About one in five new mothers say they’ve delayed or forgone needed healthcare within the first year after giving birth — which is the riskiest period for maternal health — according to new research published today in the journal Health Affairs.
That pattern was relatively consistent regardless of whether the new moms had commercial insurance or Medicaid, according to the study by researchers at Columbia University and Cornell University. Compared with people with commercial insurance, however, people on Medicaid were less likely to have a usual source of care and made significantly less use of primary, specialty and dental care in the postpartum year, the study found.
The study — the first large-scale, representative survey of postpartum health ever conducted in the U.S., according to Columbia’s Mailman School of Public Health — comes amid growing concern about pregnancy-related deaths. About 33 women died of maternal causes for every 100,000 live births in the U.S. in 2021, up from about 20 per 100,000 in 2019, according to the Centers for Disease Control and Prevention.
“The postpartum period has been really overlooked,” said Jamie Daw, an assistant professor of health policy and management at Columbia’s Mailman School and the lead author of the study. Yet more than half of pregnancy-related deaths between 2011 and 2015 occurred during the year after giving birth, and nearly two-thirds of those deaths would have been preventable with proper medical intervention, according to CDC research. Major health concerns during that period include heart conditions, mental health and substance use, Daw said.
Medicaid plays a critical role in maternal health, covering about 40% of births in the U.S., but under federal law, states are only required to provide pregnancy-related Medicaid coverage for 60 days after the birth. Thirty-nine states and Washington, D.C., have taken advantage of a new option under the American Rescue Plan Act of 2021 to extend Medicaid coverage for new mothers to 12 months after giving birth, according to KFF, a health-policy research nonprofit.
But Medicaid coverage alone isn’t enough to ensure maternal health, according to the new Health Affairs study, which is based on a survey conducted between early 2021 and spring 2022 of new mothers in six states — Kansas, Michigan, New Jersey, Pennsylvania, Virginia and Utah — and in New York City.
Compared with new mothers with commercial health coverage, new mothers on Medicaid were nearly twice as likely to report not having a usual source of care, such as a primary-care doctor, and to not fill prescriptions or take medications as prescribed because of the cost, the study found. People on Medicaid were also less likely to have a postpartum doctor visit or to see a lactation consultant and were more likely to report an emergency-room visit, according to the study.
People surveyed often skipped needed care during the postpartum year because they didn’t have child care or leave from work or school, Daw said.
While commercially insured patients in the survey fared better than those on Medicaid, their level of care was far from ideal, Daw said. Only 56% of people with commercial insurance, for example, had a primary-care visit in the year after giving birth. That’s higher than the 46% of people on Medicaid who had a primary-care visit in that year, but “you’d hope that everybody would get a well-woman visit,” Daw said. Similarly, only 52% of the commercially insured patients and 25% of people on Medicaid had any dental care in the year after giving birth.
Many people seem to get lost in the transition away from prenatal care, Daw said. Even for people who get lots of prenatal care and are well-connected to an ob-gyn, she said, “there’s not a good transfer after birth to other primary-care providers. You have a postpartum visit, and it ends, and people get lost in reconnecting to the healthcare system.”
In addition to extending health coverage in the postpartum year, states need to focus on connecting new mothers with social services to address needs that can affect their health, Daw said. More than 20% of the Medicaid recipients surveyed, for example, reported food insecurity, compared with 5% of the commercially insured.
Because of the survey’s timing, the results don’t reflect the impact of increased state abortion restrictions that have followed the U.S. Supreme Court’s 2022 decision overturning the constitutional right to abortion. The researchers will be looking at those effects when they repeat the survey to follow 2024 births, Daw said.
