In Severe Maternal Morbidity Risk, Race, Location, and Insurance Type All Matter, Study Finds

November 30, 2022

Woman with curly hair holding baby and looking over her shoulder

WASHINGTON, DC (November 30, 2022)—Researchers have previously reported that risks of severe maternal morbidity — potentially life-threatening complications of childbirth such as cardiac arrest and eclampsia — are higher among those with Medicaid coverage and in rural, Black, and Indigenous populations. Do those risks mount higher when birthing people have multiple characteristics associated with higher risk, though? In a study selected as the Editor's Choice for the November/December issue of Women's Health Issues, authors examined differences in risk of severe maternal morbidity for Medicaid-funded compared with privately insured births through specific additive and intersectional risk by rural or urban geography, race and ethnicity, and clinical factors.

Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, which is based at the Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University.

Julia Interrante, of the University of Minnesota School of Public Health, and colleagues used data on more than 6 million childbirth hospitalizations from 2007-2015 and identified those with severe maternal morbidity. They examined race and ethnicity as indicators of likely experiences of racism. Their analysis found that Indigenous rural residents with Medicaid-funded births had dramatically higher rates of severe maternal morbidity compared to other groups. Rates of severe maternal morbidity were also high among non-Hispanic Black residents of both rural and urban areas with Medicaid coverage and Hispanic urban residents with Medicaid coverage. “This finding indicates that known racial and geographic disparities are not decreased when accounting for Medicaid coverage; moreover, there is substantive interaction between these factors and Medicaid coverage,” the authors explain.

“The findings on intersectionality of SMMM risk suggest that Medicaid policy change to improve maternal health must account for the particular challenges posed by rural locations and by racism, and also that policies that lower SMMM risk among Medicaid patients could have additional additive benefits in reducing racial and ethnic and rural versus urban disparities,” Interrante and her colleagues write.

“This study’s findings emphasize the key role Medicaid can play in advancing equity,” said Karen McDonnell, Editor-in-Chief of Women's Health Issues and associate professor of prevention and community health at Milken Institute SPH. “State and federal policymakers should consider ways to make the Medicaid program an even stronger tool for ensuring all pregnant and birthing people have access to high-quality, equitable care.”

Severe Maternal Morbidity and Mortality Risk at the Intersection of Rurality, Race and Ethnicity, and Medicaid” has been published in the November/December 2022 issue of Women’s Health Issues.