Health insurance, race, and receipt of a postpartum visit among patients giving birth in a referral hospital in the US South

Background

The United States faces a maternal mortality crisis with stark and unacceptable disparities. Postpartum care (PPC) is crucial for identifying and managing complications after childbirth. However, access to PPC is inconsistent, especially for marginalized individuals such as Black birthing people and Medicaid beneficiaries. We examined the effect of the intersection of race and insurance type on the patients’ receipt of postpartum care (PPC) in a large referral hospital in the Southeast US.

Methods

In this cross-sectional retrospective cohort study, we analyzed data from electronic health records for 14,531 people who gave birth from January 2014 to March 2020 in a labor and delivery unit caring for more than 4000 births per year in the Southern US. Variables included race/ethnicity, insurance status, maternal age, number of living children, mode of delivery, and presence of chronic conditions. We produced descriptive statistics and used multivariable log-binomial models to estimate adjusted risk ratios (RR) for receiving PPC, including interaction terms between race and insurance.

Results

In a retrospective analysis of electronic health records of 14,531 patients who gave birth in a large health system in the US South, 53.0% of patients received a clinic-based PPC visit. Having private insurance, compared to Medicaid insurance, was associated with a higher likelihood of receiving clinic-based PPC but a lower likelihood of visiting the Maternity Evaluation Unit, a special unit for urgent or emergency care.

Conclusion

Type of insurance is associated with receipt of postpartum care. Disparities in PPC are modestly influenced by the interaction between race and insurance type. Private insurance, as compared to Medicaid insurance, increases the likelihood of postpartum care across all racial groups with some differences in this relationship by race/ethnicity. Next steps should include qualitative research that helps us better understand the differences in receipt of PPC by insurance coverage and the interactions between insurance status and race. Implementation research should also test practical strategies to increase access to postpartum care, particularly for Medicaid-insured and other marginalized individuals.