Pregnancy-related complications increased 9% between 2018 and 2020, with women of color especially at risk, new report shows. The complications are whether you have commercial health insurance or Medicaid.
The increase is likely due to more women suffering from chronic conditions amid Covid-19, the study said.
The Blue Cross Blue Shield (BCBS) report analyzed birth complication rates in about 11 million U.S. births to women with commercial insurance or Medicaid. Birth complications were measured based on the Centers for Disease Control and Prevention’s Severe Maternal Morbidity Measure (SMM).
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 commercial insurance or Medicaid saw an 11 percent increase.
- Latina women with commercial insurance had an 11 percent increase, and those with Medicaid had a 13 percent increase.
- Asian women with commercial insurance saw a 16 percent increase, while those with Medicaid had a 17 percent increase.
- White women with commercial insurance had a 9 percent increase, and white women with Medicaid had a 3 percent increase.
SMM rates are dramatically higher for women of color than for white women. For black women, SMM rates were 53% higher with commercial insurance and 73% higher with Medicaid. For Hispanic women, SMM rates were 22% higher and 28% higher, respectively. For Asian women, SMM levels were 15% higher and 38% higher, respectively.
Certain health conditions — including chronic conditions such as diabetes or asthma — increase women’s risk of SMM, the report said. Black women experience these conditions at the highest rates 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 the BCBS Association, in the report. “To achieve better outcomes, we need to make sure that pre-pregnancy care 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 the problems stem from broader health challenges, including underlying conditions, racial disparities and biases in the health care system, according to the report.
To combat these disparities, BCBS has listed several actions that healthcare industry participants can take. This includes adding nurse-midwives and birth centers to provider networks, expanding postpartum care coverage up to one year after birth, and using value-based maternal health contracts.
BCBS is calling not only on healthcare leaders to act, but also on government. In the report, the payer urges Congress to pass the Congressional Black Maternal Health Caucus’s Momnibus package, which provides steps to improve health outcomes for pregnant women and mothers of color. BCBS is also asking states to extend Medicaid coverage from 60 days to a full year after birth, an option made available through the American Rescue Plan Act.
“One’s race or ethnicity should not determine how likely you are to suffer pregnancy-related complications. We need to address deep-rooted issues like implicit bias and systemic racism that cause these disparities in the first place,” Myers said in news release.
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