Maternal mortality: The overlooked needs of mothers after childbirth

A study from the Columbia University Mailman School of Public Health has revealed alarming insights into the postpartum health of American mothers. According to the experts, maternal mortality is increasing, and more than half of maternal deaths occur in the postpartum year. 

Despite the common perception that pregnancy and childbirth are the most perilous times for maternal health, this study highlights the postpartum year as a critical period filled with medical and social challenges that have long been neglected.

Surging maternal mortality

The study’s findings signal a distressing rise in maternal mortality rates in the United States, with over half of these deaths occurring after childbirth. 

“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 study first author Dr. Jamie Daw.

“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”.

Pregnancy Medicaid

In response to the growing concern, 37 states along with Washington, D.C., have adopted a federal measure to extend Medicaid coverage up to a year after birth, a significant step considering Medicaid insures nearly half of all U.S. pregnancies. 

“Pregnancy Medicaid typically ends 60 days after birth. By providing public health insurance through to one year postpartum, states hope to improve access to health care services that that will translate to better health,” said study senior author Dr. Heidi Allen.

Extended healthcare coverage could make a huge difference in maternal health, especially a majority of maternal deaths were deemed preventable with adequate medical care.

Focus of the study

For the study, the experts analyzed data from the Postpartum Assessment of Health Survey (PAHS), which collected extensive data across six states and New York City. This survey is the first of its kind to gauge postpartum health on such a scale in the United States.

Disturbing findings

The study’s findings are grim, with around 20 percent of mothers reporting that they delayed or went without essential care in the postpartum year, regardless of insurance status. 

Medicaid recipients, in particular, face stark disparities, with lower access to care and higher instances of unmet social needs like food insecurity and intimate partner violence.

Mental health

Alarmingly, 12 percent of Medicaid beneficiaries reported depression, and 14 percent reported anxiety symptoms a year postpartum, yet one in four reported no healthcare use at all during this time. This gap underscores an urgent need for better access to mental and behavioral healthcare services.

Among Medicaid beneficiaries, 20 percent reported not having enough food to feed their family, 57 percent reported financial strain and seven 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,” said Dr. Daw.

“It is also clear that policymakers need to intervene beyond health care to address beneficiaries’ social needs which are likely contributing to poor maternal health outcomes and disparities.”

Study implications 

The researchers suggest that to achieve progress in improving overall postpartum health, states should leverage Medicaid’s flexibilities and connections with other social services. 

“Policymakers are actively working to improve maternal health in the U.S. Our findings emphasize that translating policies such as postpartum Medicaid extensions into improved postpartum health will require states to improve the uptake and availability of services to address social determinants of health, including food insecurity, housing instability, poverty, and intimate partner violence for families with young children,” concluded Dr. Daw.

The study is published in the journal Health Affairs.

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