A study shows that the the infant mortality rate is higher for pregnant people insured by Medicaid compared to private insurance.
A new study published in JAMA Network Open suggests that the type of health insurance pregnant people have may impact infant mortality rates. The research, led by Children’s of Alabama neonatologist Colm P. Travers, M.D., found that pregnant people with private health insurance had lower rates of infant deaths compared to those insured by Medicaid.
“The type of health insurance you have has been associated with adverse outcomes in adults and pediatric populations and differences in access to care, including prenatal care,” Travers said. “But few studies showed a difference in infant outcomes, particularly infant mortality rates, when comparing private health insurance to Medicaid public health insurance.”
The study analyzed data on more than 13 million births that occurred in the U.S. from 2017 to 2020. Overall, 46% of the pregnant people in the study had Medicaid insurance, while 54% had private insurance.
The infant mortality rate—defined as the number of deaths in the first year of life per 1,000 live births—was 2.75 deaths per 1,000 live births for those with private insurance compared to 5.30 deaths per 1,000 live births for those covered by Medicaid.
Those with private insurance also had a 43% lower risk of postneonatal mortality (from 28 days to one year after birth); a 10% lower risk of a low-birthweight infant; a 20% lower risk of vaginal breech delivery; and an 8% lower risk of preterm birth. They were 24% more likely to have received first-trimester prenatal care than those with Medicaid.
Travers said the difference may result from the onerous application process for Medicaid, which delays access to early prenatal care. Previous research shows such delays are associated with worse infant health outcomes.[1],[2]
To address this issue, Travers suggested exploring policies around presumed eligibility for pregnant Medicaid beneficiaries. “The idea there would be that once you’re pregnant, you would automatically have access to prenatal care appointments while waiting on Medicaid approval,” he said.
Travers also suggested more help for Medicaid beneficiaries with navigating the healthcare system and scheduling essential prenatal appointments. “Community health workers or healthcare navigators could have a role,” he said. Peer coaches, known as doulas, could also provide valuable emotional and informational support throughout pregnancy and childbirth.
“From a holistic perspective, infants should have good health outcomes, irrespective of their parents’ socioeconomic status,” he said. “Babies shouldn’t die because of the kind of health insurance their mother has.”
[1] Swartz JJ, Hainmueller J, Lawrence D, Rodriguez MI. Expanding prenatal care to unauthorized immigrant women and the effects on infant health. Obstet Gynecol. 2017;130(5):938-945.
[2] 22. Taylor YJ, Liu TL, Howell EA. Insurance differences in preventive care use and adverse birth outcomes among pregnant women in a Medicaid nonexpansion state: a retrospective cohort study. JWomens Health (Larchmt). 2020;29(1):29-37.
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