Food insecurity and delayed or forgone health care among pregnant and postpartum women in the United States, 2019-2021.

Objective: Despite the growing food insecurity crisis in the United States, limited evidence exists about the effects of food insecurity on the unmet health care needs of peripartum (pregnant and postpartum) women. The aim of this study was to examine the association between food insecurity and delayed or forgone health care among peripartum women in the United States from 2019 to 2021.

Methods: We conducted a pooled cross-sectional analysis using data from the 2019, 2020, and 2021 National Health Interview Surveys. Food security status was defined by type (high/marginal, low, and very low). Descriptive analysis and multivariable logistic regression, adjusted for sociodemographic and health-related characteristics, were conducted to estimate the overall and specific delayed or forgone health care (yes or no) between the different categories of food security.

Results: Of the 1525 peripartum women (weighted, N = 5,580,186), 11% of peripartum women in the United States experienced suboptimal food security in the 12 mo between 2019 and 2021, with 5% experiencing low and 5% experiencing very low food security. This included 6% (95% confidence interval [CI], 5-8%) who reported delaying filling a medical prescription, 6% (95% CI, 5-8%) who required counseling or therapy from a mental health professional but did not receive it, 6% (5-8%) who delayed counseling or therapy from a mental health professional, 8% (95% CI, 6-10%) who needed medical care but did not receive it, and 9% (95% CI, 7-10%) who delayed medical care. Peripartum women with low and very food security were more likely to delay or forego health care due to cost concerns than food-secure peripartum women. In the multivariable analyses adjusted for predisposing, enabling, and need-based factors, women with low and very low food security had higher risk for delayed or forgone health care than those with marginal or high food security.

Conclusion: This study demonstrated a positive association between food insecurity and cost-related unmet health care needs among peripartum women. Future empirical studies are needed to assess the effects of peripartum health care interventions targeting food insecurity on reducing health care access disparities associated with costs and improving peripartum health outcomes.