Though they are at a higher risk of childbirth complications and pregnancy-related death, women who are black, Hispanic or indigenous are less likely than white women to be insured, new research shows.
The study revealed that almost half of black, Hispanic and indigenous women had disruptions in insurance coverage between preconception and post-delivery compared to about one-quarter of white women. Nearly one in 10 Spanish-speaking Hispanic women weren’t insured at all during this period.
For the study, the researchers analyzed data collected on nearly 108,000 women in 40 states between 2015 and 2017. Insurance status was recorded the month before conception, at delivery and 60 days after delivery.
“Racial and ethnic disparities in maternal and child health outcomes are a national public health crisis,” said senior author Dr. Lindsay Admon, an obstetrician-gynecologist at Von Voigtlander Women’s Hospital in Ann Arbor, Mich.
Black and indigenous women in the United States are two to four times more likely to die from pregnancy-related causes than white women, the study authors noted in a University of Michigan news release.
“Throughout the most critical periods of pregnancy, we identified wide racial/ethnic disparities related to women’s ability to access preconception, prenatal and postpartum care,” Admon said, pointing out that insurance coverage is a key prerequisite for getting care.
The investigators also found that roughly half of the black women in the study had household incomes below the federal poverty level. Though that meant they were eligible for Medicaid, pregnancy-related coverage stops 60 days after the baby is born.
“Medicaid stability before and after pregnancy is critical for ensuring continuity of coverage and access to care for women of color,” said lead author Jamie Daw, an assistant professor of health policy and management at Columbia University in New York City. “Extending pregnancy Medicaid to one year after birth is likely to reduce racial disparities in insurance disruptions and, ultimately, disparities in postpartum health.”
Improving coverage before conception could also identify underlying health issues, according to Admon.
“We know that complications associated with preexisting conditions, chronic conditions such as heart disease, high blood pressure and substance use, are among the leading causes of maternal morbidity and mortality,” she said. “It’s important for women to have quality health coverage and care to manage these conditions to have the best chance of a healthy pregnancy.”
The study was recently published online in the journal Obstetrics & Gynecology.
The World Health Organization has more on maternal mortality.