In recent years, federal initiatives have focused on improving maternal health outcomes in the United States. Solutions range from community-led partnerships to health system quality initiatives to expanding perinatal health care teams. But no matter the solution, the experiences and preferences of women and birthing people must be incorporated. A research team at Urban Institute interviewed 26 Black, Native American/Indigenous, and Latinx pregnant or postpartum women in focus groups and published a report that highlights key themes to help align policy proposals with the preferences of mothers.
Experiences Accessing Health Care
The report found that while more payers are providing coverage for critical maternal health services like doula and midwifery care, women said they have inadequate information and education about their options. Women who received doula and midwifery care said these professionals advocated and supported them throughout their experiences, helping them “maneuver the [health] system.” For many women, insurance coverage and geographic proximity to providers ultimately determined where they received care. For those living in underserved rural areas with hospital and clinic closures, traveling one or two hours for prenatal care was common. This finding highlights the challenges women who live in rural maternity care deserts face. Even with increased coverage, the availability of hospitals, clinics, and providers is heavily impacted by geography.
Experiences Engaging with Providers
Women reported the importance of having providers who are caring, relationship-oriented, knowledgeable, and respectful of their birthing preferences and choices. Many women reported negative interactions with providers, including lack of communication about interventions, dismissals of complaints, and overall lack of shared decision-making. Black women shared their preference for having Black providers with shared experiences, who are educated on racial disparities in maternal health outcomes in the U.S.
Experiences Obtaining Postpartum Care
Many women said their postpartum care visits felt short, perfunctory, and impersonal. Several said they did not mention their feelings of postpartum depression or anxiety to their providers for fear of judgment and stigmatization. Women can lose postpartum coverage 30 to 90 days after giving birth in certain states. Women with Medicaid coverage expressed that having continuous postpartum coverage for 12 months could reduce stress by allowing access to care, including contraceptive care, over a longer period.
Looking Ahead
It is important that proposed policy solutions align with women’s preferences and their desired experiences. Strategies include:
- Systematically assess if care provided to women and birthing people is respectful. Women reported the importance of compassion and respect. The evidence shows that supportive, respectful care leads to better outcomes. Providers should survey patients on a regular basis or conduct focus groups to assess patients’ experiences.
- Provide clear, accessible information about care options. Women value information about the breadth of their care options, including detailed explanations of the different provider types engaging them throughout the maternal health care continuum.
- Extend postpartum coverage to 12 months in all states. Continuous coverage allows women access to the full array of care providers and services, a crucial step in promoting optimal maternal health.
