The effect of HOusing instability and neighborhood deprivation on Maternal hEalth-HOME

Morbidity and mortality rates for mothers and their infants are not fully explained by individual risk factors. Black pregnant women in the US are three times more likely to be affected than their white counterparts, and in Wisconsin, the risk is five times greater. Due to Milwaukee, Wisconsin being one of the five most segregated cities in the US, Black birthing families are also more likely to be low-income than their white counterparts and experience housing instability. Housing instability is a crucial social determinant of health that affects birthing women and their children, perpetuating poverty and poor health in future generations. There is an important gap in knowledge of the effect of housing instability on maternal health, that we seek to address in this proposal. The “Reducing HOusing instability and neighborhood deprivation for Maternal hEalth” (HOME) proposal’s central hypothesis is that investigating the effects of different housing statuses and stability on maternal physical and mental health will lead to more profound understanding of the impact of housing instability on pregnancy outcomes and motivate policy change to reduce maternal health disparities. In Aim 1, we will understand how personal and neighborhood characteristics and services contribute to housing stability among low-income pregnant women to inform programs to improve stability. In Aim 2, we will explore the impact of housing instability/homelessness and neighborhood conditions on allostatic load, physical and mental health, and pregnancy outcomes. In Aim 3, we will identify the service needs of pregnant women in each housing status, and advocate for policy-level change to address housing instability among birthing women. The proposed study will tease out the contribution of these factors and characteristics and correlate them to maternal health outcomes. This work could inform screening tools to assess pregnancy risk, inform policy change, and elucidate biological mechanisms by which structural factors result in improved maternal health outcomes.