph from the Advisory that discusses mental labor:
Additionally, the significant mental labor involved with parenting [emphasis mine] —balancing complex schedules, anticipating a child’s evolving needs, making countless decisions each day on behalf of a child, and monitoring progress—can limit working memory capacity and negatively impact attentional resources, cognitive functioning, and psychological well-being.
The name of the study that the Advisory cites related to this issue? “Gendered Mental Labor: A Systematic Literature Review on the Cognitive Dimension of Unpaid Work Within the Household and Childcare.” It reviews evidence that women perform the larger proportion of mental labor and suffer more consequences from it, ranging from increased stress to career difficulties, compared to men.
Mental labor is not a “parenting problem.” It's a mothering problem.
With all of this in mind, I decided to do the Surgeon General’s office a favor and fill in some important gaps from their Advisory that makes explicit how the concerns they outline unduly impact and relate to the stress of motherhood. You’re welcome!
Mothers bear the burden of financial strain
When families cannot afford childcare, mothers are more likely to take on primary childcare responsibilities than fathers (and directly cite childcare costs as the reason they leave the workforce). When parents rely on grandparents to help with childcare, grandmothers are more likely to provide childcare to their grandchildren than grandfathers.
Women are the sole or primary breadwinner (earning at least 50% of their household’s earnings) in approximately 41% of American households with children, as well as the “co-breadwinner” (earning at least 25% of their household’s total earnings) in over 23% of households. These rates have more than doubled since 1967.
When working women become mothers, they make less money compared to men and child-free women. One study by the Census Bureau from 2017 found that the earnings gap between opposite-sex spouses doubles the year after the birth of a couple’s first child and does not stop growing until the child is ten. Economists call this the “motherhood penalty.” On the other hand, there is a “fatherhood bonus” where men in many fields make more money after they become fathers.
Mothers are strapped for time
I already mentioned how mothers take on the majority of mental labor related to parenting. Mothers also report less leisure time and more time spent on household chores, including on days where they also engage in paid labor, compared to fathers.
The Advisory notes that parents are spending more time both at work and on childcare compared to 40 years ago. While it is impressive that fathers spent 154% more time with their children in 2022 compared to 1985, moms are still spending almost twice as much time with children compared to dads (11.8 hours per week for moms compared to 6.6 hours for dads, per the numbers noted in the Advisory itself).
Women also spend more time caring for their aging parents. The Institute on Aging suggests that upwards of 75% of caregivers of older adults are women and that women may spend as much as 50% more time on caregiving duties than men. The Alzheimer’s Association reports that two-thirds of caregivers for dementia patients are women and 25% are parents (“the sandwich generation”). Women caring for family members with dementia may experience increased caregiving burden, including higher rates of stress and depression, compared to men.
Mothers are expected to be responsible for children’s health and safety
It’s a joke in motherhood circles that no matter how many times you tell a school official to call the dad, they will inevitably call you first if there’s an issue with your kid. Indeed, one study found that a school official was 1.4 times more likely to call a child’s mother than their father in two-parent households in response to an inquiry about their child. This is just one example of how we expect mothers to be more involved and engaged in their child’s lives than fathers.
The Advisory notes that parental stress is exacerbated by parents worrying about their children’s social media use. But which parent is more involved in this matter? One study from 2022 reported that fathers were over 30% less likely to set social media rules in a household and 40% less likely to communicate with their children about frequency of social media use compared to mothers. This is in line with other research showing that women in general use social media more than men.
“Who takes the child to the doctor? Mom, pretty much all of the time.” This is the title of a study from Denmark where researchers examined all medical services performed on Danish children from 1992 to 1995. They found that over 90% of all services were coordinated by mothers. A separate American study found that mothers were over 12 times more likely to accompany their child to a pediatric cardiology appointment by themselves compared to fathers going solo with their kid.
The Advisory discusses parents’ concerns around the possibility of a school shooting as one factor related to increasing parental stress. According to the Pew Research Center, mothers are more likely than fathers to be worried about this prospect.
Mothers are stressed, tired, and lonely
The one section of the Advisory that details the difference between mothers and fathers is in discussing mental health conditions. It points out that women generally have a higher prevalence of mental health conditions than men, including higher rates of depression (including postpartum depression) and anxiety. While they acknowledge that parents and caregivers who experience specific hardships like violence and job insecurity are more likely to experience mental health concerns, it should be noted that mothers bear the brunt of many of these difficulties. For example, women are three times more likely to experience intimate partner violence compared to men, and mothers are more likely to face unemployment than fathers.
A recent Gallup poll shows that women between the ages of 18-49 (i.e., childbearing age) are less likely than any other age-by-gender group to report getting adequate sleep. Unfortunately the poll did not assess parenting status, though other studies have shown that mothers report worse sleep satisfaction compared to fathers, including outside of the immediate postpartum period.
The Advisory points to the Cigna Group’s loneliness research and how parents report higher rates of loneliness than non-parents. They fail to mention that the same study finds that mothers report being lonelier than fathers. Single parents, who are disproportionally mothers, are more likely to report loneliness than other parents.
I want to be clear that I believe that caregivers of all genders deserve adequate support.
Additionally, ignoring the concerns and challenges of fathers is actively detrimental towards the goal of gender equality in parenting. We need more research and better policies that support fathers and non-birthing parents.
The most important recommendations within the Advisory would help all caregivers, including establishing a national paid family and medical leave program, expanding funding for early childhood programs, screening all parents for mental health concerns, and ensuring that all families have access to quality, affordable mental health care.
Caregiving is essential to our humanity, the process through which we show love, respect, and community with one another. However, it remains one of our noblest of callings that is frequently denigrated and minimized due to its proximity to femininity. If we want to truly help all parents, we need to clearly and accurately define where the problems exist and where the majority of the support needs to be focused.
To put it another way: Other countries have social safety nets. The United States has women.
And we are in crisis.