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Healthy Beginnings at Home

Updated: May 6, 2021

Providing Affordable Housing to Reduce Infant Mortality and Improve Birth Outcomes

By: Amy Riegel, Priyam Chokshi, Barbara Poppe, and Gina Wilt

Safe and stable housing is essential for families to thrive and achieve optimal health. Despite the importance of housing, a lack of affordable housing nationwide has made families – particularly those of color – vulnerable to homelessness and other forms of housing instability, which contributes to poor health outcomes. The shortage of affordable and available housing is severe, placing extremely low-income families and pregnant women at high risk.

Statewide, 66 percent of extremely low-income households are severely cost burdened, meaning families in these households struggle to pay bills and other expenses due to the high cost of housing. There are only 42 affordable units for every 100 extremely low-income households. Infants and young children are substantially overrepresented in Ohio’s homeless population: Ohioans age 0-4 make up only 5.9% of Ohio’s overall population but are 11.4% of the homeless population.

Meanwhile, in Ohio – a state where infant mortality is alarmingly high – stark racial disparities in birth outcomes persist. Despite a decrease in Ohio’s infant mortality from 7.2 per 1,000 live births in 2017 to 6.9 in 2019 (compared to the national rate of 5.8), Black infants died at a rate 2.5 to 3 times higher than white infants. Among all races, prematurity-related conditions are the leading cause of infant death in Ohio, comprising nearly one-third of deaths in 2019.

Launched in 2018, Healthy Beginnings At Home: Housing Stabilization Program For Pregnant Women (HBAH) is a pilot project focused on providing affordable housing to pregnant women and young mothers, with the aim of decreasing infant mortality. Through rigorous evaluation, HBAH is strengthening the evidence-base for providing housing stabilization and rental subsidies in order to improve health outcomes for pregnant women and their newborns. Improving birth and health outcomes is a key strategy to reduce infant mortality in Ohio.

Healthy Beginnings at Home, offers a comprehensive approach, providing pregnant women with housing and rental assistance, medical care, and important social services both before and after their baby is born. Led by CelebrateOne (an infant mortality prevention collaborative), in collaboration with CareSource (a managed care organization), Homeless Families Foundation (a housing stabilization provider), and the Columbus Metropolitan Housing Authority, Healthy Beginnings at Home has demonstrated promising findings. Women who received housing assistance experienced better birth outcomes than those that did not receive this assistance.

The HBAH program partners are advocating at the state and federal level for additional funds to replicate the model and evaluate the results to reach statistical significance. HBAH research is beginning to fill a gap in the healthcare literature, demonstrating the impact of housing interventions to increase positive health outcomes. In 2021, the Ohio biennial budget (House Bill 110), as introduced, provides additional funding for housing programs that focus on reducing infant mortality. HBAH partners are promoting expansion beyond Franklin County to additional communities in Ohio.

We hope others will join us in advocating for state funding to support replication of HBAH and the research necessary to evaluate the outcomes. The results of initial HBAH implementation are very promising and if a larger study finds this same level of impact the implications for policymakers at all levels will be compelling. Ultimately, we believe that providing safe, stable housing for every expectant mother will drive down infant mortality rates and eliminate racial disparities in birth outcomes.


Amy Riegel is the Director of Housing at CareSource. Priyam Chokshi is the Director of Community and Legislative Strategies at CelebrateOne. Barbara Poppe is the Founder and Principal at Poppe and Associates. Gina Wilt is Advocacy Director at the Coalition on Homelessness and Housing in Ohio (COHHIO).


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