Racial Justice after Childbirth: Policy to Improve Postpartum Health Care Access and Quality

Over the past two decades, maternal mortality has increased more than 25 percent in the US, perpetuating long-standing racial inequities. Black and Indigenous people have a 3–4 times greater risk of maternal mortality compared with white people. Rural residents and Medicaid beneficiaries are also at increased risk of maternal morbidity and mortality, and pregnant people with multiple marginalized racial, geographic, or socioeconomic identities may be at highest risk. Recent increases in maternal mortality may be driven partly by a growing proportion of maternal deaths occurring postpartum. From 2011 to 2015, approximately half of pregnancy-related deaths occurred after childbirth. Few studies have examined postpartum care comprehensively; fewer still have taken an antiracist lens to examine intersectional identities and risk in postpartum health.  

Health insurance is crucial for ensuring access to care before, during, and after pregnancy, and expansion of Medicaid eligibility among low-income adults has been associated with decreases in maternal mortality. Medicaid finances almost half of all births nationally and more than half of births for Black, Indigenous, and Latinx people and rural residents. However, pregnancy-related Medicaid eligibility typically ends after 60 days postpartum, resulting in high rates of postpartum uninsurance. Postpartum Medicaid eligibility extensions beyond 60 days postpartum have been proposed as a central strategy for mitigating adverse health outcomes in the year after birth. Yet understanding the current context of postpartum care and health and the role of state Medicaid policies (including the degree of inclusivity toward immigrant populations and Medicaid’s interplay with Indian Health Services) are essential in understanding the potential health equity impacts of Medicaid eligibility extensions.  

This study will undertake the following: 

• use national survey data to describe receipt of postpartum care components and outcomes for English-speaking and Spanish-speaking Latine patients and for Indigenous patients and by co-occurring intersectional identities (e.g., geography, health insurance) 

• model potential health equity impacts of maternal health policies, focusing on Medicaid inclusivity toward immigrant populations and the interplay of Indian Health Services with Medicaid