Productivity Commission Inquiry into Early Childhood Education and Care 2023
AUSTRALIAN MULTIPLE BIRTH ASSOCIATION SUBMISSION

ABOUT THE AUSTRALIAN MULTIPLE BIRTH ASSOCIATION 

The Australian Multiple Birth Association is a national fully volunteer-run, not-for-profit organisation that educates, supports and advocates for multiple birth families. The Australian Multiple Birth Association has affiliated local clubs across every state and territory in Australia which have thousands of member parents of multiples. By linking parents of multiples to a support network with other local multiple birth families, providing free and publicly available education and resources, and advocating on behalf of parents of multiples, the Australian Multiple Birth Association aims to enable positive health outcomes and promote equality for multiple birth families.

INTRODUCTION
The Productivity Commission is undertaking an inquiry into the early childhood education and care (ECEC) sector in Australia (Inquiry). The Commission has been asked to make recommendations that will support affordable, accessible, equitable and high-quality ECEC that reduces barriers to workforce participation and supports children’s learning and development, including considering a universal 90 percent childcare subsidy rate. In doing so, the Commission should consider options that improve or support:
● affordability of, and access to, quality ECEC services that meet the needs of families and children
● developmental and educational outcomes for Australian children, including preparation for school
● economic growth, including through enabling workforce participation, particularly for women, and contributing to productivity
● outcomes for children and families experiencing vulnerability and/or disadvantage, First Nations children and families, and children and families experiencing disability
● the efficiency and effectiveness of government investment in the sector.

The rate of multiple births (twins, triplets and above) has continued to rise worldwide over the past three decades. These families face significant challenges from pregnancy through to birth and the first five years of their babies’ lives. ¹

The evidence is clear that the early years of a child’s life are intrinsically linked to their wellbeing and educational outcomes as an adult. A child’s earliest experiences establish foundations for life and 90 percent of brain growth occurs by the age of five. The Prime Minister has publicly committed to creating a “universal childcare and early learning system, including a policy of making early learning and childcare accessible for all Australian children and their families”. ²

For early learning and childcare to be accessible and affordable for multiple birth families, changes will need to be made to alleviate the current affordability and accessibility barriers to ECEC services that multiple birth families currently face.

In this Submission we outline the main barriers faced by families with multiples as well as the recommendations we implore the Inquiry to consider to address these barriers. We strongly encourage the Inquiry to consider the recommendations that are put forward in this submission to ensure families with multiples are included and are able to access and afford ECEC services. We also encourage the Inquiry and ECEC policy makers to consult with the Australian Multiple Birth Association and parents of multiples more generally when considering ECEC policy to ensure their perspective is considered. The unique challenges multiple birth families face must be specifically addressed so that multiple birth families have access to the resources and support they need to thrive. ³

Affordability of ECEC Services
It is well established that families with twins and triplets experience a higher financial burden than families with singletons due to increased expenses for childcare, medical care, specialised equipment, larger car and house, and daily living necessities such as food and clothing. ⁴ Twins cost 5 times and triplets 13 times more than a singleton in the early years. ⁵ With the significant upfront costs as well as decreases in income associated with having multiples, this significantly impacts the capacity to afford ECEC services.

“Educators get them mixed up despite dressing them in their own "uniform" so they can tell them apart. Exclusion periods from illnesses are too long. Twins and siblings don't get sick at the same time, they get sick back to back. I had to quit working because I was having too much time off for the twins. Daycare is expensive, even with the 95% rebate. Once the 95% rebate came in, the childcare centre just upped the fees and I was paying MORE in daycare fees than I was before the new rebate."      Parent of twins

"Have been hesitant to enrol twins in childcare as the centres will not support them to sleep in the way they currently need e.g. won't rock, hold or feed baby to sleep, will put them in cot and pat/shush them only. Perhaps not enough staff to support kids individually."    Parent of twins

In Australia, according to the recent ACCC childcare inquiry interim report, childcare fees have been rising over the 4 years from September 2018 to December 2022. This rate of increase has been faster than inflation and faster again than wage increases. ⁶

The cost of childcare is a significant barrier to multiples accessing ECEC services and mothers of multiples participating in the workforce. In a recent survey conducted of over 1500 parents of multiples in Australia, 69% of parents of multiples said that childcare was unaffordable for them. ⁷ A study published in the Journal of Marriage and Family found that mothers of multiples were more likely to experience a decline in income after the birth of their multiples, and were more likely to reduce their work hours or exit the labour force entirely, in comparison to families with singletons. This can lead to long-term economic consequences for families, including reduced savings and retirement benefits. ⁸

One in every eight families with multiples reported having to reduce the working hours of the main wage earner because of the cost of childcare. ⁹ The rate at which mothers return to paid work is also slower for mothers of multiples than mothers of singleton babies. This is because of the cost of childcare being higher with two or more same-aged children, making childcare costs unviable in some cases and a return to work impossible. ¹⁰

As parents are still recovering from the initial financial shock of suddenly growing their family bigger than expected and contending with all the additional unanticipated costs, they are then restricted to expensive childcare options if they would like to return to work. Many mothers especially reported that the cost of childcare for their twins or triplets was more than their wages and cited this as the reason they have not returned to the workforce.

"I had to return to work earlier than planned as my request to extend unplanned leave was denied by my employer, which demonstrated a lack of understanding of the challenges of having infant twins. Although we already had a singleton in a childcare centre, we still had to wait for the centre to ask if another family could change their booking days to get two spots for the 2 days. I returned to work part time to keep my ongoing employment and my partner reduced to four days work to reduce the childcare days needed due to cost and accessibility for spaces."     Parent of twins

"I have a toddler already in childcare for 3 days and I calculated how much it would cost to put the triplets in childcare as well for 3 days, we would be paying $566 for childcare per week even with the subsidies including the new subsidy for additional children. This is more than I would earn going back to work. It was just too expensive!"     Parent of triplets and toddler

Higher Childcare Subsidy
From July 2023 the Government increased the Child Care Subsidy. The aim being to provide further financial relief for families with children in ECEC services. Anticipating the increased childcare subsidies, many ECEC services raised their fees. This has had a particularly negative outcome for multiple birth families who have multiple children in ECEC services. ¹¹ In addition to this, there have been no changes to the higher childcare subsidy, the below graph demonstrates the changes that were made:

Many parents with multiples in ECEC services reported having an increase in subsidy for their first child but the subsidy rates for any subsequent children attending ECEC services stayed the same. For example one parent of twins and an older singleton child reported the differences in her childcare subsidy rate being as follows:

The outcome of this is that some multiple birth families are paying more in out of pocket fees for ECEC services after the changes were made in July 2023.

Recommendation:
● Increased child care subsidies for multiple birth families. Affordability will increase participation of multiples in ECEC services. In particular, the higher child care subsidy rate should be increased to ensure families with multiples are able to afford ECEC services.
● Increased consultation with the Australian Multiple Birth Association and parents of multiples prior to changes to policy regarding ECEC services.

Securing Placements for Multiples
In a recent survey conducted of over 1500 parents of multiples in Australia, 54% of parents of multiples reported they had trouble accessing childcare and securing a placement for their multiples. 12 There is a significant proportion of parents of multiples who would like to increase their participation in the workforce however, they are unable to access placements in traditional ECEC services in Australia. Many parents of multiples report being on waiting lists for over a year.

Competing with families to find two or more placements in ECEC services on the same days is extremely difficult for parents of multiples especially when their multiples are less than 12 months as there is usually less availability due to the ratio requirements.

Parents of multiples report that when their twins or triplets are on waiting lists for an ECEC service and one spot becomes available the ECEC service will often provide this place to a family with a singleton to fill the spot faster rather than prioritise families with multiples, even if they have been on the waitlist of an ECEC service longer. This means that parents of multiples are facing much longer wait times and are sometimes forced to send one child of a multiple on a day first until they can be eligible for a second or third spot. 

Ability to secure placements in ECEC services also contributes to the slower rate in which mothers of multiples return to paid work.

Recommendation:
● Priority placements for twins, triplets and higher order multiples in ECEC services.
● The current activity test should be abolished.

Physical Accessibility of ECEC Services for Multiples
In a recent survey conducted of over 1500 parents of multiples in Australia, 23% of parents of multiples reported physical barriers to attending ECEC services. Dropping off multiple small children at childcare centres is very difficult and can be unsafe without accessible doors, ramps and gates that can be navigated with a double pram. Many parents reported that their double prams were unable to fit through doorways and pathways to the front entrance of the ECEC centres or there was no lift access. Parents are then forced to either leave one of their children in the car or call for staff assistance. This makes the drop off and pick up very stressful, and at times, dangerous for multiple birth families.
Without clear ECEC policies around physical accessibility plans for families with multiples, it can be extremely challenging and limit the options of ECEC services for families with multiples.

Recommendation:
● The ECEC system must be inclusive, with safe drop off plans for multiple birth families and accessibility for all children.

Lack of Awareness With Early Educators
Many parents also reported having issues with educators who were not familiar with multiples and unable to meet the specific needs of their twins or triplets such as making sure they slept at the same time, having a system to be able to tell them apart if they were identical and being able to secure spots in the same room.

Accessing childcare services for multiples can be particularly challenging, as many traditional childcare providers may not be equipped to care for multiple infants at once. This can limit parents' options for childcare and may require them to seek out specialised providers, which can be more expensive and are less available. Additionally, finding childcare providers who are able to accommodate the specific needs of multiples can be challenging. A study published in the Journal of Reproductive and Infant Psychology found that mothers of multiples reported greater difficulties in finding suitable childcare arrangements than mothers of singletons. ¹³

It is well documented that babies born prematurely with a low birth rate are at increased risk of having special needs. ¹⁴ Twins, triplets and other multiples are more likely to be born prematurely. Fewer than half of twins are delivered after 37 weeks and only 1.5% of triplets are born after 37 weeks. ¹⁵ In addition, congenital anomalies, growth restriction and the unique stresses that multiples can experience during pregnancy can put them at increased risk of special needs. Special needs in twins and multiples are diverse. Previous research show that multiples are at increased risk of cerebral palsy, with one study showing a fourfold increase for twins over the general population. ¹⁶
Language and speech delays, behavioural issues and developmental delays are all more prevalent in multiples.

With these complexities, parents of multiples are more reluctant to place their children into traditional childcare centres as there is an increased risk of illness which would have a bigger impact on children who were born prematurely and are medically vulnerable. Chronic lung disease is more prevalent in premature babies and a simple cold could turn into a medical emergency.

The challenges of complex care coordination, including accessing childcare services, scheduling appointments, and coordinating support services have a significant impact on parents of multiples, who may experience higher levels of stress, anxiety, and depression compared to parents of singletons. This is exacerbated when parents of multiples are not properly supported and unable to access or afford ECEC services.

Recommendation:
● Develop specialised ECEC programs that cater specifically to the needs of multiple birth families. These programs should provide tailored educational approaches, address social and emotional development and involve the parents of multiples.

Lack of Availability of Alternative Affordable Childcare
Many parents of multiples would prefer alternative childcare options to the traditional ECEC services. In addition to the reasons stated above which could be assisted with changes to Government policy, there are consequences of ECEC services that are largely unavoidable. For example, many parents of multiples decide to remove their children from traditional ECEC services as the burden of multiple sick infants due to increased exposure in traditional ECEC services mean that parents are forced to take an increased amount of time off work to care for their sick children. Many parents of multiples conclude that the ECEC services are not worth the disruption of their ability to work and choose to become the full time carers of their children or look for alternative childcare arrangements such as family day care or in-home care services which have less prevalence of illnesses.

This being said, the numbers of family day care and in-home care services has decreased. The decline in family day care and in-home care services impacts households in vulnerable situations and areas disproportionately, such as families with multiples because they rely more on these care types than other households. ¹⁷
Further to this, there is an In Home Care program that is funded by the Department of Education. The purpose of the In Home Care program is to provide ECEC services to families who cannot access other ECEC services locally. To qualify for this, families must meet one or more of the following criteria:
1. Geographical isolation: Families that are geographically isolated from other types of approved child-caring services, particularly in rural or remote locations.
2. Non-standard working hours: Families where the parent/guardian or carers work non-standard or variable hours outside the normal child care service hours.
3. Complex or challenging need: Families who experience challenging or complex life situations such as a child with additional needs or a disability, or a family where a parent is undergoing treatment for a serious illness.

Multiple birth families, despite having substantially more complex needs and issues accessing childcare, are not eligible for the In Home Care program on the basis of having multiples. Previously the criteria for access to In Home Care included families with 3 or more children under school age.

Recommendation:
● Guaranteed access to an ECEC in-home service for multiple birth families with 3 or more children under school age.

¹ Twins Research Australia (TRA). Multiple perspectives: what support do multiple birth families need to live happy and healthy lives. TRA, The University of Melbourne, Melbourne, 2019.
² Anthony Albanese - Speaking as Opposition Leader in Parliament announcing Labor Childcare Policy.
³ D’Rosario, M., (2023) Multiples Matter: investigating the support needs of multiple birth families, AMBA, Per Capita: https://www.amba.org.au/news/multiples-matter.
⁴ D’Rosario, M., (2023) Multiples Matter: investigating the support needs of multiple birth families, AMBA, Per Capita: https://www.amba.org.au/news/multiples-matter.
⁵ D’Rosario, M., (2023) Multiples Matter: investigating the support needs of multiple birth families, AMBA, Per Capita: https://www.amba.org.au/news/multiples-matter.
⁶ Australian Competition and Consumer Commission (2023) Childcare inquiry interim report: https://www.accc.gov.au/inquiries-and-consultations/childcare-inquiry-2023/june-2023-interim-report.
⁷ Australian Multiple Birth Association, (2022) Equality of support for parents of multiples: https://www.amba.org.au/news/equality.
⁸ D’Rosario, M., (2023) Multiples Matter: investigating the support needs of multiple birth families, AMBA, Per Capita: https://www.amba.org.au/news/multiples-matter.
⁹ Twins and Multiple Births Association (TAMBA). Costs of childcare for households with multiple births: TAMBA and AMBA survey results, 2013. https://www.tamba.org.uk/document.doc?id=546
¹⁰ Twins Research Australia (TRA). Multiple perspectives: what support do multiple birth families need to live happy and healthy lives. TRA, The University of Melbourne, Melbourne, 2019.
¹¹ Sarah Ison (2023): ‘Parents of twins and triplets report paying more for childcare under new child care reforms’: https://www.theaustralian.com.au/nation/politics/parents-of-twins-and-triplets-report-paying-more-for-childcare-under-new-child-care-reforms/news-story/e060a4114aa355d53376a958eb2d489b
¹² Australian Multiple Birth Association, (2022) Equality of support for parents of multiples: https://www.amba.org.au/news/equality.
¹³ D’Rosario, M., (2023) Multiples Matter: investigating the support needs of multiple birth families, AMBA, Per Capita: https://www.amba.org.au/news/multiples-matter.
¹⁴ Twins Research Australia (TRA). Multiple perspectives: what support do multiple birth families need to live happy and healthy lives. TRA, The University of Melbourne, Melbourne, 2019.
¹⁵ Twins Research Australia (TRA). Multiple perspectives: what support do multiple birth families need to live happy and healthy lives. TRA, The University of Melbourne, Melbourne, 2019.
¹⁶ Twins Research Australia (TRA). Multiple perspectives: what support do multiple birth families need to live happy and healthy lives. TRA, The University of Melbourne, Melbourne, 2019.
¹⁷ Australian Competition and Consumer Commission (2023) Childcare inquiry interim report: https://www.accc.gov.au/inquiries-and-consultations/childcare-inquiry-2023/june-2023-interim-report.