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Profiles of Risk: Maternal Health and Well-Being

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Profiles of Risk: Maternal Health and Well-Being Profiles of Risk: Maternal Health and Well-being January/FebruaryFebruary 2012 2012 Research Brief No. 6 This ICPH research brief is the sixth in a series that highlights the characteristics of families with young children who become homeless in the urban United States. The series explores poverty in the context of housing status and puts a spotlight on the characteristics that make families who experience homelessness different from otherwise similar poor families who consistently maintain stable housing. The current brief builds on the fifth in this series, “Profiles of Risk: Sources of Income,” and examines maternal health and well-being. Physical and Mental Health of mothers who were ever at risk of homelessness reported Disparities in health are important due to the direct associa- good health (28%). Ever-homeless and ever-at-risk mothers tion between health, personal welfare, and financial stability. also experienced depression at significantly higher rates (28% This brief uses data from the Fragile Families and Child Well- and 27%, respectively) than stably housed mothers (9%). being Study (FFCWS), a national survey that followed nearly 5,000 families for five years after the birth of a focal child (see While stably housed mothers who were single at the base- description on back). Figure 1 presents poor mothers’ average line experienced worse health compared to all stably housed self-reported physical and mental health by housing status— mothers, remaining single (e.g. not marrying or cohabiting) ever homeless or doubled up, ever at risk of homelessness, or is associated with better outcomes for mothers at risk of always stably housed—over the five-year period between the homelessness; at-risk women who were single at the baseline focal child’s first to fifth birthdays. reported higher rates of good physical health (36% vs. 28%) and lower rates of depression (23% vs. 27%) than those who Among all poor women, those who were stably housed re- were married or cohabiting. Physical and mental health did ported better physical and mental health than ever-homeless not vary significantly by relationship status for mothers who or ever-at-risk women.1 Mothers who ever experienced home- were ever homeless; such women experienced poor physical lessness reported having good physical health at half the rate health and high rates of depression regardless of their rela- of stably housed women (20% vs. 41%); less than one-third tionships. Disadvantaged women experience physical and Figure 1 SELF-REPORTED HEALTH AND DEPRESSION YEARS 1–5 (by housing status years 1–5 and relationship status at baseline) All poor mothers Poor mothers single at baseline Good Physical Health Depressed Ever homeless or doubled up 20% 28% (n = 716; n = 425) 20% 28% Ever at risk of homelessness 28% 27% (n = 795; n = 409) 36% 23% Always stably housed 41% 9% (n = 325; n = 142) 23% 10% Source: ICPH analysis of Fragile Families and Child Wellbeing data. n = 1,836. Excluded are mothers who did not participate in the year-five survey, do not live with the focal child at least half of the time at year five, do not have valid sample weights, or report an average (baseline to year five) income-to-poverty ratio greater than 1.25. Differences in self-reported physical health are statistically significant at 10% for always stably housed vs. ever-homeless or ever-at-risk women. Differences in rates of depression are statistically significant at 10% for all groups. page 2 mental health challenges at greater rates than their non-poor reported illegal drug use at nearly three times the rate of stably counterparts. Such limitations contribute to employment insta- housed mothers (8% vs. 3%). Rates of drug use did not differ bility and financial insecurity (see “In Context: Poverty, Health, significantly by relationship status for stably housed or ever-home- and Employment,” below). less women. However, as with physical and mental health, mothers at risk of homelessness who remained single reported Drug Use higher rates of well-being than those who married or cohabited. There are also clear differences in rates of illegal drug use be- tween poor women who maintain housing stability and those The association between illegal drug use and housing instabil- who experience unstable housing.2 Figure 2 shows that moth- ity is well established; drug use both perpetuates homelessness ers who experienced homelessness between years one and five by depleting economic and social resources and results from the reported using illegal drugs during that period at almost four stress and strain associated with housing instability.3 Chronic times the rate of poor women who maintained stable housing drug users work and earn less than those who do not use drugs.4 (11% vs. 3%); women who were ever at risk of homelessness Additionally, mental health problems and experiences with domes- tic violence have been found to co-occur with substance abuse, suggesting that drug use is one of many interconnected barriers Figure 2 faced by homeless and at-risk poor mothers.5 ILLEGAL DRUG USE YEARS 1–5 (by housing status years 1–5 and relationship status at baseline) All poor mothers Poor mothers single at baseline 11% 11% 8% Source: ICPH analysis of Fragile 6% Families and Child Wellbeing data. n = 1,836. Excluded are mothers who did not participate in the year- 4% five survey, do not live with the 3% focal child at least half of the time at year five, do not have valid sample weights, or report an average (baseline to year five) income-to- poverty ratio greater than 1.25. Differences in rates of drug use are Ever homeless or doubled up Ever at risk of homelessness Always stably housed statistically significant at 10% for (n = 716; n = 425) (n = 795; n = 409) (n = 325; n = 142) all groups. In Poverty, Health, and Employment Context The connection between health and poverty is well documented; poor women and their children experience physical health limitations and mental health disorders at higher rates than their non-poor peers.6 Poor women often lack access to health care and are more likely to engage in risky health behaviors than those who are not poor.7 Women and children living in poverty are also exposed to physical and social environments, such as unsafe neighbor- hoods, toxins, and social isolation, which in addition to stress from the experience of poverty itself can be damaging to health. Residential crowding and poor housing quality have also been linked to adverse health outcomes.8 The ability of poor women to maintain consistent employment and achieve economic stability is hindered by health challenges. Poor women who report health barriers, such as physical disability, depression, or Post-traumatic Stress Disorder, work less frequently and consistently than those who do not.9 Health problems can also lead to job loss; studies show that approximately 10% of job losses by welfare recipients are attributed to poor health.10 Finally, caring for sick children limits the employment of impoverished women; such women are both more likely to have a child with special health needs and less likely to have access to paid sick leave and flexible child care than non-poor women.11 Profiles of Risk: Maternal Health and Well-being page 3 Domestic Violence Figure 3 Figure 3 shows that exposure to domestic violence is another DOMESTIC VIOLENCE YEARS 1–5 factor that distinguishes poor women who are stably housed (by housing status years 1–5 and relationship status at baseline) from those who are not.12 Of all poor women in the FFCWS sample, stably housed mothers experienced the least domestic All poor mothers Poor mothers single at baseline violence between years one and five, reporting less than half 28% the rate of ever-homeless mothers (10% vs. 22%). Notably, poor 22% mothers at risk of homelessness experienced the most violence 20% (28%). Regardless of housing stability, mothers who remained 16% single at the baseline experienced lower rates of domestic 10% violence. Domestic violence has long been linked to housing 4% instability through numerous mechanisms (see “In Context: Domestic Violence and Housing Instability,” below). Ever homeless Ever at risk of Always stably or doubled up homelessness housed (n = 716; n = 425) (n = 795; n = 409) (n = 325; n = 142) Health and Well-being: A Differentiating Factor Health and well-being is a clear differentiating factor between Source: ICPH analysis of Fragile Families and Child Wellbeing data. n = 1,836. Excluded are mothers who did not participate in the year-five survey, do not live with the focal child at least poor mothers who experience homelessness and those who half of the time at year five, do not have valid sample weights, or report an average (baseline to year five) income-to-poverty ratio greater than 1.25. Differences in rates of domestic vio- maintain stable housing. Unstably housed women report worse lence are statistically significant at 10% for all groups. physical health, higher rates of depression, more drug use, and higher rates of domestic violence than their stably housed counterparts. Housing and welfare policies that aim to reduce uncertainty.13 Contrary to what has been found for single women child and family homelessness should incorporate comprehen- in general, women at risk of homelessness who remain single are sive mental and physical health services and support pathways to in better health, report less drug use, and experience less domes- overcome drug use and escape domestic violence. Poor women tic violence than those who marry or cohabit.14 It is vital that with such limitations are unlikely to maintain sufficient employ- work- and marriage-centered welfare policies addressing the dual ment critical to exiting poverty.
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