Columbia World Projects (CWP) announced on Monday that it will partner with six states and New York City to conduct a first-of-its-kind, multi-state survey of women who gave birth in 2020. The survey will assess women’s health outcomes, overall well-being and experience of care, as well as health care access, barriers, quality and costs in the year after birth.

The data gathered through the survey 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 reduce postpartum morbidity and mortality in the United States.

“One third of maternal deaths occur from one week to one year after birth. There is significant state and federal policy momentum to develop policies and programs to reduce maternal morbidity in the 'fourth trimester,' but little data is available to help policymakers prioritize these investments. This survey is designed to fill this gap and promote evidence-based approaches to improving postpartum health,” Jamie Daw, Assistant Professor, said.

The survey — the Postpartum Assessment of Women Survey (PAWS) – was designed by an interdisciplinary team of Columbia researchers from three schools: Heidi L. Allen , MSW, PhD (School of Social Work); Jamie Daw, PhD (Mailman School of Public Health); and Kristen Underhill, JD, DPhil (Columbia Law School). The team first began working together when they developed a proposal for Columbia World Projects, which solicited proposals for interdisciplinary maternal health projects in late 2018. PAWS will be distributed in Kansas, Michigan, New Jersey, Pennsylvania, Virginia, Utah and New York City, whose health departments are working closely with the project team to design and disseminate the survey.

In response to the current pandemic, the survey will also include questions on how COVID-19 has impacted health, health care access, financial security and family support for women and families after birth. This will be the first large-scale, multi-state survey to examine the impact of the pandemic on postpartum women and children in the first year of life.

The opportunity to participate in PAWS will be offered to women in the participating states and New York City who take part in the Pregnancy Risk Assessment Monitoring System (PRAMS), an annual survey that has been used since 1987 to collect data on maternal and child health indicators. PAWS is expected to reach a representative sample of at least 10,000 women.

The survey is one part of Leveraging Policy to Improve Maternal Health in the Fourth Trimester, a CWP project that was proposed at CWP’s Maternal Health Forum to use Medicaid policy as a tool to avert pregnancy-related mortality and health problems after birth. Medicaid covers nearly half of all births in the United States, yet many low-income women lose access to Medicaid coverage after birth, and even postpartum women who stay enrolled may not have access to the services and support they need. In the second phase of this project, the research team would partner with interested state Medicaid programs to implement policy changes that respond directly to the gaps and barriers identified in the PAWS survey and to conduct a study of the effects of implemented reforms. 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. 
 
“We are pleased to work with Columbia researchers and faculty from multiple disciplines who are putting into effect our goal of using Columbia research to better people's lives,” Nicholas Lemann, the director of Columbia World Projects, said. “The results of this survey will provide crucial new information that has the potential to affect vulnerable women across the country for years to come."

(Update: December 4, 2020: One of the states that PAWS was initially planned to be distributed in, Montana, will no longer take part in the survey. This announcement has been updated accordingly.)