Publication Date

2024

Document Type

Dissertation/Thesis

First Advisor

Clay, Shondra Loggins

Degree Name

Ph.D. (Doctor of Philosophy)

Legacy Department

School of Family and Consumer Sciences

Abstract

This dissertation explores the ways in which access acts as both a barrier and facilitator to healthy birth outcomes. In particular, access to food, maternity care, and Medicaid coverage of doula services are explored alongside low birthweight in this dissertation through both population health and health disparity lenses. Low birthweight is a leading cause of infant mortality and thought to reflect nations’ long-term public health problems such as maternal malnutrition and inadequate receipt of maternity care. As such, sufficient access to healthy food and maternity care is essential for healthy birth outcomes.

Chapter 1 of this dissertation contains an introduction to the dissertation topic, discusses the etiology and risk factors for low birthweight, and includes details about the significance of the problem. Chapter 2 provides an evaluation of prior literature and discusses theoretical and conceptual frameworks that support the literature and explain the factors contributing to low birthweight. Chapter 3 contains the methods section which includes details about the research questions and hypotheses, study designs, data collection, and statistical analyses used for each of the three study aims.

Chapter 4 contains the results for each study aim. Examination of access to food and low birthweight in US counties in Aim 1 revealed that food insecurity significantly predicted low birthweight overall and for both Black and White women. Exploration of access to maternity care by race and geographic classification in US counties in Aim 2 revealed that in rural counties without access to maternity care, prevalence of low birthweight was significantly higher for Black women compared to White women. Aim 3 findings revealed that exposure to statewide expansion of Medicaid coverage of doula services may reduce low birthweight prevalence for women with Medicaid overall and Black women with Medicaid in particular.

Chapter 5 includes detailed discussions of the results for each study aim presented in Chapter 4 and contains a comprehensive conclusion of the dissertation. Evidence from the findings of this dissertation study suggest that access to food, maternity care, and Medicaid coverage of doula services are important modifiable factors that should be considered when planning prevention efforts at the state and county levels, as well as when planning efforts aimed at reducing racial disparities in low birthweight.

Extent

101 pages

Language

en

Publisher

Northern Illinois University

Rights Statement

In Copyright

Rights Statement 2

NIU theses are protected by copyright. They may be viewed from Huskie Commons for any purpose, but reproduction or distribution in any format is prohibited without the written permission of the authors.

Media Type

Text

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