Housing and Perinatal and Infant Outcomes

ABSTRACT/SUMMARY Pregnancy-related outcomes, and disparities in these outcomes, remain poor and have worsened in recent years. At the same time, the lack of safe and affordable housing has become a national crisis. Despite the strong potential for housing insecurity to impact the perinatal period, there is a paucity of evidence connecting these two areas. The Care, Housing Assistance, Medicaid, and Perinatal (CHAMP) Health Outcomes Study is a highly innovative investigation of the association between housing security and perinatal and infant outcomes. It focuses on the role of federal housing assistance which, through a variety of programs, including Housing Choice Vouchers, public housing, and multifamily housing, limit household spending on rent and utilities. By increasing housing affordability and stability, improving housing quality, changing neighborhood context, and connecting residents with health and social services, federal housing assistance has the potential to improve the quality of care that pregnant individuals receive and, more broadly, shed light on the intersection of pregnancy and housing. The study makes use of a novel dataset linking national Medicaid claims for the years 2016-2023 with U.S. Department of Housing and Urban Development data on the receipt of federal housing assistance. Because individuals who receive housing assistance may be fundamentally different from those who do not, the study makes use of an innovative ‘pseudo’ waitlist control design that leverages the limited supply of housing assistance relative to demand and the random timing of the receipt of housing assistance. The first aim examines the overall relationship between receipt of federal housing assistance and pregnant and postpartum individuals (including pre- and post-natal care and morbidity) and newborns (including low birth weight, preterm birth, and neonatal intensive care admission). The second aim investigates whether these relationships vary across a range of factors including race and ethnicity, neighborhood socioeconomic context, and type of housing assistance. The final aim uses qualitative methods to elicit narratives and perspectives on how housing assistance can support perinatal and infant health through interviews with policy and program officials, practitioners, and people with lived experience.