Rates of Severe Complications After Pregnancy Rising Among Women of All Backgrounds

09.29.2022 | 4 min read

Dr. Patricia Ferguson, M.D., is medical director at Senior Health Services, Emergent Holdings. Emergent Holdings is a separate entity contracted by Blue Cross Blue Shield of Michigan to perform administrative services for Blue Cross’ Medicare Advantage program. She is a fellow of the American College of Obstetricians and Gynecologists and is a member of the National Medical Association. She is a founder of the 501(c)3 nonprofit organization Each One Teach One.

More women in the U.S. are experiencing severe and even fatal complications after delivering a child, according to a new Blue Cross Blue Shield Health of America report. Rates of severe maternal morbidity have risen 9% from 2018 to 2020 for all racial and ethnic groups, regardless of the type of insurance they carry, according to the report. The report analyzed data from Blue Cross members with commercial insurance, as well as Medicaid members. Severe maternal morbidity is any unexpected outcome from labor and delivery that impacts the health of the mother, including death. It is likely the pandemic only worsened this trend, according to a preliminary analysis of data among Blue Cross members. In Michigan, the data is even more troublesome. Rates of severe complications after delivery are worse than the national average for women regardless of insurance type or racial background. Overall rates of severe maternal morbidity increased 22% from 2018 to 2021 among Michigan Blue Cross members with commercial insurance.

Risk factors

Rates of severe maternal morbidity have been rising in the U.S. as an increasing number of women are entering pregnancy with chronic conditions like hypertension and diabetes, according to the report. These conditions are strongly correlated with unfavorable pregnancy outcomes and higher rates of severe maternal morbidity. The risk for severe complications after delivery increases for all women with their age. Women ages 35-44 of all backgrounds are more likely to have severe complications than younger women; however Black women in that age range are 66% more likely to have higher rates of severe complications.

Racial disparities

Women who are Black, Latina and Asian are at a substantially higher risk for severe complications after delivery, regardless of the type of health insurance they carry. Black women are at the highest risk for adverse health outcomes out of all racial groups:

Black women with commercial insurance: 53% higher risk for severe maternal morbidity than White women
Black women with Medicaid: 73% higher risk for severe maternal morbidity than White women
Latina women with commercial insurance: 22% higher risk for severe maternal morbidity than White women
Latina women with Medicaid: 28% higher risk for severe maternal morbidity than White women
Asian women with commercial insurance: 15% higher risk for severe maternal morbidity than White women
Asian women with Medicaid: 38% higher risk for severe maternal morbidity than White women

These disparities are due, in part, to rates of chronic conditions. Black, Latina and Asian women have higher rates of asthma, diabetes and high blood pressure than white women – all risk factors for severe maternal morbidity. A recent study found Black and Hispanic mothers have higher rates of depressive symptoms than non-Hispanic White mothers. Women who have psychiatric illness during pregnancy are less likely to receive adequate prenatal care – putting them at risk for several adverse pregnancy outcomes. Additionally, women who are Black, Latina and Asian may be more affected by social determinants of health, including poverty, housing, food security and access to competent, quality health care. Systemic racism and discrimination in society can further put people of color at risk for adverse health outcomes. Even in a health care setting, unconscious biases can affect how a woman’s concerns are handled by providers. Providers may make assumptions about a patient based on their own biases, which can affect the quality of care delivered.

Ensuring access to care for women

Blue Cross Blue Shield is committed to working to reduce these disparities for mothers of all races, and to prevent dangerous and tragic outcomes. The Blue Cross Blue Shield Association is working with its affiliate companies across the country – including Blue Cross Blue Shield of Michigan – to reduce racial disparities in maternal health by 50% by 2026. Women of all backgrounds and income levels need accessible, equitable health care – including robust prenatal services, ongoing postpartum resources, including behavioral health screening and treatment – to ensure their health and safety. More from MIBluesPerspectives:

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