June 20, 2024
Low-income mothers are disproportionately affected by poor maternal healthcare outcomes and a higher likelihood of encountering child protection systems. Often misconstrued as a result of negligent parenting, a growing body of research is shifting the focus towards structural barriers such as poverty and homelessness. These constraints significantly impede a mother's ability to adequately care for her children, suggesting a need to reevaluate the root causes of these disparities.
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Likewise, quality postpartum care, comprehensive, accessible, timely, effective, and patient-centered, remains elusive for many, especially those on a limited budget. A study examining Medicaid-paid deliveries in Illinois found that non-Hispanic Black mothers and those from low-income backgrounds had notably lower rates of postpartum care visits.
Furthermore, inadequate postpartum care impedes access to contraception, which increases the risk of shorter gaps between pregnancies, and risk of preterm births. Enhancing the scope and consistency of care for vulnerable groups is essential for improving health outcomes and reducing long-term disparities.
Less than one-third of pregnant women in the U.S. meet the prenatal nutrition, exercise, and stress management guidelines essential for healthy pregnancies.
The American College of Obstetricians and Gynecologists recommends limiting calories from added sugars and saturated fat, eating multiple servings of fruits and vegetables, and maintaining regular moderate exercise. Yet, only 35–38% of pregnant women meet these nutrition and exercise standards, and less than 25% engage in effective stress management. Alarmingly, only 14% with mental health symptoms are referred for stress management.
These rates are even lower among low-income and ethnic minority women who already face a disproportionately higher risk of pregnancy-associated complications. Food insecure households struggle to consume healthy diets that meet national guidelines for a number of reasons, including the rising cost of healthy foods, leading to the overconsumption of an unhealthy diet. In 2019, more than 10% of households experienced food insecurity, while a third of women scheduled for prenatal visits in April 2021 were unable to afford food sufficient to support a health pregnancy.
Furthermore, the culture of poverty may be passed down through generations as a lifestyle in the process of socialization, which can accentuate the occurrence of unhealthy behaviors in some. A Canadian study revealed that over 75% of pregnant smokers were from low-income and less-than-university educated backgrounds, confirming a higher prevalence of tobacco use and unhealthy behaviors during pregnancy among women in these socioeconomic groups.
Smoking during pregnancy raises the risk of preterm birth, low birth weight and birth defects. Yet many pregnant smokers face barriers to quitting, such as inadequate stress management, lack of self-confidence, nicotine addiction, hormonal changes, social support for smoking, insufficient professional support, and a lack of awareness about the effects of smoking on the fetus and pregnancy.
These unhealthy behaviors, directly contribute to higher incidences of severe pregnancy complications, such as hypertension, low birth weight, preterm deliveries, and the necessity for cesarean section.
On average, Black families in the U.S. possess about one-twentieth the wealth of their White peers, and Black women are nearly four times more likely to experience and die from pregnancy-related complications than White women.
Confounded by the correlation between race and poverty, research has tended to focus on the aforementioned downstream effects of low-income on health such as nutrition, exercise and stress. Yet while many racial minorities experience low-income, frustrating access to care or healthy lifestyle practices, the racialized differentials and implicit bias in providers’ recognition of the experiences and culture of these women can also affect how obstetricians and gynecologists counsel their patients on treatment options.
Less-than-optimal pain relief for Black women is often provided due to historical misconceptions that people of color have stronger bones, a better pain tolerance, and fewer nerve endings, and medically unnecessary caesarian sections are suggested possibly due to the systemic misunderstanding of racial disparities in weight status and other risk factors attributed to the need for a caesarian section.
Rather than a root cause, low income is one of a multitude of barriers to maternal health inequality perpetuated by structural racism and economic marginalization of minorities, which alongside implicit bias, frustrates maternal health improvements.
Access to healthcare is also a significant challenge for low-income mothers in the United States, a problem compounded by insufficient health insurance coverage. In 2020, approximately 11.6% of women of childbearing age were uninsured. Without consistent insurance, many women do not receive the necessary services to prevent or treat health issues, exacerbating the risk of complications.
Moreover, over 5.6 million women live in so-called "maternity care deserts"; these are areas with no hospitals or birth centers offering obstetric care and no obstetric providers which subsequently hinders access to essential maternity care, particularly in rural counties. This means that mothers-to-be living in such areas are expected to travel further for basic healthcare needs, which can increase the likelihood of poorer birth outcomes. Between 2004 and 2014, the percentage of rural counties with hospital-based obstetric services declined from 54% to 45%, and these figures are expected to keep declining, predicting worsening conditions for maternal health access.
The intersection of low-income and minority status further complicates this landscape, resulting in a stark disparity in maternal mortality. These women often reside in communities plagued by a combination of economic hardship, inadequate education about health, insufficient public services, and limited transportation options, all of which restrict their access to necessary healthcare services.
Improving access to healthcare for low-income mothers requires a multi-faceted approach that addresses systemic barriers and promotes healthier lifestyles. Many low-income women face significant obstacles in obtaining prenatal care due to a scarcity of local healthcare providers, especially those accepting Medicaid or offering reduced-cost services. In response, some regions have expanded the capacity of prenatal care systems used by low income women by enlarging existing clinics, opening new facilities, or incentivizing private providers to serve uninsured women.
Revising operational policies within healthcare facilities can further enhance access. For example, encouraging respectful care and compassion among staff can play a significant role in bettering health outcomes. Respectful maternity care prioritizes the fundamental rights of women, newborns, and families, ensuring equitable access to evidence-based care while addressing individual needs and preferences. This practice combats implicit and explicit biases that can harm patients during pregnancy. Key elements include providing clear information about healthcare options, ensuring high-quality care, and supporting informed decision-making, all while demanding dignity, non-discrimination, and comprehensive support for all patients, to promote a safe and respectful childbirth experience.
Furthermore policies reducing out-of-pocket expenses like copayments and deductibles, coupled with expanded Medicaid coverage for specialty care, could also encourage more specialists to serve low-income women, particularly in rural areas.
Integrating digital health solutions like telehealth can help to overcome geographic and scheduling barriers, allowing women to attend appointments without sacrificing work hours.
Mother Goose Health effectively enhances healthcare access for low-income mothers by utilizing advanced data connectivity and sharing capabilities. This approach ensures timely identification of pregnancy risks and facilitates faster clinical interventions, helping to prevent complications such as preterm births and extended NICU stays.
The platform integrates telehealth solutions, allowing mothers to easily access medical advice and support from the comfort of their homes, even if their home is in one of the many healthcare deserts in the USA. By connecting patients directly with healthcare providers via its mobile app, Mother Goose Health breaks down traditional barriers to care and helps prompt when face-to-face appointments are needed.
Additionally, the platform supports nutritional health by connecting mothers with local food support services and leveraging health plan benefits from government programs like WIC and SNAP. And seamlessly integrates mental health services within the maternity care pathway, providing women with mental health treatment that they would otherwise fail to access.
This comprehensive support network, accessible through Mother Goose Health’s free services provided via partnerships with independent health systems and health plans, ensures that mothers, regardless of their health insurance coverage, have the resources they need for a healthier pregnancy and postpartum experience.