Funded Projects

One less thing to worry about: did eviction moratoria improve maternal and infant outcomes for Medicaid-insured and uninsured birthing people?

Grantee: Emory University
Principal Investigator: Kaitlyn Stanhope
Project Number: R42MC50214
Project Date: 7/1/2023

Age group(s)

• Perinatal/Infancy (0-12 months)
• Women/Maternal

Abstract

Housing is a fundamental determinant of maternal and infant health. Housing insecurity causes chronic and acute stress and financial strain, possibly increasing the risk of poor pregnancy outcomes. Policies to decrease housing insecurity may result in improved perinatal health by decreasing stress and increasing financial security; however, this remains untested. We need to understand the impact of changes in housing policy on perinatal outcomes to inform potential interventions. The proposed project is directly aligned with the MCHB guiding principal of incorporating social determinants of health and health equity into all funded projects and MCHB Goals 2 and 3 of promoting the health and wellbeing of mothers and children.

Goals and Objectives:

We propose to leverage variation in the timing of eviction moratoria, implemented during the COVID-19 pandemic, across states to estimate the impact of eviction moratoria policies on maternal and infant outcomes among Medicaid-insured and uninsured birthing people. We will do this through the following specific aims: (1). Using multilevel models, estimate the effect of different lengths of exposure to eviction moratoria (0, 1, 2, 3, 4, or 5+ months) on (a) infant outcomes (preterm birth, birthweight), (b) primary cesarean delivery, © maternal morbidity (transfusion, eclampsia, ICU admission, or unplanned hysterectomy), and (d) prenatal care use behavior (adequacy of prenatal care) for Medicaid-insured and uninsured birthing people who conceived in March-May 2020. (2). Estimate the effect of exposure to the expiration of an eviction moratorium during gestation (trimester 1, 2, or 3) on (a) infant outcomes (preterm birth, low birthweight), (b) primary cesarean delivery, © maternal morbidity (transfusion, eclampsia, ICU admission, or unplanned hysterectomy), and (d) prenatal care use behavior (adequacy of prenatal care) among Medicaid-insured and uninsured birthing people in 2020 - 2022. PROPOSED DATA SETS AND TARGET POPULATION: We plan to use data from the United States Natality files 2020-2022 linked with information from the Eviction Moratoria dataset to conduct a retrospective cohort study on all individuals who gave birth to a live born infant and were uninsured or insured by Medicaid during their pregnancy in all US states and the District of Columbia. PRODUCTS: We will disseminate the results through at least two peer-reviewed manuscripts, conference presentations, and an infographic to be disseminated by our standing Community Advisory Board to impacted communities and community organizations.

Evaluation:

We will monitor process objectives throughout the study period through monthly team meetings and implement alternate strategies if process objectives are not met.