concentrated disadvantage, stress and their effects …

CONCENTRATED DISADVANTAGE, STRESS AND THEIR EFFECTS ON PREGNANCY

Life CourseA life course perspective is a framework to show how health develops over a lifetime, with health improving or diminishing based inpart on exposures to risk and protective factors that go beyond biology and individual behaviors to include social, economic, andenvironmental impacts. Pregnancy is a critical and sensitive period in the life course of a woman -- her experiences of stress and thepotential corrosive effect of living in a segregated, disadvantaged community directly impact the health and wellbeing of her childrenand her children's children, and herself later in life. Stressful experiences prior to pregnancy may also set the stage for pregnancy-related health conditions or adverse birth outcomes for her infant.

One life course indicator, “concentrated disadvantage”, is a measure of the socioeconomic wellbeing in a neighborhood thatincludes more than just individual indicators of poverty, educational level and employment in a community. Concentrateddisadvantage is a community-level measure which may impact the availability of services and opportunities for residents in aneighborhood including access to health care, grocery stores and better schools. (http://www.amchp.org/programsandtopics/data-assessment/LifeCourseIndicatorDocuments/LC-06_ConcentratedDisad_Final-4-24-2014.pdf)

￭ Concentrated disadvantage is calculated from five Census variables from the U.S Census Bureau’s AmericanCommunity Survey:• % of individuals below poverty line

• % of individuals on public assistance

• % of female-headed households

• % of working-age individuals unemployed

• % of individuals under age 18

Key findings of concentrateddisadvantage by census tract:

￭ Generally, high concentrateddisadvantage (CD) is prevalent in thenorthwest and southern regions ofNew Mexico.

￭ Of New Mexico’s 499 census tracts,15.8% (79) of them fell within the“high” CD category, and 36.9% (184)and 39.3% (196) fell within the“medium high” and “medium low” CDcategories, respectively.

￭ Only 8% (four) of New Mexico’s 499census tracts were categorized as“low” CD.”

Low CD Med Low CD Medium High CD High CD

Concentrated Disadvantage by Census Tract, New Mexico, 2010-2014

The birth rate among teens aged 15 to 19 yearsin NM was 3 times higher in areas of highconcentrated disadvantage compared to areasof low concentrated disadvantage.

(Source: New Mexico Bureau of Vital Recordsand Health Statistics)

Consequences of Teen PregnancyResearch consistently shows that teen pregnancy and births affect the lifetime health and well-being of teen parents, theirchildren and the community at large.

• Teen births are associated with a lower annual income for the mother compared to older mothers. Eighty percent ofteen mothers must rely on welfare at some point.

• Teen pregnancy and educational achievement are strongly linked: only about one-third of teen mothers receive a highschool diploma.

• New Mexico had the 4th highest rate of teen births in the country in 2014. The failure to support young people indelaying parenthood costs New Mexico taxpayers up to $103 million a year from lost tax revenues, public assistance,child health care, foster care.

Women living in areas of high concentrateddisadvantage are less likely to have prenatalcare in the first trimester.

(Source: New Mexico Bureau of VitalRecords and Health Statistics)

Benefits of Early and Regular Prenatal Care• Improved birth weight of baby ( >2500 grams)• Decreased risk of preterm delivery• Lower infant mortality rate• Decreased risk of other pregnancy-related complications including preeclampsia and complications from diabetes

References:* https://thenationalcampaign.org/data/compare/1701* http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive-health/teen-pregnancy/health-impact.html* http://www.healthcommunities.com/teen-pregnancy/children/overview-of-teen-pregnancy.shtml

Close family member sick

Husband/partner lost job

Separated or divorced

Could not pay bills

Moved tonew address

Pregnant womanlost job

Argued with husband/partner more than usual

Husband/partner did notwant pregnancy

Someone very close had problem with

drinking/drugs

Pregnant woman or husband/partner

went to jail

Someonevery close died

Pregnant woman physically abused by husband/partner

during pregnancy

Pregnant woman physically abused by husband/partner

before pregnancy

Stress Experienced by NM Women in the Year Prior to Delivery of an InfantLow income women and unmarried women giving live birth are at increased risk for stress. Prenatal stress is a risk factor for adversebirth outcomes including low birth weight, preterm birth and postpartum anxiety and depression.

Click on the rectangles to view graphs of the percent of women reporting a stressful event in the 12 months prior to giving birth byfederal poverty level and marital status. (SOURCE: New Mexico Department of Health, Maternal and Child Health, PRAMS 2011-2013)

Husband or partner abuse before and during pregnancyincreases the risk of stress among pregnant women.

The cumulative number of stressors that newmothers reported during the 12 months priorto giving birth by federal poverty level (FPL)is shown in the figure.

(Source: NM PRAMS)

• Women living in households over 185% of the FPL were more likely to report no stressors during the 12 months priorto giving birth than women living in households at or below the FPL.

• Women living in households at or below the FPL were more likely to report three or more stressors during the 12months prior to giving birth than women living in households over 185% of the federal FPL

1. Families First—A case management program of the New Mexico Department of Health, Public Health Division It isfunded by Medicaid to provide perinatal case management to Medicaid eligible pregnant women and children 0-3years old. Contact: phone: 505-476-8911; https://nmhealth.org/about/phd/fhb/ffp/

2. Children Youth and Families Department Home Visiting—A program in which home visitors partner with families topromote child development and confident parenting by supporting the relationship among the family, home visitor andthe community. Contact: phone: 505-827-7946; https://cyfd.org/home-visiting

3. Chi St. Joseph’s Children Home Visiting Program— A program that provides mothers, fathers, and primary careproviders with education and support to encourage normal growth and development of happy, healthy babies inpositive, nurturing families. Contact: phone 505-924-8000;http://www.stjosephnm.org/Home_Visiting_Program.aspx

4. First Born® Program—A home visiting program that provides services for women pregnant for the first time, familiesparenting for the first time, and families adopting their first baby. Contact phone: 575-538-8504; http://firstbornprogram.org/

Technical Note

How Quartiles of Concentrated Disadvantage (CD) are Calculated:The percentages by census tract in NM of each census variable were calculated. Then, the percentages were Z-scoretransformed by subtracting the mean of the distribution from the variable value and dividing the difference by the standarddeviation of the distribution. Z = (score - mean)/standard deviation. The Z-scores for the five components in a census tractwere averaged, resulting in one Z-score per NM census tract. After Z-scores were calculated for all census tracts, the Z-scores were divided into quartiles. The highest 25% of scores fall into the highest CD quartile.

Resources to improve health outcomes from pregnancy through early childhood in New Mexico:

September 2016

Family Health Bureau2040 S. Pacheco

Santa Fe, NM 87505ph: (505) 476-8888

Women living at or below the FPL were 60% more likely to report someone very close died than women living at 186+ % of the FPL

Unmarried women were nearly 30% more likely to report someone very close died than married women

24.218.95

14.89

0

5

10

15

20

25

30

0-100% 101-185% 186+%

Perc

ent

Federal Poverty Level

Percent of women reporting the stressful event: "Someone very close died", in the 12 months prior to giving birth by Federal

Poverty Level, 2011-2013

17.3222.71

0

5

10

15

20

25

30

Married Not Married

Perc

ent

Marital Status

Percent of women reporting the stressful event: "Someone very close died", in the 12 months prior to giving birth by Marital

Status, 2011-2013

Unmarried women were 3.3 times more likely to report that their husband or partner physically abused them before pregnancy than married women

Women living at or below the FPL were 4.5 times more likely to report that their husband or partner physically abused them before pregnancy than women living at 186+ % of the FPL

5.93

3.64

1.340

1

2

3

4

5

6

7

8

0-100% 101-185% 186+%

Perc

ent


Percent of women reporting that their husband or partner physically abused them during the 12 months before they got

pregnant by Federal Poverty Level, 2011-2013

1.78

5.91

0

1

2

3

4

5

6

7

8

Married Not Married

Perc

ent

Percent of women reporting that their husband or partner physically abused them during the 12 months before they got

pregnant by Marital Status, 2011-2013

Women living at or below the FPL were 4.2 times more likely to report that their husband or partner physically abused them during pregnancy than women living at

Unmarried women were 2.7 times more likely to report that their husband or partner physically abused them during pregnancy than married women

4.61

2.111.14

0

1

2

3

4

5

6

0-100% 101-185% 186+%

Perc

ent


Percent of women reporting that their husband or partner physically abused them during their most recent pregnancy by

Federal Poverty Level, 2011-2013

1.614.25

0

1

2

3

4

5

Married Not Married

Perc

ent

Marital Status

Percent of women reporting that their husband or partner physically abused them during their most recent pregnancy by

Marital Status, 2011-2013

Women living at or below the FPL were 1.8 times more likely to report arguing with their husband or partner more than usual than women living at 186+ % of the FPL

Unmarried women were 50% more likely to report arguing with their husband or partner more than usual than married women

31.0124.07

16.92

0

5

10

15

20

25

30

35

40

0-100% 101-185% 186+%

Perc

ent


Percent of women reporting the stressful event: "argued with husband or partner more than usual", in the 12 months prior to

giving birth by Federal Poverty Level, 2011-2013

19.58

29.28

0

5

10

15

20

25

30

35

Married Not Married

Perc

ent

Marital Status

Percent of women reporting the stressful event: "argued with husband or partner more than usual", in the 12 months prior to

giving birth by Marital Status, 2011-2013

Women living at or below the FPL were 2.8 times more likely to report being unable to pay bills than women living at 186+ % of the FPL

Unmarried women were 30% more likely to report being unable to pay bills than married women

30.923.69

10.9705

10152025303540

0-100% 101-185% 186+%

Perc

ent


Percent of women reporting the stressful event: "Could not pay bills", in the 12 months prior to giving birth by Federal Poverty

Level, 2011-2013

20.0226.59

05

101520253035

Married Not Married

Perc

ent

Marital Status

Percent of women reporting the stressful event: "Could not pay bills", in the 12 months prior to giving birth by Marital Status,

2011-2013

No significant difference was found among married and unmarried women who reported that a close family member was very sick

No significant difference was found among women of the three federal poverty levels who reported that a close family memberwas very sick

24.2122.7 22.38

0

5

10

15

20

25

30

0-100% 101-185% 186+%

Perc

ent


Percent of women reporting the stressful event: "a close family member was very sick and had to go into the hospital", in the 12 months prior to giving birth by Federal Poverty Level, 2011-2013

21.36 24.16

0

5

10

15

20

25

30

Married Not Married

Perc

ent

Marital Status

Percent of women reporting the stressful event: "a close family member was very sick and had to go into the hospital", in the 12

months prior to giving birth by Marital Status, 2011-2013

Married

Not Married

Unmarried women were 2.6 times more likely to report their husband or partner did not want the pregnancy than married women

Women living at or below the FPL were 2.1 times more likely to report their husband or partner did not want the pregnancy than women living at 186+ % of the FPL

9.356.99

4.51

0

2

4

6

8

10

12

0-100% 101-185% 186+%

Perc

ent


Percent of women reporting the stressful event: "Husband or partner said he did not want the pregnancy", in the 12 months

prior to giving birth by Federal Poverty Level, 2011-2013

4.1

10.53

0

2

4

6

8

10

12

14

Married Not Married

Perc

ent

Marital Status

Percent of women reporting the stressful event: "Husband or partner said he did not want the pregnancy", in the 12 months

prior to giving birth by Marital Status, 2011-2013

Women living at or below the FPL were 4.1 times more likely to report a husband or partner losing a job than women living at 186+ % of the FPL

Unmarried women were 30% more likely to report a husband or partner lost his job than married women

21.49

13.26

6.31

0

5

10

15

20

25

0-100% 101-185% 186+%

Perc

ent


Percent of women reporting the stressful event: "husband or partner lost his job", in the 12 months prior to giving birth by

Federal Poverty Level, 2011-2013

12.8

16.74

0

5

10

15

20

Married Not Married

Perc

ent

Marital Status

Percent of women reporting the stressful event: "husband or partner lost his job", in the 12 months prior to giving birth by

Marital Status, 2011-2013

Women living at or below the FPL were 5.7 times more likely to report they or their husband or partner went to jail than Women living at 186+ % of the FPL

Unmarried women were 2.9 times more likely to report they or their husband or partner went to jail than married women

10.26

3.841.77

0

2

4

6

8

10

12

14

0-100% 101-185% 186+%

Perc

ent


Percent of women reporting the stressful event: "They or their husband or partner went to jail", in the 12 months prior to


3.17

9.35

0

2

4

6

8

10

12

Married Not Married

Perc

ent

Marital Status

Percent of women reporting the stressful event: "They or their husband or partner went to jail", in the 12 months prior to


Women living at or below the FPL were 4 times more likely to report losing a job than women living at 186+ % of the FPL

Unmarried women were 2.3 times more likely to report losing a job than married women married women

15.92

9.46

3.9602468

101214161820

0-100% 101-185% 186+%

Perc

ent


Percent of women reporting the stressful event: "lost job", in the 12 months prior to giving birth by Federal Poverty Level,

2011-2013

6.63

14.87

02468

1012141618

Married Not Married

Perc

ent

Marital Ststus

Percent of women reporting the stressful event: "lost job", in the 12 months prior to giving birth by Marital Status, 2011-

2013

No significant difference was found among women of the three federal poverty levels who reported moving to a new address

Unmarried women were 20% more likely to report moving to a new address than married women

39.44 39.1834.02

05

1015202530354045

0-100% 101-185% 186+%

Perc

ent


Percent of women reporting the stressful event: "moved to a new address", in the 12 months prior to giving birth by Federal

Poverty Level, 2011-2013

33.95 41.13

0

10

20

30

40

50

Married Not Married

Perc

ent

Marital Status

Percent of women reporting the stressful event: "moved to a new address", in the 12 months prior to giving birth by Marital

Status, 2011-2013

Women living at or below the FPL were 2.2 times more likely to report someone very close had a problem with drinking or drugs than women living at 186+ % of

Unmarried women were nearly 2 times more likely to report someone very close had a problem with drinking or drugs than married women

23.1316.56

10.63

0

5

10

15

20

25

30

0-100% 101-185% 186+%

Perc

ent


Percent of women reporting the stressful event: "Someone very close had a problem with drinking or drugs", in the 12 months

prior to giving birth by Federal Poverty Level, 2011-2013

12.24

23.07

0

5

10

15

20

25

30

Married Not Married

Perc

ent

Marital Status

Percent of women reporting the stressful event: "Someone very close had a problem with drinking or drugs", in the 12 months

prior to giving birth by Marital Status, 2011-2013

Women living at or below the FPL were 3.7 times more likely to report being separated or divorced than women living at 186+ % of the FPL

Unmarried women were 3.2 times more likely to report being separated or divorced than married women

15.57

9.324.2

02468

101214161820

0-100% 101-185% 186+%

Perc

ent


Percent of women reporting the stressful event: "separated or divorced from husband or partner", in the 12 months prior to


5.21

16.47

0

5

10

15

20

Married Not Married

Perc

ent

Marital Sttus

Percent of women reporting the stressful event: "separated or divorced from husband or partner", in the 12 months prior to
