How Can We Improve Postpartum Health Outcomes in the United States?

Maternal mortality and morbidity is becoming a public health crisis in the United States. A multi-disciplinary team from Columbia aims to address this problem.

Caroline Harting
February 11, 2021

Taking Action is a Columbia News series that seeks to showcase efforts from around the university that rely on academic knowledge to tackle real-world challenges in a purposeful way. 

Many of us associate maternal mortality and morbidity as a problem for developing nations. However, the maternal mortality rate in the United States is worse than any comparable high-income nation with many pregnancy-related deaths occurring from one-week to one-year postpartum, also known as the “fourth trimester.” According to a 2018 report from the CDC, the U.S.’s maternal mortality rate is 17.4 per 100,000 live births. The rate is even higher for non-Hispanic Black women at 37.1 per 100,000. At Columbia World Projects, a team led by Heidi L. Allen, associate professor at the School of Social Work; Jamie Daw, assistant professor at the Mailman School of Public Health; and Kristen Underhill, associate professor at Columbia Law School, intends to change this trajectory.

Partnering with state health departments and New York City Department of Health and Mental Hygiene, they’re conducting a first-of-its kind survey of women who gave birth in 2020 to learn more about their postpartum health, an area of maternal health that is sorely under examined. The project will use this data to improve maternal health policy with an eye to expand Medicaid benefits for women post-pregnancy.

Columbia News caught up with the project leads to find out why they took on this issue, how they are going to solve it, and what their hopes are for the outcome.

Q: What area are you focusing on to help mitigate maternal health issues in the United States?

A: The high rates of maternal mortality and morbidity in the United States are increasingly recognized as a national public health crisis. There is significant interest among federal and state lawmakers to implement policies and programs to improve health outcomes in the “fourth trimester." However, there is a lack of evidence to inform the development and prioritization of these efforts, and we hope to fill this gap through our project.

Q: Why did you decide to tackle this issue?

A: While preventing maternal deaths during pregnancy and childbirth has been the primary focus of efforts to reduce maternal mortality, one third of maternal deaths in the U.S. occur in the year after birth. Public health indicators of maternal health and associated data collection efforts have long been focused on pregnancy and childbirth, with little attention given to the well-being of women and their families in the postpartum year. Further, less attention has been given to the role of health policy—and Medicaid policy in particular—in mitigating this public health issue.

All three of us conduct research on how policy can be leveraged to improve health and well-being, but from the different perspectives of social work, public health, and law. We believe that our project, which brings an interdisciplinary lens and focuses specifically on policy change, will offer new solutions to this vexing problem.

Q: How do you intend to solve it?

A: In partnership with seven city and state health departments, we have launched the Postpartum Assessment of Women Survey (PAWS). This survey is the first large scale effort to collect data directly from U.S. women in the year after birth. It is a unique example of a deep collaboration between university-based researchers and government stakeholders; we worked directly with health departments to develop questions about a range of issues that intersect with women’s well-being in the “fourth trimester" including health care access, health insurance, discrimination, and the social determinants of health. This postpartum information will be linked to birth certificate data and the Pregnancy Risk Assessment Monitoring System to create a rich, longitudinal dataset from preconception through to one year after birth.

Q: What do you hope will be the outcome for the project?

A: We anticipate the PAWS to provide timely, policy-relevant insights that can inform the development and prioritization of policies and programs to improve maternal and child health outcomes in the year after birth. This information will be used by the state and city health departments that we are collaborating with, as well as a broader set of policymakers and stakeholders at the local, city, state, and national levels.

We also expect that we will identify several viable Medicaid policy changes that could be used to improve postpartum health. These may include, for example, coverage expansions, new benefits for health and non-health services, or changes to payment and reimbursement policy. We plan to provide technical assistance and a policy toolkit that won’t just focus on what states could do but how they could do it, for example, using executive authority, legislation, or regulatory change. Having an interdisciplinary team, including expertise in law, is essential for us to be able to provide this practical guidance on how evidence-based change could be achieved.

Ultimately, we hope that the PAWS prompts sustained efforts to collect data on indicators of maternal well-being after childbirth, and that evidence-informed interventions are implemented that will reduce postpartum morbidity and mortality in the U.S.