Matern Child Health J (2016) 20:139–148
DOI 10.1007/s10995-015-1812-0
Post-partum Residential Mobility Among a Statewide
Representative Sample of California Women, 2003–2007
Claire Margerison-Zilko1 • Catherine Cubbin2 • Jina Jun3 • Kristen Marchi4
Paula Braveman4
Published online: 26 July 2015
Ó Springer Science+Business Media New York 2015
Abstract
Objectives Researchers often examine neighborhood
socioeconomic environment and health during the perinatal
period using geocoded addresses recorded on birth certifi-
cates at the time of delivery. Our objective was to assess
the potential for post-partum neighborhood misclassifica-
tion by examining whether women move neighborhoods
during the immediate post-partum period, whether they
move to neighborhoods of different socioeconomic status
(SES), and whether mobility differs by maternal
characteristics.
Methods We used data from the 2003–2007 California
Maternal and Infant Health Assessment (MIHA), an
annual, statewide-representative survey of post-partum
women, to examine women’s neighborhood mobility pat-
terns between giving birth and completing a survey
2–7 months post-partum. We examined whether women
changed neighborhoods, whether moves were to neigh-
borhoods of higher, lower, or similar socioeconomic status
(SES), and whether these patterns differed by maternal
race/ethnicity, maternal SES, or other demographic
characteristics.
& Claire Margerison-Zilko
cmargerisonzilko@epi.msu.edu
1
Department of Epidemiology and Biostatistics, Michigan
State University, 909 Fee Hall, Room 601B, East Lansing,
MI 48823, USA
2
School of Social Work, University of Texas at Austin,
Austin, TX, USA
3
Health Policy Research Department, Korea Institute for
Health and Social Affairs, Seoul, Korea
4
Department of Family and Community Medicine, University
of California, San Francisco, San Francisco, CA, USA
•
Results Overall, 93 % of women either did not move
neighborhoods or moved to a neighborhood of similar SES
post-partum. Only 4 % of women moved to a neighbor-
hood of lower SES and 3 % to an area of higher SES.
Mothers who were non-Hispanic black or US-born His-
panic, young, unmarried, primiparous, or lower SES were
slightly more likely to move overall and more likely to
move to neighborhoods with different SES, compared to
other women.
Conclusions These findings suggest that geocoded
addresses from birth certificates can be used to estimate
women’s neighborhood SES during the early post-partum
period with little misclassification, an especially relevant
finding for researchers using post-partum surveys.
Keywords Residential mobility
Neighborhood
Post-
partum
Socioeconomic status
Birth certificate
Significance
What is already known on the subject? Approximately
12–30 % of women move during pregnancy and up to
50 % move in the first year of their infants’ lives. Few
studies have examined the post-partum period or investi-
gated whether women move between neighborhoods of
different SES.
What does this study add? Only about 6 % of all women
(and up to 10 % of non-Hispanic black or US born His-
panic, young, unmarried, primiparous and lower SES
women) moved to a neighborhood of different SES in the
post-partum period. We conclude that it is reasonable to
use geocoded addresses from birth certificates to estimate
women’s neighborhood SES during the early post-partum
period.
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Background
Researchers are often interested in how neighborhood
characteristics, such as socioeconomic status (SES), impact
perinatal health [1–4]. Geocoded birth certificate data are
therefore used to examine the effects of neighborhood
environments on maternal and infant health around the
time of delivery. Post-partum, population-based surveys
such as the Centers for Disease Control’s Pregnancy Risk
Assessment Monitoring System (PRAMS, which covers
78 % of live births in the US) and California’s Maternal
and Infant Health Assessment (MIHA, which accounts for
another 13 % of births in the US) provide an additional
unique opportunity to link residential addresses from the
birth certificate to detailed data on a wide range of perinatal
factors such as pregnancy and post-partum health behav-
iors, stressful life events, breastfeeding, and post-partum
mental health. For researchers using these data sources,
there is a critical need to know whether women’s neigh-
borhood socioeconomic environments at the time of
delivery adequately reflect their neighborhood environ-
ments in the months after their babies are born.
Evidence suggests that 12–30 % of women move during
pregnancy [5–7] and up to 50 % may move in the first year
of their infants’ lives [8, 9]. Only one study in the US,
however, has examined whether women move between
neighborhoods of different SES. A recent study of women
giving birth in Rhode Island (n = 740) found that 63 % of
participants lived in the same neighborhood (census block
group) throughout their pregnancies and during the
13 months post-partum [10]. Among women who did move
at least once during the study, about 12 % moved to
neighborhoods of higher poverty, and 12 % moved to less
impoverished neighborhoods. Non-Hispanic White women
with more than a high school education were more likely
than their non-White and less educated counterparts to
move to neighborhoods with lower levels of poverty. That
study indicates that, although many women move during
the perinatal period, a relatively small proportion move
between neighborhoods of different SES. To avoid mis-
classification of women’s neighborhood environments
based on birth certificate data, it is important to know not
only the extent to which women move in the post-partum
period, but whether they move to neighborhoods with
different SES, and whether mobility patterns vary by SES
and racial/ethnic group. To our knowledge, no other studies
have specifically examined neighborhood residential
mobility in the post-partum period using large, represen-
tative samples with substantial racial, ethnic, and socioe-
conomic diversity.
The objective of the current study was to assess the
potential for misclassification of women’s post-partum
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Matern Child Health J (2016) 20:139–148
neighborhood when using birth certificate addresses by
examining neighborhood residential mobility patterns
among California women who recently had a live birth.
Specifically, we examined whether women changed
neighborhoods between delivery and 2–7 months post-
partum, whether moves were to neighborhoods of higher,
lower, or similar SES, and whether these patterns differed
by maternal race/ethnicity, maternal SES, or other demo-
graphic characteristics.
Methods
Data
We analyzed data from the 2003–2007 Maternal and Infant
Health Assessment (MIHA) in California (CA), conducted
by the California Department of Public Health Maternal,
Child, and Adolescent Health Division in collaboration
with researchers at the University of California, San
Francisco. MIHA is an annual, population-based, state-
wide-representative mail survey with telephone follow-up
to non-respondents; MIHA collects health-related infor-
mation from women who gave birth to a live infant during
February through May each year. Respondents provide
their current address at the time of the survey for a thank
you gift card to be mailed. Overall un-weighted response
rates ranged from 71 to 74 % during 2003–2007. MIHA
data, described in detail elsewhere [11], were linked with
birth certificate information and weighted to reflect the
sampling design and to be representative of all women
delivering an infant in CA in the index year. California
births represent one-eighth of all births in the US. This
research was approved by the University of Texas at Austin
Institutional Review Board and the California Committee
for the Protection of Human Subjects.
Neighborhood socioeconomic data came from the
American Community Survey 2005–2009 (ACS), an
ongoing annual survey that collects data similar to that of
the US Census to provide more up-to-date information than
the decennial census. These 5-year estimates provide
information at the census tract level, corresponding to
Census 2000 boundaries. Following prior work, we use
census tracts as proxies for neighborhoods [12].
All women in MIHA (n = 18,273) had an address
reported on the birth certificate because it is a requirement
of sampling. We linked women’s addresses reported on the
birth certificate and in the MIHA post-partum survey to
census tracts based on geocodes of those addresses. The
analytic sample excluded women for whom we did not
have a valid address on the MIHA survey (n = 544) and
those whose birth certificate (n = 311) or post-partum
Matern Child Health J (2016) 20:139–148
(n = 1106) addresses could not be accurately geocoded to
a census tract, for a final sample size of 16,312.
Measures
Neighborhood Socioeconomic Status (SES)
Following methods used by Winkleby and colleagues [13],
we created an index of neighborhood SES for all California
neighborhoods based on a principal components analysis
using the following five ACS variables at the census tract
level, standardized and summed with equal weights: per-
cent blue collar workers, percent of adults over 25 with less
than a college education, median family income, median
housing value, and percent of adults over 18 who are
unemployed. We categorized the index into low (\25th
percentile), moderate (25th–75th percentile), and high
([75th percentile) SES.
Residential Mobility Status and Patterns
We categorized women’s residential mobility status during
the post-partum period as ‘‘changed neighborhood’’ if their
census tracts based on geocoded addresses from the birth
certificate differed from their census tracts based on geo-
coded addresses post-partum. We then defined residential
mobility patterns as follows. Women who did not change
neighborhoods post-partum were categorized as living in
low, moderate, and high SES neighborhoods. Women who
did change neighborhoods post-partum were categorized as
follows: (1) moved from one low SES neighborhood to
another low SES neighborhood (‘‘low–low’’), (2) moved
from one moderate SES neighborhood to another (‘‘mod-
erate–moderate’’), (3) moved from one high SES neigh-
borhood to another (‘‘high–high’’), (4) moved from a
neighborhood of moderate or high SES to a neighborhood
of low or moderate SES, respectively (‘‘moved to lower
SES’’), and (5) moved from a neighborhood of low or
moderate SES to a neighborhood of moderate or high SES,
respectively (‘‘moved to higher SES’’). Women who
changed neighborhoods post-partum represent those whose
neighborhood would potentially be assigned incorrectly if
researchers used the birth certificate address to assign
neighborhood. However, only women in the ‘‘moved to
lower SES’’ and ‘‘moved to higher SES’’ categories would
be misclassified in terms of post-partum neighborhood SES
using birth certificate address.
Maternal Characteristics
Maternal race/ethnicity/nativity was based on birth cer-
tificate data and was categorized into five mutually
exclusive groups: Asian/Pacific Islander, non-Hispanic
141
black, immigrant Hispanic, US-born Hispanic, and non-
Hispanic White. Additional maternal demographic char-
acteristics from the birth certificate included age (catego-
rized as 21 years or less, 22–34 years, and 35 years or
more) and parity (including the index birth, categorized as
1st birth, 2nd to 4th birth, or 5th birth or more). Maternal
socioeconomic variables from MIHA data included marital
status at delivery, the mother’s and her parents’ educational
attainment (categorized as less than high school, high
school/GED, some college, and college graduate), and
income during pregnancy (categorized in relation to the
respondent’s family size as \100 % of the federal poverty
level, 101–200 % of poverty, 201–300 %, 301–400 %, or
[400 % of poverty). Maternal parents’ educational
attainment was defined as the highest education level that
had been attained by either parent or main guardian when
the respondent was 13 years old. Income was defined as the
total before-tax annual family income from all sources.
Statistical Analysis
We calculated the proportion (and 95 % confidence inter-
val [CI]) of women who changed neighborhoods (i.e.,
‘‘residential mobility status’’) during the post-partum per-
iod, overall and by maternal characteristics. We used Rao–
Scott Chi square tests to assess differences in residential
mobility status by maternal characteristics. We then cal-
culated the proportion of women in each residential
mobility pattern category, overall and by maternal char-
acteristics. In addition to maternal characteristics, we also
assessed whether residential mobility status and patterns
differed by region of the state or year to determine whether
secular or geographic factors affect the probability of
misclassification.
Women typically completed the MIHA survey between
2 and 7 months post-partum, and we hypothesized that
women completing their surveys closer to the time of birth
would have had less time to move. We therefore conducted
an ancillary analysis comparing women who completed the
MIHA survey at \5 months post-partum (the median time
for completion) to those completing the survey at
C5 months post-partum. All analyses were weighted to
account for the stratified sample design of MIHA and
conducted using survey procedures in SAS software (ver-
sion 9.2, SAS Institute Inc.).
Results
Table 1 shows the racial/ethnic, demographic, and
socioeconomic characteristics of the sample. The MIHA
sample is racially and ethnically diverse with approxi-
mately 11 % Asian/Pacific Islander, 5 % non-Hispanic
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Table 1 Distribution of maternal characteristics in study sample; black, 33 % immigrant Hispanic, 19 % US born Hispanic,
Maternal and Infant Health Assessment, 2003–2007 (n = 16,312) and 32 % non-Hispanic White. Approximately one-fifth of
Total sample women were 21 years of age or younger and 17 % were
n (%) over 35 years. One-fifth of mothers had less than a high
school education, 28 % had a high school diploma or GED,
Total 16,312 (100)
26 % had some college education, and 26 % had a college
Age
diploma. A third of women had incomes below 100 %
21 years or younger 3127 (18.0)
FPL, and another 20 % had incomes between 100 and
22–34 years 10,553 (65.5)
200 % FPL.
35 years or older 2632 (16.5)
Table 2 shows residential mobility status overall and
Marital status
by maternal characteristics. Only about 14 % of women
Unmarried 6509 (37.0)
changed neighborhoods in the 2–7 months after delivery
Married 9694 (63.0)
(Table 2). There were significant differences (p \ 0.01) in
Race/ethnicity
the prevalence of moving by age, marital status, race/
Asian/Pacific Islander 1469 (10.5) ethnicity/nativity, parity, maternal education, parental
Non-Hispanic black 2366 (5.2) education, and income. For example, almost 20 % of
Hispanic, immigrant 4880 (33.2) women 21 years or younger changed neighborhoods post-
Hispanic, US-born 2838 (19.4) partum, compared to only 13 % of women 22–34 and
Non-Hispanic white 4472 (31.7) 9 % of women 35 and older. Almost 18 % of non-His-
Parity panic black women and almost 17 % of US-born Hispanic
First birth 6558 (40.0) women changed neighborhood compared to only 11 and
2–4 births 9041 (55.9) 13 % of Asian/Pacific Islander and non-Hispanic white
5 or more births 713 (4.1) women, respectively (Table 2). Changing neighborhoods
Maternal education was more common in 2006–2007 compared to 2003–2005
Less than high school 3445 (20.3) (Table 2); there were no significant differences by region
High school/GED 4442 (27.6) (data not shown).
Some college 4298 (26.0) Table 3 shows the residential mobility patterns of
College graduate 4038 (26.1) women overall and by maternal characteristics. Women
Parent’s education who moved are stratified by whether they moved to a
Less than high school 5037 (35.5) neighborhood of similar or different SES, and non-movers
High school/GED 3323 (21.9) are stratified by the SES category of the neighborhoods that
Some college 2842 (17.8) they lived in throughout the post-partum period. Almost
College graduate 3664 (24.9) 8 % of all women did change neighborhoods, but moved
Income between neighborhoods of similar SES. That is, 2 %
Missing 1511 (9.0) moved from one high SES neighborhood to another
0–100 % 5702 (33.6) (‘‘high–high’’), 4 % moved from one moderate SES
101–200 % 3268 (20.1) neighborhood to another (‘‘moderate–moderate’’), and 2 %
201–300 % 1418 (8.8) moved from one low SES neighborhood to another (‘‘low–
301–400 % 1066 (6.7) low’’) (Table 3). Only 7 % of all women moved to a
400 %? 3347 (21.7) neighborhood of different SES category during the post-
Year partum period: 3 % to neighborhoods of higher SES and
2003 3264 (20.3) 4 % to neighborhoods of lower SES (Table 3). Close to
2004 3146 (20.7)
one-quarter of all women lived in the same high SES
2005 3359 (21.5)
neighborhoods at both time points, 42 % lived in the same
2006 3471 (21.6)
moderate SES neighborhood, and 21 % lived in the same
low SES neighborhood (Table 3).
2007 3072 (15.8)
Residential mobility patterns also differed by race/eth-
All percentages weighted to account for the stratified sample design nicity, age, marital status, parity, maternal education, par-
of MIHA
ental education, and income. For example, over 9 % of
Missing or unknown observations not shown in Table 1 include 109
missing marital status, 287 with missing, unknown, or American
women 21 years or younger moved to a neighborhood of
Indian race/ethnicity, 89 missing maternal education, and 1446 either higher or lower SES compared to only about 4 % of
missing parental education women 35 or older. About 8 % of non-Hispanic black and

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Table 2 Post-partum residential mobility status overall and by maternal characteristics; Maternal and Infant Health Assessment, 2003–2007
(n = 16,312)
Changed neighborhood post-partum Did not change neighborhood post-partum p valuea
n (%) 95 % CI n (%) 95 % CI

Total 2317 (13.8) (13.2, 14.3) 13,995 (86.2) (85.7, 86.8) \0.01
Age
21 years or younger 631 (19.7) (18.2, 21.2) 2496 (80.3) (78.8, 81.8) \0.01
22–34 years 1440 (13.3) (12.6, 14.0) 9113 (86.7) (86.0, 87.4)
35 years or older 246 (9.0) (7.9, 10.2) 2386 (91.0) (89.8, 92.1)
Marital status
Unmarried 1109 (11.3) (10.6, 11.9) 8585 (88.7) (88.1, 89.4) \0.01
Married 1195 (18.1) (17.0, 19.1) 5314 (81.9) (80.9, 83.0)
Race/ethnicity
Asian/Pacific Islander 166 (11.2) (9.6, 12.8) 1303 (88.8) (87.2, 90.4) \0.01
Non-Hispanic black 429 (17.8) (16.1, 19.5) 1937 (82.2) (80.5, 83.9)
Hispanic, immigrant 654 (13.4) (12.5, 14.4) 4226 (86.6) (85.6, 87.5)
Hispanic, US-born 464 (16.5) (15.1, 17.9) 2374 (83.5) (82.1, 84.9)
Non-Hispanic white 567 (12.7) (11.7, 13.6) 3905 (87.3) (86.4, 88.3)
Parity
First birth 1052 (15.8) (14.9, 16.7) 5506 (84.2) (83.3, 85.1) \0.01
2–4 births 1171 (12.4) (11.7, 13.1) 7870 (87.6) (86.9, 88.3)
5 or more births 94 (13.0) (10.3, 15.7) 619 (87.0) (84.3, 89.7)
Maternal education
Less than high school 526 (15.0) (13.7, 16.2) 2919 (85.0) (83.8, 86.3) \0.01
High school/GED 715 (15.6) (14.4, 16.7) 3727 (84.4) (83.3, 85.6)
Some college 645 (14.4) (13.3, 15.5) 3653 (85.6) (84.5, 86.7)
College graduate 413 (10.1) (9.2, 11.1) 3625 (89.9) (88.9, 90.8)
Parent’s education
Less than high school 690 (13.5) (12.6, 14.5) 4347 (86.5) (85.5, 87.4) \0.01
High school/GED 561 (16.6) (15.3, 18.0) 2762 (83.4) (82.0, 84.7)
Some college 418 (14.2) (12.8, 15.6) 2424 (85.8) (84.4, 87.2)
College graduate 450 (11.4) (10.3, 12.5) 3214 (88.6) (87.5, 89.7)
Income
Missing 225 (14.7) (12.8, 16.6) 1286 (85.3) (83.4, 87.2) \0.01
0–100 % 993 (17.0) (16, 18.1) 4709 (83.0) (81.9, 84.0)
101–200 % 495 (14.8) (13.5, 16) 2773 (85.2) (84.0, 86.5)
201–300 % 176 (11.9) (10.2, 13.7) 1242 (88.1) (86.3, 89.8)
301–400 % 124 (11.4) (9.4, 13.4) 942 (88.6) (86.6, 90.6)
400 %? 304 (8.9) (7.9, 9.9) 3043 (91.1) (90.1, 92.1)
Year
2003 351 (10.3) (9.2, 11.4) 2913 (89.7) (88.6, 90.8) \0.01
2004 376 (11.8) (10.6, 12.9) 2770 (88.2) (87.1, 89.4)
2005 443 (13.1) (11.9, 14.3) 2916 (86.9) (85.7, 88.1)
2006 610 (17.1) (15.8, 18.5) 2861 (82.9) (81.5, 84.2)
2007 537 (17.2) (15.8, 18.6) 2535 (82.8) (81.4, 84.2)
All percentages weighted to account for the stratified sample design of MIHA
a
p value for Rao–Scott Chi square comparing mobility status by maternal characteristics

almost 9 % of US-born Hispanic women moved to a the 2006 and 2007 surveys were more likely to move to
neighborhood of different SES compared to approximately neighborhoods of lower SES (5.7 and 6.1 %, respectively)
4 % of Asian/Pacific Islanders (Table 3). Participants in compared to women in previous years (Table 3).

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Table 3 Post-partum residential mobility patterns overall and by maternal characteristics, Maternal and Infant Health Assessment, 2003–2007
(n = 16,312)
Changed neighborhood post-partum Did not change neighborhood post-partum
High– Moderate– Low–low Moved to a Moved to a Lived in Lived in Lived in
high SESa moderate SESa SESa higher SESa lower SESa high SESa moderate SESa low SESa
N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%)

Total 294 (1.9) 628 (3.7) 310 (1.8) 455 (2.7) 630 (3.6) 3535 (23.0) 6976 (42.1) 3484 (21.2)
Age
21 years or 16 (0.5) 187 (6.0) 124 (3.9) 134 (4.3) 170 (5.0) 211 (6.5) 1358 (42.8) 927 (30.9)
younger
22–34 years 209 (2.2) 390 (3.5) 166 (1.5) 278 (2.6) 397 (3.6) 2302 (23.0) 4629 (43.3) 2182 (20.4)
35 years or 69 (2.6) 51 (1.9) 20 (0.7) 43 (1.5) 63 (2.3) 1022 (40.7) 989 (36.4) 375 (13.9)
older
Marital status
Unmarried 57 (0.9) 344 (5.2) 219 (3.3) 241 (3.8) 334 (4.9) 570 (8.9) 2809 (42.6) 1935 (30.5)
Married 237 (2.6) 280 (2.8) 89 (0.9) 211 (2.1) 292 (2.9) 2949 (31.3) 4120 (41.8) 1516 (15.6)
Race/ethnicity
Asian/Pacific 53 (3.6) 40 (2.8) 7 (0.4) 32 (2.1) 34 (2.3) 657 (45.4) 548 (36.9) 98 (6.5)
Islander
Non- 23 (0.9) 132 (5.4) 73 (3.3) 85 (3.8) 116 (4.3) 289 (11.6) 1077 (45.6) 571 (25.0)
Hispanic
black
Hispanic, 30 (0.6) 184 (3.9) 136 (2.9) 114 (2.4) 190 (3.7) 343 (6.9) 2155 (43.5) 1728 (36.2)
immigrant
Hispanic, 23 (0.9) 124 (4.5) 74 (2.6) 101 (3.6) 142 (4.9) 318 (11.3) 1260 (43.9) 796 (28.2)
US-born
Non- 160 (3.6) 136 (3.0) 18 (0.4) 116 (2.6) 137 (3.1) 1818 (40.8) 1819 (40.5) 268 (6.1)
Hispanic
white
Parity
First birth 151 (2.5) 290 (4.4) 127 (1.8) 209 (3.1) 275 (4.0) 1625 (26.2) 2704 (40.3) 1177 (17.7)
2–4 births 139 (1.6) 312 (3.2) 168 (1.7) 230 (2.5) 322 (3.3) 1847 (21.6) 3982 (43.6) 2041 (22.5)
5 or more 4 (0.7) 26 (3.8) 15 (2.1) 16 (2.0) 33 (4.5) 63 (9.9) 290 (39.0) 266 (38.1)
births
Maternal education
Less than 17 (0.5) 143 (4.2) 115 (3.5) 98 (2.9) 153 (3.9) 220 (6.0) 1488 (42.4) 1211 (36.7)
high school
High school/ 39 (0.9) 220 (4.9) 122 (2.5) 138 (3.1) 196 (4.2) 388 (8.9) 2026 (45.4) 1313 (30.1)
GED
Some college 79 (2.0) 186 (3.9) 60 (1.2) 133 (3.0) 187 (4.3) 872 (21.7) 2046 (47.6) 735 (16.2)
College 158 (4.1) 74 (1.8) 9 (0.2) 82 (1.9) 90 (2.2) 2043 (52.6) 1385 (32.8) 197 (4.4)
graduate
Parent’s education
Less than 28 (0.6) 169 (3.5) 146 (2.9) 142 (2.8) 205 (3.7) 441 (8.7) 2236 (44.0) 1670 (33.7)
high school
High school/ 52 (1.8) 172 (5.1) 76 (1.9) 119 (3.6) 142 (4.2) 625 (20.4) 1486 (44.4) 651 (18.6)
GED
Some college 67 (2.6) 119 (3.8) 32 (0.9) 84 (2.8) 116 (4.1) 739 (28.6) 1309 (45.7) 376 (11.5)
College 135 (4.0) 107 (2.5) 21 (0.3) 73 (1.9) 114 (2.7) 1604 (47.2) 1320 (34.6) 290 (6.8)
graduate
Income
Missing 29 (2.0) 59 (4.0) 37 (2.4) 40 (2.7) 60 (3.6) 253 (16.9) 647 (42.3) 386 (26.1)
0–100 % 33 (0.6) 287 (4.9) 202 (3.5) 195 (3.4) 276 (4.5) 359 (6.4) 2403 (41.5) 1947 (35.1)
101–200 % 31 (1.0) 161 (4.7) 49 (1.4) 109 (3.2) 145 (4.4) 356 (11.2) 1631 (49.8) 786 (24.2)

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Table 3 continued
Changed neighborhood post-partum Did not change neighborhood post-partum
High–high Moderate– Low–low Moved to a Moved to a Lived in Lived in Lived in
SESa moderate SESa SESa higher SESa lower SESa high SESa moderate SESa low SESa
N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%)

201–300 % 24 (1.8) 54 (3.8) 13 (0.6) 35 (2.6) 50 (3.1) 301 (22.0) 736 (52.2) 205 (13.8)
301–400 % 25 (2.7) 29 (2.4) 4 (0.3) 28 (2.7) 38 (3.4) 365 (35.4) 503 (46.3) 74 (6.8)
400 %? 152 (4.6) 38 (1.1) 5 (0.1) 48 (1.3) 61 (1.8) 1901 (58.5) 1056 (30.3) 86 (2.3)
Year
2003 33 (1.1) 112 (3.3) 59 (1.6) 74 (2.0) 73 (2.3) 752 (25.2) 1425 (42.8) 736 (21.7)
2004 49 (1.7) 119 (3.6) 49 (1.5) 93 (2.9) 66 (2.1) 708 (23.3) 1370 (42.8) 692 (22.2)
2005 54 (1.7) 142 (4.1) 59 (1.7) 98 (3.0) 90 (2.5) 765 (23.3) 1445 (41.8) 706 (21.9)
2006 81 (2.5) 140 (3.9) 72 (2.0) 109 (3.1) 208 (5.7) 722 (21.6) 1458 (41.6) 681 (19.7)
2007 77 (2.9) 115 (3.4) 71 (2.1) 81 (2.7) 193 (6.1) 588 (21.4) 1278 (41.1) 669 (20.3)
All percentages weighted to account for the stratified sample design of MIHA
High–high SES = moved from a high SES tract at time of birth to a different high SES tract at post-partum survey
Moderate–moderate SES = moved from a moderate SES tract at time of birth to a different moderate SES tract at post-partum survey
Low–low SES = moved from a low SES tract at time of birth to a different low SES tract at post-partum survey
Moved to a lower SES = moved from a high or moderate SES tract at time of birth to a moderate or low SES tract at post-partum survey
Moved to a higher SES = moved from a low or moderate SES tract at time of birth to a high or moderate SES tract at post-partum survey
Lived in low SES = lived in a low SES neighborhood at birth and post-partum
Lived in moderate SES = lived in a moderate SES neighborhood at birth and post-partum
Lived in high SES = lived in a high SES neighborhood at birth and post-partum
a
SES index based on principal components analysis of percent blue collar, percent less than high school education, median family income,
median housing value, and percent unemployment: low B25th percentile, moderate = 50th–75th percentile, high C75th percentile

When we stratified the sample by date of survey com-
pletion (using the median value of 5 months as the cut-off),
we found that women completing the survey at C5 months
post-partum (n = 5119 or 32 %) were slightly younger and
more likely to be unmarried, non-Hispanic black or His-
panic, multiparous, or to have a high school education or
less, missing income, or income\200 % FPL, compared to
women completing the survey at \5 months post-partum
(Table 4). Compared to women completing the survey
\5 months post-partum, late survey completers were more
likely to have moved post-partum (19 vs. 11 %, p \ 0.01)
(Table 4). However, even among late survey completers,
relatively small proportions (approximately 4 %) moved to
neighborhoods of higher or lower SES (Table 4).
Discussion
This study sought to determine the extent to which using
women’s addresses from the birth certificate to characterize
their neighborhoods in the post-partum period might lead
to misclassification error. To do this, we examined the
percent of women moving to different neighborhoods in
the early post-partum period, whether women moved to
neighborhoods of higher, lower, or similar SES, and how
residential mobility patterns differed by maternal charac-
teristics. We found that approximately 94 % of women
either did not move to a different neighborhood (86 %) or
moved to a neighborhood of similar SES as their neigh-
borhood at the time of delivery (8 %). Higher proportions
of non-Hispanic black or US born Hispanic, young,
unmarried, primiparous and lower SES women moved to
neighborhoods of different SES post-partum (compared to
other women); however, these proportions were still
\10 %.
These findings imply that in a study using similar
methods to categorize neighborhood SES in the post-partum
period, only about 6 % of all women and less than 10 % of
women in any race/ethnic or socioeconomic category would
be potentially misclassified by using the birth certificate
address. We therefore conclude that it is reasonable to use
geocoded addresses from birth certificates to estimate
women’s neighborhood SES during the early post-partum
period, an especially relevant finding for researchers using
birth certificate data alone or linked with post-partum sur-
veys such as MIHA or PRAMS. We caution, however, that
potential for differential misclassification and subsequent
bias may still exist when using neighborhood at delivery as
a proxy for post-partum neighborhood, if the outcome of
interest also differs by maternal race/ethnicity or

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Table 4 Comparison of maternal characteristics, mobility status, and mobility patterns between women completing MIHA survey \5 versus
C5 months post-partum
Completed survey \5 months Completed survey C5 months p valuea
post-partum post-partum
N (%) N (%)

Total 10,464 (67.9) 5119 (32.1) \0.01

Age \0.01
21 years or younger 1919 (17.2) 1036 (18.9)
22–34 years 6795 (65.6) 3303 (65.6)
35 years or older 1750 (17.2) 780 (15.5)
Marital status \0.01
Unmarried 3981 (35.3) 2191 (39.8)
Married 6393 (64.7) 2919 (60.2)
Race/ethnicity \0.01
Asian/Pacific Islander 1026 (11.4) 396 (9.2)
Non-Hispanic black 1395 (4.8) 863 (6.2)
Hispanic, immigrant 2707 (28.4) 1835 (40.5)
Hispanic, US-born 1773 (18.6) 951 (21.4)
Non-Hispanic white 3370 (36.8) 989 (22.8)
Parity \0.01
First birth 4429 (42.3) 1862 (35.8)
2–4 births 5628 (54.2) 2992 (59.2)
5 or more births 407 (3.6) 265 (5.0)
Maternal education \0.01
Less than high school 1888 (16.8) 1326 (25.9)
High school/GED 2511 (24.7) 1679 (32.8)
Some college 3002 (28.4) 1163 (22.3)
College graduate 2992 (30.2) 941 (19.0)
Parent’s education \0.01
Less than high school 3153 (33) 1578 (38.8)
High school/GED 2058 (20.6) 1132 (25.2)
Some college 2130 (20.2) 622 (13.0)
College graduate 2544 (26.2) 1019 (23.1)
Income \0.01
Missing 733 (6.9) 685 (13)
0–100 % 3462 (31.2) 1905 (37.0)
101–200 % 2053 (19.8) 1061 (20.7)
201–300 % 940 (9.2) 429 (8.3)
301–400 % 765 (7.5) 280 (5.5)
400 %? 2511 (25.4) 759 (15.5)
Changed neighborhood post-partum
Yes 1187 (11.1) 1028 (19.4) \0.01
No 9277 (88.9) 4091 (80.6)
Post-partum mobility pattern \0.01
Changed neighborhood
High–high SES 159 (1.6) 123 (2.6)
Moderate–moderate SES 305 (2.8) 298 (5.7)
Low–low SES 147 (1.3) 143 (2.7)
Moved to a higher SES 223 (2.1) 212 (4.0)
Moved to a lower SES 353 (3.3) 252 (4.3)

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Table 4 continued
Completed survey \5 months
post-partum
N (%)
Did not change neighborhood
Stayed in high SES 2597 (26.2)
Stayed in moderate SES 4574 (43.0)
Lived in low SES 2106 (19.6)
All percentages weighted to account for the stratified sample design of MIHA
a
p value for Rao–Scott Chi square comparing those completing survey at \5 versus C5 months post-partum
sociodemographic characteristics. The only other study we
identified that examined neighborhood SES mobility pat-
terns among women in the US reported that approximately
one-quarter of women moved to neighborhoods of different
SES in the entire perinatal period (pregnancy and post-
partum). Those authors found that downward neighborhood
mobility was more common for non-White women with
lower SES, whereas upward neighborhood mobility was
more likely among white, higher SES mothers [10]. In
contrast, our study—covering the post-partum period
only—found that non-white, lower SES women were more
likely to move to neighborhoods of either higher or lower
SES compared to their neighborhood at the time of delivery.
Differences in the study populations may explain these
inconsistent findings; the MIHA sample was younger, less
well-educated, and included fewer non-Hispanic white
women; in particular, 33 % of MIHA women were Hispanic
immigrants, and these women may have different residen-
tial mobility patterns than non-White women in the previ-
ous study. In addition, the previous study assessed
neighborhood SES using quintiles of multiple dimensions
of SES such as % poor, % renter occupied, etc. whereas
we categorized neighborhoods as high, moderate, or low
SES using an index measure. Prior work has also reported
that 12–30 % of women move during pregnancy [5–7], with
younger, minority, and lower SES women more likely to
move [5].
Strengths of the current study include that MIHA data
provide a much larger and more diverse sample than has
previously been used to examine residential mobility pat-
terns in the US. MIHA is a population-based sample of
women delivering infants in a state that contains one-eighth
of all births nationwide. The MIHA sample is ethnically
diverse and includes large numbers of both native-born and
immigrant Hispanics, in addition to other groups. More-
over, the rate of geocoding accurately to census tracts with
street addresses was very high at 93 %. Our study also
makes a unique contribution to the literature in that it
focuses solely on the post-partum period, whereas previous
studies have assessed residential mobility during pregnancy
and post-partum combined [7, 10].
147
Completed survey C5 months p valuea
post-partum
N (%)
830 (17.1)
2081 (39.9)
1180 (23.6)
A limitation of the current study is that approximately
11 % of the original MIHA sample was excluded due to
lack of a post-partum address or inability to accurately
geocode; if these women were more likely to have moved
in the post-partum period, our findings may have under-
estimated the total percent of women changing neighbor-
hoods and/or the percent moving to neighborhoods of
higher or lower SES. In addition, seasonality of moving
may have influenced our findings, as MIHA surveys are
completed annually between May and January, and data
show that people are more likely to move during the
summer months [14]. Although we did find evidence that
higher proportions of women completing the MIHA survey
at C5 months post-partum moved compared to those
completing the survey earlier, we still found low propor-
tions (approximately 4 %) of women in this group moving
to neighborhoods of higher or lower SES, suggesting that
longer intervals between delivery and post-partum survey
do not substantially increase potential for misclassification
of neighborhood SES.
There are also many other characteristics of neigh-
borhoods (e.g. racial/ethnic segregation, social capital,
and the physical and built environment) that are important
for perinatal health other than the SES characteristics
included in our measures, and researchers may use other
methods to measure neighborhood SES (e.g., percent
poor, median income, or other indices) or other geo-
graphic units of analysis (e.g., block group). Our estimate
that only 6–10 % of women would be misclassified when
using birth certificate addresses to assess post-partum
neighborhood socioeconomic environment may only be
relevant if researchers use similar methods to ours to
categorize neighborhood SES or if the neighborhood
exposure of interest is highly correlated with our measure
of SES (e.g., air pollution, crime, segregation are likely
correlated with an SES index). Women may move to
neighborhoods that are similar with respect to SES but
differ on other characteristics; future work should also
assess this. We also note that the potential for differential
misclassification increased in the last 2 years of our sur-
vey; we hypothesize that this change may have been
123
148
driven by slightly higher proportions of US born Hispanic
participants in these years (21 % in 2006 and 2007
compared to 18–19 % in previous years); there were no
significant differences across years in age, educational
attainment, or parity. These differences by year may also
reflect a secular trend towards increased residential
mobility in the population.
Although beyond the scope of this study, residential
mobility—regardless of whether women change neigh-
borhood—represents an important life stressor that should
be considered when assessing women’s health and expe-
riences during both pregnancy and post-partum. Unfortu-
nately, few sources of data on large, representative samples
of women collect detailed residential histories during
pregnancy and in the post-partum period. Approximately
30 % of women self-reported moving during pregnancy on
the MIHA surveys from 2003 to 2007; however, we do not
have information on the location of these moves. As
interest continues to grow in assessing the impacts on
health of neighborhood factors or other spatially-oriented
exposures, more detailed information on residential
mobility patterns should be collected. Future work using
the MIHA data could also examine the associations
between residential mobility in the post-partum period and
maternal and infant health outcomes.
In summary, we found that less than 20 % of all
women moved to different neighborhoods during the early
post-partum period, and among those who did, the
majority moved to a neighborhood with similar SES
characteristics to their neighborhood at the time of
delivery. Less than 7 % of the total sample moved to a
neighborhood with a higher or lower SES compared with
their previous neighborhood. This study suggests that
using addresses from the time of delivery linked with
information from external sources (e.g., the Census) are
reasonably adequate for reflecting neighborhood socioe-
conomic exposure during the early post-partum period.
These findings are particularly relevant for maternal and
child health researchers interested in examining the
associations between neighborhood SES and maternal and
infant health outcomes from post-partum surveys that are
linked to the birth certificate, such as PRAMS and MIHA,
which are now cover nearly 90 % of the US delivery
population.
Acknowledgments This work was supported by a grant from the
American Cancer Society (RSGT-11-010-01-CPPB) to C. Cubbin.
123
Matern Child Health J (2016) 20:139–148
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