Poverty, Near-Poverty, and Hardship Around the Time of Pregnancy

Abstract

To describe income levels and the prevalence of major hardships among women during or just before pregnancy. We separately analyzed 2002-2006 population-based postpartum survey data from California's Maternal and Infant Health Assessment (n = 18,332) and 19 states participating in CDC's Pregnancy Risk Assessment Monitoring System (n = 143,452) to examine income and several hardships (divorce/separation, domestic violence, homelessness, financial difficulties, spouse/partner's or respondent's involuntary job loss or incarceration, and, in California only, food insecurity and no social support) during/just before pregnancy. In both samples, over 30% of women were poor (income </=100% of federal poverty level [FPL]) and 20% near-poor (101-200% FPL); and around 60% of low-income (poor or near-poor) women experienced at least one hardship. While hardship prevalence decreased significantly as income increased, many non-low-income women also experienced hardships; e.g., in California, 43% of all women and 13% with incomes >400% FPL experienced one or more hardships. These findings paint a disturbing picture of experiences around the time of pregnancy in the United States for many women giving birth and their children, particularly because 60% had previous births. The high prevalence of low income and of serious hardships during pregnancy is of concern, given previous research documenting the adverse health consequences of these experiences and recognition of pregnancy as a critical period for health throughout the life course. Low income and major hardships around the time of pregnancy should be addressed as mainstream U.S. maternal-infant health and social policy issues.

‘Me and my Bump’: An interpretative phenomenological analysis of the experiences of pregnancy for vulnerable women

“…Pregnancy was experienced by some as a time of separation from, or loss of others, including partners and friends (Furber et al, 2009;Chase et al, 2009). This suggests that Braveman et al"s (2010) research identifying causes of stress during pregnancy may need to be expanded to include the stress caused by any anxiety or loss experienced as a result of the pregnancy itself.…”

The Social Determinants of Health: Coming of Age

“…Recent evidence implicates chronic stress in the causal pathways linking multiple upstream social determinants with health, through neuroendocrine, inflammatory, immune, and/or vascular mechanisms (71,108). Stressful experiences-such as those associated with social disadvantage, including economic hardship (12,40) and racial discrimination (118)-may trigger the release of cortisol, cytokines, and other substances that can damage immune defenses, vital organs, and physiologic systems (71,101). This mechanism can lead to more rapid onset or progression of chronic illnesses, including cardiovascular disease (108), and the bodily wear and tear associated with chronic stress may accelerate aging (70,102,103).…”

Maternal prenatal stress and infant birth weight and gestational age: A meta-analysis of prospective studies

“…Several interpretations of this finding are possible. First, the level of risk has been shown to be linked to different variables that may influence maternal health during pregnancy, such as attention to nutrition and exercise, racial and socioeconomic factors, as well as drug, alcohol and tobacco use (Braveman et al, 2010). Researchers have varied in their consideration of such factors, mostly in the inclusion and exclusion criteria of participants (e.g, Berle et al, 2005;Field et al, 2010;Goedhart et al, 2010;McCool et al, 1994).…”