Missed opportunities to improve food security for pregnant people: a qualitative study of prenatal care settings in Northern New England during the COVID-19 pandemic

Chelsey R Canavan,Arvind Suresh,Meaghan A Kennedy,Kayla E Hatchell,Tiffany D’Cruze,Maureen Boardman,Alka Dev,Daisy Goodman

doi:10.1186/s40795-022-00499-7

Abstract

BackgroundFood insecurity during pregnancy has important implications for maternal and newborn health. There is increasing commitment to screening for social needs within health care settings. However, little is known about current screening processes or the capacity for prenatal care clinics to address food insecurity among their patients. We aimed to assess barriers and facilitators prenatal care clinics face in addressing food insecurity among pregnant people and to identify opportunities to improve food security among this population.MethodsWe conducted a qualitative study among prenatal care clinics in New Hampshire and Vermont. Staff and clinicians engaged in food security screening and intervention processes at clinics affiliated with the Northern New England Perinatal Quality Improvement Network (NNEPQIN) were recruited to participate in key informant interviews. Thematic analysis was used to identify prominent themes in the interview data.ResultsNine staff members or clinicians were enrolled and participated in key informant interviews. Key barriers to food security screening and interventions included lack of protocols and dedicated staff at the clinic as well as community factors such as availability of food distribution services and transportation. Facilitators of screening and intervention included a supportive culture at the clinic, trusting relationships between patients and clinicians, and availability of clinic-based and community resources.ConclusionPrenatal care settings present an important opportunity to identify and address food insecurity among pregnant people, yet most practices lack specific protocols for screening. Our findings indicate that more systematic processes for screening and referrals, dedicated staff, and onsite food programs that address transportation and other access barriers could improve the capacity of prenatal care clinics to improve food security during pregnancy.

Highlights

Food insecurity during pregnancy has important implications for maternal and newborn health
We aimed to assess barriers and facilitators prenatal care clinics face in addressing food insecurity among pregnant people in northern New England
Northern New England Perinatal Quality Improvement Network (NNEPQIN) is a voluntary consortium of approximately 50 hospitals, outpatient clinics, and other organizations involved in perinatal care in ME, NH, and VT convened to improve the rapid dissemination of evidence-based practices in prenatal, intrapartum, and newborn care

Summary

Introduction

Food insecurity during pregnancy has important implications for maternal and newborn health. There is a critical need to understand how to best screen for and address social risk factors—including food, housing, transportation, and other factors [11]— within health care settings generally [12]. This is important in prenatal care settings, given mounting evidence that supports interventions to reduce risk factors such as food insecurity [13]. Screening for food insecurity during prenatal care visits identifies those at-risk and provides an early opportunity for intervention to support the health of mother and child [5].

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