Critical Health Equity Context Needed in New Maternal and Infant Health Data Profile

Just before the end of 2020, CMS published a valuable new trove of data on indicators of maternal and infant health in Medicaid, designed to create a profile of the health status of pregnant and postpartum women and their infants. The information is part of several new reports and learning communities launched by CMS to improve infant and maternal health in Medicaid.

While all this data was publicly available prior to the release, the chart pack, called the “Medicaid and CHIP Beneficiary Profile: Maternal and Infant Health,” provides a comprehensive look at demographics, health status, health outcomes, risk factors, and health care utilization among reproductive-age women, birthing people, and infants covered by Medicaid, and pulls the data all together in one place.

The data paint a concerning picture of maternal and infant health in the Medicaid program, where women who are covered by Medicaid for their pregnancy and childbirth are more likely to experience severe maternal morbidity than women with private coverage, and infants whose births are financed by Medicaid have the highest mortality rate of any payer, including babies who are born to uninsured mothers.

Yet, by consistently comparing Medicaid beneficiaries to privately insured individuals without context, the data run the risk of leading audiences to cast blame on beneficiaries as they seek to draw conclusions. While we know that disaggregated data is important to illuminate disparities between groups, context matters. The comparisons can set up one group as the “baseline” or the “high achiever,” and reinforce implicit biases fueled by centuries of racism. In a smart blog post from strategist Pieta Blakely on data visualization and equity, she writes that simply comparing groups to each other, without reference to an overall goal, “encourages a deficit-based perspective rather than challenging [the viewer] to consider each group’s specific assets and needs.”

For instance, the chartbook shows that women covered by Medicaid are the group least likely to receive a postpartum visit between 21 and 56 days after delivery, and infants with Medicaid are the group least likely to receive a developmental screening. This is concerning, yet the data does not probe the many reasons why this might occur—lack of transportation access, lack of paid maternity leave, child care needs, few culturally competent providers, inconsistent work schedules—many of which are not solely determined by their coverage status. It would be helpful to present, alongside the data, an exploration of what supports, services, and infrastructure postpartum individuals covered by Medicaid need in order to access care.

The profile also shows stark racial disparities in health status and outcomes for women and infants covered by both Medicaid and private coverage. For instance, Black infants covered by Medicaid at birth had the highest mortality rate at 11.5 percent, followed closely by Native American/Alaska Native babies at 10.9 percent, which were nearly twice the rates of White, Hispanic, and Asian babies born in 2017 while covered by Medicaid. This is a disturbing statistic on its face, but without context regarding why this might be happening, it provides an incomplete picture.

Researchers are digging deeper into these questions. An important study released recently found that when Black babies are cared for by Black doctors after birth, their mortality rate was cut in half compared to Black babies cared for by White doctors. The researchers point out that more research is needed to get to the root of, “our understanding of inequality, its origins, and how practitioners can work toward creating better and more-equitable birth outcomes.” The findings are proof that there is a deep need to investigate the structural causes of these racial disparities and not just the disparate health status of expectant parents. Only the last section of the chartbook, which explores the maternity-related healthcare provider workforce, scratches the surface of systemic barriers that many parents and infants face.

To come up with policy changes that maximize Medicaid’s potential to ensure that all families get their healthiest start possible, we need more studies and research to help us get to the “why” underlying the differences reflected in the data and listen to the families profiled in the data to learn about the challenges they face and solutions they seek. We are encouraged that CMS is making a commitment to improving infant and maternal health in Medicaid and welcome their attention to this critical challenge.