Maternal Health Awareness Day: January 23, 2024

Access to maternal health care—the theme of this year’s Maternal Health Awareness Day—is not consistently available for many people having a baby in the U.S. Challenges are particularly acute for those with mental health and substance use issues in geographically isolated communities with limited obstetric care providers, digital connectivity, transportation options, and other barriers. Policy decisions also affect access, especially for individuals on lower incomes.

Medicaid coverage protections during the COVID-19 public health emergency provided pregnancy-related coverage beyond the traditional 60-day postpartum period. Now, coverage and access gains are at risk as states redetermine eligibility for millions of people enrolled in Medicaid.

Access to care also varies across states based on factors such as their Medicaid expansion status, the extension of pregnancy-related Medicaid coverage to 12 months postpartum, and restrictions on abortion and reproductive health care.

Also, some individuals might hesitate to seek care because of language barriers, concerns about child welfare involvement, or past experiences of care that did not align with their values, preferences, and needs.

I know a woman who has faced all of these barriers. Unable to access mental health care and substance abuse treatment while she was pregnant led to a physical and mental health downward spiral and threatened her custody of her children. How can this trajectory be avoided for her and other women who face any, most, or all of these barriers?

In my work for Westat, my team and I have focused on these barriers, working collaboratively with federal agencies to address issues related to maternal health access. Our research underscores the unique obstacles encountered by individuals from underserved populations, revealing that social and structural factors frequently exacerbate access barriers. Black and American Indian and Alaska Native individuals giving birth, especially those with intersecting marginalized identities in rural areas or on Medicaid, experience disproportionate challenges. Our work has also identified potential solutions, including the critical role of involving communities as full and equal partners in the design and delivery of maternal health programs.

Examples of the questions we study in our research include the following:

• Centers for Medicare & Medicaid Services (CMS) Maternal Opioid Misuse (MOM) Model: How can we address the challenges of opioid use in pregnancy?
• Centers for Disease Control and Prevention (CDC) ERASE Maternal Mortality (ERASE MM) initiative: How can we eliminate preventable pregnancy-related deaths?
• Health Resources Services Administration (HRSA) Rural Maternity and Obstetrics Management Strategies (RMOMS): How can access to maternal and obstetrics care in rural areas be improved?
• National Institutes of Health (NIH) Maternal Health Community Implementation Program (MH-CIP): How can disparities in maternal health outcomes be reduced?

The woman I mentioned earlier with complex issues surrounding her mental health and ability to parent successfully is in treatment and maintains regular contact with her children. Her story and the circumstances of many others with barriers to maternal and obstetric care embody “the why” my colleagues and I are committed to this research.

Westat has been a trusted partner to changemakers for over 60 years, informing and inspiring solutions through technical assistance, evaluation, and research. Our commitment continues today, on Maternal Health Awareness Day, and every day.

Submitted by Nicole Harlaar, PhD, a Principal Research Associate for Public Health.