In September 2017, feeling the first twinges of labor, I walked beyond the ten-block radius my ob-gyn had prescribed me, defying her bed-rest orders for one reason: to tour day-care centers and get my unborn kid on as many wait lists as possible.

I knew I had to take the risk only because I’d worked for three years on youth and family programs at a high-quality New York nonprofit.

When I’d started in 2012, our preschool had a two-year wait list. By the time I left, the wait list had swelled to almost four years, which meant that most children who had been added to the list never got into the program. We had at least twenty applications for children in utero, and two for children who hadn’t yet been conceived. Sometimes mothers mentioned to me that they’d miscarried, but would like to keep their application open, and did in fact conceive again before receiving an offer of admission. One baby died while on the list.

My program was unusual in that it featured a first-come/first-serve “need blind” admissions process and substantial tuition assistance to families who could prove that they needed it — but its $37,000 a year price tag was all too typical for American childcare.

For the Church, life begins at the moment of conception. For an American baby, life starts much sooner — the moment a parent (almost always a mother) begins to think about how and when she can afford to have a child, and who will care for the child when she returns to work, as the vast majority of parents must do. If she has been in the same job for a year and worked at least 1,250 hours for an employer who also happens to employ at least fifty people within a seventy-five-mile radius of her workplace, then she will be eligible for twelve weeks of unpaid time off and continuation of health benefits under the Family Medical Leave Act (FMLA). She may be able to extend that slightly further with unused sick time — assuming she has any.

FMLA is an accommodating piece of legislation passed during the labor-punishing Clinton era, which applies to a little over half of US workers. It was the Democrats’ polite throat-clearing sigh, a gentle nudge in the general direction of our bosses, asking “Please sir, can I have my job back after taking care of my dying daughter?” when working families needed a paid family leave program comparable to the rest of the world’s, and a universal, federally funded childcare program. Since 1985, the majority of mothers of preschool children have participated in the workforce, and in the thirty years since, unprecedented growth in wealth inequality has transformed an urgent need into a moral and economic crisis. Now, as Baby Boomers age and a smaller percentage of the population has young children, there are fewer adult advocates for their needs.

At the same time we thrust new parents back into the labor market, we also insist that they comparison shop for childcare in a country with no national standards for quality, accessibility, or safety.

There is no reason we can’t have nationally subsidized, paid parental leave and childcare today. At present, public spending on early childhood education and care in the United States represents less than 0.5 percent of GDP, less than any OECD country besides Croatia, Latvia, and Turkey.

At the time of its bipartisan passage in 1993, the Chamber of Commerce warned that FMLA set a “dangerous precedent,” and John Boehner muttered something about “the light of freedom growing dimmer,” but twenty-five years later, a vast majority of employers report that complying with FMLA is easy and has had a positive or neutral effect on their workplaces. It is the sole non-means-tested federal provision for American families in the first few weeks of their children’s lives. Still, the burden is on parents to obtain doctor’s notes and coordinate it — and even it can hardly be called universal.

Employers approve, but how has it turned out for families? Many of those who are eligible can’t actually afford to take it. A full quarter of American mothers return to work less than two weeks after giving birth. Marissa Mayer aside, those who return soonest are most likely to be working class. Mothers who do not have housekeepers or nannies are constrained in their parenting choices, such as whether and how to breastfeed, and are more susceptible to depression.

One factory worker described breaking down in tears of exhaustion while pumping in a parking lot after a twelve-hour shift. The cheerful slogan “breast is best” is more likely to produce heart pangs than an eye-roll in the 88 percent of women who have no paid time off.

Nurri Latef, an early childhood teacher who I spoke to about her experience returning to school when her son was two months old, says, “I hated it. I felt like I was leaving my child at such a critical bonding time for the two of us, and he was premature. He spent a month in the hospital, so … I was only at home for one month with Nasir before I had to jump back into toddler-teacher mode so I could keep a roof over our heads.” No parent in any job should have to feel this way, but there’s a unique cruelty to forcing women to leave their own children before they feel ready to take care of other people’s children.

Meanwhile, Apple and Google employees get eighteen weeks of paid leave and backup or on-site day care. Googlers are awarded $500 cash referred to as “Baby Bonding Bucks.” Of course, not every worker shares in the benefits even at these seemingly enlightened firms: tech companies often outsource security, food service, and janitorial work by hiring private contractors, who are not eligible. Overall, about a third of American workers in management and other professional jobs have paid parental leave, while just over 5 percent in service occupations do.

Here’s how Julia Roitfeld, the daughter of the editor of French Vogue , describes impending motherhood: “It was like a detox — I ate healthy, I slept a lot, and I didn’t drink. All of my hormones were at the perfect levels. I was super-happy, and I really didn’t give a shit about work. Usually I’m so on top of work, but I was in a little cloud. But in August I thought, ‘Okay, I need to go back to work and start making a living again.’”

How long can a parent stay in that “little cloud” and “not give a shit” about the cost of diapers, formula, and rent? That depends both on one’s class and nationality. Brazilian mothers get seventeen weeks of leave to take care of their little ones at their full salary; Canadian parental leave was recently extended from one year to eighteen months at about 55 percent pay; Russia offers mothers twenty-four weeks paid. I could go on. The United States, Papua New Guinea, and Lesotho are the only countries in the world that don’t guarantee all workers paid time off to care for a new child — here, parental leave is a luxury reserved for the rich.

At the same time we thrust new parents back into the labor market, we also insist that they comparison shop for childcare in a country with no national standards for quality, accessibility or safety. Nearly 11 million children, including over half of children below the age of one, spend an average of twenty-seven hours a week in some kind of childcare setting, yet the burden is on individual parents to assess the risks and benefits of a confusing, unaccountable, generally private system pieced together state by state for the care of our littlest and most vulnerable children. In essence, giving birth or adopting a child in America means you also take on the job of government regulator. It’s an impossible task, with occasionally tragic consequences.

In 2013, a day-care worker in Mississippi handed a ten-week-old baby boy over to his father at pickup time without noticing that the child’s skin was blue and he was unresponsive. The father directed the staff to call 911 while he performed CPR — none of the staff knew how — and his son was finally rushed to the emergency room, where he died. After an investigation, the state concluded that the childcare center met all legal requirements for operation. It remains open.

In 2014, Kellie Rynn Martin suffocated at the age of three months in a day-care center run out of a middle-class suburban home in South Carolina, where her mother suspects she was put to sleep in a bassinet with a blanket or even another infant. When forensics searched the house, they found fourteen children playing “the quiet game” in the eighty-five-degree basement under the supervision of the owner’s daughter. In an interview, Martin’s mother stressed that the day-care owner’s home had appeared clean and the owner appeared competent when she toured the program only a few weeks earlier.

On March 22, 2016, three infants died in three different unlicensed and illegally operating day-care programs in Connecticut, one from Sudden Infant Death Syndrome (SIDS), another from an overdose of Benadryl, and the third from a blunt injury to the head. One of the providers had had her license revoked by the state the previous year for failure to comply with safety regulations — and yet continued to operate her center. The Connecticut assistant child advocate Faith Vos Winkel blamed parents, telling the Hartford Courant that they have ample opportunities to find licensed providers through the Office of Early Childhood’s website and the 211 Infoline.

The death rate of children enrolled in home-based day care — which is far more likely to be unlicensed than a center-based program — is twelve times that of center-based care. But home-based and unlicensed childcare is simply more plentiful and affordable. Licensed childcare centers are either geographically or financially out of reach for the majority of families.

Nearly half of American children under five live in areas where the demand for openings in childcare centers surpasses availability. (Spots for infants and toddlers in childcare centers are even more limited than those for three-to-four year olds, since the low teacher-to-child ratio necessary to ensure safety also make them difficult to profit from.) Where licensed, high-quality care is available, individual families shoulder most of the cost — and it is often prohibitively expensive.

Nationally, the average cost of tuition at a childcare center is over $10,000 per year — nearly 20 percent of the median household income. In the majority of states, childcare costs more than college tuition. Because it is largely private, our system is deeply inefficient, placing parents in competition against each other for coveted spots, instead of allowing them to negotiate prices collectively. Families in the United States spend 25.6 percent of their income on childcare, compared to an OEDC average of 13 percent, while getting significantly lower quality care.

Further, the grossly inadequate twelve weeks of job protection offered by FMLA means that many American children start day care at the exact time that the risk of dying from SIDS is highest: two to three months of age. Experts theorize that the reason why day-care deaths often happen in the first week or so that a child attends a new program is because children whose parents practice safe sleep practices at home are especially susceptible to SIDS when they are moved to unsafe sleep environments.

Derek Dodd relied on the recommendation of a friend when looking for childcare for his eleven-week-old son. But despite having been cited by the Department of Health just ten days earlier for unsafe sleep practices, the home-based provider “put our child in an unbuckled car seat on the floor, swaddled, where he wiggled down until he lost his airway and suffocated to death.” The baby was left unmonitored for two hours behind a closet door before the provider checked on him and found him blue.

Amber Scorah, whose son died on his first day in an unlicensed program in New York City, writes, “It’s possible that even in a different system, Karl still might not have lived a day longer; but had he been with me, where I wanted him, I wouldn’t be sitting here, living with the nearly incapacitating anguish of a question that has no answer.” Neither family wanted their child to be in day care so young — both were refused additional unpaid leave by their employers, and could not afford to quit.

Simply put, the deaths of these children must be counted as casualties of capitalism, an economic system which prioritizes profit over human life, especially those who do not yet add tangible value to the societies in which they live.

It’s easy to imagine negligent and abusive providers as monsters, but childcare is an exceptionally difficult job, demanding patience, creativity, compassion, self-control, and sometimes, selflessness. To consistently provide safe, quality care requires serious social investment in the well-being of children. For the most part, childcare workers and day-care directors devote an extraordinary amount of time and energy to filling in the immense gaps left by lack of federal guidance, funding, and support. The first year I worked as a teacher, I subsisted entirely on Red Bull and smoked-turkey slices I kept in my purse, so I could use the twenty-five minutes students were given for lunch to talk to them about things other than “content.” I do not know a single teacher who hasn’t routinely given up lunch breaks or taken work home to do into the wee hours of the morning, after putting their own kids to bed.

It’s a hell of a lot to demand of people making $20,320 a year, the national median wage for early childhood teachers, which is below the poverty threshold for a family of four. These working-class women and men are increasingly being required to pay thousands of dollars out of their own pockets for college classes and state exams, while receiving wages far lower than the value they are providing — and lower than those of teachers who work with older kids. In essence, we are subsidizing our current system of early childhood education on their backs. It’s unfair, and it leads to high turnover — which can be dangerous. It’s also inefficient: there is a strong and well-documented relationship between higher teacher salaries and higher childcare program quality.

Yet all human beings are fallible, which is why we need consistent federal regulations in place for the protection of both children and the day-care workers who care for them. Systems like those used effectively in the community-based early childcare center I ran are critical to ensure that no child experiences the tragic negligence endured by Dodd’s son.

Our infant/toddler classroom consisted of ten children cared for by four teachers, who supported each other and kept each other responsible with extraordinary grace and effort in a demanding job. Every single teacher was trained annually in CPR and safe sleep practices, even though it meant closing the school for a couple days a year. We hired two substitute teachers who showed up every day to enable us to meet the child/teacher ratios suggested by experts, even when teachers were out sick. The presence of a program director and assistant director — as well as regular unannounced visits from the state — ensured that teachers followed guidelines at all times. Infant/toddler teachers kept a log (as required by New York state law) in which teachers initialed that they had checked on a baby in its sleep every fifteen minutes. The inspectors always examined the logs when they came to visit.

Unfortunately — and contrary to the suggestion of Connecticut’s assistant child advocate — even regulated childcare in America is not uniformly high quality. In a recent report on childcare quality and oversight of regulated centers compiled by the advocacy organization Child Care Aware of America, not one state earned an “A.” The only program to earn a “B” was the Department of Defense’s, which is run by the federal government. Ten, including New York, earned a “C,” twenty-one states earned a “D,” and nineteen failed.

It was a simple survey: the organization used fifteen basic benchmarks representing research-backed criteria. It revealed that only thirty-one states plus the dod require a fingerprint check for childcare center staff, and just twenty-three require a check of the sex-offender registry. Thirty states plus the dod inspect centers two or more times per year, but nine states do not require any type of annual inspection. Only sixteen states addressed each of ten basic health and safety requirements recommended by pediatric experts in their licensing requirements. Just thirty-nine states in the wealthiest country in the world even have a program that rates the quality of day-care centers.