The recession has left many Missouri children and their families in "economically tenuous circumstances" as they try to cope with rising poverty, high unemployment and less access to affordable health care, according to the latest Kids Count report for Missouri.

But the report, issued by Citizens for Missouri's Children, points to some improvements, along with many setbacks, for children between 2004, the base year used for the study, and 2008. The study said births to mothers without high school diplomas decreased slightly to 17.9 percent from 18.6 percent, while infant mortality also declined to 7.4 percent from 7.7 percent per 1,000 live births. The study also found decreases in reported cases of child abuse and neglect, out of home placements and violent teen deaths. 

The study also stressed that early childhood education was the key to improving the well-being of children in the long run. It gives Missouri mixed reviews on this issue. It points to a 6 percent increase in the number of slots available in licensed child-care facilities throughout Missouri during the past five years. But the report says the number of poor children receiving subsidized child care in Missouri had "dropped precipitously" by about 6 percent -- to 42,224 children in 2008, from 45,071 in 2004.

At the same time, the study said economic conditions posed many challenges for children. It said the number of children enrolled in free or reduced lunches increased to 42 percent from 40.5 percent. The percentage of low birth weight infants rose slightly to 8.1 percent from 7.8 percent. The school dropout rate rose to 3.9 percent from 3.3 percent, while the rate of births to teens between the ages of 15 and 19 rose to 45.4 per 1,000 from 44.3.

Emily Schwartze (right), director of the Kids Count project, says the recession has complicated efforts to improve circumstances for poor children. Examples, she said, included Labor Department numbers that put Missouri's unemployment rate at roughly 9 percent for 2009. She says that number indirectly hurts children because it means many parents no longer have access to affordable health insurance at a time when the number of children enrolled in the state's HealthNet for Kids insurance program is declining.

While Missouri is generous in providing care for children, it imposes high barriers for parents to qualify for Medicaid for themselves. Children can qualify for Medicaid in families earning up to 300 percent of the poverty level, which is about $22,500 for a family of four. But Schwartze says parents in a family of four don't qualify for Medicaid if they earn more than roughly $340 a month. She says insuring parents is a must because studies show that parents who have health insurance are more likely to push for health care for their children.

"Health insurance is an important foundation for success in life," she says, adding that HealthNet needs to reach all eligible children. She urges state lawmakers to expand eligibility guidelines to target more children and families for all public assistance programs.

The Kids County report is based on child well-being data for Missouri's 114 counties and the City of St. Louis. St. Charles County ranks second best in the state, just behind Osage County. St. Louis County ranks 15th, and Jefferson County ranks 20th. St. Louis city was at the very bottom with a ranking of 115th. The city's rate is hurt partly because 74 percent of its students receive free or reduced lunches, compared to a state rate of 42 percent. The second issue that hurt the city was its dropout rate of 22.2 percent, compared to the state's overall rate of 3.9 percent.