The Postpartum Assessment of Women Survey (PAWS): Informing Medicaid Policies to Improve Health in the "Fourth Trimester"

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PROJECT SUMMARY The year after birth, also known as the “fourth trimester”, is a growing focus of efforts to address high rates of maternal morbidity and mortality in the United States (U.S.), which disproportionally affect racial-ethnic minorities, rural women and women insured by Medicaid at delivery. More than half of pregnancy-related deaths occur in the year after delivery and a significant share of women experience postpartum morbidity due to physical and mental health conditions. As the payer for nearly half of U.S. births and a larger share of births among Black and Indigenous women, Medicaid is a key lever to improve population-level postpartum health disparities. As the COVID-19 pandemic subsides, policymakers are considering a range of Medicaid policy changes—alone and in conjunction with other social policy sectors—aimed to improve postpartum health, such as extending pregnancy Medicaid one year postpartum or addressing social risk factors. Yet, the determinants of postpartum wellbeing and health disparities are poorly understood. This is largely because the fourth trimester has been a neglected focus of maternal health policy and research. To drive evidence-based policymaking and fill the significant gap in high quality, representative data on postpartum health, our multidisciplinary team developed a large-scale follow-up survey administered one year after birth in collaboration with six states and New York City: the Postpartum Assessment of Women Survey (PAWS). The 2020 PAWS captured the postpartum experience of women who gave birth in 2020, during the height of the public health emergency (PHE). This proposed project leverages and builds on this first-of-its kind data collection effort to respond to the urgent needs of policymakers to improve postpartum health in the new public health, policy and social context that will emerge as the pandemic subsides, as the policies and protections of the PHE end, and as new policies begin (e.g. postpartum Medicaid extensions in 2022). Specifically, we will launch a new PAWS survey round following a 2023 birth cohort (data collected in 2024) to measure (1) maternal health outcome disparities in the postpartum year (by insurance, race-ethnicity, and urban/rural residence), (2) health care-related disparities and their contribution to disparities in postpartum health outcomes, and (3) social and economic disparities and their contribution to disparities in postpartum health outcomes. Drawing on expertise from our diverse, interdisciplinary team of junior and senior investigators, and in deep collaboration with state and city government partners, we will produce a highly valuable scientific resource and generate timely, rigorous findings to inform evidence-based policies with the potential to advance maternal health equity in the U.S.