The Great Recession and Health Disparities: A Study of Maternal and Child Health Outcomes in Washington and Florida

Abstract

Introduction: The Great Recession (GR) (December 2007-June 2009) resulted in widespread increases in need, prompting concern about negative effects on maternal and child health (MCH) outcomes. This dissertation explores relationships between MCH outcomes and disparities before, during, and after the GR in three research papers. Methods: Analyses for each paper (1, 2, 3) utilized de-identified birth certificate and linked community characteristic data from Washington (WA) and Florida (FL). First (1), Healthy People protocols were used to assess the degree of disparities on seven MCH outcomes (study period 2005-2011; n= 897,483). Next (2), regression modeling was used to estimate relative contributions of individual, community, and local health department (LHD) expenditure covariates on the probability of a pregnant woman entering prenatal care late or not at all (late/no PNC) (study period 2005-2010; n= 678,235). Finally (3), interactions between enrollment in the WIC Supplemental Nutrition Program and individual characteristics in relation to BW were modeled among a higher need subset of the study population (study period 2005-2009; n= 226,835). Results: In the first paper (1), MCH disparities increased for some groups during and after the GR. There were more total increases in disparities in WA than in FL and more disparity increases after the GR than during. The second paper (2) revealed consistent contributions of individual-level maternal predictors (e.g., young age, low education) to late/no PNC but varied associations among some community-level predictors (e.g., % voting Republican; LHD expenditures). Also, women enrolled in WIC had a lower probability of late/no PNC than those without WIC. In the third paper (3), WIC interactions revealed beneficial BW effects for infants of mothers with late/no PNC and non-Hispanic Black infants. Supplemental materials are available. Conclusions: Some MCH outcomes and disparities worsened during the GR (1). In the case of late/no PNC, augmented associations between percent voting Republican and LHD expenditures should be further explored (2). Beneficial WIC interaction effects on BW were found among some groups in a high-need population. Further research is needed to explore how benefits of WIC and other programs might be increased or extended to more comprehensively address MCH disparities (3).