Missed opportunities to improve food security for pregnant people: a qualitative study of prenatal care settings in Northern New England during the COVID-19 pandemic

Abstract

Background Food insecurity during pregnancy has important implications for maternal and newborn health. There is increasing commitment to screening for social needs within health care settings. However, little is known about current screening processes or the capacity for prenatal care clinics to address food insecurity among their patients. We aimed to assess barriers and facilitators prenatal care clinics face in addressing food insecurity among pregnant people and to identify opportunities to improve food security among this population. Methods We conducted a qualitative study among prenatal care clinics in New Hampshire and Vermont. Staff and clinicians engaged in food security screening and intervention processes at clinics affiliated with the Northern New England Perinatal Quality Improvement Network (NNEPQIN) were recruited to participate in key informant interviews. Thematic analysis was used to identify prominent themes in the interview data. Results Nine staff members or clinicians were enrolled and participated in key informant interviews. Key barriers to food security screening and interventions included lack of protocols and dedicated staff at the clinic as well as community factors such as availability of food distribution services and transportation. Facilitators of screening and intervention included a supportive culture at the clinic, trusting relationships between patients and clinicians, and availability of clinic-based and community resources. Conclusion Prenatal care settings present an important opportunity to identify and address food insecurity among pregnant people, yet most practices lack specific protocols for screening. Our findings indicate that more systematic processes for screening and referrals, dedicated staff, and onsite food programs that address transportation and other access barriers could improve the capacity of prenatal care clinics to improve food security during pregnancy.

The Impact of the COVID-19 Pandemic on Food Insecurity in Northern New England Primary and Prenatal Care Settings

“…Studies have shown that interventions involving referrals from practices to community food resources can increase use of food resources among patients. 12 In our team’s qualitative work on FI in prenatal care settings, 22 clinics primarily addressed FI through internal referrals to clinic-based staff, such as a dedicated resource specialist, who could then refer to community resources. Practice staff discussed the importance of strong relationships between the clinic and the community organizations, and felt that better coordination between clinics and various community resources was needed to address FI.…”

“…Practice staff discussed the importance of strong relationships between the clinic and the community organizations, and felt that better coordination between clinics and various community resources was needed to address FI. 22 Health care organizations that screen for FI and connect patients to food resources partner with a variety of community organizations, most commonly food banks. 23 This supports our findings, which suggest that collaboration between practices and community food programs is important for addressing FI.…”

Nutrition as Personalized Medicine against SARS-CoV-2 Infections: Clinical and Oncological Options with a Specific Female Groups Overview

“…In addition to the low quality of the foods consumed, the perinatal outcomes got worse [ 101 ]. Interestingly, researchers in Northern New England have proposed a model to identify and address questionable food choices among pregnant women during the pandemic period, highlighting the need for specific food programs [ 107 ]. Erol et al discussed that vit E and Afamin are significant predictors of adverse perinatal outcomes in COVID-19 infected women.…”

Consensus from an expert panel on how to identify and support food insecurity during pregnancy: A modified Delphi study

“…Short screening measures are limited in that they do not allow for the assessment of the severity of food insecurity, however, they are more appropriate for busy clinical settings and take into consideration barriers including time constraints and increased workloads experienced by clinicians, while still being able to determine food secure status [ 55 ]. While it is clear that clinicians consider food insecurity screening as an important component of antenatal healthcare [ 16 , 56 ], there are a variety of barriers that may prevent them from asking their patients about their household food security. This includes a lack of guidelines, uncertainty surrounding responsibility for screening, inadequate clinical knowledge and training, and time constraints [ 16 , 56 ].…”

“…Recent research has found that while health care providers in one Australian antenatal setting were aware of the importance of maternal nutrition for the short- and long-term health of both the mother and baby, they were uncertain how to broach issues surrounding food insecurity, and when they do, they have few strategies to assist the hungry or food insecure parent [ 16 ]. Assisting clinicians when they encounter women who are experiencing hunger or food insecurity during their pregnancy will increase the opportunity for better birth and pregnancy outcomes [ 17 ]. Clinical practice guidelines are often used in these situations to provide guidance for clinicians when dealing with patient concerns, however, as yet there are no such Australian guidelines or advice that assist antenatal management of women who are food insecure both during and following pregnancy.…”