Maternal Mortality Occurs More Often After Pregnancy and Labor Are Over

Maternal mortality in the U.S. is on the rise and more than half of maternal deaths occur in the postpartum year. A study by researchers at Columbia University Mailman School of Public Health and the Columbia School of Social Work provides insights into the challenges that birthing people face in the year after birth — both medical and social — which could be drivers of postpartum morbidity and mortality.

“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 lead author Jamie Daw, an assistant professor of health policy and management. “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.”

Approximately one in five mothers reported delaying or forgoing needed care in the postpartum year regardless of insurance type. Compared with respondents who had commercial insurance, Medicaid respondents were less likely to have a usual source of care and reported substantially less use of primary, specialty, and dental care in the postpartum year. One in four Medicaid beneficiaries reported no healthcare use at all in the year after birth. With approximately 12 percent of Medicaid beneficiaries reporting depression symptoms and about 14 percent having anxiety symptoms at one year postpartum, the researchers point to the need for focusing on efforts to expand access to the availability of mental and behavioral health care.

The study also found that many social needs — which can affect health and well-being after birth — such as food insecurity, intimate partner violence, and financial strain were significantly higher in 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 healthcare to address beneficiaries’ social needs which are likely contributing to poor maternal health outcomes and disparities,” observed Dr. Daw.

Dr. Daw is a graduate of McMaster University in Hamilton, Ontario. She holds a master’s degree from the University of British Columbia and a Ph.D. from Harvard University.

The full study, The Health And Social Needs Of Medicaid Beneficiaries In The Postpartum Year: Evidence From A Multistate Survey, was published in the journal Health Affairs. It may be accessed here.