A mixed-methods investigation of race, income, food insecurity and maternal and infant health.

OBJECTIVE

To examine how race, income and food insecurity (FI) interact during pregnancy and whether FI contributes to disparities in maternal and infant health outcomes.

DESIGN

Observational cohort study employed sequential explanatory a mixed-methods design, with a survey phase (including Household Food Security Survey Module [HFSSM] six-item) and medical record abstraction followed by semi-structured interviews.

SETTING

Online survey, virtual interviews.

PARTICIPANTS

The participants were individuals who gave birth in Louisiana, USA, between June 2020 and June 2021. The quantitative phase comprised 1691 individuals who completed the survey. A nested cohort of forty individuals (evenly split by race (Black v. White) and income (low v. high)) subsequently completed semi-structured interviews.

RESULTS

Race and income were independently associated with both FI and maternal and infant health outcomes. When considering both income and FI, low-income individuals with FI were 1·73 times more likely to deliver low birthweight (LBW) infants (adjusted Odds Ratio [aOR] 95 % CI: 1·07, 2·82) and 1·43 times more likely to experience adverse infant outcomes (aOR 95 % CI: 1·02, 2·00) than high-income individuals without FI. Black individuals with FI were 2·49 times more likely to deliver LBW infants (aOR 95 % CI: 1·45, 4·29) than White individuals without FI. Interview findings revealed low-income individuals faced disproportionate barriers to accessing healthy food and making dietary choices, which were further complicated by pregnancy-related conditions.

CONCLUSIONS

The interplay between race, income and FI significantly increases the risk of adverse infant health outcomes, demonstrating a synergistic effect. Targeted efforts to address FI, particularly among low-income pregnant individuals, are essential to improving maternal and infant health outcomes.