Pregnancy-related complications increased 9% between 2018 and 2020, with women of color especially at risk, a new report shows. The complications are regardless of having commercial health insurance or Medicaid.
The increase is likely due to more women experiencing chronic conditions amid Covid-19, the study said.
The Blue Cross Blue Shield (BCBS) report analyzed the rate of childbirth complications in about 11 million U.S. births for women with commercial insurance or Medicaid. The childbirth complications were measured based on the Centers for Disease Control and Prevention’s Severe Maternal Morbidity (SMM) measure.
While SMM rates rose 9% between 2018 and 2020 for all women with commercial insurance or Medicaid, the rate of change was different when broken down by race:
- Black women with either commercial insurance or Medicaid saw an 11% increase.
- Latina women with commercial insurance experienced an 11% increase and those with Medicaid had a 13% increase.
- Asian women with commercial insurance saw a 16% increase, while those with Medicaid experienced a 17% increase.
- White women with commercial insurance had a 9% increase and White women with Medicaid had a 3% increase.
SMM rates are drastically higher for women of color than White women. For Black women, SMM rates were 53% higher with commercial insurance and 73% higher with Medicaid. For Latina women, SMM rates were 22% higher and 28% higher, respectively. For Asian women, SMM rates were 15% higher and 38% higher, respectively.
Certain health conditions — including chronic conditions like diabetes or asthma — increase a woman’s risk for SMM, the report said. Black women experience these conditions at the highest rate compared to other groups.
“Preexisting chronic conditions, such as hypertension and diabetes, strongly correlate with higher SMM and worse pregnancy outcomes,” said Dr. Adam Myers, chief clinical transformation officer at BCBS Association, in the report. “To achieve better outcomes, we need to make sure care before pregnancy is easily accessible and equitable for all women, in addition to robust prenatal care, and ongoing postpartum care to ensure the safety of future pregnancies.”
The fact that racial disparities exist regardless of commercial insurance or Medicaid coverage suggests that the issues are due to broader health challenges, including underlying conditions, racial inequities and biases in the healthcare system, according to the report.
To combat these disparities, BCBS listed several actions players in the healthcare industry can take. This includes adding nurse-midwives and birthing centers to provider networks, expanding coverage for postpartum care to one year after giving birth and using value-based contracts for maternal health.
BCBS doesn’t just call on healthcare leaders to act, but the government as well. In the report, the payer urges Congress to pass the Congressional Black Maternal Health Caucus’ Momnibus package, which provides steps to improve health outcomes for pregnant women and mothers of color. BCBS also asks for states to extend Medicaid coverage from 60 days to a full year postpartum, an option provided through the American Rescue Plan Act.
“One’s race or ethnicity should not determine how likely you are to suffer from pregnancy-related complications. We must address deep-rooted issues like implicit bias and systemic racism that cause these disparities in the first place,” Myers said in a news release.
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