More Than Shelter: Housing for Urban Maternal and Infant Health

Abstract

Housing quality, stability, and affordability have a direct relationship to socioemotional and physical health. Both city planning and public health have long recognized the role of housing in health, but the complexity of this relationship in regard to infant and maternal health is less understood. Focusing on literature specifically relevant to U.S. metropolitan areas, I conduct a multidisciplinary literature review to understand the influence of housing factors and interventions that impact infant and maternal health. The paper seeks to achieve three primary goals. First, to identify the primary “pathways” by which housing influences infant and maternal health. Second, the review focuses on the role and influence of historical housing discrimination on maternal health outcomes. Third, the review identifies emergent practice-based housing interventions in planning and public health practice to support infant and maternal health. The literature suggests that the impact of housing on infant health is complex, multifaceted, and intergenerational. Historical housing discrimination also directly impacts contemporary infant and maternal health outcomes. Policy interventions to support infant health through housing are just emerging but demonstrate promising outcomes. Structural barriers to housing affordability in the United States will require new resources to foster greater collaboration between the housing and the health sectors.

A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality

“…Policies guiding mortgage lending practices and community development shape communities, and more specifically, the resources, exposures, and social capital they contain. For instance, safe, stable, affordable, and quality housing has a direct relationship with physical and mental health, and is a key SDoH in health promotion [164]. Racial and ethnic minority families are more likely to live in areas with concentrated poverty, experience housing insecurity and housing segregation which contribute to greater disparities in infant mortality and birth outcomes [163][164][165].…”

“…For instance, safe, stable, affordable, and quality housing has a direct relationship with physical and mental health, and is a key SDoH in health promotion [164]. Racial and ethnic minority families are more likely to live in areas with concentrated poverty, experience housing insecurity and housing segregation which contribute to greater disparities in infant mortality and birth outcomes [163][164][165]. One study comparing state-level measures of structural racism and Black infant mortality found that for all states, increasing racial inequity in unemployment was associated with a 5% increase in Black infant mortality [14].…”

Housing instability: Exploring socioecological influences on the health of birthing people

“…In an urban‐based quasi‐experimental study of over 10,000 participants, Pollack and colleagues reported that people living in unaffordable housing had increased odds of poor self‐rated health (AOR 1.75, 95% CI 1.33, 2.29) (Pollack et al, 2010). Reece brilliantly describes the pillars of influence of housing as a social determinant of maternal health (Reece, 2021). These primary pathways of housing conditions and habitability, neighbourhood effect, and housing stability/affordability are witnessed in these interviews and affect maternal health outcomes (Reece, 2021).…”

“…Reece brilliantly describes the pillars of influence of housing as a social determinant of maternal health (Reece, 2021). These primary pathways of housing conditions and habitability, neighbourhood effect, and housing stability/affordability are witnessed in these interviews and affect maternal health outcomes (Reece, 2021). Systemic racism is undoubtedly a piece of this puzzle that we must address.…”

Towards a mother-centred maternal health promotion

“…Unsafe, insecure and damp housing has well-established links to adverse socio-emotional and physical health outcomes ( Rolfe et al , 2020 ). For mothers/parents at such a vulnerable time, insecure and inadequate housing has multifaceted, complex and intergenerational effects on health ( Reece, 2021 ) and destabilizes their ability to adjust to new challenges of mother/parenthood. The idea that housing is linked to adverse health is not new, albeit unresolved and under-addressed; however, linking housing as a core strategy within a coordinated maternal health promotion approach crucially steps away from remaining at more widespread behavioural approaches to improving maternal health.…”