Medicaid Expansion and Maternal Health in Racial and Ethnic Minority Women

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The broad long-term objective of the proposed research project is to ensure equitable access to safe and quality maternal care. Compared with non-Hispanic White women, racial and ethnic minority women are at significantly increased risks of experiencing severe pain and life-threatening complications during childbirth. Reducing racial and ethnic disparities in peripartum pain management and severe maternal morbidity is a national priority. Neuraxial analgesia (i.e., epidural or spinal analgesia) is the most effective technique to relieve labor pain, and it is associated with a reduced risk of severe obstetric hemorrhage. In the United States, severe obstetric hemorrhage disproportionately affects racial and ethnic minority women and is the leading cause of preventable maternal morbidity, peripartum maternal blood transfusion, hemostatic hysterectomy, and intensive care unit admission. However, labor neuraxial analgesia is underutilized in uninsured racial and ethnic minority women. Increasing access and utilization of labor neuraxial analgesia in uninsured racial and ethnic minority women could help reduce peripartum disparities in pain management and severe maternal morbidity. The 2014 Medicaid expansion under the Affordable Care Act has decreased the proportion of uninsured pregnant women and may have been associated with increased utilization of labor neuraxial analgesia and decreased risk of severe maternal morbidity. The proposed research project aims to assess in racial and ethnic minority women: 1) the association between labor neuraxial analgesia and the risks of 1a) peripartum maternal blood transfusion or hemostatic hysterectomy, and 1b) intensive care unit admission; and 2) the effectiveness of the 2014 Medicaid expansion under the Affordable Care Act in 2a) increasing labor neuraxial analgesia utilization, and 2b) reducing the risk of severe maternal morbidity. These specific aims will be achieved by analyzing birth certificate data from 2010 to 2018 from the National Vital Statistics System of the Centers for Disease Control and Prevention. This data system is a census of US births in the 50 states and the District of Columbia, based on the 2003 revised US Standard Certificate of Live Birth. Results of this project could provide scientific evidence for evaluating the Affordable Care Act and for informing healthcare policy to reduce racial and ethnic disparities in maternal health.