Low-income mothers and the constellation of poor health, sick children, and economic hardship

Diana Romero, PhD, MA¹, Wendy Chavkin, MD, MPH¹, Lauren A. Smith, MD, MPH², and Paul Wise, MD, MPH³. (1) Department of Population and Family Health, Columbia University, 60 Haven Avenue, B-2, New York, NY 10032, 212-304-5232, drr6@columbia.edu, (2) Dept of Pediatrics, Bosotn Medical Center, 91 East Concord, Maternity Bldg, 4th floor, Boston, MA 02118, (3) Boston Medical Center, Maternity 4, Dept of Pediatrics, One Boston Medical Center Place, Boston, MA 02118

Objective: Determine if low-income women with children with chronic health problems have fared better or worse during the welfare reform era. Methods: A longitudinal study of low-income women with chronically ill children was conducted in San Antonio, TX. Measures included child and maternal health and health insurance, welfare and other program participation, employment, and material hardship. Changes in select measures between baseline (T1)(n=504) and follow-up (T2)(n=396) were assessed according to welfare status (follow-up=79%). Findings: A greater proportion of mothers receiving TANF at T2 (vs. T1) reported chronic health problems (92% v. 82%), depression (52% v. 43%), and material hardship (80% v. 69%). Low levels of current maternal health insurance persisted (46% at T1 and T2), while insurance gaps in the past year increased (28% v. 35%). This contrasts with increases in current child health insurance (82% v. 88%) and decreases in child insurance gaps (26% v. 17%) at T2. The number of families receiving welfare at T2 declined (9.6% v. 12.5%), although the proportion of child-only cases increased (44% v. 40%). Although respondents recruited from TANF sites at T1 were more likely to be lost-to-follow-up (p<.001), increased problems with health and well-being persisted among mothers with TANF experience, thus likely underestimating these problems. Policy implications: Despite increased employment among poor women with sick children, their health and economic situations have worsened during the post welfare-reform era. These findings call for consideration of the maternal health consequences of welfare policy as reauthorization of the welfare law is deliberated.

Learning Objectives:

At the conclusion of this session, the participant in this session will be able to

-Understand the major health-related components of the 1996 welfare reform law.
-Describe the health and employment barriers faced by poor women in the context of new welfare policies, such as increased work requirements and proscribed reproductive health-related behaviors.
-Identify health-related concerns of low-income families that may be susceptible to welfare and other social policy changes.
-Assess the potential impact of subsequent poverty policy changes on the health and well-being of poor mothers with children with special health care needs.

Keywords: Women's Health, Welfare

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Women's Health: Women and Their Environments - Work, Home and Community

The 132nd Annual Meeting (November 6-10, 2004) of APHA