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

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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.

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Acknowledgements

The authors wish to acknowledge Shabbir Ahmad, DVM, MS, PhD, Acting Director, and Eugene R. Takahashi, PhD, MPH, of the Maternal, Child and Adolescent Health Program, Center for Family Health, California Department of Public Health, who have played major roles in developing MIHA, including supporting the inclusion in MIHA of the measures examined in this study. We would also like to thank the PRAMS Working Group. This research was supported primarily by APTR/CDC Cooperative Agreement TS-0842 from the Centers for Disease Control’s Division of Reproductive Health. Dr. Kim’s involvement in this study was primarily supported by a postdoctoral fellowship as a Kellogg Foundation Health Scholar. None of the authors has any direct financial interest in the subject matter or materials discussed in this manuscript. We wish to thank Mercedes Dekker, MPH, Teri Moore, MPH, and Veronica Pedregon, MPH for research assistance.

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Authors and Affiliations

  1. Center on Social Disparities in Health, Department of Family and Community Medicine, University of California, San Francisco, 3333 California Street, Suite 365, Box 0943, San Francisco, CA, 94118, USA

    Paula Braveman, Kristen Marchi & Susan Egerter

  2. Health Improvement Program, Stanford Prevention Research Center, Stanford University Hoover Pavilion, 211 Quarry Road, N404, Stanford, CA, 94305-5705, USA

    Soowon Kim

  3. Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Bldg KOGR, MS K30, Atlanta, GA, 30341, USA

    Marilyn Metzler

  4. Division of Reproductive Health, National Center for Chronic Disease Prevention, and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Atlanta, GA, 30341-3717, USA

    Tonya Stancil

  5. Epidemiology, Assessment and Program Development, Maternal, Child and Adolescent Health Program, Center for Family Health, California Department of Public Health, 1615 Capitol Ave., MS 8304, PO Box 942732, Sacramento, CA, 94234-7320, USA

    Moreen Libet

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  1. Paula Braveman
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Correspondence to Paula Braveman.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the University of California, Stanford University, the Centers for Disease Control and Prevention, or the California Department of Public Health.

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Braveman, P., Marchi, K., Egerter, S. et al. Poverty, Near-Poverty, and Hardship Around the Time of Pregnancy. Matern Child Health J 14, 20–35 (2010). https://doi.org/10.1007/s10995-008-0427-0

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