Black, Hispanic and indigenous women are more likely than white women to have disruptions in health insurance coverage around the time of pregnancy, according to a study published in Obstetrics & Gynecology.
“Racial and ethnic disparities in maternal and child health outcomes are a national public health crisis,” Lindsay Admon, MD, MSc, an assistant professor of Obstetrics and Gynecology at the University of Michigan Medical School, said in a press release.
Just last year, a CDC Vital Signs report identified significantly higher rates of maternal mortality among black and indigenous women compared with those of white women.
“Throughout the most critical periods of pregnancy, we identified wide racial-ethnic disparities related to women’s ability to access to preconception, prenatal, and postpartum care,” Admon said.
Reference: Daw JR, et al. Obstet Gynecol. 2020;doi:10.1097/AOG.0000000000003728.
Admon and colleagues analyzed cross-sectional survey data from women across 40 states who participated in the CDC’s Pregnancy Risk Assessment and Monitoring System between 2015 and 2017. Data from the 107,921 women assessed in the study were collected through mail and telephone surveys and included information on insurance status, demographic characteristics, health care use and health outcomes before, during and after pregnancy.
The researchers also calculated unadjusted estimates for women’s insurance status in preconception, delivery and postpartum periods and compared these estimates among seven racial and ethnic groups. They used linear regression models to determine the probability of not being insured by race/ethnicity and income.
Compared with white women, researchers found that minority women in all groups had higher rates of uninsurance before, after and during pregnancy.
They determined that 75.3% (95% CI, 74.7-75.8) of white women had continuous insurance coverage from preconception to postpartum. Meanwhile, the prevalence of continuous insurance coverage was 55.4% in black women (95% CI, 54.2-56.6), 49.9% among indigenous women (95% CI, 46.8-53) and 20.5% among Hispanic Spanish-speaking women (95% CI, 18.9-22.2).
In an adjusted analysis based on women’s household income, researchers found that compared with white women, Hispanic and indigenous women had a higher predicted probability of being uninsured before conception and after birth.
The researchers explained that expanding Medicaid coverage from 60 days to 1 year after birth would help to address the high rates of uninsurance after pregnancy among minority women.
“Medicaid stability before and after pregnancy is critical for ensuring continuity of coverage and access to care for women of color,” Jamie Daw, PhD, a researcher in the department of health policy and management at Columbia University, said in the release. “Extending pregnancy Medicaid to 1 year after birth is likely to reduce racial disparities in insurance disruptions and, ultimately, disparities in postpartum health.” – by Erin Michael
Disclosures: Admon and Daw report no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.
