As the Trump administration explores ways to increase births while also threatening to dismantle social services that make thriving families possible, advocates are struggling to ensure that all families in the United States have access to high-quality maternal health care. Ideas range from simply protecting Medicaid in all its dysfunction to bolstering community mutual aid so that people are cared for when the government refuses to care for them.
It’s time for the U.S. government, and our society, to take care of moms and infants, from prenatal care to postpartum and early childhood. But what would such a plan look like?
On April 29, Senator Bernie Sanders reintroduced the Medicare for All Act, which would establish a national health insurance program to provide free health care to every American. In theory, Medicare for All includes prenatal and postpartum care, but in this political environment, it’s unlikely to pass. However, at a time when politicians and legislators on both sides of the aisle are, in their own unique ways, saying that they care about moms and infants, a first step toward the universal health care the United States desperately needs could be to guarantee free, high-quality maternity care for all families.
Protecting Medicaid isn’t enough.
Protecting Medicaid, Medicare, and federal maternal and child health programs is the bare minimum that the government could do for our nation’s families, yet these are under threat by the same administration that claims to be pro-birth and pro-family.
Medicaid and the Children’s Health Insurance Program (CHIP) cover over 40 percent of all births in the United States, including nearly 50 percent of births in rural communities—any cuts (let alone the $880 billion currently being sought) would worsen maternal health outcomes and put moms at greater risk of dying from pregnancy (mortality) or living with long-term health issues as a result of pregnancy and childbearing (morbidity). Stripping people of access to primary, preventive, and maternity care would worsen the health of the entire population and worsen their health care experiences, which influence whether or not people seek care or put it off until there is an emergency.
There are a number of quality concerns reported from people who utilize Medicaid and clinicians providing services through the program. For example, provider reimbursement challenges and time constraints contribute to inadequate screening for intimate partner violence (IPV) among Medicaid enrollees and IPV is a contributor to maternal mortality. Respectful maternity care is also a problem for all Americans, but women on Medicaid are more likely to report being disrespected by providers, having their concerns ignored, and seeing others prioritized ahead of them.
Some moms still lack maternity care coverage.
Out-of-pocket costs associated with pregnancy, childbirth, and postpartum care have averaged between $14,768 and $26,280 for patients and families enrolled in large group health plans. Pregnant patients who receive life-saving Cesarean sections (C-sections) incur higher out-of-pocket health care costs than those who do not receive the service during labor and delivery. Furthermore, another 900,000 women do not have access to prenatal and postpartum services covered under Medicaid because they fall into the coverage gap caused by the ten states that have not expanded Medicaid under the Affordable Care Act (ACA).
Out-of-pocket costs associated with pregnancy, childbirth, and postpartum care have averaged between $14,768 and $26,280 for patients and families enrolled in large group health plans.
In 2024, the Centers for Medicare and Medicaid Services (CMS) began its Transforming Maternal Health (TMaH) Model—a ten-year delivery and payment model designed to identify ways to use the implementation of evidence-informed interventions to improve maternal health outcomes while reducing costs within Medicaid and CHIP. The rationale for this model is that, without sustained federal funding, hospitals and other health care providers may find it challenging to gather the data necessary to identify opportunities for reducing spending within both federal programs.
Respectful care could improve care quality and maternal health outcomes.
Not only is care in the United States restricted by financial concerns, women seeking maternity care sometimes do not receive high-quality, respectful care. According to the Centers for Disease Control and Prevention, about one in five women report experiencing mistreatment during maternity care; the rate for Black, Hispanic, and multiracial women is even worse, about one in three. Furthermore, about 40 percent of women of color reported experiencing discrimination during maternity care.
Respectful maternity care is defined as “care that maintains dignity, privacy, and confidentiality of pregnant and birthing women, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labor and birth.” It is in the absence of respectful care that negative experiences and outcomes occur, including maternal mortality and morbidity. The government has a critical role in remedying systemwide issues that affect many American families.
The Health Resources and Services Administration (HRSA), the Agency for Healthcare Research and Quality (AHRQ), and the Centers for Medicare and Medicaid Services (CMS) help improve quality indicators to identify and analyze trends in severe maternal morbidity; develop new quality standards; and enforce federal regulations that improve maternal health outcomes. Strengthening the federal workforce at these agencies and preserving federal funding for their programs and initiatives is critical. Supporting state-level efforts to design and implement new bundled maternal health care services through HRSA’s Alliance for Innovation on Maternal Health (AIM) program and strengthening patient safety culture within labor and delivery units through AHRQ’s Safety Program for Perinatal Care (SPPC) are both essential federal efforts that help prevent adverse maternal health outcomes resulting from poor communication among health care providers and from health system failures.
For example, by December 2024, HRSA had engaged with 75 percent of all labor and delivery facilities in the United States (over 2,000 facilities in total) to ensure that hospitals implemented AIM safety bundles and were prepared to treat acute and chronic conditions that have led to adverse pregnancy outcomes (for example, obstetric hemorrhage, high blood pressure). Each AIM bundle touches on respectful care and provides best practices for implementing equitable and responsive care.
Maternity care deserts are worsening.
As of 2022, over 35 percent (1,104) of all U.S. counties lacked a birthing facility or obstetric clinician. These counties are commonly referred to as maternity care deserts. However, it should be noted that some advocates are moving away from using the term “desert” to use “medically underserved areas” instead. Their reasoning is that while desert refers to a naturally occurring phenomenon, these counties lacking maternal health care providers and facilities are the result of structurally designed inequities and policy decisions that allocate resources to some communities but not others. At the federal level, these areas are referred to as Maternity Care Target Areas (MCTAs).
One solution to improve this crisis of medically underserved areas/MCTAs is to fund the creation of and support existing community-based birth centers.
One solution to improve this crisis of medically underserved areas/MCTAs is to fund the creation of and support existing community-based birth centers. Research indicates that community-based care yields better health outcomes, improves health equity, and lowers costs, especially when it comes to maternal health. Funding for community birth centers must be inclusive of comprehensive training and pathway programs to prioritize educating those in the community who have an interest in becoming perinatal health care professionals, and ensure financial incentives to attract medical and health care professionals from elsewhere to those underserved areas if there is a lack of interest or availability within the community itself.
It is important to note that abortion bans and restrictions are exacerbating the crisis in MCTAs and, in some cases, they are the driving cause by making it more difficult for practitioners to provide care—creating intersecting harms for women and birthing people of reproductive age across the country.
In order to ensure that perinatal and reproductive health care practitioners can stay to care for those in their respective states and communities, policymakers need to make them feel safe and legally protected to provide the full spectrum of reproductive health care that they have taken an oath to offer their patients. Eradicating the conditions that plague MCTAs is essential to making it so that everyone who needs safe, affordable, and respectful maternity care can access it no matter their zip code. This requires federal protection for abortion care and federal investment to both fuel the creation of new community-based birth centers in areas that lack them and to fund the expansion of existing birth centers.
Looking Ahead
Access to free maternal health care for all is a goal that the current administration and future administrations should support if they truly want healthy moms and babies. The existing maternity care system is failing families. Change is possible. Yes, it requires funding, but any upfront expense is well worth it. Investments in maternity care are likely to yield returns in the form of a healthy, thriving populace as well as long-term health care cost savings. It’s time for universal maternity care.
Tags: medicaid, maternal health, maternity care, family planning
Maternal Health Care for All Must Be Made a Reality
As the Trump administration explores ways to increase births while also threatening to dismantle social services that make thriving families possible, advocates are struggling to ensure that all families in the United States have access to high-quality maternal health care. Ideas range from simply protecting Medicaid in all its dysfunction to bolstering community mutual aid so that people are cared for when the government refuses to care for them.
It’s time for the U.S. government, and our society, to take care of moms and infants, from prenatal care to postpartum and early childhood. But what would such a plan look like?
On April 29, Senator Bernie Sanders reintroduced the Medicare for All Act, which would establish a national health insurance program to provide free health care to every American. In theory, Medicare for All includes prenatal and postpartum care, but in this political environment, it’s unlikely to pass. However, at a time when politicians and legislators on both sides of the aisle are, in their own unique ways, saying that they care about moms and infants, a first step toward the universal health care the United States desperately needs could be to guarantee free, high-quality maternity care for all families.
Protecting Medicaid isn’t enough.
Protecting Medicaid, Medicare, and federal maternal and child health programs is the bare minimum that the government could do for our nation’s families, yet these are under threat by the same administration that claims to be pro-birth and pro-family.
Medicaid and the Children’s Health Insurance Program (CHIP) cover over 40 percent of all births in the United States, including nearly 50 percent of births in rural communities—any cuts (let alone the $880 billion currently being sought) would worsen maternal health outcomes and put moms at greater risk of dying from pregnancy (mortality) or living with long-term health issues as a result of pregnancy and childbearing (morbidity). Stripping people of access to primary, preventive, and maternity care would worsen the health of the entire population and worsen their health care experiences, which influence whether or not people seek care or put it off until there is an emergency.
There are a number of quality concerns reported from people who utilize Medicaid and clinicians providing services through the program. For example, provider reimbursement challenges and time constraints contribute to inadequate screening for intimate partner violence (IPV) among Medicaid enrollees and IPV is a contributor to maternal mortality. Respectful maternity care is also a problem for all Americans, but women on Medicaid are more likely to report being disrespected by providers, having their concerns ignored, and seeing others prioritized ahead of them.
Some moms still lack maternity care coverage.
Out-of-pocket costs associated with pregnancy, childbirth, and postpartum care have averaged between $14,768 and $26,280 for patients and families enrolled in large group health plans. Pregnant patients who receive life-saving Cesarean sections (C-sections) incur higher out-of-pocket health care costs than those who do not receive the service during labor and delivery. Furthermore, another 900,000 women do not have access to prenatal and postpartum services covered under Medicaid because they fall into the coverage gap caused by the ten states that have not expanded Medicaid under the Affordable Care Act (ACA).
In 2024, the Centers for Medicare and Medicaid Services (CMS) began its Transforming Maternal Health (TMaH) Model—a ten-year delivery and payment model designed to identify ways to use the implementation of evidence-informed interventions to improve maternal health outcomes while reducing costs within Medicaid and CHIP. The rationale for this model is that, without sustained federal funding, hospitals and other health care providers may find it challenging to gather the data necessary to identify opportunities for reducing spending within both federal programs.
Respectful care could improve care quality and maternal health outcomes.
Not only is care in the United States restricted by financial concerns, women seeking maternity care sometimes do not receive high-quality, respectful care. According to the Centers for Disease Control and Prevention, about one in five women report experiencing mistreatment during maternity care; the rate for Black, Hispanic, and multiracial women is even worse, about one in three. Furthermore, about 40 percent of women of color reported experiencing discrimination during maternity care.
Respectful maternity care is defined as “care that maintains dignity, privacy, and confidentiality of pregnant and birthing women, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labor and birth.” It is in the absence of respectful care that negative experiences and outcomes occur, including maternal mortality and morbidity. The government has a critical role in remedying systemwide issues that affect many American families.
The Health Resources and Services Administration (HRSA), the Agency for Healthcare Research and Quality (AHRQ), and the Centers for Medicare and Medicaid Services (CMS) help improve quality indicators to identify and analyze trends in severe maternal morbidity; develop new quality standards; and enforce federal regulations that improve maternal health outcomes. Strengthening the federal workforce at these agencies and preserving federal funding for their programs and initiatives is critical. Supporting state-level efforts to design and implement new bundled maternal health care services through HRSA’s Alliance for Innovation on Maternal Health (AIM) program and strengthening patient safety culture within labor and delivery units through AHRQ’s Safety Program for Perinatal Care (SPPC) are both essential federal efforts that help prevent adverse maternal health outcomes resulting from poor communication among health care providers and from health system failures.
For example, by December 2024, HRSA had engaged with 75 percent of all labor and delivery facilities in the United States (over 2,000 facilities in total) to ensure that hospitals implemented AIM safety bundles and were prepared to treat acute and chronic conditions that have led to adverse pregnancy outcomes (for example, obstetric hemorrhage, high blood pressure). Each AIM bundle touches on respectful care and provides best practices for implementing equitable and responsive care.
Maternity care deserts are worsening.
As of 2022, over 35 percent (1,104) of all U.S. counties lacked a birthing facility or obstetric clinician. These counties are commonly referred to as maternity care deserts. However, it should be noted that some advocates are moving away from using the term “desert” to use “medically underserved areas” instead. Their reasoning is that while desert refers to a naturally occurring phenomenon, these counties lacking maternal health care providers and facilities are the result of structurally designed inequities and policy decisions that allocate resources to some communities but not others. At the federal level, these areas are referred to as Maternity Care Target Areas (MCTAs).
One solution to improve this crisis of medically underserved areas/MCTAs is to fund the creation of and support existing community-based birth centers. Research indicates that community-based care yields better health outcomes, improves health equity, and lowers costs, especially when it comes to maternal health. Funding for community birth centers must be inclusive of comprehensive training and pathway programs to prioritize educating those in the community who have an interest in becoming perinatal health care professionals, and ensure financial incentives to attract medical and health care professionals from elsewhere to those underserved areas if there is a lack of interest or availability within the community itself.
It is important to note that abortion bans and restrictions are exacerbating the crisis in MCTAs and, in some cases, they are the driving cause by making it more difficult for practitioners to provide care—creating intersecting harms for women and birthing people of reproductive age across the country.
In order to ensure that perinatal and reproductive health care practitioners can stay to care for those in their respective states and communities, policymakers need to make them feel safe and legally protected to provide the full spectrum of reproductive health care that they have taken an oath to offer their patients. Eradicating the conditions that plague MCTAs is essential to making it so that everyone who needs safe, affordable, and respectful maternity care can access it no matter their zip code. This requires federal protection for abortion care and federal investment to both fuel the creation of new community-based birth centers in areas that lack them and to fund the expansion of existing birth centers.
Looking Ahead
Access to free maternal health care for all is a goal that the current administration and future administrations should support if they truly want healthy moms and babies. The existing maternity care system is failing families. Change is possible. Yes, it requires funding, but any upfront expense is well worth it. Investments in maternity care are likely to yield returns in the form of a healthy, thriving populace as well as long-term health care cost savings. It’s time for universal maternity care.
Tags: medicaid, maternal health, maternity care, family planning