How Transportation, Housing, and Food Insecurity Affect Maternal and Infant Health

By Birth & Baby University · Last updated: October 2026 · 7 min read

A prenatal appointment assumes a way to get there. A nutrition recommendation assumes a way to buy the food. A plan for rest and recovery assumes a stable place to live. When those assumptions fail, health advice can become a list of things a family cannot do. This article looks at what research says about transportation, housing and food insecurity in pregnancy and early parenthood, how strong each body of evidence is, and what a doula can do within the doula role.

Key takeaways

Quick answer: studies link food insecurity, housing instability and transportation problems to worse access to care and, in several cohorts, to more perinatal complications. The evidence is mostly observational, and some findings weaken or disappear after adjustment for other factors, so the safest claim is association and risk, not simple cause.

• In a Northern California cohort of 19,338 people, 14.0 percent reported food insecurity in pregnancy, and it was associated with higher risk of gestational diabetes, preeclampsia, preterm birth and NICU admission. Among those who received food assistance, most associations were attenuated to the null.
• In a national survey of births, homelessness was associated with higher prevalence of small-for-gestational-age, low birth weight and preterm birth before adjustment, but the associations were no longer significant after adjusting for other factors.
• A scoping review found seven of eight studies reported a positive association between eviction and adverse pregnancy outcomes, with preterm birth the most consistent.
• For transportation, seven of nine studies in a scoping review linked lack of reliable transportation to delayed or missed prenatal care, while two found a weak or no association.

Food insecurity

Chehab and colleagues (2025) used a pregnancy survey from Kaiser Permanente Northern California and the two-item Hunger Vital Sign screener. Among 19,338 individuals who delivered singletons, 2,707 (14.0 percent) reported food insecurity in pregnancy. Compared with others, they had a higher risk of gestational diabetes (adjusted relative risk 1.13), preeclampsia (1.28), preterm birth (1.19), NICU admission (1.23) and a composite adverse outcome (1.07). Among the 1,471 people (7.6 percent) who received food assistance in pregnancy, associations were attenuated to the null, except for preeclampsia, while associations persisted among people who did not receive assistance. The authors conclude that this supports screening and expanded food assistance. Because this is an observational cohort in one health system, the pattern could reflect other differences between people who do and do not receive assistance, and it does not prove that assistance caused the difference.

Food insecurity is also linked to mental health after birth. Stone and Amiri (2026) reviewed 20 studies and found that 19 reported an association between food insecurity and postpartum depression. They note that the direction of the relationship remains unclear, that studies used varied tools, mostly symptom-based screening, and that measures often overlook physical access to food.

Housing instability, homelessness and eviction

Meehan and colleagues (2025) analyzed 2016 to 2020 data from the Pregnancy Risk Assessment Monitoring System across 31 sites. Of 138,603 respondents, 2.4 percent (weighted) reported homelessness in the 12 months before giving birth. Unadjusted models showed higher prevalence of small-for-gestational-age birth, low birth weight and preterm birth. After adjusting for maternal age, race and ethnicity, education, body mass index and smoking, the differences were attenuated and no longer significant. The authors say that people reporting homelessness are still at higher risk of inadequate health care use and adverse outcomes because of other demographic and social factors, so the result does not mean homelessness has no consequences. It means the independent effect could not be separated from related factors in this analysis.

A 2026 scoping review (Oladebo and colleagues, 2026) included eight studies on eviction and adverse pregnancy outcomes. Seven reported a positive association, and preterm birth was the most consistent finding. Only one study assessed individual-level eviction, while most relied on area-level or proxy measures, so the results speak more to high-eviction environments than to individual households.

Transportation

Appiah-Kubi and colleagues (2025) reviewed nine studies on transportation barriers to prenatal care among Black and African American people. Seven indicated that lack of reliable transportation contributed to delayed initiation of prenatal care, missed or cancelled appointments and rescheduling. Two found a weak or no association with attendance and use. The authors call for further research because of substantial gaps in the literature. The review is limited to one population and to prenatal care, and it does not measure how transportation affects birth or infant health.

What the evidence cannot tell us

• Cause and effect. These are mostly cohort studies, surveys and reviews of observational work. Food, housing and transportation problems cluster with other disadvantages, and separating one factor from the rest is difficult.
• Whether help works. The food assistance finding is promising but observational. No source here tests whether a doula’s help with food, housing or transport changes outcomes.
• Measurement. Studies define and measure these needs differently, including self-report, screeners and area-level proxies.

What this means for doulas

• Ask, with permission. A client may not mention that groceries are tight or that a ride to appointments is uncertain. Open questions during prenatal and postpartum visits help, and the client decides what to share.
• Connect, do not prescribe. A doula can share a vetted list of local food assistance, housing support and transport options and help a client make calls. A doula does not give nutrition therapy, legal advice about eviction, or medical advice about what a client should do about symptoms.
• Treat missed appointments as information. Before assuming disinterest, ask whether getting there is the problem.
• Coordinate with the care team when asked. If a client wants the team to know about a barrier, help them say it. Some clinics may have staff who can help with transport or benefits, so it is worth asking.
• Know your limits on money and time. Doulas often want to rescue a client from an unsafe or stressful situation. A realistic plan for what you can and cannot offer protects both of you.

Putting it into practice

1. Assemble a one-page local resource list covering food, housing and transportation, and note when each entry was last confirmed.
2. Add a gentle intake question such as “Is anything about food, housing or getting around making the next few months harder?”
3. When a client names a need, offer two or three options and let them choose, then follow up at the next contact.
4. For urgent safety concerns, such as having nowhere safe to stay, connect the client to emergency services or the appropriate local hotline rather than handling it alone.
5. Read our related article on social determinants of health in pregnancy and postpartum care for the wider framework.

Limits and uncertainty

The evidence combines one large health-system cohort, a national survey, and small scoping reviews that range from eight to 20 studies. Several findings are weaker once other factors are accounted for, and scoping reviews do not weigh study quality in the same way systematic reviews do. Most studies are from the United States and may not apply elsewhere. Resource availability, eligibility rules and program names change over time, so check local details directly.

The bottom line

Food, housing and transportation problems are tied to worse access to care and, in several studies, to more complications for parents and babies, although the evidence is observational and sometimes mixed. For doulas, the practical response is to ask thoughtfully, connect families to real local resources, and stay within the role while the larger solutions sit with systems and policy.

Birth & Baby University’s For Doulas page outlines its online, self-paced birth and postpartum doula training, recertification and mentorship, for doulas who want to build practical, client-centered support skills.

This article is for professional education. It is not medical, legal, financial or tax advice. Check the standards of your certifying organization and the rules where you work.

Sources and further reading

• Chehab RF, Croen LA, Laraia BA, et al. Food insecurity in pregnancy, receipt of food assistance, and perinatal complications. JAMA Network Open (2025). Read the source
• Stone BS, Amiri A. Exploring the relationship between food insecurity and postpartum depression: a scoping review. Archives of Women’s Mental Health (2026). Read the source
• Meehan AA, Steele-Baser M, Machefsky AM, et al. Homelessness and birth outcomes in the Pregnancy Risk Assessment Monitoring System, 2016-2020. Maternal and Child Health Journal (2025). Read the source
• Oladebo T, Beyer K, Walsh J, et al. Exploring the link between eviction and birth outcomes in the United States: a scoping review. Health & Place (2026). Read the source
• Appiah-Kubi R, Iradukunda F, Perry M, et al. Transportation barriers to prenatal care among Black/African Americans: a scoping review. Public Health Challenges (2025). Read the source

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