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Financial hardship exceedingly common among pregnant and postpartum women in the U.S.

Pregnancy and the year after childbirth is a critical period for access to health care for those giving birth and babies.

But this could also be a time when families face significant financial pressures that prevent them from accessing critical health services. Nearly one-fourth of pregnant and recently pregnant women in a new study say they haven’t been able to afford necessary health care, and three-fifths are concerned about paying medical bills.

More than half of the women in the five-year survey also described general financial stress about other expenses, including monthly bills, housing costs, minimum payments on credit cards or maintaining living standards.

Our study suggests that financial difficulties are extremely common among the birth population in the United States, with many parents experiencing an unmet need for health care due to the cost, unaffordability of health care and general financial stress.”

Michelle Moniz, MD, M.Sc., senior author, obstetrician gynecologist, University of Michigan Health Von Voigtlander Women’s Hospital

The findings, appearing in JAMA Network Open, include a national sample of 3,509 women in the peripartum, weighted to represent more than 1 million women, between 2013 and 2018.

“Prenatal and postpartum visits provide essential preventive services for both women and infants, including vaccinations, screening for gestational diabetes and anemia, and an opportunity for early diagnosis and treatment of pregnancy complications,” Moniz said. “But for some, health care costs are a barrier to using these recommended services.”

Financial burdens affect maternal care

Women with private insurance and those with lower incomes were more likely to receive unaffordable health care than women with public insurance and those with higher incomes, Moniz and colleagues found.

The 24% of women with unmet health care needs said they could not afford medical care, prescription drugs, glasses or mental health care or said they or a family member delayed or delayed getting needed care because of cost.

“People who delay or forgo medical care because of financial impediments are more likely to suffer from poorer health,” Moniz said. “Financial difficulties have also been shown to be linked to poor mental health.”

The 60% of women who said health care was unaffordable said they were concerned about potential medical bills, existing medical debt, or problems paying medical bills.

Financial pressures may reflect families’ out-of-pocket costs for pregnancy, postpartum and newborn health care, as well as other conditions that contribute to financial instability, Moniz said. She noted that household income often falls dramatically around the time of childbirth, and that the United States is the only country with resources without compulsory paid parental leave.

Policies and programs that address social needs during pregnancy, she said, have clear benefits for birth and developmental outcomes, such as preterm birth and low birth weight, while helping to alleviate general financial stress and ensuring every family has the best start in life. gets life.

Improving coverage and affordability of recommended health services

Rates of unmet health care needs and health care unaffordability were highest among women in the peripartum without health insurance coverage, researchers found. Disruptions in insurance coverage are common during pregnancy and the first six months after childbirth, affecting women with both private and public insurance, Moniz said.

“These data may help explain why a lack of insurance during pregnancy is associated with inadequate and late prenatal care and a higher risk of adverse birth outcomes,” Moniz said.

“Our findings underscore the importance of stable insurance coverage for pregnant and postpartum women.”

In particular, the “uninsured” group was by far the smallest group in the study. The remarkably high prevalence of unaffordability of health care among commercially insured persons is striking. “While we often view this group as ‘provided’,” says Moniz, “about 1/3 of privately insured women live in low-income households. Our findings point to an urgent need to improve the affordability of health care among private individuals. or eliminating out-of-pocket costs—that is, co-payments, coinsurance, and deductible payments—because recommended health care is an important strategy for improving economic stability for families and ensuring that families receive the health care they need. “

Some progress has been made with policies such as the Patient Protection and Affordable Care Act (ACA), which require coverage for certain non-cost-sharing prenatal services for those with private insurance. Other provisions are also intended to broadly expand coverage and affordability for all women of childbearing age.

Such moves generally benefit women, with improved insurance coverage and reduced cost-related barriers to care, especially among those living on low incomes, Moniz said.

Still, financial barriers continue to affect both those without insurance who are exposed to full health care costs and those with insurance through copayments, coinsurance, and deductibles.

“Improving the coverage and affordability of recommended health care for peripartum women has been a policy goal for decades,” Moniz said. “We need more targeted interventions to advance the overall economic security of peripartum women and their growing families.”


Michigan Medicine – University of Michigan

Reference magazine:

Taylor, K., et al. (2021) Financial Difficulties in Pregnant and Postpartum Women in the United States, 2013 to 2018. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2021.32103.

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