Pregnant and Stressed: Assessing the Social Determinants impacting Pregnant Women in Indiana

Background: Indiana currently has one of the highest infant mortality rates in the nation. In 2012, Indiana had an infant mortality rate of 7.8 per 1000 births. In order to address the issue of infant mortality, the Indiana State Department of Health has been investigating the cultural, environmental, political, and psychosocial factors that impact the lives of pregnant Hoosiers.

Methods: In 2014, ISDH surveyed pregnant women (n=1,242) and prenatal care coordinators (n=58) throughout the state to gain a better understanding of the issues facing pregnant women in Indiana. This two-fold project focused on identifying the social determinants and stressors that pregnant women are facing, such as access to care, insurance coverage, transportation, and unplanned pregnancies.

Results: Of the women that completed the survey, 93% were Medicaid-eligible, 69% were single, and 72% of these pregnancies were unplanned. The study results found significant differences between planned pregnancy and marital status (p=.000), age (p=.001), and race (p=.003). The results also indicated that Race was significantly associated with smoking status (p=.000) and breastfeeding rates (p=.015). In further investigating the root causal factors, researchers found that Age (p=0.011) and Race (p=0.00) were significantly associated with stressors such as lack of support, insurance coverage, and family issues.  These findings also revealed that pregnant women who were smoking during pregnancy were significantly more stressed than pregnant non-smokers (p=0.035).

Conclusions: Understanding and addressing the social determinants that impact the health of pregnant women can help to improve the lives of the mother and her child.