Many New Moms Can’t Access Good Health Care, Report Finds

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Many new moms, particularly those on Medicaid, struggle to get health care and social support in the year following their baby’s birth, new research reveals.

“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,” said study first author Jamie Daw, an assistant professor of health policy and management at Columbia University’s Mailman School of Public Health, in New York City. “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 improve postpartum health, 37 states and Washington, D.C., have adopted a new federal option to extend pregnancy Medicaid eligibility to one year postpartum, the researchers noted. Medicaid covers almost half of all U.S. pregnancies and an even larger portion of births among Black, rural and low-income women.

“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 that will translate to better health,” explained senior study author Heidi Allen, an associate professor of social work at Columbia.

To figure out what services new moms need, Allen’s team launched the first multi-state survey on postpartum health in the year after birth in the United States. Data was collected from January 2021 to March 2022 in six states and New York City. The researchers measured responses related to postpartum well-being, including health insurance; health care access, quality and use; health outcomes; substance use; and social needs.

The findings, published Nov. 6 in the journal Health Affairs, were reported separately for people with Medicaid and for those who had private insurance when they gave birth. That was done to better understand the unique needs of each group.

Approximately 1 in 5 mothers reported delaying or forgoing needed care a year after childbirth, regardless of insurance type.

And when compared with those who had private health insurance, Medicaid respondents were less likely to have a usual source of care and reported substantially less use of all health care during the postpartum year.

Meanwhile, 1 in 4 Medicaid beneficiaries reported no health care use at all in the year following a birth.

With approximately 12 percent of Medicaid beneficiaries reporting depression symptoms and roughly 14 percent having anxiety symptoms at one year postpartum, the researchers said efforts must be made to expand access to mental health care.

The study also found that a lack of adequate food, intimate partner violence and financial strain were significantly higher among the Medicaid population.

Among Medicaid beneficiaries, 20 percent reported not having enough food to feed their family, 57 percent reported financial strain and 7 percent reported experiencing intimate partner violence since giving birth.

“Our results clearly show there are significant gaps in postpartum health care access, particularly for mental health services and for mothers with Medicaid coverage. It is also clear that policymakers need to intervene beyond health care to address beneficiaries’ social needs, which are likely contributing to poor maternal health outcomes and disparities,” Daw said in a Columbia news release.

To address the disparities, the researchers suggested that states should leverage Medicaid’s flexibilities and connections with other social services.

“Policymakers are actively working to improve maternal health in the U.S.,” Daw said. “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.”

More information

Visit the American College of Obstetricians and Gynecologists for more on postpartum health care.

SOURCE: Columbia University Mailman School of Public Health, news release, Nov. 6, 2023

Source: HealthDay

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