Issue #5: Stable Housing as a Strategy to Reduce Infant Mortality

Policymakers and advocates work to save babies’ lives by connecting families to quality, affordable housing.

The big picture: The infant mortality rate in the United States remains unacceptably high, with staggering disparities – black babies are roughly twice as likely to die as non-Hispanic white babies (and their mothers are nearly four times as likely to die as white mothers, regardless of income). As with other social determinants of health (see Issue #1: Efforts to Address Social Determinants of Health above), a number of factors related to housing can affect birth outcomes. For example, residential segregation means many low-income black women must contend with poor quality housing and exposure to toxins, like lead. And housing instability makes it harder for some women to access consistent prenatal care and raises the risk of homelessness, which is associated with poor health outcomes. In other words, lack of access to affordable, stable, safe housing is a contributor to poor infant and maternal health outcomes.

On the horizon: At the federal level, Congress has yet to pass legislation to fund various U.S. Department of Housing and Urban Development programs for fiscal year 2019, including the Housing Choice Voucher program (also known as Section 8 vouchers) and homelessness assistance programs. These are important support channels for women and families, including pregnant women, and we will be watching to see how much funding they receive when all is said and done (likely in 2019).

To address increasing rates of death from pregnancy and childbirth, H.R. 1318, the Preventing Maternal Deaths Act of 2018, was signed into law. This legislation directs states to investigate the causes of death and to develop prevention plans.

At the state and local level, public health advocates and maternal health experts are working with housing agencies to connect pregnant women with housing to prevent poor birth outcomes. For example, Boston’s home visiting program identified housing instability as a critical factor in poor birth outcomes and worked with the housing authority to secure housing for high-risk pregnant women; an evaluation showed improvements in participants’ physical and mental health as a result of the program. Washington, D.C.’s Community of Hope, a rapid re-housing program, not only helps pregnant women find housing, it also operates an in-house birthing center and supports new mothers through baby’s first year of life. In 2018, central Ohio’s infant mortality coalition, CelebrateOne, received a state grant to help 50 pregnant women find and pay for housing. In 2019 and beyond, we will be looking for other creative programs that address social determinants of maternal and infant health, like housing, in the name of saving moms’ and babies’ lives.