New York City, NY – Nov 07, 2023 – A recent study reveals that many new mothers, particularly those relying on Medicaid, encounter substantial difficulties in obtaining healthcare and social support during the year following childbirth.
The research underscores a critical but often overlooked period of maternal healthcare risk, as it is during the postpartum phase that mothers face the highest risk of morbidity and mortality, according to study lead author Jamie Daw, an assistant professor of health policy and management at Columbia University’s Mailman School of Public Health.
“Most people think of labor and birth as the most dangerous part of pregnancy, but the highest risk time for maternal morbidity and mortality is actually after the baby is born,” Daw emphasized. “Yet, the postpartum period has long been overlooked, and we understand very little about, and have taken very little action to address the social and medical needs of mothers after birth.”
In an effort to enhance postpartum healthcare, 37 states and Washington, D.C., have embraced a federal option to extend Medicaid eligibility up to one year after childbirth. This initiative aims to enhance access to healthcare services and ultimately improve overall health outcomes, especially for Medicaid beneficiaries, who represent a substantial proportion of births among marginalized populations.
“Pregnancy Medicaid typically ends 60 days after birth. By providing public health insurance through to one year postpartum, states hope to improve access to health care services that will translate to better health,” explained senior study author Heidi Allen, an associate professor of social work at Columbia.
To identify the specific needs of new mothers, Allen’s team initiated the first multi-state survey on postpartum health in the United States, collecting data from January 2021 to March 2022 in six states and New York City. The survey encompassed various aspects of postpartum well-being, including health insurance, healthcare access, quality, and utilization, health outcomes, substance use, and social needs.
The research findings, published in the journal Health Affairs on November 6, were presented separately for individuals with Medicaid and those with private insurance at the time of giving birth to better address the unique requirements of each group.
The study revealed that around 20 percent of mothers, regardless of insurance type, reported delaying or forgoing necessary care within the year following childbirth.
However, Medicaid beneficiaries were less likely to have a consistent source of care and reported significantly lower healthcare utilization throughout the postpartum year compared to those with private health insurance.
Shockingly, one in four Medicaid beneficiaries reported no healthcare utilization whatsoever in the year following childbirth.
Mental health concerns were also prominently highlighted, as approximately 12 percent of Medicaid beneficiaries reported depression symptoms, while roughly 14 percent displayed symptoms of anxiety one year postpartum. These figures underscore the urgency of expanding access to mental health services for new mothers.
The research further revealed that food insufficiency, intimate partner violence, and financial strain were notably more prevalent among the Medicaid population. Among Medicaid beneficiaries, 20 percent reported insufficient food to feed their families, 57 percent experienced financial difficulties, and 7 percent reported intimate partner violence since giving birth.
In response to these findings, Daw emphasized the need for comprehensive interventions that go beyond healthcare access. She highlighted the importance of addressing social determinants of health, including food insecurity, housing instability, poverty, and intimate partner violence, for families with young children.
To address these disparities, the researchers recommended that states leverage Medicaid’s flexibilities and establish connections with other social services.
“Policymakers are actively working to improve maternal health in the U.S.,” Daw stated. “Our findings emphasize that translating policies such as postpartum Medicaid extensions into improved postpartum health will require states to improve the uptake and availability of services to address social determinants of health, including food insecurity, housing instability, poverty, and intimate partner violence for families with young children.”
