Nutrition Matters – Maternal Health Policy Opportunities
Sarah Johanek, MPH
By Sarah Johanek, MPH
In June, our team was invited to attend the Pregnancy in Nutrition Conference, hosted by the Moore Institute at the Oregon Health and Science University in DC. This conference convened obstetricians, family medicine practitioners, midwives, dieticians, policy advocates, scientists, doulas, and more. Each discipline shared the most recent research on successful programs and necessary policies to address the challenges to proper nutrition before, during, and after pregnancy. There were presentations ranging from the biology of breast milk to the impact of racial disparities and toxic stress on mothers. This conference, like so many maternal child health conferences, highlighted the importance of cross-sector collaboration to support the diverse disciplines that all have the unifying goal of improving the health of mothers and babies.
Food Deserts and Pregnancy Outcomes
Understanding the social determinants of health, or the conditions where people are born, grow, and live, is vital to providing care and effectively supporting communities. At the Pregnancy in Nutrition Conference, doctors, dietitians, and policy advocates all emphasized the necessity of being educated on the food climate of their patients and pregnant populations. Access to nutritious and culturally appropriate food is a key social determinant of health that defines the trajectory of an individual’s physical and mental well-being. Living in a food desert, an area that has extremely limited access to affordable, healthy food, increases the likelihood of a mother to have one or more morbidity during pregnancy.1 Because living four or more miles away from a supermarket is associated with lower diet quality, pregnant people in food deserts have an increased risk for birth complications.1 Lower access to healthy food leads to higher rates of gestational diabetes, increasing the risk of high blood pressure, preeclampsia, and future diabetes.1
Not only do food deserts affect the health status of moms, but they can lead to a wide range of health challenges for newborns. Malnutrition in early life stages leads to a significantly increased risk of chronic disease, such as diabetes.2 The risk for diabetes is related to growth patterns and nutrition before birth, with significantly low or high birth weight babies having a higher risk of diabetes.2 In addition to a mother’s malnutrition during pregnancy, fetal growth suppression is also associated with maternal social stress.2 Maternal social stress is caused by nutritional stress and toxic social stress.2 Nutritional stress is defined by a harmful diet of nutrient imbalances, high levels of sugar, refined grains, saturated fats, and oils.2 Toxic social stress refers to the ongoing activation of a stress response, even when the stressor is not visibly present.3 Examples of toxic stress include racism, physical/mental abuse, poverty, and food insecurity.2,3 Food deserts not only impact the health of the mother and baby by providing a lower quality diet, but the stress associated with living in a food desert compounds these already existing health issues. One study found that food deserts are associated with a 257% higher risk of anxiety and 253% higher risk of depression, compared to those who are not living within food deserts, due to the high level of stress associated with food insecurity.4 The constant worry that a mother may have about food access can lead to immune system disorders and brain development issues within the baby.3
Food Deserts and Race
Food deserts and the health implications for mothers and babies disproportionately affect Black and Hispanic families. In 2019, 19.1% of Black households and 15.6% of Hispanic households experienced food insecurity, compared to 7.9% of white households.5 Research has shown that predominantly white neighborhoods have four times the number of supermarkets as predominantly Black communities.6 This massive disparity is a product of the perpetuation of systemic racism implemented at the foundation of the United States and is upheld through redlining and redistricting policies. These significantly higher rates of food insecurity in Black and Latino families exacerbates the health outcomes due to malnutrition and toxic stress, leading to poor mental health outcomes within the mother and baby.
WIC’s Policy Solutions
The integrated effects that food (including formula) insecurity has on the physical and mental health of families underscores the importance of advocacy and policy change to support those living in food deserts. The federal safety net program for women and babies called “Women, Infants and Children” (WIC) launched a program in seven states to help pediatric doctors screen for food insecurity and refer families to WIC.7 By expanding this program to all states and addressing common barriers to accessing WIC, communities can better provide women and children with the nutrition they need.7 In addition, expanding WIC’s eligibility to beyond 60 days postpartum will allow resources to be centered on maternal nutrition as well as infant nutrition. Lastly, increasing awareness across all health sectors on the importance of understanding the food climate of communities is vital to diminish food insecurity and increase food equity.
Mom Congress Members Want to See More Women Supported by WIC
In the June member survey, members flagged the policy priority of supporting women with unplanned pregnancies in obtaining resource assistance through WIC. The Mom Congress team will be exploring ways our membership can support connecting more women with unplanned pregnancies in obtaining these resources. If you have an interest in supporting this exploratory work, please contact Info@Mom-Congress.com to share your interest.
1Gittelsohn, Joel. (2022, June 2-3). Improving food access in low income communities to improve diet and reduce noncommunicable diseases in pregnancy and childhood [Conference Presentation]. Nutrition in Pregnancy 2022, Washington, DC, United States.
2Thornburg, Kent. (2022, June 2-3). Setting the stage for the importance of nutrition in early life: vision [Conference Presentation]. Nutrition in Pregnancy 2022, Washington, DC, United States.
3Essel, Kofi. (2022, June 2-3). Pediatric food insecurity and toxic stress [Conference Presentation]. Nutrition in Pregnancy 2022, Washington, DC, United States.
4Fang, D., Thomsen, M.R. & Nayga, R.M. The association between food insecurity and mental health during the COVID-19 pandemic. BMC Public Health 21, 607 (2021). https://doi.org/10.1186/s12889-021-10631-0
5Silva, C. (2020, September 27). Food Insecurity In The U.S. By The Numbers. Retrieved June 13th, 2022, from https://www.npr.org/2020/09/27/912486921/food-insecurity-in-the-u-s-by-the-numbers
6Food Deserts*. (2020). Retrieved November 25, 2020, from https://foodispower.org/access-health/food-deserts/
7Lynch, C. and Bremer, A. (2022, June 2-3). Overview of nutrition-related issues at NICHD and NIH Office of Nutrition Research [Conference Presentation]. Nutrition in Pregnancy 2022, Washington, D.C., United States.