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Reports and Briefs

Profiles of Risk No. 6: Maternal Health and Well-being

This ICPH research brief is the sixth in a series that highlights the characteristics of families with young children who become homeless in the urban United States. The series explores poverty in the context of housing status and puts a spotlight on the characteristics that make families who experience homelessness different from otherwise similar poor families who consistently maintain stable housing. The current brief builds on the fifth in this series, “Profiles of Risk: Sources of Income,” and examines maternal health and well-being.


Physical and Mental Health

Disparities in health are important due to the direct association between health, personal welfare, and financial stability. This brief uses data from the Fragile Families and Child Wellbeing Study (FFCWS), a national survey that followed nearly 5,000 families for five years after the birth of a focal child (see description). Figure 1 presents poor mothers’ average self-reported physical and mental health by housing status—ever homeless or doubled up, ever at risk of homelessness, or always stably housed—over the five-year period between the focal child’s first to fifth birthdays.

Figure 1
Source: ICPH analysis of Fragile Families and Child Wellbeing data. n = 1,836. Excluded are mothers who did not participate in the year-five survey, do not live with the focal child at least half of the time at year five, do not have valid sample weights, or report an average (baseline to year five) income-to-poverty ration greater than 1.25. Differences in self-reported physical health are statistically significant at 10% for always stably housed vs. ever-homeless or ever-at-risk women. Differences in rates of depression are statistically significant at 10% for all groups.

Among all poor women, those who were stably housed reported better physical and mental health than ever-homeless or ever-at-risk women.[i] Mothers who ever experienced homelessness reported having good physical health at half the rate of stably housed women (20% vs. 41%); less than one-third of mothers who were ever at risk of homelessness reported good health (28%). Ever-homeless and ever-at-risk mothers also experienced depression at significantly higher rates (28% and 27%, respectively) than stably housed mothers (9%).

While stably housed mothers who were single at the baseline experienced worse health compared to all stably housed mothers, remaining single (e.g. not marrying or cohabiting) is associated with better outcomes for mothers at risk of homelessness; at-risk women who were single at the baseline reported higher rates of good physical health (36% vs. 28%) and lower rates of depression (23% vs. 27%) than those who were married or cohabiting. Physical and mental health did not vary significantly by relationship status for mothers who were ever homeless; such women experienced poor physical health and high rates of depression regardless of their relationships.

Disadvantaged women experience physical and mental health challenges at greater rates than their non-poor counterparts. Such limitations contribute to employment instability and financial insecurity (see “In Context: Poverty, Health, and Employment,” below).

In Context
Poverty, Health, and Employment

The connection between health and poverty is well documented; poor women and their children experience physical health limitations and mental health disorders at higher rates than their non-poor peers.[ii] Poor women often lack access to health care and are more likely to engage in risky health behaviors than those who are not poor.[iii]

Women and children living in poverty are also exposed to physical and social environments, such as unsafe neighborhoods, toxins, and social isolation, which in addition to stress from the experience of poverty itself can be damaging to health. Residential crowding and poor housing quality have also been linked to adverse health outcomes.[iv]

The ability of poor women to maintain consistent employment and achieve economic stability is hindered by health challenges. Poor women who report health barriers, such as physical disability, depression, or Post-traumatic Stress Disorder, work less frequently and consistently than those who do not.[v] Health problems can also lead to job loss; studies show that approximately 10% of job losses by welfare recipients are attributed to poor health.[vi] Finally, caring for sick children limits the employment of impoverished women; such women are both more likely to have a child with special health needs and less likely to have access to paid sick leave and flexible child care than non-poor women.[vii]


[i] Mothers are classified as being in “good physical health” if they reported an average of “very good” or “excellent” health between years one and five. Depression is measured using the Composite International Diagnostic Interview—Short Form (CIDI—SF), a standardized instrument for assessment of mental disorders.

[ii] Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, “CDC Health Disparities and Inequalities Report—United States, 2011,” Morbidity and Mortality Weekly Report 60, Supplement (January 14, 2011): 1–113.

[iii] Nancy Adler and Katherine Newman, “Socioeconomic Disparities in Health: Pathways and Policies,” Health Affairs 21, no. 2 (2002): 60 –76; Nancy Adler and David Rehkopf, “U.S. Disparities in Health: Descriptions, Causes, and Mechanisms,” Annual Review of Public Health 29 (2008): 235 –52.

[iv] Gary Evans and Lyscha Marcynyszyn, “Environmental Justice, Cumulative Environmental Risk, and Health Among Low- and Middle-Income Children in Upstate New York,” American Journal of Public Health 94, no. 11 (2004): 1941– 44.

[v] Krista Olson and LaDonna Pavetti, Personal and Family Challenges to the Successful Transition from Welfare to Work, The Urban Institute, 1996; Mary Corcoran, Sandra Danziger, and Richard Tolman, “Long Term Employment of African-American and White Welfare Recipients and the Role of Persistent Health and Mental Health Problems,” Women and Health 39, no. 4 (2004): 21– 40; Sandra Danziger, Ariel Kalil, and Nathaniel Anderson, “Human Capital, Health and Mental Health of Welfare Recipients: Co-occurence and Correlates,” Journal of Social Issues 56, no. 4 (2000): 635–54.

[vi] Alan Hershey and LaDonna Pavetti, “Turning Job Finders into Job Keepers,” The Future of Children 7, no. 1 (1997): 74–86.

[vii] Jody Heymann and Alison Earle, “The Impact of Welfare Reform on Parents’ Ability to Care for Their Children’s Health,” American Journal of Public Health 89, no. 4 (1999): 502–5; Jodie Levin-Epstein, Welfare, Women and Health: The Role of Temporary Assistance for Needy Families, Henry J. Kaiser Family Foundation, 2003.


The American Almanac at a Glance
10/2013

A Theory of Poverty Destabilization: Why Low-income Families Become Homeless in New York City
6/2013

Little Room to Play: How Changes to City Child-Care Policies Reduce Opportunities for Working Families
7/2012


Self-reported Health and Depression Years 1–5
(by housing status years 1–5 and relationship status at baseline)


Illegal Drug Use Years 1–5
(by housing status years 1–5 and relationship status at baseline)


Domestic Violence Years 1–5
(by housing status years 1–5 and relationship status at baseline)


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