The 34th edition of the Annie E. Casey Foundation's KIDS COUNT® Data Book describes how the country’s lack of affordable and accessible child care negatively affects children, families and U.S. businesses.
This year’s publication continues to present national and state data across four domains — economic well-being, education, health and family and community — and ranks states in overall child well-being. The report includes pre-pandemic figures as well as more recent statistics, and shares the latest information of its kind available.
America's child care system is broken. Safe, reliable child care has largely been inaccessible and unaffordable for too many Americans. Disparities between who can and can't afford child care reflect long-standing structural inequities in the United States. Shift workers, single parents, student parents and families of color are particularly affected by the failings of the child care system. Children are deprived of nurturing care, and caregivers are prevented from earning money to meet basic needs.
The child care system's inadequacies hinder family economic mobility and perpetuate generational wealth gaps. Affordability impacts accessibility, and the cost of child care has tripled since the publication of the first KIDS COUNT Data Book in 1990. The inability to access care can force caregivers to have to leave work early, be late for work or miss days entirely. Even more troubling: Almost a quarter of parents report being fired because of difficulties accessing child care. It's a cycle: Child care is inaccessible, the parent loses their job, which makes affording child care to secure a new job even more difficult.
And affordability isn't the only determinant of access. Often, families can't get to child care because of distance or a lack of public transportation infrastructure.
While families face rising costs and unreliable access, child care providers confront precarious operating conditions and low wages. Labor costs account for the bulk of child care providers' expenses. With caregiver-to-child ratios mandated by law and safety best practices, operating a child care business is expensive. Though the associated costs get passed on to families, these businesses typically survive on profit margins of less than 1%. Wages are astonishingly low, with child care workers making less than 98% of the nation's other workers.
To give kids, their caregivers and child care providers the best chance to thrive, policymakers must make significant improvements to the child care system.
The need for a child care system that works for families and providers is urgent. The Foundation recommends American policymakers take action:
In terms of overall child well-being, the top-performing states have shifted slightly last year's Data Book was published. New Hampshire now holds the top spot. Utah rose to second, and Massachusetts has slightly fallen, rounding out the top three. The lowest-ranked states remained the same: Mississippi (48), Louisiana (49) and New Mexico (50).
As in previous Data Books, the 2023 KIDS COUNT Data Book reports on racial and ethnic disparities that persist in America today. New findings include:
The stark racial and ethnic disparities shaping American childhoods today — which the KIDS COUNT Data Book series captures year after year — are indicative of why accessible, affordable and equitable child care is vital.
View the national data profile or download your state's data profile as a PDF below:
View the 2023 U.S. Data Profile in Spanish or download your state's data profile as a PDF below:
The Foundation calculates a composite index of overall child well-being for each state by combining data across four domains: (1) Economic Well-Being, (2) Education, (3) Health and (4) Family and Community. These scores are then translated into state rankings. Explore overall child well-being in the interactive KIDS COUNT Data Book.
New Hampshire holds the top spot for overall child well-being and ranks impressively in all other categories — fourth in economic well-being and education, third in health and second in family and community. Massachusetts also ranks high again, holding the top spots in health and education. At the other end of the list: New Mexico, Louisiana and Mississippi consistently appear in the bottom five for each domain.
States in the Southeast and Southwest continue to sit at the bottom of the overall rankings. These states also tend to fall on the lower end of the median income spectrum.
The Northeast and the Midwest continue to dominate in terms of overall child well-being. Nine of the top 10 ranking states were from these regions. Utah is the lone outlier at No. 2.
To help children grow into prepared, productive adults, parents need jobs with family-sustaining pay, affordable housing and the ability to invest in their children’s future. Explore economic well-being data in the interactive KIDS COUNT Data Book.
Growing up in poverty is one of the greatest threats to healthy child development. It increases the likelihood that a child will be exposed to factors that can impair brain development and lead to poor academic, cognitive and health outcomes. It also can result in higher rates of risky health-related behaviors among adolescents.
The poverty rate among Black and American Indian children (31% and 28%, respectively) was well over twice the rate for white and Asian and Pacific Islander children (11% for both). The poverty rate for Latino kids (23%) was also high. The official poverty level in 2021 was $27,479 for a family of two adults and two children. Nationally, 17% of children (12.2 million) lived in families below the poverty line. The child poverty rate remained unchanged since 2019. The child poverty rate for 2021 ranged from a low of 8% in Utah to a high of 28% in Mississippi. In Puerto Rico, 55% of children lived in poverty.
Housing typically is one of the largest family expenses. Paying too much for housing limits the resources families have for other necessities, such as child care, food, health care and transportation, as well as their ability to save and achieve financial stability.
In 2021, 30% of children (21.9 million) lived in families with a high housing cost burden. The rate remained unchanged since 2019. At 40%, California had the highest rate of children in families who spent more than 30% of income on housing in 2021. Iowa, Kansas, North Dakota and South Dakota all tied for the lowest rate, at 20% each. In 2021, 44% of Black children and 39% of Latino children lived in households with a high housing cost burden, compared with 21% of white kids.
Employment insecurity and the accompanying income loss can disrupt daily living and relationships and limit families’ access to resources to invest in their children’s development, which can, in turn, diminish children’s achievement in school and chances of future success. Current education systems and training programs fail to provide all people with the high-quality education and preparation needed to access jobs that pay enough to support a family.
The pandemic negatively affected the financial stability of families across the board. At 19% each, Nebraska and Utah had the lowest percentage of children in families without secure parental employment in 2021. West Virginia had the highest rate (36%). The share was even greater in the District of Columbia (41%) and Puerto Rico (51%). In 2021, 29% or 21.1 million children lived in families where no parent had full-time, year-round employment. That is 2.3 million more than 2019.
The early years of children’s lives set the foundation for their lifelong success. Closing significant academic achievement gaps is vital to ensuring that the nation’s future workforce can continue to compete on a global scale. Explore education data in the interactive KIDS COUNT Data Book.
High-quality preschool programs for 3- to 4-year-olds help set the stage for future skill development, well-being and learning, particularly for those from low-income households. Although Head Start and the expansion of state-funded programs since the 1990s have greatly increased access to preschool and kindergarten, many kids — especially 3-year-olds and children living in low-income families — continue to be left out, exacerbating socioeconomic differences in educational achievement.
During 2017–21, 4.4 million young kids ages 3 to 4 were not in school, representing more than half (54%) of all children in that age group. The rate of participation has worsened slightly since 2012–16. Roughly half of white and Black 3- and 4-year-olds (52% for both) were not in any school programs; the percentage was slightly lower for Asian and Pacific islander kids (51%). The rates were noticeably higher for Latino (61%), American Indian (58%) and multiracial (57%) children.
Reading proficiency by the end of third grade is a critical marker in a child’s educational development. By fourth grade, children are expected to use reading to learn other subjects. Therefore, mastery of reading at this level becomes important for students to keep up academically. Children who reach fourth grade without being able to read proficiently are more likely to struggle academically and eventually drop out of school.
Sixty-eight percent of fourth-graders in public schools were not proficient readers in 2022, an increase from 2019, when 66% were not proficient. All states have more than half of their fourth-graders struggling to read on grade level. In 2022, 84% of Black, 82% of American Indian, 80% of Latino and 63% of multiracial fourth-graders were not proficient in reading, compared with 59% of white and 45% of Asian and Pacific Islander students.
As technology continues to transform the economy, the demand grows for a workforce with aligned math and science skills and training that can keep pace with technological advancement. Students with strong math and science skills are more likely to graduate from high school, attend and complete college, earn higher incomes and take advantage of the future opportunities available to them.
Nationwide, close to 3 out of every 4 (74%) public school eighth-graders were not proficient in math in 2022 — the worst rate in the last two decades. At 65%, students in Massachusetts and Utah performed best in math. New Mexico had the highest rate of nonproficient math students at 87%. Eighth-grade math achievement worsened across all racial and ethnic groups between 2019 and 2022.
Good health is central to a child’s overall development and ensuring that kids are born healthy is an important first step toward lifelong success. Explore health data in the interactive KIDS COUNT Data Book.
Birth weight is an important indicator of an infant’s health. Babies born at a low birth weight (less than 5.5 pounds) have a high probability of experiencing developmental problems and short- and long-term disabilities. Infections, multiple births, obesity, poor nutrition, poverty, smoking, stress and violence can increase the chances of a baby being born at a low birth weight.
Nationally, low birth-weight babies represented 8.5% of all live births in 2021. This is the highest rate witnessed in the last decade. North Dakota had the lowest percentage of low birth-weight babies in 2021 (6.6% of live births), while Mississippi had the highest (2.3%). The rate increased from 2019 to 2021 among all racial and ethnic groups. Black babies were most likely to be born at low birth weight, at 14.1% of live births in 2021. That number was close to twice the rate for Latino (7.8%) infants and twice the rate for white (7.0%) infants.
Children with health insurance are more likely to have a regular source of health care they can access for preventive care services and developmental screenings, to treat acute and chronic conditions or to address injuries when they occur. Having health insurance can protect families from financial crisis when a child experiences a serious or chronic illness and can help kids remain active, healthy and in school.
Across the nation, 5% of children ages 18 and younger (4.2 million) lacked health insurance in 2021 — fewer than prior to the pandemic. Massachusetts had the lowest rate of children without insurance, 1%, compared with highs of 12% in Texas and 11% in Wyoming. American Indian (12%) and Latino (9%) children were far more likely to be uninsured than their multiracial (6%), Black (5%), Asian and Pacific Islander and white peers. Children in the latter two groups had uninsured rates of 4% each.
The child and teen death rate (deaths per 100,000 children ages 1 to 19) reflects a broad array of factors. Accidents, primarily those involving motor vehicles, were the leading cause of death for children and youth. As children move further into their teenage years, they encounter new risks. In 2021, accidents, homicides and suicides accounted for 76% of deaths for teens ages 15 to 19. For the second year in a row, firearm-related deaths were the leading cause of death among teens.
More than 23,000 children and youth ages 1 to 19 died in the United States, which translates into a morality rate of 30 deaths per 100,000 children and teens in 2021. The mortality rate among children and youth increased by 20% since 2019. The sizable increase in the mortality rate can largely be explained by the increase in homicides, drug overdoses and motor vehicle accidents among 15- to 19-year-olds.
Children who live in nurturing families and supportive communities have stronger personal connections and realize higher academic achievements. Explore family and community data in the interactive KIDS COUNT Data Book.
Even with the best efforts of parents, children growing up in single-parent families typically have access to fewer economic resources and valuable time with adults than children in two-parent families in which child-raising responsibilities can be shared. For example, in 2021, 29% of single-parent families had incomes below the poverty line, compared with 6% of married couples with children.
In 2021, 23.6 million children lived in single-parent families. The percentage of children living in single-parent families remained unchanged between 2019 and 2021, at 34%. Almost two-thirds of Black children (64%), close to half of American Indian children (49%), 42% of Latino children and 38% of multiracial children lived in single-parent families in 2021. By comparison, 24% of white children and 16% of Asian and Pacific Islander children lived in single-parent families.
High-poverty neighborhoods — where poverty rates for the total population are 30% or more — come with a number of challenges that affect the children and families who live there. Residents of these neighborhoods contend with poorer health, higher rates of crime and violence, poor-performing schools due to inadequate funding and limited access to support networks and job opportunities. They also experience higher levels of financial instability.
During the period from 2017–21, a total of 6.1 million children (8%) lived in high-poverty areas. This is 3.4 million fewer children than 2012–16. Variation among the states remains wide: 1% of children in New Hampshire and Utah lived in high-poverty areas, compared with 22% of Mississippi’s and 20% of the District of Columbia’s children. Puerto Rico (82%) had the highest rate. American Indian (22%), Black (21%) and Latino (12%) children were much more likely to have lived in high-poverty areas than their multiracial (8%), Asian and Pacific Islander (4%) and white (3%) counterparts.
Teenage childbearing can have long-term negative effects for mother and child. Babies born to teens are far more likely to be born preterm and at a low birth weight and into families with limited educational attainment and economic resources, which undermines their future success. Although the teen birth rate is currently at a historic low, the teen birth rate in the United States remains the highest among affluent countries.
In 2021, 146,973 babies were born to mothers ages 15 to 19. That translates to a birth rate of 14 births per 1,000 teens. Among the states, the teen birth rate for 2021 ranged from a low of five births per 1,000 teens ages 15 to 19 in New Hampshire to a high of 27 births per 1,000 in Arkansas. Black (22 births per 1,000) and Latina (21 births per 1,000) teens had the highest birth rates across major racial and ethnic groups. Although still high, the 2021 teen birth rate was the lowest rate on record for both groups.
