Food insecurity and delayed or forgone health care among pregnant and postpartum women in the United States, 2019-2021

•10.7% of peripartum US women experienced low or very low food security between 2019 and 2021•16.9% of peripartum US women reported foregoing or delaying any health care due to cost concerns•Peripartum US women experiencing low/very low food security are likely to delay/forego a form of medical care when compared to their counterparts with high/marginal food security Despite the growing crisis of food insecurity in the US, there is limited evidence about the impact of food insecurity on unmet health care needs for peripartum (pregnant and postpartum) women. This study examines the association between food insecurity and delayed or forgone healthcare among peripartum women in the United States from 2019 to 2021. We conducted a pooled cross-sectional analysis using data from the 2019, 2020, and 2021 National Health Interview Surveys. Food security status was defined by type (high/marginal, low, and very low). Descriptive analysis and multivariable logistic regression, adjusted for sociodemographic and health-related characteristics, were conducted to estimate the overall and specific delayed or forgone health care (yes or no) between the different categories of food security. Of the 1,525 peripartum women (Weighted, N = 5,580,186), 10.7% of peripartum women in the US experienced suboptimal food security in the preceding 12 months between 2019 and 2021, with 5.3% experiencing low and 5.4% experiencing very low food security. This included 6.2% (95% CI, 4.9%-7.7%) who reported delaying filling a medical prescription, 6.4% (95% CI, 5.0%-8.2%) who needed counseling or therapy from a mental health professional but did not receive it, 5.9% (4.6%-7.6%) who delayed counseling or therapy from a mental health professional, 7.6% (95% CI, 6.0%-9.6%) who needed medical care but did not receive it, and 8.6% (95% CI, 6.9%-10.3%) who delayed medical care. Peripartum women with low and very food security were more likely to delay or forego health care due to cost concerns than peripartum women who were food secure. In the multivariable analyses adjusted for predisposing, enabling and need-based factors, those with low and very low food security had higher risk of delayed or forgone health care compared to women with marginal/high food security. In this study, we demonstrated a positive association between food insecurity and cost-related unmet healthcare needs among peripartum women. Future empirical studies are needed to assess the impact of peripartum healthcare interventi