Addressing Maternal Mortality in Underserved Communities

Addressing Maternal Mortality: The Role of Medicaid Expansion and Telehealth in Reducing Disparities

Section I: Health Problem and Research Question

Maternal mortality is a critical and urgent public health issue in the United States, particularly in underserved communities and among racial minorities. The high rates of maternal mortality, especially in rural areas and among Black and Hispanic women, are linked to various systemic inequities, including inadequate access to postpartum care. Studies show that Medicaid is crucial to maternal health, covering many births. However, there are gaps in extending postpartum care and addressing racial and ethnic disparities in maternal outcomes?.

Research Question: How can extending Medicaid postpartum care coverage in underserved communities reduce maternal mortality and improve health equity for Black and Hispanic women?

Rationale: This question was selected because data indicates that many maternal deaths occur during the postpartum period. Extending Medicaid postpartum coverage from 60 days to one year has been shown to improve maternal outcomes by providing continued care for postpartum complications. Focusing on underserved communities and racial minorities is essential as these groups disproportionately suffer from higher maternal mortality rates?.

Section II: Annotated Bibliography

Cohen, J. L., & Daw, J. R. (2021). Postpartum cliffs—missed opportunities to promote maternal health in the United States. JAMA Health Forum,

This article identifies several “postpartum cliffs” that compromise healthy transitions from pregnancy to parenthood in the US. The authors highlight gaps in patient planning, physician handoffs, insurance coverage, cost sharing, payment models, and quality measurement for postpartum care (Cohen & Daw, 2021). They propose potential solutions, including extending Medicaid coverage, improving care transitions, and developing new quality metrics for postpartum care. This primary source provides a comprehensive overview of systemic issues affecting postpartum care quality and access. The proposed solutions offer promising directions for intervention design and policy changes.

Cross-Barnet, C., Courtot, B., Benatar, S., & Hill, I. (2020). Preeclampsia risk and prevention among pregnant Medicaid beneficiaries. Journal of Health Care for the Poor and Underserved, 31(4), 1634-1647.

This mixed-methods study examined low-dose aspirin (LDA) use to prevent preeclampsia among Medicaid beneficiaries enrolled in the federal Strong Start for Mothers and Newborns II initiative. Cross-Barnet et al. (2020) found many Strong Start participants had risk factors warranting LDA use, but most practices reported inconsistent or non-existent prescribing. LDA use varied across care models, such as birth centers, group prenatal care, and maternity care homes, as well as across different provider types. Additionally, ancillary care team members often lacked knowledge of LDA benefits, leading to missed patient education opportunities. The study concludes that clear policies and integrated care teams could increase evidence-based LDA use. Despite recommendations, it reveals gaps in LDA implementation for at-risk Medicaid beneficiaries and highlights opportunities to improve preeclampsia prevention through provider education, care coordination, and consistent policies.

Haley, J. M., Hinojosa, S., Lacy, L., & Willis, C. (2022). Advancing Maternal Health Equity in Southern States.

This study examines Medicaid policies to improve maternal health equity in Southern U.S. states, focusing on postpartum care coverage and racial disparities. Through interviews with experts and policymakers, the study reveals gaps in addressing racial inequities despite the efforts to improve maternal health outcomes. It highlights critical strategies such as expanding postpartum Medicaid coverage and emphasizes the need for data to track the effectiveness of these policies. This primary research source is relevant to addressing disparities in maternal mortality through Medicaid (Haley et al., 2022)?.

Pedersen, S., Zapata, D., & Jones, C. (2023). The Role of Medicaid Policy in Reducing Racial Disparities in Maternal Mortality and Other Health Outcomes: A Literature Review Series.

The literature review explores how Medicaid policies, specifically postpartum long-acting reversible contraception (LARC), can reduce racial disparities in maternal health (Pedersen et al., 2023). The review focuses on the US maternal health crisis, particularly among Black, Native, and Hispanic women, emphasizing Medicaid’s critical role in maternity care. Key findings suggest that increased access to LARC can improve maternal outcomes by reducing short-interval pregnancies. However, disparities persist in LARC access, driven by historical, financial, and logistical barriers. The authors recommend policy interventions to address these challenges, such as provider training and counseling. This primary research underscores Medicaid’s potential to improve maternal health equity.

Shah, L. M., Varma, B., Nasir, K., Walsh, M. N., Blumenthal, R. S., Mehta, L. S., & Sharma, G. (2021). Reducing disparities in adverse pregnancy outcomes in the United States. American heart journal, 242, 92-102.

The authors examine how social determinants of health (SDOH) and systemic inequities contribute to adverse pregnancy outcomes and maternal mortality, particularly among racial and rural populations. Cardiovascular disease (CVD), the leading cause of maternal deaths, is often preventable, with many deaths linked to SDOH, like socioeconomic status, health literacy, and food security (Shah et al., 2021). The article emphasizes the need to address these disparities through interventions such as safety bundles, improved clinician-patient communication, and tackling structural racism. The authors call for systemic changes to improve maternal health equity, identifying research gaps in understanding the mechanisms linking SDOH to maternal outcomes. This source is crucial for understanding maternal health disparities and the role of policy in mitigating them.

Sundstrom, B., DeMaria, A. L., Ferrara, M., Meier, S., & Billings, D. (2019). “The closer, the better:” the role of telehealth in increasing contraceptive access among women in rural South Carolina. Maternal and Child Health Journal, 23, 1196-1205.

This article explores the potential of telehealth services to improve maternal healthcare access in rural areas. The study demonstrates how telehealth can provide postpartum and contraceptive services in remote regions, reducing maternal mortality and morbidity (Sundstrom et al., 2019). This study is essential for understanding how technological interventions like telehealth can complement Medicaid expansions in underserved areas to improve maternal outcomes. This is a primary research source that highlights innovative solutions for maternal health.