Stressors of African American Pregnancy, Food Insecurity, and Housing
- Dr. Kesha Nelson
- Feb 13
- 2 min read
Below is a mental health–informed lens on food insecurity, housing instability, and broader stressors impacting African American pregnancy.
1. Chronic Stress & Weathering
The “weathering” hypothesis, introduced by Arline T. Geronimus, explains how chronic exposure to racism and socioeconomic disadvantage accelerates biological aging and increases adverse birth outcomes.
Mental Health Impact:
Elevated cortisol levels
Increased risk of perinatal anxiety and depression
Sleep disturbance
Heightened hypervigilance
Trauma reactivation (especially in those with prior adverse experiences)
Pregnancy becomes layered with survival stress rather than safety and celebration.
2. Food Insecurity in Pregnancy
Food insecurity disproportionately affects Black households due to wage inequities and systemic barriers.
Psychological Stressors:
Anxiety about feeding oneself and other children
Guilt and shame
Fear of child welfare involvement
Nutritional deficiencies that may worsen mood disorders
Nutritional insufficiency is linked to:
Increased risk of perinatal depression
Iron deficiency is contributing to fatigue and low mood
Poor glycemic control, which can heighten mood fluctuations
From a PMHNP lens, food insecurity is not just a resource gap—it is a chronic psychological threat.
3. Housing Instability & Environmental Stress
Housing instability includes eviction risk, overcrowding, unsafe neighborhoods, or frequent relocation.
Mental Health Consequences:
Persistent fight-or-flight activation
Increased intimate partner conflict
Reduced prenatal care adherence
Sleep disruption
Increased risk of postpartum depression
Environmental stress (violence exposure, neighborhood disinvestment) compounds trauma load during pregnancy.
4. Structural Racism & Medical Mistrust
Historical trauma (e.g., exploitation in research and reproductive injustice) contributes to medical mistrust. This affects engagement in prenatal and mental health care.
For example, the legacy of Henrietta Lacks and abuses like the Tuskegee Syphilis Study continue to influence perceptions of safety in healthcare systems.
Mental Health Effects:
Delayed disclosure of depressive symptoms
Underreporting of suicidal ideation
Fear of being labeled “unfit.”
Emotional suppression
5. Intersection of Perinatal Mood & Anxiety Disorders (PMADs)
Black women are:
Less likely to be screened adequately
Less likely to receive culturally responsive treatment
More likely to experience untreated depression and anxiety
Untreated PMADs can lead to:
Preterm birth
Impaired bonding
Increased maternal morbidity
Long-term developmental stress exposure for the infant
Protective & Healing Factors
Despite structural stressors, resilience is profound.
Protective Buffers:
Faith communities
Intergenerational support
Culturally affirming providers
Community-based doulas and midwives
Peer support groups
Culturally responsive care models, such as those supported by the Black Mamas Matter Alliance, emphasize:
Reproductive justice
Community-driven care
Policy advocacy
Whole-person mental health
Clinical Implications (PMHNP Lens)
Screen beyond EPDS — assess food, housing, safety.
Normalize survival stress responses.
Use trauma-informed, culturally humble language.
Collaborate with social work & community organizations.
Avoid pathologizing adaptive coping behaviors.
Address systemic stress without individual blame.
Reframing the Narrative
African American pregnancy is not inherently “high risk.”It is made high-risk by:
Structural inequities
Economic instability
Racialized stress
Healthcare bias
When we address food security, stable housing, and culturally competent mental healthcare, we reduce psychiatric burden and improve birth outcomes.
Kesha Nelson, PhD, MSN/Ed, RN, APRN-CNP, PMHNP-BC, ADHD-CCSP
Director of Mental Health – BLACK BERRY & JUICE Program
The BLACK Collaborative Inc.
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