Food insecurity—the lack of steady access to nutritionally adequate food—during pregnancy is linked to premature births and poorer health for low-income mothers and their babies, contributing to staggering rates of infant mortality in Cleveland and Cuyahoga County.
To address this critical need, a partnership between Case Western Reserve University School of Medicine, Greater Cleveland Food Bank (GCFB) and Better Health Partnership’s Community Pathways HUB (HUB) created a pilot program called Nourishing Beginnings (NB). The program was launched in 2022 with funding from the Vitamix and Bruening foundations and CWRU’s Clinical and Translational Science Collaborative.
Now, with a $500,000 grant from the Robert Wood Johnson Foundation (RWJF)’s Systems for Action program, the partnership will expand the program and study its execution and effectiveness. At stake is one of the highest infant mortality rates in the country, according to First Year Cleveland, a CWRU-based nonprofit dedicated to reversing this trend.
“We want to better understand not only how healthy food access might improve pregnancy outcomes, but also the barriers that low-income pregnant women face and the kinks in the system that contribute to these barriers,” said Elaine Borawski, professor and vice chair for applied research at the School of Medicine’s Department of Nutrition.
Borawski, who’s leading the study, said the partners also want to learn how the program that combines a community health worker (CHW) with direct food access interventions may impact related issues such as prenatal visits, diet quality, stress, depression and reports of discrimination, “all of which are also linked to prematurity and other health outcomes.”
NB links low-income pregnant women in Cuyahoga County receiving support from a CHW through the HUB with direct access to healthy food in one of two ways: a tailored food box from the GCFB delivered to their home every other week or cash for groceries along with personalized navigation to retail locations offering healthy foods in their neighborhoods, developed by CWRU’s Prevention Research Center for Healthy Neighborhoods. Participants also receive help with needed kitchen items and easy-to-understand recipes and nutrition information during and after pregnancy.
“The use of a CHW has been shown to be an effective approach to improving health outcomes in at-risk populations in previous studies,” said Christopher Mundorf, HUB’s director of analytics and a co-lead of the program. “The NB program capitalizes on the strength of this relationship by having a CHW not only directly address a client’s food security and other social needs, but also serve as a trusted, resourceful ally for clients as they navigate their prenatal experiences.”
“If found to be effective, it is the hope that funding for food-is-medicine initiatives like Nourishing Beginnings will be reimbursed through the health care system,” Borawski said.
“With this support, the program could be distributed across the region and state, using Ohio’s rich network of Pathway HUBS and food banks.”
The grant was one of only two RWJF awarded nationally this year through its 2022 Systems for Action: Systems and Services Research to Build a Culture of Health Call for Proposals.
Investigators hypothesize aligning the referral and delivery system, support of a caring community health worker and direct access to healthy food will lead to healthier moms and babies.
“Eating healthy is critical during pregnancy,” said Alissa Glenn, one of the program leaders and GCFB’s director of community nutrition. “And yet many low-income pregnant women not only have difficulty affording healthy, nutritious foods, but often live in neighborhoods with limited healthy food options, making affordable, high-quality, nutritious food needed during pregnancy challenging to obtain.”
Referrals to supportive federal programs like the Supplemental Nutrition Assistance Program and Women, Infants and Children or even the food bank are helpful, Glenn said, but often don’t adequately overcome the barriers to healthy food access.
“What is needed,” she said, “is a strategy that directly connects pregnant women to resources without placing additional burden on them.”