This evaluation examines a Houston Food Bank-implemented food prescription program designed to support high-risk pregnant women who are members of Community Health Choice. The initiative sought to address the persistent challenge of food insecurity during pregnancy, a period marked by heightened nutritional vulnerability and elevated risks for adverse maternal and infant outcomes. The population enrolled in this program represents a group with substantial needs and limited resources, underscoring the urgency of identifying effective interventions. Nearly all participants were Medicaid-insured, over threequarters were food insecure at baseline, one quarter were nutrition insecure, and the median household size was three. These women entered pregnancy with a high burden of health risks; among those with prior pregnancies, nine percent reported past gestational diabetes, thirteen percent reported pregnancy induced hypertension, and fourteen percent reported a history of preterm birth. This pattern of high baseline morbidity signals the importance of strengthening supports for maternal health during pregnancy, particularly in settings of sustained economic hardship.
Overall, rates of gestational diabetes (GDM), hypertension (HTN), low birthweight (LBW), and macrosomia were lower in the FIM-exposed sample as compared to the Medicaid population nationally and in other states, and significantly so in the case of LBW rates, both overall and for African-American women generally. Although the results are not conclusive due to limitations of our study design, they do suggest
that exposure to the FIM program may have resulted in some improvements in rates of adverse pregnancy and birth outcomes. Impact on dietary behaviors in this population, apart from a slight increase in fruit intake, were minimal. There was a significant improvement in self-rated health in the participants over the course of the intervention. We also examined if the dose of exposure, operationalized as the number of redemptions, impacted clinical and dietary outcomes.
Overall, this evaluation identifies clear opportunities for investment and program strengthening. The women enrolled in this initiative represent a population with elevated clinical risk, substantial social vulnerabilities, and high structural barriers to food access. The program’s low and uneven redemption rates reflect operational challenges, not lack of need or interest. Enhancing enrollment procedures, key performance metrics related to implementation that are available for trouble-shooting in real-time, improving communication, reducing delays between enrollment and delivery, and ensuring consistent delivery of food benefits are likely to increase exposure and, by extension, increase the potential for meaningful impact. High-needs groups such as these require reliable and well-supported interventions. Continued support to enable program refinements that improve reach and mitigate known barriers while supporting an evidence-building agenda that remains critical for advancing maternal health equity.