Housing Instability and Prenatal Care Utilization:Healthcare and Business Administration Perspectives on Maternal Health Outcomes in Low-Income U.S. Populations

Maternal health disparities remain a critical public health concern in the United States, particularly among low-income populations where adverse outcomes such as severe maternal morbidity, preterm births, and inadequate prenatal care are disproportionately common. Housing instability—encompassing homelessness, frequent moves, overcrowding, and unaffordable rent—has emerged as a significant social determinant of health that directly disrupts access to timely and adequate prenatal care. This study examined the relationship between housing instability and prenatal care utilization, with a dual focus on healthcare and business administration perspectives, in order to identify sustainable strategies for improving maternal outcomes. A mixed-methods design was employed. Quantitative data were collected from 250 respondents at BronxCare Health System, New York, using structured questionnaires. Descriptive statistics summarized participant demographics and prenatal care patterns, while inferential tests, including chi-square, correlation, and logistic regression, assessed the associations between housing instability and maternal health outcomes. Complementary qualitative data were collected through interviews with key stakeholders and analyzed thematically using NVivo software, generating themes such as affordability, accessibility, housing-related stress, and systemic barriers. Findings revealed that women experiencing housing instability were more likely to initiate prenatal care late, attend fewer visits, and face heightened risks of poor maternal and infant health outcomes. Logistic regression identified age and income as significant predictors of prenatal care utilization, while thematic analysis highlighted housing-related stress and fragmented service delivery as barriers to care. The study concludes that housing instability significantly undermines maternal health and that effective solutions require cross-sectoral integration. Healthcare strategies such as housing risk screenings and navigation services, when combined with business administration frameworks like return-on-investment analysis, process improvement, and sustainable financing models, can ensure that interventions are both effective and scalable. The research recommends policy reforms, resource allocation, and healthcare–housing partnerships to improve maternal health equity in low-income U.S. populations. Keywords: Housing instability, prenatal care utilization, maternal health outcomes, social determinants of health, healthcare, business administration.