Dataset Information

Exploring factors associated with pregnant women’s experiences of material hardship during COVID-19: a cross-sectional Qualtrics survey in the United States

ABSTRACT:

Background

The COVID-19 pandemic has exacerbated the financial insecurity of women and their families globally. Some studies have explored the impact of financial strain among pregnant women, in particular, during the pandemic. However, less is known about the factors associated with pregnant women’s experiences of material hardship.

Methods

This cross-sectional study used a non-probability sample to examine the factors associated with pregnant women’s experiences of material hardship during the COVID-19 pandemic. In January 2021, 183 pregnant women living in the United States participated in an online Qualtrics panel survey. In addition to socio-demographic characteristics, individuals were asked about their finances and predictors of financial well-being, mental health symptoms, and intimate partner violence (IPV) experiences. Chi-square analysis and one-way ANOVA were used to examine whether women’s experiences with material hardship and associated factors differed by income level (i.e., less than $20,000; $20,000 to $60,000; more than $60,000). Ordinary least squares regression was used to calculate unadjusted and adjusted estimates.

Results

Study findings showed that the majority of women in the sample experienced at least one form of material hardship in the past year. Individuals with an annual household income less than $20,000 reported the highest average number of material hardships experienced (M = 3.7, SD = 2.8). Compared to women with household incomes less than $20,000, women with incomes of more than $60,000 reported significantly fewer material hardships, less financial strain, and higher levels of financial support, economic self-efficacy, and economic-self-sufficiency. Women with incomes of $60,000 or more also reported significantly lower levels of psychological abuse, and a smaller percentage met the cut-off for anxiety. Economic self-sufficiency, financial strain, posttraumatic stress disorder, and economic abuse were all significantly associated with material hardship.

Conclusions

A contribution of this study is that it highlights the significant, positive association between economic abuse, a unique form of IPV, and material hardship among pregnant women during the pandemic. These findings suggest the need for policy and practice interventions that help to ameliorate the financial insecurity experienced by some pregnant women, as well as respond to associated bidirectional vulnerabilities (e.g., mental health symptoms, experiences of IPV).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04234-1.

SUBMITTER: Johnson L

PROVIDER: S-EPMC8573078 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:ImportanceFinancial hardship affects health care access and health outcomes among peripartum women.ObjectiveTo evaluate the prevalence of financial hardship among peripartum women over time and by insurance type and income.Design, setting, and participantsThis cross-sectional study included peripartum women, defined as women aged 18 to 45 years who reported being currently pregnant or pregnant in the past 12 months, who participated in the National Health Interview Survey from 2013 to 2018. Data were analyzed from January to May 2021.ExposuresCurrent pregnancy or recent pregnancy as well as insurance type and income.Main outcomes and measuresThree measures of financial hardship within the last year were evaluated: (1) unmet health care need due to cost (unmet need for medical care or delayed or deferred medical care due to cost); (2) health care unaffordability (worry about paying for potential medical bills or existing medical debt); and (3) general financial stress (worry about subsistence spending [eg, monthly bills, housing]).ResultsThe study cohort included 3509 peripartum women, weighted to represent 1 050 789 women (2018: an estimated 36 045 of 184 018 [19.6%] Hispanic, 39 017 [21.2%] Black, and 97 366 [52.9%] White), with a mean (SD) age of 29 (6) years. Overall, from 2013 to 2018, 24.2% (95% CI, 22.6%-26.0%) of peripartum women reported unmet health care need, 60.0% (95% CI, 58.0%-61.9%) reported health care unaffordability, and 54.0% (95% CI, 51.5%-56.5%) reported general financial stress. The prevalence of financial hardship outcomes did not substantially change between 2013 and 2018 (unmet health care need in 2013: 27.9% [95% CI, 24.4%-31.7%]; in 2018: 23.7% [95% CI, 19.5%-28.6%]; health care unaffordability in 2013: 65.7% [95% CI, 61.1%-70.0%]; in 2018: 58.8% [95% CI, 53.4%-64.0%]; general financial stress in 2013: 60.6% [95% CI, 55.2%-65.8%]; in 2018: 53.8% [95% CI, 47.8%-59.8%]). Women with private insurance had lower odds of unmet need (adjusted odds ratio [aOR], 0.67; 95% CI, 0.52-0.87) but higher odds of health care unaffordability (aOR, 1.88; 95% CI, 1.49-2.36) compared with women with public insurance. Peripartum women with household incomes less than 400% of the federal poverty level had higher odds of unmet need (aOR, 1.50; 95% CI, 1.08-2.08) and unaffordable care (aOR, 1.98; 95% CI, 1.54-2.55) compared with those with household incomes 400% or more of federal poverty level.Conclusions and relevanceThese findings suggest that financial hardship among peripartum women in the United States was common from 2013 to 2018, including 24% of pregnant and postpartum women reporting unmet health care need and 60% reporting health care unaffordability. Women with private insurance and those living on lower incomes were more likely to experience unaffordable health care than women with pubic insurance and those with higher incomes, respectively. Targeted policy interventions are needed to improve health care affordability and promote overall economic security among peripartum women.

Project description:BACKGROUND:Weight stigma is a societal phenomenon that is very prevalent in healthcare, precipitating poor patient-provider relationships, discontinuity of care, and delayed cancer screening. Little research, though, has investigated weight stigma in prenatal and postpartum healthcare. To address this gap, this study examined the prevalence and frequency of weight-stigmatizing experiences in prenatal and postpartum healthcare. METHODS:501 pregnant and postpartum women responded to an online survey where they reported whether they had experienced weight stigma in prenatal or postpartum healthcare and, if so, how frequently. Participants also responded to questions about how providers had treated them regarding their weight and their reactions to these experiences. A subset of participants (n?=?80) also provided examples of their experiences, and these were subjected to a thematic analysis and coded for overarching themes. RESULTS:Nearly 1 in 5 women (n?=?92) reported experiencing weight stigma in healthcare settings. Percentages differed by BMI, with 28.4% of participants with pre-pregnancy obesity endorsing healthcare providers as a source of weight stigma. Experiences occurred between "less than once a month" and "a few times a month." Obstetricians were the most commonly-reported source (33.8%), followed by nurses (11.3%). Participants reported feeling judged, shamed, and guilty because of their weight during healthcare visits. Additionally, 37 participants (7.7%) reported having changed providers because of treatment regarding their weight. Many also reported that they expected to feel or had felt uncomfortable seeking help with breastfeeding from a healthcare professional. Finally, thematic analysis of the open-ended examples identified four key themes: (1) negative attitudes and unkind or disrespectful treatment from providers; (2) evaluative comments about their weight; (3) healthcare providers focusing on their high-risk status and potential negative consequences (often when birth outcomes were ultimately healthy); and (4) inappropriate or demeaning comments. CONCLUSIONS:Weight stigma may be a common experience in pregnancy and postpartum healthcare. Providers need additional training to avoid stigmatizing their patients and inadvertently undermining patient-provider relationships, quality of care, and health outcomes.

Project description:ObjectiveTo determine medical students' perceptions of having been harassed or belittled and their correlates, for the purposes of reducing such abuses.DesignLongitudinal survey.Setting16 nationally representative US medical schools.Participants2884 students from class of 2003.Main outcome measuresExperiences of harassment and belittlement at freshman orientation, at entry to wards, and in senior year by other students, by residents or fellows, by preclinical professors, by clinical professors or attendings, or by patients.Results2316 students provided data (response rate 80.3%). Among seniors, 42% (581/1387) reported having experienced harassment and 84% (1166/1393) belittlement during medical school. These types of abuse were caused by other students (11% (158/1389) and 32% (443/1390) of students experienced such harassment or belittlement, respectively). Harassment and belittlement was also caused by residents (27% (374/1387) and 71% (993/1393)), preclinical professors (9% (131/1386) and 29% (398/1385)), clinical professors (21% (285/1386) and 63% (878/1390)), and patients (25% (352/1387) and 43% (592/1388)). Only 13% (181/1385) of students classified any of these experiences as severe. Medical students who reported having been harassed or belittled did not differ significantly from those not reporting such experiences by sex, ethnicity, political orientation, or religion. They did differ significantly by chosen specialty and were significantly more likely to be stressed, depressed, and suicidal, to drink alcohol or to binge drink, and to state that their faculty did not care about medical students. They were also significantly less likely to be glad they trained to become a doctor.ConclusionMost medical students in the United States report having been harassed or belittled during their training. Although few students characterised the harassment or belittlement as severe, poor mental health and low career satisfaction were significantly correlated with these experiences.