February 15, 2022

Insurance coverage is a major contributor to health disparities, with big differences in health among people without insurance and different kinds of insurance. Even within the same facility, insurance type is an important factor in quality of care. It’s especially critical for people giving birth, as insurance may limit care for conditions that could contribute to poor outcomes for the person giving birth and their infant.

Insurance type is an important risk factor for two significant causes of poor maternal and neonatal health: severe maternal morbidity and preterm birth. The CDC defines severe maternal morbidity as unexpected outcomes of labor and delivery that result in significant short- or long-term consequences for the woman’s health and preterm birth as when a baby is born too early, before 37 weeks of pregnancy. Families deal with physical, psychological, social and financial consequences when they face both at the same time.

New research from Alison El Ayadi and colleagues sought to understand how the risk factors of dual burden of severe maternal morbidity and preterm birth varied by insurance type. They found that the risk of dual burden was highest among women with no health insurance or insurance other than private or Medi-Cal (such as TRICARE or Indian Health Services). Previous studies have only compared Medicaid versus privately insured patients; this study supports the need to focus on the broader range of insurance types.

The risk factors influence dual burden of severe maternal morbidity and preterm birth were generally highest among uninsured women, followed by women with Medi-Cal. The findings were consistent with the literature linking structural racism to poor health outcomes, with a significantly higher risk for Black women compared to white women with all insurance types except women with no insurance. This may reflect the greater disadvantage among the uninsured population overall.

These findings suggest areas for additional research. Insurance status likely represents a variety of characteristics or exposures that may be linked to the risk of dual burden. The differences in magnitude of effects of social, demographic, pregnancy-related and obstetric factors by insurance type raises concerns that important differences in care quality exist by insurance type, which may increase the risk of dual burden of SMM and preterm birth. The findings align with previous studies demonstrating differences in care quality by insurance type for other conditions and suggest that we need attention to ensuring that all birthing people and infants receive high-quality care regardless of what kind of insurance they have to improve maternal and neonatal health.