In 2019, in preparation for the 2020 decennial Census, CHAI became aware of a very important and alarming issue—that young children ages 0-4 were at risk of being missed in the Census. The Census occurs once every ten years with the goal of counting every person living in the United States. As outlined in the Constitution, this determines states’ representation in Congress as well as the number of electoral votes they receive. Very importantly, the Census also guides the spending of over 300 federal programs that distribute funds back to the states for things like schools and healthcare.¹ When young children are missed in the Census, their community misses out on these funds for an entire decade—basically their whole childhood.

So why did we—a hospital—quickly get involved in Census promotion? Research on Census “trusted messengers” found that doctors were among the most trusted source of information regarding the Census.² We also realized that the very children at risk of being missed were also more likely to rely on programs such as WIC, SNAP, Medicaid, and School Lunch– all funded based on the Census. In response, we spread awareness among our doctors, nurses, clinic staff, and throughout our hospital system so that families would be encouraged to complete their forms.

Advocating for All Children to Be Counted in the 2020 Census with Our “Count Your Cuties” Campaign at DC’s 2019 Maternal and Child Health Meeting

We recruited Census Ambassadors, a group of pediatric doctors and nurses to promote this issue in the hospital and our primary care clinics. We became very involved in the National Count All Kids Committee. Locally, we served as the subgroup lead for counting young children in the District of Columbia’s Complete Count Committee. We published weekly updates through the DC Health Matters Collaborative to track response rates throughout neighborhoods in DC. We attended community events where we discussed the importance of completing the census form and why everyone, including the youngest children must be counted. We partnered with community health centers and diaper banks to distribute promotional materials such as flyers, posters, bibs, band-aids, and coloring books available in several languages.

The undercount of young children is not a new phenomenon.  This has been happening since at least 1950, when both adults and children were undercounted at about the same rate.³ However, after 1990 the adult undercount actually improved while the child undercount got much worse. This worsening trend persists today and unfortunately, more children were missed in the 2020 census than any other census in the past 50 years.² More than 1.5 million children were not counted.³

A recent report by Dr. Bill O’Hare found that in 2020 the District of Columbia had a high (11.5%) undercount rate of children ages 0-17.³ This means that about 14,850 children who live in DC were not accounted for. This particular report only focused on ages 0-17 because data on young children (ages 0-4) will not be available until later this year.³ While it is very disappointing to see these results, I can’t help but believe that the undercount would have only been worse, had the CHAI not raised so much awareness.

2020 was a year of many challenges to a successful Census. The world shut down during the early days of the COVID-19 pandemic. Though we had plans to meet our community in person and hold census-themed events and outreach, we could not due to social restrictions. Daycares and schools, important partners in this work, also shut down. It was also the first census to rely mostly on internet submissions and much more outreach needed to be done to ensure our community trusted and understood this approach. President Trump also attempted to include a citizenship question, which was ultimately declined, but raised fear and concern among many people. These challenges are in addition to the known historical barriers of counting young children, most notably that they are more likely to live in complex households, more likely to live in rental housing, and more likely to live with grandparents than older children.²

Preparation is already underway for the 2030 Census. We continue to advocate for research on the undercount of young children and novel approaches to improving the count. We are forever grateful to our Children’s National Hospital Census Champions and Ambassadors who helped spread awareness of this important, and little-known issue