Racial and Ethnic Disparities in Maternal Health

Pregnancy and childbirth complications in the United States have increased among all women1 by about 9% between 2018-2020. Moreover, racial and ethnic disparities in those complications persist. Black, Latina and Asian2 women all continue to fare worse than white women when it comes to the likelihood of complications.

Most striking, this trend holds true for all women in this study, suggesting that increases in childbirth complications are rising, regardless of whether a woman has commercial health insurance or Medicaid.3

This report analyzes the latest trends in severe maternal morbidity (SMM). It examines nearly 11 million births4 to women with either commercial insurance or Medicaid. Data cover the years 2018 to 2021 for women with commercial insurance and 2016 to 2020 for women with Medicaid.6 Studying births to women with both kinds of insurance provides a comprehensive picture of trends in maternal health across the United States.

The severe maternal morbidity rates in this report are a measure of unexpected outcomes at the time of hospital deliveries through six weeks postpartum. These complications can cause serious short- or long-term health consequences. SMM is made up of 21 adverse events known as indicators.7 A woman who experiences one or more of the 21 indicators is considered to have experienced an severe maternal morbidity event.

Note: The SMM rate presented here differs somewhat from that used by the Centers for Disease Control and Prevention (CDC). The CDC’s SMM rate includes only complications occurring during the delivery experience, while the mother is in the hospital. The SMM rates considered in this report include complications through the first six weeks after discharge because a third of SMM events occur during this time.

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Key Findings

01

SMM rates have risen about 9% for all racial and ethnic groups in both the BCBS commercially insured and Medicaid populations between 2018 and 2020. Early evidence among commercially insured women indicates the pandemic has likely worsened this trend.

Key Findings

02

SMM rates are consistently higher among Black, Latina and Asian women compared to white women, regardless of age or type of insurance.

Key Findings

03

While SMM rates for all women rise with age, Black women ages 35-44, especially those with chronic conditions, have a 66% higher risk of experiencing an SMM event than white women.

Key Findings

04

Black, Latina and Asian women have higher rates of many risk factors (such as asthma, diabetes or high blood pressure) for SMM than white women.

ENDNOTES

  1. In this report, the words “woman” or “women” refer to people designated female at birth. A birthing person’s gender identity may differ from this terminology.
  2. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent.
  3. Commercial data comes from the Blue Cross Blue Shield (BCBS) national claims database, BCBS Axis. Medicaid data comes from claims data submitted to the Centers for Medicare and Medicaid.
  4. This study examines more than 3.1 million births covered by Blue Cross Blue Shield commercially insured women and more than 7.8 million births covered by all Medicaid plans.
  5. Commercial data comes from the Blue Cross Blue Shield (BCBS) national claims database, BCBS Axis. Medicaid data comes from claims data submitted to the Centers for Medicare and Medicaid.
  6. Medicaid data is currently only available through 2020, while BCBS Axis data is available through 2021.
  7. Severe Maternal Morbidity in the United States, Centers for Disease Control and Prevention.

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