Racial Disparities in Maternal Health

A little girl in a flower dress kisses her mother's baby bump. They are on-location at sunset.

Problem

Pregnancy and childbirth complications in the United States have increased among women by about 9% between 2018-2020; however, racial and ethnic disparities in those complications persist. Black, Latina and Asian women all continue to fare worse than White women when it comes to the likelihood of complications.

The Blue Cross Blue Shield Association (BCBSA) is committed to reducing racial disparities in maternal health. In May 2021, BCBSA released its Health of America report examining racial disparities in severe maternal morbidity (SMM) using commercial plan data from its Blues member plans. However, because Medicaid finances over 40 percent of births, adding Medicaid data is critical to analyzing maternal mortality in the United States. Doing so provides BCBSA with a comprehensive understanding of maternal health in the United States.

Solution

NORC used nationally representative Medicaid data to quantify the maternal health disparities in Medicaid.

Using Transformed Medicaid Statistical Information System (T-MSIS) data, the Health Care Strategy (HCS) team developed estimates and trends of pregnancy and childbirth complications in Medicaid. These data were benchmarked to findings derived from the Blues’ commercial plan data.

Specifically, NORC used the T-MSIS 2019 data to identify and quantify the prevalence of maternal health outcomes using the Centers for Disease Control and Prevention's 21 defined SMM indicators. Given the importance of prenatal and postnatal care to pregnancy and postpartum health outcomes, NORC produced measures related to prenatal and postpartum care, such as the HEDIS Prenatal and Postpartum Care (PPC) measure, as well as utilization of prenatal and postpartum OBY/GN care, Neonatal Intensive Care Unit (NICU) and Pediatric Intensive Care Unit (PICU) utilization, and markers of postpartum depression (90 days; up to 12 months postpartum).

Result

SMM Rates Rising Among Women with Medicaid Coverage.

Between 2018 and 2020, SMM rates have increased by about 9% for women with either commercial insurance or Medicaid. This rising trend in SMM rates holds for all groups of women in this study. However, rate increases are slightly larger for Black women (+11% and +11%); Latina women (+11% and +13%) and Asian women (+16% and +17%) with commercial insurance and Medicaid, respectively. The increase in SMM rates for White women are +9% and +3% for those with commercial insurance and Medicaid, respectively.

SMM Rates Are Substantially Higher for Black, Latina and Asian Women.

For Black women with commercial insurance, SMM rates were 53% higher, and with Medicaid, 73% higher than SMM rates for White women. Rates were also higher among Latina and Asian women. Latina women with commercial insurance had 22% higher rates and with Medicaid, 28% higher rates of SMM than White women. Asian women with commercial insurance had 15% higher rates and, with Medicaid, 38% higher rates of SMM than White women.

SMM Rates Are Higher Among Women of Color, Regardless of Age.

Across all populations, women ages 35-44 were more likely to have an SMM event than younger women. However, Black women with either commercial insurance or Medicaid in this age range have 66% higher rates of SMM compared to White women.