To describe income levels and the prevalence of major hardships among women during or just before pregnancy. We separately
analyzed 2002–2006 population-based postpartum survey data from California’s Maternal and Infant Health Assessment (
n = 18,332) and 19 states participating in CDC’s Pregnancy Risk Assessment Monitoring System (
n = 143,452) to examine income and several hardships (divorce/separation, domestic violence, homelessness, financial difficulties,
spouse/partner’s or respondent’s involuntary job loss or incarceration, and, in California only, food insecurity and no social
support) during/just before pregnancy. In both samples, over 30% of women were poor (income ≤100% of federal poverty level
[FPL]) and 20% near-poor (101–200% FPL); and around 60% of low-income (poor or near-poor) women experienced at least one hardship.
While hardship prevalence decreased significantly as income increased, many non-low-income women also experienced hardships;
e.g., in California, 43% of all women and 13% with incomes >400% FPL experienced one or more hardships. These findings paint
a disturbing picture of experiences around the time of pregnancy in the United States for many women giving birth and their
children, particularly because 60% had previous births. The high prevalence of low income and of serious hardships during
pregnancy is of concern, given previous research documenting the adverse health consequences of these experiences and recognition
of pregnancy as a critical period for health throughout the life course. Low income and major hardships around the time of
pregnancy should be addressed as mainstream U.S. maternal-infant health and social policy issues.
Keywords Poverty - Low income - Pregnancy - Stress - Adversity
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the University
of California, Stanford University, the Centers for Disease Control and Prevention, or the California Department of Public
Health.