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Maternal and Infant Health Assessment
Food Insecurity and Housing Instability Early in the COVID-19 Pandemic

Maternal and Infant Health Assessment (MIHA)

Publish Date

January 2024

This data brief series describes the well-being of Californians who gave birth early in the pandemic using data from the Maternal and Infant Health Assessment (MIHA) survey. The MIHA 2020 sample was drawn from births occurring from March 16, 2020 to June 15, 2020. For more information about MIHA visit MIHA webpage.

Food Insecurity and Housing Instability Early in the COVID-19 Pandemic

COVID-19 impacts on pregnant people and families in California, 2020

Experiencing food insecurity and housing instability after childbirth can have negative impacts on maternal physical and mental health and on infant health and development.^1–4

In California in 2020, many birthing people experienced food insecurity or housing instability after pregnancy:

1 in 6
was food insecure

1 in 20
had unstable housing

Financial Hardships and Food Insecurity or Housing Instability

Job and income loss were widespread during the COVID-19 pandemic.^5-6 These financial hardships can negatively impact family well-being, including the ability to afford food and stable housing. After pregnancy, 17.8% of birthing people experienced food insecurity and 5.2% experienced housing instability. Birthing people who experienced job loss or loss of all or a lot income during or after pregnancy were three to four times more likely than were those without these financial hardships to also experience food insecurity or housing instability.

Percentage of food insecurity was greater among those with financial hardships than among those without financial hardships

Percentage of housing instability was greater among those with financial hardships than among those without financial hardships

“Since COVID, the need for housing has increased tremendously, so it would be nice to have more housing for single mothers, low-income families or mothers.”

– MIHA 2020 respondent

Race and Ethnicity and Food Insecurity or Housing Instability

Food insecurity was most common among Black and Hispanic birthing people, with about one in four experiencing food insecurity, compared to one in ten White and Asian/Pacific Islander birthing people. Among Black birthing people, 11.3% experienced housing instability, more than twice the percentage in other racial and ethnic groups.

"I’m lucky that I didn’t miscarry during my pregnancy due to my lack of food. It is so terrible to be hungry and not know what to do or when you will be able to eat."

– MIHA 2020 respondent

Experience of food insecurity and housing instability by race and ethnicity

Black, Food insecurity - 25.4%, Housing instability - 11.3%;Hispanic, Food insecurity - 24.1%,Housing instability - 5.5%; White, Food insecurity - 10.6%, Housing instability - 4.5%; Asian/Pacific Islander, Food insecurity - 10.1%, Housing instability - 3.1%;

Food Insecurity and Housing Instability as Barriers to Health Equity

Financial hardships increased during the COVID-19 pandemic, which had negative impacts on the health of families, especially families with lower incomes.^7-9 A lack of consistent access to food or housing during and after pregnancy can have direct impacts on the health and well-being of families, including detrimental effects on maternal and child mental and physical health, as well as access to care.^10-11 These hardships in early childhood can not only affect child development and weight, but also increase the risks for chronic health conditions and childhood hospitalizations.^1-4, 12

Millions of California families relied on safety net programs to meet their needs for food and housing during the COVID-19 pandemic.⁷ Several federal, state, and local policies were enacted in response to the pandemic, including eviction moratoriums; government cash assistance; and expansions in food assistance, Medicaid coverage, and unemployment insurance programs. In California, participation in Medi-Cal, the Supplemental Nutrition Assistance Program (SNAP or CalFresh) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) grew substantially in 2020.¹³ The high rates and large disparities in food insecurity and housing instability highlight the need for critical safety net resources for the health and well-being of birthing people and their families, in pursuit of health equity for all. ¹⁴

Resources for California Families

Housing Assistance	Food Assistance
California Public Housing Authorities List of local housing authorities	Women, Infants, Children (WIC) Supplementary Food Program 1-888- 942-9675
California Department of Housing and Community Development Affordable housing rental directory	CalFresh/Food Stamps 1-877-847-3663
California Business, Consumer Services and Housing Agency Resources for renters, landlords and homeowners	California Association of Food Banks List of local food banks

About the Data

Methods

This data brief uses 2020 data from the Maternal and Infant Health Assessment (MIHA) survey, a statewide representative survey of individuals with a recent live birth in California, conducted annually since 1999, linked to birth certificates. The survey collects self-reported information about maternal and infant experiences before, during, and shortly after pregnancy.

MIHA is a stratified random sample of English- or Spanish-speaking individuals. MIHA data used in this brief are weighted to be representative of California residents with a live birth from May 16, 2020 to June 15, 2020, excluding those who were younger than 15 years old at delivery, had a multiple birth greater than triplets, or had a missing address on the birth certificate. The MIHA 2020 sample size was 6,363. For more information on weighting and technical definitions, see the MIHA Technical Notes at go.cdph.ca.gov/MIHA-methods.

MIHA is led by the Maternal, Child and Adolescent Health Division in the California Department of Public Health (CDPH) in collaboration with the CDPH Women, Infants and Children (WIC) Division and the Center for Health Equity at the University of California, San Francisco.

Definitions

Food insecurity – Since most recent birth, sometimes or often worried whether food run out before they got money to buy more, or the food bought didn’t last and they didn’t have money to get more.

Housing instability – Since most recent birth, had to move because of problems paying rent or mortgage, did not have a regular place to sleep at night (had to move from house to house), or was homeless (had to sleep outside, in a car or in a shelter).

References

Nagata JM, Gomberg S, Hagan MJ et al. Food insecurity is associated with maternal depression and child pervasive developmental symptoms in low-income Latino households. J Hunger Environ Nutr. 2019;14(4):526-539.
Cutts DB, Meyers AF, Maureen MB et al. US Housing Insecurity and the Health of Very Young Children. American Journal of Public Health. 2011; 101(8): 1508-1514.
Suglia SF, Duarte CS, Sandel MT. Housing Quality, Housing Instability, and Maternal Mental Health. J Urban Health 2011; 88, 1105- 1116.
Sandel M, Sheward R, Ettinger de Cuba S, et al. Unstable Housing and Caregiver and Child Health in Renter Families. Pediatrics. 2018; 141 (2): 2017-219.
California Employment Development Department, California Labor Market-Current Status. https://www.labormarketinfo.edd.ca.gov/, accessed August 16, 2021.
COVID-19 Impacts on Pregnant People and Families in California, 2020: Income loss, job loss and childcare problems early in the COVID-19 pandemic. California Department of Public Health, 2022.
Parolin Z. Unemployment and child health during COVID-19 in the USA. The Lancet Public Health; 5(10):E521-E522, 2020.
The COVID-19 Economy’s Effects on Food, Housing, and Employment Hardships. Center on Budget and Policy Priorities, 2021.
Hake M, Dewey A, Engelhard E et al. The impact of the coronavirus pandemic on food insecurity in 2020. Feeding America, October 2020.
Christine T. Ma, Lauren Gee, Margot B. Kushel. Associations Between Housing Instability and Food Insecurity With Health Care Access in Low-Income Children. Ambulatory Pediatrics. 2008;8(1): 50-57. https://doi.org/10.1016/j.ambp.2007.08.004.
Thomas MMC, Miller DP, Morrissey TW. Food Insecurity and Child Health. Pediatrics. 2019;144(4): e20190397
Cook JT, Frank DA, Berkowitz C, et al. Food insecurity is associated with adverse health outcomes among human infants and toddlers. J Nutr 2004; 134:1432-1438.
Lauren Hall and Zoë Neuberger, “Eligible Low-Income Children Missing Out on Crucial WIC Benefits During Pandemic,” CBPP, July 12, 2021, https://www.cbpp.org/wicpandemicparticipation.
Danielson C. Pandemic aid helped lower poverty in California. Public Policy Institute of California, September 24, 2021.

Food insecurity and housing instability after pregnancy among individuals who gave birth in spring 2020, Maternal and Infant Health Assessment, 2020

Category	Food insecurity		Housing instability
Category	%	95% Confidence Interval	%	95% Confidence Interval
California total	17.8	16.5 – 19.1	5.2	4.5 – 5.9
Age
Age 15–19 years	27.1	19.4 – 34.8	7.5interpret with caution	3.1 – 11.9
Age 20–24 years	28.2	24.0 – 32.4	8.5	5.9 – 11.1
Age 25–29 years	17.3	15.0 – 19.7	6.5	4.9 – 8.1
Age 30–34 years	14.9	12.7 – 17.0	4.0	2.9 – 5.1
Age 35 years or older	15.1	12.7 – 17.5	3.2	2.0 – 4.3
Education
Education <High school	37.7	33.2 – 42.2	10.8	7.9 – 13.6
Education High school or GED	25.5	22.0 – 29.0	6.4	4.5 – 8.3
Education Some college	19.2	16.9 – 21.6	5.5	4.2 – 6.9
Education College graduate	7.0	5.5 – 8.4	2.4	1.5 – 3.3
Income as percentage of Family Poverty Guidelines (FPG)
Income as percentage of Family Poverty Guidelines 0-200% FPG	30.5	28.3 – 32.8	8.5	7.1 – 9.9
Income as percentage of Family Poverty Guidelines 201-400% FPG	11.4	8.6 – 14.2	2.1	1.1 – 3.1
Income as percentage of Family Poverty Guidelines >400% FPG	1.6	0.8 – 2.4	1.2	0.5 – 1.8
Nativity
Nativity Born outside the U.S.	21.0	18.6 – 23.4	5.2	3.9 – 6.5
Nativity Born in the U.S.	16.2	14.7 – 17.7	5.1	4.2 – 5.9
Prenatal health insurance
Prenatal health insurance Medi-Cal	28.6	26.3 – 30.8	8.6	7.2 – 10.0
Prenatal health insurance Private	7.9	6.6 – 9.3	1.9	1.3 – 2.5
Prenatal health insurance Uninsured	36.1	23.1 – 49.0	11.2interpret with caution	3.0 – 19.5
Race/ethnicity
Race/ethnicity: Asian/Pacific Islander	10.1	7.3 – 12.9	3.1interpret with caution	1.2 – 5.1
Race/ethnicity: Black	25.4	21.5 – 29.3	11.3	8.3 – 14.3
Race/ethnicity: Hispanic	24.1	22.0 – 26.3	5.5	4.5 – 6.5
Race/ethnicity: White	10.6	8.6 – 12.6	4.5	3.1 – 5.9
Total live births
Total live births: First live birth	13.5	11.8 – 15.3	4.8	3.6 – 5.9
Total live births: Second live birth or more	20.7	18.9 – 22.4	5.5	4.5 – 6.4
Hardships during pregnancy
Hardships during pregnancy: Trouble paying bills	50.2	46.5 – 54.0	16.0	13.4 – 18.6
Hardships during pregnancy: Lost all or a lot of income	39.0	35.1 – 42.90	13.1	10.5 – 15.8
Hardships during pregnancy: Job loss or pay cut	29.0	26.7 – 31.3	8.8	7.4 – 10.2
MIHA region
MIHA region: Los Angeles County	17.5	14.5 – 20.5	5.4	3.8 – 7.1
MIHA region: San Francisco Bay Area	11.7	9.7 – 13.7	5.4	3.8 – 7.1
MIHA region: San Diego County	15.3	10.4 – 20.2	4.4	2.0 – 6.7
MIHA region: Orange County	14.1	8.7 – 19.5	2.8interpret with caution	0.7 – 4.9
MIHA region: San Joaquin Valley	23.4	20.3 – 26.6	5.3	3.7 – 6.9
MIHA region: Greater Sacramento Area	19.2	14.7 – 23.6	4.0	1.8 – 6.1
MIHA region: Southeastern California	20.9	16.6 – 25.3	6.4	3.6 – 9.1
MIHA region: Central Coast Area	22.8	19.4 – 26.2	5.1	3.3 – 6.8
MIHA region: North/Mountain Region	25.0	17.9 – 32.1	7.4interpret with caution	2.5 – 12.2
County
County: Alameda	12.9	7.4 – 18.4	5.1interpret with caution	1.6 – 8.5
County: Butte	23.4	12.0 – 34.8	estimate not shown	not applicable
County: Contra Costa	13.3	8.4 – 18.3	7.1interpret with caution	2.4 – 11.8
County: El Dorado	23.6	11.3 – 36.0	estimate not shown	not applicable
County: Fresno	23.7	16.1 – 31.3	7.8interpret with caution	2.9 – 12.7
County: Humboldt	22.0	13.6 – 30.4	estimate not shown	not applicable
County: Imperial	24.8	15.3 – 34.2	6.4interpret with caution	2.0 – 10.8
County: Kern	23.8	16.5 – 31.0	5.0interpret with caution	1.7 – 8.3
County: Kings	23.6	10.3 – 36.9	estimate not shown	not applicable
County: Los Angeles	17.5	14.5 – 20.5	5.4	3.8 – 7.1
County: Madera	21.1	10.5 – 31.7	estimate not shown	not applicable
County: Marin	17.0	8.9 – 25.1	estimate not shown	not applicable
County: Merced	28.6	16.6 – 40.6	5.9interpret with caution	1.0 – 10.9
County: Monterey	35.8	26.8 – 44.8	4.9interpret with caution	1.3 – 8.5
County: Napa	11.5	5.6 – 17.4	estimate not shown	not applicable
County: Orange	14.1	8.7 – 19.5	2.8interpret with caution	0.7 – 4.9
County: Placer	14.9interpret with caution	5.4 – 24.4	estimate not shown	not applicable
County: Riverside	18.7	12.8 – 24.7	6.4interpret with caution	2.0 – 10.8
County: Sacramento	19.5	13.6 – 25.4	4.2interpret with caution	1.3 – 7.1
County: San Bernardino	22.8	16.0 – 29.5	6.3	2.6 – 10.0
County: San Diego	15.3	10.4 – 20.2	4.4	2.0 – 6.7
County: San Francisco	10.8	6.5 – 15.1	6.7	3.1 – 10.3
County: San Joaquin	22.2	14.9 – 29.6	2.7interpret with caution	0.4 – 5.0
County: San Luis Obispo	14.2	6.7 – 21.8	estimate not shown	not applicable
County: San Mateo	11.6	6.3 – 16.9	3.5interpret with caution	1.0 – 6.0
County: Santa Barbara	24.3	17.4 – 31.2	10.9	5.3 – 16.5
County: Santa Clara	6.9	3.2 – 10.6	4.8interpret with caution	0.6 – 9.0
County: Santa Cruz	17.3	9.8 – 24.7	estimate not shown	not applicable
County: Shasta	13.0interpret with caution	4.7 – 21.3	estimate not shown	not applicable
County: Solano	19.6	12.2 – 27.0	9.5interpret with caution	3.6 – 15.4
County: Sonoma	16.0	8.1 – 24.0	4.2interpret with caution	0.7 – 7.8
County: Stanislaus	21.2	13.1 – 29.4	3.9interpret with caution	0.8 – 7.0
County: Tulare	23.9	17.0 – 30.9	5.2interpret with caution	1.5 – 9.0
County: Ventura	19.1	13.4 – 24.8	estimate not shown	not applicable
County: Yolo	20.2interpret with caution	8.1 – 32.3	estimate not shown	not applicable

-- Estimate not shown because the Relative Standard Error (RSE) is greater than 50% or fewer than 5 individuals reported.

* Estimate should be interpreted with caution due to low statistical reliability (Relative Standard Error between 30% and 50%)

MIHA 2020 sample size was 6,363. Percent (%) and 95% confidence interval (95% CI) are weighted to represent all California residents with a live birth from May 16, 2020 to June 15, 2020. See the MIHA Technical Notes for information on weighting and technical definitions.

Table Citation: COVID-19 Impacts on Pregnant People and Families in California: Mental health during and after pregnancy early in the COVID-19 pandemic, Maternal and Infant Health Assessment, 2020. California Department of Public Health, 2022.

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Maternal and Infant Health Assessment (MIHA)

Publish Date

Food Insecurity and Housing Instability Early in the COVID-19 Pandemic

Financial Hardships and Food Insecurity or Housing Instability

Percentage of food insecurity was greater among those with financial hardships than among those without financial hardships

Percentage of housing instability was greater among those with financial hardships than among those without financial hardships

Race and Ethnicity and Food Insecurity or Housing Instability

Experience of food insecurity and housing instability by race and ethnicity

Food Insecurity and Housing Instability as Barriers to Health Equity

Data Tables

Resources for California Families

About the Data

Methods

Definitions

References

Food insecurity and housing instability after pregnancy among individuals who gave birth in spring 2020, Maternal and Infant Health Assessment, 2020