Author: Eliza Schultz and Jamila Taylor - Center for American Progress | Date: 01 May 2018
Access to quality, whole foods and adequate nutrition is an integral part of not only a balanced diet but also a healthy and prosperous life. It is also a pivotal component of maternal and infant health. Unfortunately, food insecurity is a major problem in the United States; today, millions of Americans—a disproportionate share of whom are African American—live and work in geographic areas that lack affordable and nutritious food, and millions more lack the economic resources to afford adequate food in a given month. It is no coincidence that this problem is most prevalent among African American* families, who continue to experience racial and economic inequality disproportionate to that of any other group in the United States. Food insecurity is yet another way that systemic inequality manifests within many African Americans’ daily lives. It is also no coincidence that the policies and programs that support adequate nutrition among poor families are currently under threat.
The Trump administration and the majority of House Republicans have proposed deep cuts and structural changes to nutrition assistance programs, despite the fact that research has consistently shown that these programs help fill the nutrition and hunger gap for women and children. If policymakers continue to promote inequality by imposing structural barriers, draconian policy changes, and cuts to these programs, poor maternal and infant health outcomes may worsen in the midst of an already dire mortality crisis—particularly among African Americans.
The negative effects of food insecurity on maternal and infant health
For the 15.6 million households that face food insecurity—that is, lack reliable access to food that is both nutritious and affordable—as of 2016, a lot is at stake. Food insecurity can lead to physical and mental health problems and can adversely affect a child’s ability to learn and perform in school, potentially leading to lifelong repercussions. Food insecurity can particularly wreak havoc when it coincides with a woman’s pregnancy. When a pregnant woman is food insecure, she is at heightened risk of depression as well as unhealthy weight gain and gestational diabetes. Moreover, an infant exposed to food insecurity in utero is more likely to experience negative health outcomes such as anencephaly—which is almost invariably lethal—an increased risk of vertical HIV transmission from the mother to the child; and low birth weight—which is associatedwith an increased likelihood of infant mortality as well as lower educational attainment, higher risk of chronic illnesses, and long-term cognitive and developmental delays. Food insecurity has also been shown to negatively affect breastfeeding and other infant feeding practices.
African American households are disproportionately affected by food insecurity: Nearly one-quarter, or 22.5 percent, were food-insecure in 2016—nearly double the national average of 12.3 percent and more than twice the 9.3 percent rate for white households. These racial disparities are also reflected in America’s maternal and infant mortality rates. African American women are between three and four times more likely to die of pregnancy-related causes than non-Hispanic white women. What’s more, in 2015, the infant mortality rate among African Americans was 11.3 deaths per 1,000 live births, compared with 4.9 deaths among non-Hispanic white infants and 5 deaths among Hispanic infants. Notably, these high rates of maternal and infant mortality do not compare favorably to the United States’ peer countries. The average infant mortality rate among high-income countries is 5 infant deaths per 1,000 live births, compared with 6 infant deaths per 1,000 live births in the United States. And women in high-income countries die during childbirth at an average rate of 10 per 100,000 live births, whereas in the United States, women die at a rate of 14 per 100,000 live births.
The role of nutrition assistance programs
Fortunately, several food assistance programs in the United States specifically work to mitigate hunger and food insecurity. The Supplemental Nutrition Assistance Program (SNAP)—formerly known as food stamps—helped about 44 million people per month afford groceries in 2016. Nearly half—or 43 percent—of SNAP households include at least one child. Monthly benefits in these households are modest at an average of $121per person—less than $4 per day. Even this level of benefits is critically helpful, however, especially when a family welcomes a new child—and tightens its household budgets as a result.
Participation in SNAP has proven to lower the risk of food insecurity. By one estimate, six months’ enrollment in SNAP reduces the likelihood of food insecurity by 30 percent.Of course, SNAP’s ability to mitigate food insecurity can be hampered for Americans who live in food deserts—areas, usually impoverished, where residents do not have easy access to healthy foods. People of color are more likely than white people to reside in such areas.
Another critical safeguard against hunger that is specifically geared toward maternal and infant health is the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). WIC offers not just food assistance but also a range of services to expectant and postpartum mothers, including critically important breastfeedingcounsel
It comes as little surprise, then, that a large body of research has found that SNAP and WIC are linked to positive outcomes for both mothers and infants. Access to SNAP in utero and in early childhood helps to reduce infant mortality and the likelihood of low birth weight—the latter by 23 percent. For pregnant mothers, SNAP protects against food insecurity and, therefore, may help to prevent the negative health outcomes food insecurity can cause. WIC, too, is associated with significant health gains for infants and mothers alike. For example, it is has been found to lower infant mortality rates and protect against low birth weight. WIC participation also increases immunization rates and improves diets among very young children. The prenatal, obstetric, and maternal care to which WIC connects mothers is critical to maternal health.
The benefits of SNAP and WIC extend beyond the early years of an infant’s life and carry over well into adulthood. Early access to SNAP significantly reduces the long-term symptoms of metabolic syndrome such as obesity, high blood pressure, heart disease, and diabetes. Women who participate in SNAP as children are more likely to be economically self-sufficient as adults: They tend to have higher wages and educational attainment and are less likely to need to turn to public-assistance programs. As for WIC, which reaches children at a critical time in their cognitive development, child participants make more use of health care services; may have lower rates of anemiaand childhood obesity; and perform better in school as they grow older—which has significant future economic benefits.
These two programs—SNAP and WIC—not only help to protect against negative health outcomes for mothers and infants; each also yields significant dividends for participants in the long term. Unfortunately, both programs have come under serious threat by the Trump administration and House Republicans. At stake is the wellness of pregnant and postpartum mothers and that of their infants, as well as the likelihood that these infants will age into healthy toddlers, teenagers, and, ultimately, adults. Given that people of color—particularly African Americans—already face such high rates of maternal and infant mortality, the Trump administration’s efforts to slash SNAP and WIC will likely be catastrophic for them and will exacerbate the already severe racial disparities in health, maternal and infant mortality, and adult outcomes in the United States.
Eliza Schultz is the research associate for the Poverty to Prosperity Program at the Center for American Progress. Jamila Taylor is a senior fellow at the Center.
*Authors’ note: The U.S. Department of Agriculture Economic Research Service uses “non-Hispanic black” in their Current Population Survey Food Security Supplement. In the interest of clarity and brevity, the authors use the term “African American” to refer to this group throughout this column.