The maternal mortality rate in the United States is higher than any comparable high-income nation with stark racial inequities. One third of pregnancy-related deaths occur from one week to one year postpartum (the “fourth trimester”) and more than half are preventable. Beyond mortality, many more postpartum people experience morbidities from physical and mental health conditions in the year after childbirth. 

Federal and state policymakers are actively seeking solutions to the maternal health crisis in America with a particular focus on the postpartum year. Many of these efforts focus on expanding eligibility and services for the nearly half of U.S. births that are covered by Medicaid. For example, as of 2024,  nearly all states have implemented an extension of pregnancy Medicaid coverage through one year postpartum and many states are adding doula care to the list of reimbursed pregnancy-related services. However, the enactment, implementation and evaluation of these policies has been hindered by the lack of systematic, representative data collection on the health and social needs of birthing people and their families in the year after a child is born. While pregnancy and birth outcomes are well documented in the United States, the lack of data on postpartum outcomes represents a significant gap in the nation’s public health data infrastructure. 

To address this gap, this five-year project aimed to drive the development of evidence-based Medicaid and other social policies to improve the health of postpartum people in the year after childbirth through the Postpartum Assessment of Health Survey (PAHS), a first-of-its-kind multi-state survey on postpartum health outcomes, overall well-being, experience of care, as well as health care access, quality, costs, and barriers in the postpartum year. 

People who had given birth in 2020 were recruited to participate in the study, which was designed in partnership with seven state and city health departments to understand the specific needs and experiences of individuals living in their jurisdictions. Data was collected and linked to birth certificate and Centers for Disease Control and Prevention Pregnancy Risk Assessment Monitoring Systems (PRAMS) data, and analyzed data on a state and multi-state level. The team aggregated the data for states, and summarized the findings in a series of publications and policy presentations made to state and federal government committees and agencies. The team continues to publish findings from PAHS in leading medical and health policy journals.

In addition to providing data and analysis for policy makers, professional associations and advocacy organizations, the team was awarded funding through the National Institute for Minority Health and Health Disparities(NIMHD) to implement another round of the PAHS for a cohort of individuals who give birth in 2024 in an expanded set of jurisdictions. For additional information on the future of PAHS visit here. 

In Partnership With:

• Kansas Department of Health & Environment
• Michigan Department of Health and Human Services
• New Jersey Department of Health
• New York City Department of Health and Mental Hygiene
• Pennsylvania Department of Health
• Utah Department of Health
• Virginia Department of Health