Addressing disparities in serious childbirth complications

Published June 10, 2024

The crisis of maternal mortality rightfully garners serious focus from health care leaders and policy makers, but it is far from the only maternal health crisis. Severe maternal morbidity (SMM) events are dangerous, unexpected birth complications that result in short- and long-term health consequences, often causing new moms to return to the hospital after they have been discharged.

The Health of AmericaSM report paints a stark picture of complications after birth

The Blue Cross Blue Shield Association is driving awareness about this crisis through a new Health of AmericaSM report, Improving Postpartum Maternal Health. It reveals that a third of these childbirth complications occur in the six weeks following hospital discharge. The data also shows deep racial and ethnic disparities embedded in the SMM crisis.

  • Postpartum SMM rates are 87% higher among Black patients and 7% higher among Latina patients than white patients.
  • Black patients are hospitalized more than 70% more often than white patients for post-partum SMM events.
  • Six events account for three quarters of postpartum SMM events: sepsis, acute heart failure, acute respiratory distress syndrome, acute renal failure, thrombotic embolism and eclampsia.
  • For all six of these SMM events, prevalence rates are higher for Black patients than for white patients.

What’s more, due to gaps in the health care system, racial disparities in postpartum SMM rates have persisted over the past five years.

Our analysis draws on one of the largest data sets in the country. It includes data from more than 700,000 Blue Cross Blue Shield (BCBS) commercially insured births. Additionally, we analyzed more than 1.5 million Medicaid births from the Centers for Medicare & Medicaid Services (CMS), which was provided by and analyzed by The National Opinion Research Center (NORC) at the University of Chicago.

Blue Cross and Blue Shield companies remain focused on the crisis

In 2021, BCBS companies launched a nationwide commitment to drive action to improve maternal health throughout the health care ecosystem. We continue to leverage our deep community roots to support mothers and enable providers to eliminate disparities. Many of these efforts include doulas and midwives, who become the community-based touchpoints some mothers may need between OBGYN appointments. They are trained to spot physical, social or mental health needs before they become a problem. For example:

  • Blue Shield of California identified counties with higher rates of maternal health disparities and collaborated with Mahmee to address them. Mahmee offers in-person and virtual doula visits as well as an app for patients and providers to manage care. Read more about Mahmee and watch a video about Blue Shield of California’s work to make childbirth and the postpartum period safer for members.
  • In Philadelphia, Independence Blue Cross partners with Cayaba Care, a provider that deploys maternity navigators to the homes of pregnant and postpartum women who benefit from weekly support for physical, educational, emotional and social needs. Learn more about Cayaba Care and meet a maternity navigator who is helping at-risk Independence Blue Cross members stay healthy postpartum.

National programs from BCBS companies focus on maternal health

BCBS companies’ broad, national reach complements these deeply local efforts.

Urgent policy changes to address the rising prevalence of SMM

Going forward, we will continue to advocate for a robust policy platform to help reduce disparities in SMM. Our health equity platform prioritizes:

  • Establishing state-based SMM review committees. Many states already collect data on maternal mortality. We are advocating for states to establish SMM committees to collect and share state-level SMM data. This would provide The Centers for Disease Control & Prevention insight into the national picture and enable the agency to develop and share appropriate interventions.
  • Improving access to and the affordability of doulas and midwives as part of a maternal health care team.
  • Addressing the social drivers of health that often have a more direct effect on outcomes than clinical interventions.
  • Building an equitable workforce. Reducing racial and ethnic disparities in care requires culturally sensitive providers who understand their patients’ lived experience.
  • Standardizing racial and ethnic data. We cannot manage what we cannot measure. Our involvement in the Data Equity Coalition and partnership with the National Minority Quality Forum to advance data equity can help us reach this goal.

In addition, we have long advocated for policies such as those covered by the Momnibus bill that improve outcomes during the postpartum period. Those include extending Medicaid postpartum coverage from 60 days to 12 months. To-date, 44 states have adopted this change.

We believe these actions can help ensure every mother and baby thrive.

Read the report

The Blue Cross and Blue Shield Association is an association of independently owned and operated Blue Cross and Blue Shield companies.