The maternal mortality rate in the United States is higher than any comparable high-income nation. 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 women also experience morbidities from physical and mental health conditions in the year after childbirth.
Medicaid, the public health insurance program for low-income Americans that covers nearly half of all U.S. births, has been an underused tool in the effort to reduce postpartum maternal mortality and morbidity. This is partly the result of the lack of systematic data available to help direct and prioritize policymakers’ efforts to improve the health of new mothers.
This project aims to drive the development and evaluation of evidence-based Medicaid policies to improve the health of women in the year after childbirth. Starting in 2020, new mothers are being contacted to participate in the Postpartum Assessment of Women Survey (PAWS), a first-of-its-kind multi-state survey on health outcomes, overall well-being, experience of care, as well as health care access, quality, costs, and barriers for women one-year postpartum. This data will be used to help advocacy organizations, governments and medical professional organizations develop recommendations for improvements to health and social policy – and the Medicaid program in particular – that have the potential to meaningfully affect maternal health.
A second proposed part of this project would partner with interested state Medicaid programs to implement Medicaid policy changes that respond directly to the gaps and barriers identified; and to conduct a study of the effects of implemented reforms. The project team is currently working to identify interested jurisdictions for this collaboration. Building on lessons learned from this pilot, the project team would engage with other states and federal actors to encourage broader Medicaid policy change. By pursuing changes at the policy-level, this project has the potential to significantly reduce population-level maternal mortality and morbidity in the United States.
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
Heidi L. Allen, MSW, PhDColumbia UniversityProject LeadRead Full Bio arrow_right_alt
Heidi L. Allen, MSW, PhD is an Associate Professor at Columbia University’s School of Social Work, and is a nationally recognized expert on Medicaid policy.
Jamie Daw, PhDColumbia UniversityProject LeadRead Full Bio arrow_right_alt
Jamie Daw, PhD is an Assistant Professor of Health Policy and Management at Columbia University’s Mailman School of Public Health. She is a quantitative health services researcher whose...
Kristen Underhill, JD, DPhilCornell UniversityProject LeadRead Full Bio arrow_right_alt
Kristen Underhill, JD, DPhil is an Associate Professor of Law at Cornell Law School. Her expertise is in both law and public health, including legal research, survey methods, and qualitative data collection.
- 1 in 3pregnancy-related deaths occurs in the year after delivery
- 87-94percent of women report at least one health problem in the first three months postpartum
- 1 in 2pregnancy-related deaths is estimated to be preventable