Determinants of foregone care among parents: The Evane 2024, French cross-sectional survey

Background

In 2024, the French public health agency launched Evane, the first survey examining the determinants of parenting experiences and practices among parents of children aged 0-2, in metropolitan France. Evane is based on Bronfenbrenner’s ecological model and Belsky and Jaffee’s parenting model. This study aims to assess the prevalence and main reasons for foregone care among fathers and mothers, and to explore associations with determinants of parenting.

Methods

Evane is an online cross-sectional survey of a representative sample of 5,235 fathers and 5,049 mothers, selected by one-stage random sampling method, stratified by income and gender. Parents reporting forgone care identified the main reason (economic, geographical or structural barriers). Weighted prevalence was estimated, and associations with the determinants of parenting were analysed (prevalence is shown for p < 0.05, chi-squared test). Preliminary results; multivariate analyses are currently ongoing.

Results

Overall, 14.5% [13.8-15.2] reported forgone care (16.9% [15.8-18.0] of mothers vs. 11.7% [10.8-12.6] of fathers). The main reasons were economic (57.8%), lack of appointments (24.6%) or geographical (4.1%). While no differences were found based on parental age, SES including diploma, foregone care was significantly higher among financially strained parents (33.4%), poor health (27.2%), limited partner support (26.3%), high parental stress (22.2%), or a history of at least three Adverse childhood experiences (ACE, 24.7%). Prevalence was higher when the child had a health problem (22.7%) or an intense temperament (20.0%). Mothers reported higher rates of foregone care than fathers across all determinants.

Conclusions

These novel results show that foregone care is strongly driven by psychosocial vulnerabilities and parental stress. These findings highlight the need for public policies integrating mental health and social support to ensure healthcare access during early childhood.

Key messages

• Beyond financial constraints, psychosocial factors-including parental stress, ACEs and social support - are major determinants of foregone care.

• The gender gap in reporting foregone care highlights the disproportionate burden and specific vulnerability of mothers in managing family healthcare needs.