The Risks of Childbirth Persist Weeks After Patients Leave the Hospital

Analysis of millions of births shows one-third of birth complications occur during the six weeks following discharge and disproportionately affect Black patients.

CHICAGO – The country’s maternal health crisis goes far beyond the delivery room. New data shows that dangerous, unexpected birth complications often emerge weeks after the patient and baby have left the hospital, with Black patients experiencing these events at a rate 87% higher than white patients.

The analysis of these birth complications, known as severe maternal morbidity (SMM), draws on data from more than 700,000 Blue Cross Blue Shield (BCBS) commercially insured births. Additionally, the report analyzed data on more than 1.5 million Medicaid births provided by NORC at the University of Chicago.

“One of the many tragedies of America’s maternal health crisis is that so many of these events are preventable,” said Kim Keck, president and CEO of the Blue Cross Blue Shield Association (BCBSA). “We need providers, payers, policymakers and community leaders to work in partnership to create a better system of health—one that ensures every mother and baby goes home health and remains healthy.”

In both data sets, SMM events were higher for Black and Latina patients than white patients in commercially insured and Medicaid populations.

BCBS Data on Rate of SMM Events by Ethnicity in Commercially Insured Population

Race/Ethnicity Commercial
Black patients 87% higher than white patients
Latina patients 7% higher than white patients


NORC Data on Rate of SMM Events by Ethnicity in Medicaid Population

Race/Ethnicity Medicaid
Black patients 90% higher than white patients
Latina patients 6% higher than white patients

Note: The BCBS data and NORC data come from distinct datasets and thus are not intended for direct comparison.

Additional findings from the report show:

  • Racial disparities increase with age: In both the NORC Medicaid data and BCBS commercial data, SMM rates for Black patients ages 35 to 44 are more than twice as high as white patients.
  • Six health events account for over three-quarters of SMM events in both commercially insured and Medicaid populations, including sepsis, eclampsia and acute renal failure.

In April, BCBSA released a national health equity policy platform that outlines solutions to meaningfully improve how care is delivered and experienced.

Chief among the solutions identified in the platform is a call for Congress to provide funding to the Centers for Disease Control and Prevention to help states establish, coordinate and manage SMM Review Committees. Like the state-level Maternal Mortality Review Committees, these new committees would help identify the root causes of SMM events and create focused interventions during every stage of pregnancy.

Other recommendations include expanding access to care for Americans, addressing and mitigating impacts of social determinants of health, and investing in efforts to expand and diversify the health care workforce.

The platform builds on the more than 400 programs that BCBS companies already have in place to address health disparities.

By covering one in three Americans across every ZIP code, we unlock a wealth of data that provides crucial insights into America’s health. We publish these findings as part of the BCBS Health of America® series. This current report expands on previous studies, examining disparities throughout the entire spectrum of maternal care.

Read the full report, “Improving Postpartum Maternal Health Outcomes,” here.

The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies.