In the United States, nearly one quarter of women giving birth were born outside of the United States, and an estimated one out of every 13 births in the country is to an undocumented immigrant mother. While most low-income women are eligible for Medicaid during and after pregnancy, in many states low-income undocumented and recent immigrants are not eligible for pregnancy Medicaid and are covered instead by less generous programs which often do not cover postpartum care.

Assistant Professor of Population Studies Maria Steenland has received funding from the National Institutes of Health to investigate whether postpartum outcomes vary between foreign-born and U.S.-born low-income women. Dr. Steenland, a health services and health policy researcher focused on maternal and reproductive health policy in the United States, will examine the relationship between state public coverage policies for pregnant and postpartum immigrant women and disparities in postpartum care between foreign and U.S.-born women.  

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 43 percent of births in the United States, covers women for at least 60 days after childbirth. The majority of low-income women qualify for Medicaid during pregnancy, but 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 the specific services covered under alterative public coverage options for childbirth in each state and how this may affect postpartum outcomes among immigrant women. Dr. Steenland and her research team will create the first database linking data from the Pregnancy Risk Assessment Monitoring System (PRAMS) with information on maternal place of birth and documenting state variations in public coverage policies for immigrant women during pregnancy in PRAMS states (including undocumented women and legally residing non-citizens). They will use the data compiled to compare postpartum health care use (including contraceptive use), outcomes, and behaviors between women born within and outside the U.S., as well as examine the association between state policies for public coverage of immigrant women during and after pregnancy and disparities in postpartum care utilization and health outcomes between postpartum women born within and outside of the U.S.

This project will be the first study to examine the relationship between state public coverage for immigrant women during pregnancy and postpartum care. Dr. Steenland and her team look forward to sharing their results with public health practitioners, policy makers, and colleagues in the field.