Postpartum health care receipt among immigrant women in the United States

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PROJECT SUMMARY The postpartum period, defined as the three months after childbirth, is a critical and often neglected period for maternal health. Routine postpartum health care, including testing for common postpartum health conditions and counseling on breastfeeding and contraception, is recommended by the American College of Obstetricians and Gynecologists for all postpartum women. Medicaid coverage during pregnancy, which pays for the health care costs associated with forty three percent of births in the United States, covers women for at least 60 days after childbirth. While the majority of low-income women qualify for Medicaid during pregnancy, most states limit eligibility to citizens or lawfully residing immigrants with greater than five years of legal residence. States offer a patchwork of alternative public coverage options, such as Emergency Medicaid, to cover the cost of labor and delivery for women who are not eligible for traditional Medicaid coverage because of their immigration status. Unlike traditional Medicaid, these coverage alternatives often do not cover health care during the postpartum period. Little is currently known about what specific services are covered under alterative public coverage options for childbirth in each state, and how this may affect postpartum outcomes among immigrant women. This research has four aims: In Aim 1, we will create the first database linking data from the Pregnancy Risk Assessment Monitoring System (PRAMS) with information on maternal place of birth from birth certificate records. In Aim 2, we will document state variation in public coverage policies for immigrant women during pregnancy in PRAMS states (including undocumented women and legally residing non-citizens) Aim 3 will use the data compiled in Aim 1 to compare postpartum health care use (including contraceptive use), health outcomes and health behaviors between women born within and outside the U.S. Aim 4 will use the dataset created in Aim 1, and the policy information compiled in Aim 2, to examine the association between state policies for public coverage of immigrant women during and after pregnancy and disparities in postpartum care utilization, health outcomes and health behaviors between postpartum women born within and outside of the US This project will be the first study to examine the association between maternal place of birth and postpartum care receipt, and the first to examine the relationship between state public coverage for immigrant women during pregnancy and postpartum care in this population. The results of this study will provide information to public health practitioners and policy makers about whether there are disparities in health care use after pregnancy between immigrant women and women born in the United States. Further, this study will contribute to our understanding of the relationship between state insurance coverage policies for pregnant and postpartum immigrant women and postpartum health care use.