Getting postpartum care is unaffordable for many women

Known as the fourth trimester of care, postpartum care has become unaffordable for many women. The costs of care are increasing, due to rising deductibles, increasing chronic diseases, and a lack of access to Medicaid.

While postpartum care technically refers to the 12-week period after delivery, there is a movement to recognize that adequate postpartum care may require follow-up for a year or longer. This is especially true in order to address increasingly common chronic conditions, family planning needs, and mental health. And this extended care may help reduce the growing incidence of maternal mortality.

In the latest issue of Medical Care, Hannah MacDougall and colleagues present evidence that postpartum individuals are more likely than non-postpartum people to report trouble paying medical bills (18.4% vs. 14.2%)—or to be unable to pay medical bills altogether (12.8% vs. 9.4%). This pattern holds regardless of whether people live in urban or rural counties.

The data “supports existing advocacy and legislation to expand health coverage in the postpartum period especially for those who are low-income,” the authors write.

A nationwide study captured worries about health care affordability

Every year, trained census workers conduct the National Health Interview Survey (NHIS), interviewing a random sample of people in their homes about their illnesses and disabilities. The researchers used data on 17,800 people who participated during the years 2019–2021.

By statistically “weighting” the individual data, the research team estimated the responses that would have come from 57 million U.S. residents (6% postpartum and 12% rural). Compared with non-postpartum respondents, individuals who had given birth to a live child within the past year were:

  • 18% more likely to have problems paying bills
  • 13% more likely to be completely unable to pay medical bills

Clearly, postpartum care is unaffordable for many women. These findings held even after accounting for age, income, race/ethnicity, education, marital status, health insurance type, and number of children. Rural residents overall reported greater problems with medical bills than urban residents did. But the differences didn’t hold up after adjustment for age and the other factors.

Beyond the postpartum period, parents worry less about paying bills

Outside of the postpartum period, parents were slightly less likely than adults without children to worry about paying medical bills. The researchers write, “One might surmise that based on the high costs of raising children…parents may experience more difficulty.”

Yet, there were almost no differences. In fact, parents with two or more children “worried” less than adults without children about paying medical bills. Having children can increase eligibility for safety net programs like Medicaid, which can lesson the burden of medical debt. In fact, among all adults, Medicaid coverage reduced difficulties paying medical bills even below that of having private health insurance.

The authors also note that part of their study period overlapped with the COVID-19 pandemic. This period was accompanied by tax relief and stimulus payments. “Indeed, health care unaffordability concerns in these years…were affected by both pandemic relief measures and increased postpartum insurance coverage.”

You can read the full study here.

And to learn more about maternal health care, consider reading our blog series on birth equity (and a related podcast). Check out other articles on better ways to pay for maternal health care and avoiding obstetric violence.

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