Authors: Meghan Etsey, Rhea Manohar, MPH; Dr. Ariela L. Marshall, MD on behalf on AMWA’s Gender Equity Task Force

If You Give a Mother No Choice

If you give a mother no choice,
she’ll give her child the last meal in the house.

If she gives her child the last meal in the house,
she’ll skip dinner again that night.

If she skips dinner again that night,
she’ll wake up dizzy but still pack lunches.

If she wakes up dizzy but still packs lunches,
she’ll send her children to school with a smile,
and a stomach that’s empty but a heart that’s full.

When the Supplemental Nutrition Assistance Program (SNAP) falters, it is not only an economic issue, but also a public health emergency. SNAP is the largest federal nutrition assistance program in the United States, serving more than 41 million people (U.S. Department of Agriculture [USDA], 2024). Nearly two-thirds of SNAP participants live in families with children under 18 years old (Center on Budget and Policy Priorities [CBPP], 2023). When funding is delayed or reduced, the burden of food insecurity does not fall equally. Women, especially single mothers, are left to absorb the impact.

If you give a mother no choice,
she’ll ration groceries instead of resting.
She’ll cut her prescriptions in half to buy milk.
She’ll stretch the week’s worth of food into two.
She’ll tell her kids, “I’m not hungry,” even though she is, but their hunger hurts more.

The intersection of gender and poverty magnifies these vulnerabilities. Women are overrepresented in low-wage and part-time employment, leaving them especially exposed to economic shocks. The U.S. Census Bureau (2024) reported that over 23% of households led by single mothers experienced food insecurity in the past year, compared to just 7.7% in two-parent or other family structures. For these families, SNAP is not supplemental, it is essential.

Food insecurity is a measurable determinant of health. Malnutrition worsens chronic disease outcomes, undermines immune function, and increases rates of anemia, hypertension, and diabetes (Seligman & Berkowitz, 2019). In children, inconsistent access to nutrition correlates with developmental delays, behavioral issues, and impaired academic performance. These intergenerational effects accumulate over time, creating  health inequities.

If you give a mother no choice,
you’ll see it in the waiting room.
You’ll see it when her blood pressure rises,
when her glucose levels fall,
when she hesitates to refill her medication.
You’ll see it in the child who can’t focus,
in the teenager who faints at practice,
in the elder who divides her insulin dose to make it last the month.

When SNAP funding is halted, the strain on the healthcare system becomes visible. Physicians will see higher rates of hospitalizations for preventable conditions, medication nonadherence due to competing financial priorities, and emergency visits tied to nutrition-sensitive conditions. This is seen in a longitudinal study showing that a $100 increase in monthly SNAP benefits was linked with nearly 800 fewer asthma-related ED visits per 100,000 children; suggesting that strong food assistance is seen with fewer acute health crises in children (Heflin, 2019).

If you give a mother no choice,
you are not saving tax dollars, you are shifting costs to mothers, children, and the healthcare system.
Every skipped meal becomes a clinical consequence.
Every delayed refill becomes a preventable admission.

At its core, the SNAP debate is a question of whether nutrition is treated as a commodity or as a fundamental component of health. Clinicians are uniquely positioned to witness the downstream consequences of policy decisions. When a mother skips her medication to afford groceries, when a child’s asthma worsens because of undernutrition, or when a diabetic patient cannot maintain a consistent diet to stabilize blood glucose, these are not isolated choices, they are systemic failures.  For these reasons, the American Academy of Family Physicians and the American Academy of Pediatrics both recommend routine screening for food insecurity as part of comprehensive care (AAP, 2022).

Physicians can act within their scope: screen for food insecurity, connect patients to community resources, and advocate for nutrition-supportive policies. Advocacy grounded in evidence and clinical experience strengthens the argument that nutrition stability underpins all aspects of health.

Protecting and expanding SNAP is not charity, it is evidence-based medicine. Nutrition determines outcomes, from maternal mortality to chronic disease control. When safety-net programs fail, women, children, and marginalized communities suffer first and longest.

If you give a mother no choice,
she’ll still choose her children.
Every time.
But it should never cost her her health to do so.

References:

  1. American Academy of Pediatrics. (2022). Pediatricians and food insecurity: Policy statement. https://www.aap.org
  2. Center on Budget and Policy Priorities. (2023). Policy basics: The Supplemental Nutrition Assistance Program (SNAP).https://www.cbpp.org
  3. Heflin, C. (2019, June). Food Assistance may help families prevent emergency department visits for child asthma. Maxwell School. https://www.maxwell.syr.edu/research/lerner-center/population-health-research-brief-series/article/food-assistance-may-help-families-prevent-emergency-department-visits-for-child-asthma
  4. Seligman, H. K., & Berkowitz, S. A. (2019). Aligning programs and policies to support food security and public health goals in the United States. Annual Review of Public Health, 40, 319–337. https://doi.org/10.1146/annurev-publhealth-040218-044132
  5. U.S. Census Bureau. (2024). Income and poverty in the United States: 2023. https://www.census.gov
  6. U.S. Department of Agriculture. (2024). SNAP data and participation tables. https://www.fns.usda.gov/snap

Authors:

Meghan Etsey, MS4

Meghan Etsey is a fourth year medical student from St. George’s University. She has a Bachelors of Arts in Biology and a Bachelors of Arts in Nutrition and Dietetics from Bluffton University in Bluffton, Ohio. She served as the President of the St. George’s University’s Women in Medicine chapter in St. George, Grenada where she expanded relationships with the community and worked towards educating women and helping the youth. She is also a member of the Gender Equity Task Force and Sex and Gender Health Collaborative Committees within the American Medical Women’s Association. When she is not pursuing medicine, you can find her with her friends and family on different road trips and adventures exploring the world.

Rhea Manohar, MPH, MS3

Rhea Manohar is a third year medical student from St. George’s University. She has a Masters in Public Health with a concentration in Maternal and Child Health from George Washington University Milken Institute of Public Health and a Bachelors of Science in Microbiology, Immunology, and Public Health from the University of Miami. She served as Co-VP of OB/GYN Education for St. George’s University’s Women in Medicine chapter in St. George, Grenada where she developed and implemented hands-on workshops to further reproductive health issues and bolstered medical students abilities to navigate physician-patient communication. Prior to medical school, she was a Research Associate for Fors Marsh Group, where she led qualitative and quantitative public health research and campaign development for federal agencies (e.g., CDC, NIH, DHHS, CPSC). She is also a member of the Gender Equity Task Force and Reproductive Health Coalition within the American Medical Women’s Association. When she is not pursuing medicine, you can find her reading, exploring artistic passions, and spending time connecting with friends and family.

Dr. Ariela L. Marshall, MD

Dr. Ariela Marshall is a Harvard-trained physician and an internationally renowned advocate, career development advisor, and mentor. Dr. Marshall specializes in bleeding and clotting disorders, especially as they relate to women’s health. She has worked at Mayo Clinic and the University of Pennsylvania and currently practices part-time as a consultative hematologist at the University of Minnesota. In addition to her clinical work, Dr. Marshall is a highly respected leader, mentor, and speaker. She is an active leader with the American Society of Hematology (where she led efforts to found the Women in Hematology Working Group and currently holds seats on the Women in Heme Working Group, Committee on Communications and Media Experts Subcommittee) and American Medical Women’s Association (leading the Infertility Working Group and holding seats on the Gender Equity Task Force). She is the Chief Innovation Officer at Women in Medicine and the Curriculum Chair at IGNITEMed, which are both 501(c)(3) nonprofit organizations dedicated to promoting career development for women in medicine. She speaks regularly on a national and international scope to discuss her efforts to advance career development and mentorship for physicians, gender equity, fertility/infertility awareness, parental health and wellbeing, reproductive health and rights, and work-life integration.