One quarter of pregnant and postpartum struggle to afford health care

Disruptions in insurance coverage are common during pregnancy and the first six months postpartum — affecting women with both private and public insurance. (Photo: Shutterstock)

Nearly one-quarter of pregnant and recently pregnant women indicate that they’ve been unable to afford necessary health care. What’s more, three-fifths report concern about paying medical bills, and more than half expressed general financial anxiety about such expenses as monthly bills, housing costs, credit card payments, and maintaining their standard of living.

This information comes from a five-year study conducted by researchers at the University of Michigan Health Von Voigtlander Women’s Hospital. The findings appear in Jama Network Open and include a national sample taken between 2013 and 2018 of more than 3,500 peripartum women, which is weighted to represent more than one million women. (“Peripartum” is defined as the time period shortly before, during, and immediately after giving birth.)

“Our study suggests that financial hardship is exceedingly common among the birthing population in the United States, with many parents experiencing unmet health care need due to cost, health care unaffordability, and general financial stress,” said senior author Michelle Moniz, an obstetrician-gynecologist at the hospital. “Prenatal and postpartum visits provide essential preventive services for both women and infants, including vaccinations, screening for gestational diabetes and anemia, and an opportunity for early diagnosis and management of pregnancy complications. But for some, the cost of health care is a barrier to utilizing these recommended services.”

The 24% of women unable to afford health care said they or a family member delayed or deferred medical or mental health care, prescription medications, or eyeglasses. Meanwhile, the 60% of women reporting financial concerns said those worries stem from potential medical bill, existing medical debt, or problems paying off medical bills.

‘Stable’ coverage needed

Women with private insurance and those living on lower incomes were more likely to experience unaffordable health care than women with public insurance and those with higher incomes, researchers found. They also noted that falling household income often coincides with childbirth, adding a reminder that the United States is the only “resourced country” without mandatory paid parental leave.

Additionally, the rates of unmet health care needs and health care unaffordability were highest among peripartum women without health insurance coverage, according to researchers. Disruptions in insurance coverage are common during pregnancy and the first six months postpartum — affecting women with both private and public insurance, they said.

“These data may help explain why lack of insurance during pregnancy is associated with inadequate and late prenatal care and higher risk of adverse birth outcomes,” Moniz said. “Our findings underscore the importance of stable insurance coverage for pregnant and postpartum women.”

Although the Patient Protection and Affordable Care Act requires coverage for certain prenatal services without cost-sharing for those with private insurance, Moniz added that financial barriers continue to affect both those without insurance who are exposed to full charges for health care services and those with insurance via copayments, coinsurance, and deductibles. “Improving coverage and affordability of recommended health care for peripartum women is a decades-long policy goal,” she said. “We need more targeted interventions to promote overall economic security among peripartum women and their growing families.”