5 barriers pregnant women in poverty face in getting the care they need

Everyone deserves to have a healthy pregnancy free of anxiety and worry. However, many pregnant women worry about where their next meal will come from, how they will pay the rent, and if they will truly be able to provide for their unborn child. I have worked in the public health field for over 15 years with individuals and families who are at risk in our communities. They are our refugee and immigrant families, our teen parents, our working poor who tirelessly attempt to hold numerous jobs and balance life with children, more often than not, as single parents.

What I have found over the years is that the concerns of expectant women have remained constant. The individuals I have worked with want to have a safe pregnancy and a healthy baby; however, not everyone has the same opportunity. Often, they have not received education on the importance of prenatal care, or systematic barriers prevent them from getting the care and support they need.

Pregnancy and birth are the first of several definitive life events that shape health outcomes within the course of an individual’s lifetime. Health care does not impact one’s health as much as the social determinants of health, such as access to quality housing, healthy food, and financial resources. We can screen for these factors to identify women who may need greater support to promote whole-person care and to create the best foundation for their child's future.

Here are five areas where pregnant women living in poverty often need support to have a safe pregnancy and a healthy baby.

1. Access to health care

Imagine not being able to obtain health services when needed for you or your child. This lack of access to health care can have a detrimental impact on a person’s overall physical and mental well-being. Differences in access among populations is the main reason for disparities in health care. People need to have access to affordable, quality health care from providers and facilities that are close to where they live and accessible by transportation.

Prenatal care is especially critical to reducing the risk of pregnancy-related complications for mother and infant. In addition to access, a woman's perception of whether the care is useful and supportive affects the quality of prenatal services. Care must be culturally comprehensive and in a language the pregnant woman speaks.

2. Transportation

Transportation is a significant barrier to whether a pregnant woman can make it to her prenatal appointments. Long distances to reach a provider, the high cost of transportation, and no transportation options are all challenges for pregnant woman when attempting to follow through with scheduled prenatal appointments. Women who miss appointments can easily be labeled as “non-compliant” with care, when the reality is that transportation access is a real barrier, especially for women living in poverty.

3. Child care

One of the biggest expenses a family can face is affordable, quality child care. The barrier to quality care can impact a woman’s ability to work, go to school, and access prenatal care. Unfortunately, if affordable, convenient child care is difficult to arrange, a pregnant mother may have to bring older children to a prenatal care appointment. For some, the burden of taking children may outweigh the perceived benefits of the prenatal visit.

4. Financial

Not being able to afford basic needs impacts a family’s ability to thrive. In particular, it can impact pregnant women several ways:

• Unsafe housing. The shortage of affordable housing drastically limits the choices about where a person can live often leading to substandard housing choices. Many times, EveryStep’s Nine2Thrive program works with families that indicate they do not feel safe in their neighborhood due to crime and violence. Unsafe conditions in the neighborhoods where homes are located can potentially have powerful effects on a pregnant woman and her family’s health and well-being.
• Not having access to healthy food. Worrying about when or where a family will eat their next meal is a familiar reality for the families I work with. A layoff of the bread winner in the family, a hospital bill, or an unexpected home or car expense is common for families, and wages and reliable work do not support the ability to build a savings to kick in after a life setback. This hard time can easily force a family to choose between buying food and paying bills. Food insecurity has significant direct and indirect impacts on physical and mental health. It is especially detrimental for pregnant women and children.  For pregnant women, not having regular access to healthy food, while being an enormous ongoing stressor, is linked with gestational diabetes, iron deficiency, and low birth weight for their babies.
• Constant stress. Unemployment or underemployment impacts that core ability to meet the financial obligations of the family and can lead to poorer health and strained family relationships. Pregnant women with high levels of stress are more susceptible to health problems and stress can increase the chances of having a premature baby or a low-birth weight baby.

5. Social Support

Social support during pregnancy is critical to helping alleviate stress and provide for maximum emotional wellness during this life changing time. While friends and family are important in providing this essential support, the community also has many resources to work with moms struggling to overcome possible obstacles. In the work I do, we partner as a public health community agency with OB/GYN providers to support that mom through a healthy pregnancy and beyond.  Some of the most common concerns we work to address with pregnant women are relationship/family issues; refugee/immigration status and navigating a new country; lack of help with children; financial concerns and needing baby supplies; inability to make food resources last the entire month; and housing and transportation concerns.

So now what?

Having an awareness of these barriers can help us as health and human service providers be more impactful in the work that we do with families. It starts by better assessing the needs of one’s family and working piece by piece to help reduce the barriers that are causing the stressors in the pregnancy. Partnering with pregnant woman and taking the time to provide a surveillance and screening tool to gain a better understanding of the challenges someone may be dealing with allow for better assessment and more useful referrals to community resources.

• Learn more about EveryStep's care and support services for families.‍
• Learn more about prenatal strategies to support families.