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Zivin K, Pangori A, Zhang X, Tilea A, Hall SV, Vance A, Dalton VK, Schroeder A, Courant A, Tabb KM. Perinatal Mood And Anxiety Disorders Rose Among Privately Insured People, 2008-20. Health Aff (Millwood) 2024; 43:496-503. [PMID: 38507649 PMCID: PMC11163973 DOI: 10.1377/hlthaff.2023.01437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Nationwide, perinatal mood and anxiety disorder (PMAD) diagnoses among privately insured people increased by 93.3 percent from 2008 to 2020, growing faster in 2015-20 than in 2008-14. Most states and demographic subgroups experienced increases, suggesting worsening morbidity in maternal mental health nationwide. PMAD-associated suicidality and psychotherapy rates also increased nationwide from 2008 to 2020. Relative to 2008-14, psychotherapy rates continued to rise in 2015-20, whereas suicidality rates declined.
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Affiliation(s)
- Kara Zivin
- Kara Zivin , University of Michigan, Veterans Affairs Ann Arbor Healthcare System, and Mathematica, Ann Arbor, Michigan
| | | | | | | | | | - Ashlee Vance
- Ashlee Vance, Henry Ford Health System, Detroit, Michigan
| | | | | | | | - Karen M Tabb
- Karen M. Tabb, University of Illinois at Urbana-Champaign, Champaign, Illinois
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Fuchs JR, Schiff MA, Coronado E. Substance Use Disorder-Related Deaths and Maternal Mortality in New Mexico, 2015-2019. Matern Child Health J 2023; 27:23-33. [PMID: 37306823 PMCID: PMC10691991 DOI: 10.1007/s10995-023-03691-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND In recent decades, maternal mortality has increased across the U.S. Experiences of pregnant and postpartum people with Substance Use Disorder (SUD)-related deaths have not been previously evaluated in New Mexico. The aim of this study was to analyze risk factors related to substance use and explore substance use patterns among pregnancy-associated deaths in New Mexico from 2015 to 2019. METHODS We conducted an analysis of pregnancy-associated deaths to assess the association between demographics, pregnancy factors, circumstances surrounding death, treatment of mental health conditions, and experiences with social stressors among Substance Use Disorder (SUD)-related and non-SUD-related deaths. We performed univariate analyses of risk factors using chi-square tests to assess the differences between SUD-related and non-SUD-related deaths. We also examined substance use at time of death. RESULTS People with SUD-related deaths were more likely to die 43-365 days postpartum (81% vs. 45%, p-value = 0.002), have had a primary cause of death of mental health conditions (47% vs 10%, p < 0.001), have died of an overdose (41% vs. 8%, p-value = 0.002), have had experienced any social stressors (86% vs 30%, p < 0.001) compared to people with non-SUD-related deaths, and received treatment for SUD at any point before, during, or after pregnancy (49% vs. 2%, p < 0.001). The substances most used at time of death were amphetamines (70%), and most cases engaged in polysubstance use (63%). CONCLUSIONS FOR PRACTICE Providers, health departments, and community organizations must prioritize supporting people using substances during and after pregnancy to prevent death and improve quality of life for pregnant and postpartum people.
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Affiliation(s)
- Jessica R Fuchs
- New Mexico Department of Health, 2040 S. Pacheco St, Santa Fe, NM, 87505, USA.
| | - Melissa A Schiff
- Department of Internal Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, Albuquerque, NM, 8713, USA
| | - Eirian Coronado
- New Mexico Department of Health, 2040 S. Pacheco St, Santa Fe, NM, 87505, USA
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Eapen D, Mbango C, Daniels G, Mathew Joseph N, Mary A, Mathews N, Carr KK, Wells C, Suriaga A, Saint Fleur A. Recommendations to improve maternal health equity among Black women in "The South": A position paper from the SNRS minority health research interest & implementation group. Res Nurs Health 2023; 46:457-461. [PMID: 37525299 DOI: 10.1002/nur.22332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
Black women in the United States experience a higher maternal mortality rate compared to other racial groups. The maternal mortality rate among non-Hispanic Black women is 3.5 times that of non-Hispanic White women and is higher in the South compared to other regions. The majority of pregnancy-related deaths in Black women are deemed to be preventable. Healthy People 2030 directs healthcare providers to advance health equity through societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. The Southern Nursing Research Society has put forward this position paper to provide recommendations to improve maternal health equity among Black women. Recommendations for nurses, multidisciplinary healthcare providers, policymakers, and researchers are discussed.
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Affiliation(s)
- Doncy Eapen
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Catherine Mbango
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas, USA
| | - Glenda Daniels
- Harris College of Nursing & Health Sciences, Texas Christian University, Fort Worth, Texas, USA
| | - Nitha Mathew Joseph
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Annapoorna Mary
- Loewenberg College of Nursing, The University of Memphis, Memphis, Tennessee, USA
| | - Nisha Mathews
- College of Human Sciences and Humanities, University of Houston-Clear Lake (Pearland), Pearland, Texas, USA
| | - Kathryn Kravetz Carr
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Cheryl Wells
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Armiel Suriaga
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
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Dahl AA, Yada FN, Butts SJ, Tolley A, Hirsch S, Lalgondar P, Wilson KS, Shade L. Contextualizing the experiences of Black pregnant women during the COVID-19 pandemic: 'It's been a lonely ride'. Reprod Health 2023; 20:124. [PMID: 37626357 PMCID: PMC10463995 DOI: 10.1186/s12978-023-01670-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
The emergence of the COVID-19 pandemic significantly changed the prenatal care experience, specifically regarding medical appointments and social opportunities. It is critical to capture this change through the narratives of pregnant people, particularly those of marginalized populations, whose voices may often be underrepresented in the literature. This mixed-methods paper summarizes the experiences of 40 pregnant Black/African American (AA) women during the COVID-19 pandemic. A cross-sectional, online survey was administered between 2020 and 2021 to assess prenatal health and the impacts of the COVID-19 pandemic on patients' pregnancy experience. Coping behaviors during the pandemic were self-reported using the COPE-IS. Univariate analyses were conducted. An additional analysis of participants (n = 4) was explored through a week-long qualitative exercise using a photo documentation procedure. Photo-Elicitation Interviews (PEI) were conducted to capture and center their pandemic pregnancy experiences. Sources of stress during the pandemic varied, with the most common being financial concerns (n = 19, 47.5%). Over half of the sample (n = 18, 54.5%) self-reported increases in their positive coping behaviors during the pandemic, such as communicating with friends and family, talking to healthcare providers, listening to music, and engaging in spiritual practices-such as prayer. The four PEI study participants reflected on the impacts of social distancing on their prenatal experience and mentioned hospital and provider-related weariness due to their race. The findings of this study suggest that during the COVID-19 pandemic, Black/AA pregnant women in Charlotte, NC used social support, mindfulness practices, self-advocacy, and health literacy to navigate challenges present during their prenatal health experience. This paper highlights the personal, social, and structural experiences of pregnant women during a public health crisis so that responsive and effective programs or policies can be planned in the future.
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Affiliation(s)
- Alicia A Dahl
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA.
| | - Farida N Yada
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Shanika Jerger Butts
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Annalise Tolley
- Department of Psychological Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Sophie Hirsch
- Department of Psychological Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Priyanka Lalgondar
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Kala S Wilson
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Lindsay Shade
- Department of Family Medicine, Atrium Health, 2001 Vail Avenue, Suite 400-B Mercy Medical Plaza, Charlotte, NC, 28207, USA
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Buchbinder M, Mishtal J, Singer EO, Wendland CL. Society for Medical Anthropology Statement on Supreme Court Dobbs v. Jackson Women's Health Organization Decision. Med Anthropol Q 2022; 36:433-441. [PMID: 36433774 PMCID: PMC10098746 DOI: 10.1111/maq.12741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This statement summarizes key findings from anthropological and related scholarship on the harmful consequences of inadequate abortion access, leading the Society for Medical Anthropology to register profound concern about the recent Supreme Court decision in Dobbs v. Jackson. After circulation to SMA members for input, a finalized version passed a membership vote by an overwhelming margin. This statement complements one produced by the Council for Anthropology and Reproduction, available here.
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Affiliation(s)
- Mara Buchbinder
- University of North Carolina at Chapel Hill, Department of Social Medicine
| | - Joanna Mishtal
- University of Central Florida, Department of Anthropology
| | | | - Claire L Wendland
- University of Wisconsin-Madison, Departments of Anthropology and Obstetrics and Gynecology
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Jeung C, Attanasio LB, Geissler KH. Transitions in Health Insurance During the Perinatal Period Among Patients With Continuous Insurance Coverage. JAMA Netw Open 2022; 5:e2239803. [PMID: 36322086 PMCID: PMC9631105 DOI: 10.1001/jamanetworkopen.2022.39803] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
IMPORTANCE Although health insurance continuity is important during the perinatal period to improve birth outcomes and reduce maternal morbidity and mortality, insurance disruptions are common. However, little is known about insurance transitions among insurance types for individuals who remained insured during the perinatal period. OBJECTIVE To examine insurance transitions for birthing individuals with continuous insurance, including those with Medicaid and Medicaid managed care coverage, before, during, and after pregnancy. DESIGN, SETTING, AND PARTICIPANTS This cohort study used January 1, 2014 to December 31, 2018 data from the Massachusetts All-Payer Claims Database. The sample included deliveries from January 1, 2015, to December 31, 2017, to birthing individuals aged 18 to 44 years old with continuous insurance for 12 months before and after delivery. Data were analyzed from November 9, 2021, to September 2, 2022. EXPOSURE Insurance type at delivery. MAIN OUTCOMES AND MEASURES The primary outcome was a binary indicator of any transition in insurance type from 12 months before and/or after delivery. The secondary outcomes were measures of any predelivery transition (12 months before delivery month) and any transition during the postpartum period (delivery month to 12 months post partum). Multivariate logit regression models were used to analyze the association of an insurance transition in the perinatal period with insurance type in the delivery month, controlling for age and socioeconomic status based on a 5-digit zip code. RESULTS The analytic sample included 97 335 deliveries (mean [SD] maternal age at delivery, 30.4 [5.5] years). Of these deliveries, 23.4% (22 794) were insured by Medicaid and 28.1% (27 347) by Medicaid managed care in the delivery month. A total of 37.1% of the sample (36 127) had at least 1 insurance transition during the 12 months before and/or after delivery. In regression-adjusted analyses, those individuals covered by Medicaid and Medicaid managed care at delivery were 47.0 (95% CI, 46.3-47.7) percentage points and 50.1 (95% CI, 49.4-50.8) percentage points, respectively, more likely to have an insurance transition than those covered by private insurance. Those covered by Marketplace plans at delivery had a 33.1% (95% CI, 31.4%-34.8%) regression-adjusted predicted probability of having a postpartum insurance transition. CONCLUSIONS AND RELEVANCE Results of this study showed that insurance transitions during the perinatal period occurred for more than 1 in 3 birthing individuals with continuous insurance and were more common among those with Medicaid or Medicaid managed care at delivery. Further research is needed to examine the role of insurance transitions in health care use and outcomes during the perinatal period.
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Affiliation(s)
- Chanup Jeung
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst
| | - Laura B. Attanasio
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst
| | - Kimberley H. Geissler
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst
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Carty DC, Mpofu JJ, Kress AC, Robinson D, Miller SA. Addressing Racial Disparities in Pregnancy-Related Deaths: An Analysis of Maternal Mortality-Related Federal Legislation, 2017-2021. J Womens Health (Larchmt) 2022; 31:1222-1231. [PMID: 36112423 PMCID: PMC10949966 DOI: 10.1089/jwh.2022.0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There has been increasing national attention to the issue of racial disparities in pregnancy-related deaths. Federal legislation can support approaches at multiple levels of intervention to improve maternal health. As part of the CDC Policy Academy, a team of CDC staff completed a policy analysis to determine the approaches addressed in federal legislation to reduce racial disparities in pregnancy-related deaths. We analyzed federal maternal mortality legislation introduced January 2017 through December 2021. Common approaches addressed by the legislation were categorized into themes and reviewed for their alignment with approaches identified in clinical and public health literature to reduce pregnancy-related deaths, with an emphasis on social determinants of health (SDOH) approaches and reducing racial disparities. Thirty-seven unduplicated bills addressed pregnancy-related deaths, including 27 House or Senate bills that were introduced but not passed, 6 resolutions highlighting the maternal health crisis, 2 bills that passed the House only, and 2 bills enacted into law (Preventing Maternal Deaths Act of 2018 and Protecting Moms Who Served Act). The most common themes mentioned in federal legislation were improving maternal health care, addressing health inequities and SDOH, enhancing data, and promoting women's health. Legislation focused on health inequities and SDOH emphasized implicit bias training and improving SDOH, including racism and other social factors. The reviewed federal legislation reflected common clinical and public health approaches to prevent pregnancy-related deaths, including a significant focus on reducing bias and improving SDOH to address racial disparities.
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Affiliation(s)
- Denise C. Carty
- Office of Women’s Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonetta J. Mpofu
- Office of Minority Health and Health Equity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- U.S. Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Alissa C. Kress
- Office of Women’s Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Desireé Robinson
- Office of Minority Health and Health Equity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott A. Miller
- Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Gendered Racism on the Body: An Intersectional Approach to Maternal Mortality in the United States. POPULATION RESEARCH AND POLICY REVIEW 2022. [DOI: 10.1007/s11113-021-09691-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Reddy S, Patel N, Saxon M, Amin N, Biviji R. Innovations in U.S. Health Care Delivery to Reduce Disparities in Maternal Mortality Among African American and American Indian/Alaskan Native Women. J Patient Cent Res Rev 2021; 8:140-145. [PMID: 33898647 PMCID: PMC8060040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Despite spending more on health care than any other country, the United States has the worst maternal mortality rate among all developed nations. African American and American Indian/Alaskan Native women have the worst outcomes by race, representing a stark health disparity within the country. Contributing factors disproportionately experienced by these minority populations include challenges of access to consistent and high-quality prenatal care, prevalence of underlying conditions, toxic stress due to systemic racism, and unconscious bias in health care. While many of these factors lie upstream in the lives of women, and seemingly beyond the scope of the clinical walls, the downstream health care delivery system can serve as a vital part of the solution via innovative practices, community-based collaborations, and by serving as advocates for the communities served. Such alignments between clinicians, community leaders, policymakers, and patients that extend beyond the health system can serve as the missing piece needed within the clinic to reverse the trajectory of maternal mortality for American women, especially those from traditionally underserved populations.
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Affiliation(s)
- Swapna Reddy
- College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Nina Patel
- College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Mary Saxon
- College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Nina Amin
- Phoenix Country Day School, Paradise Valley, AZ
| | - Rizwana Biviji
- College of Health Solutions, Arizona State University, Phoenix, AZ
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Maron JL. Evaluating Therapeutics and Interventions Throughout the Female Life Course. Clin Ther 2020; 42:379-380. [DOI: 10.1016/j.clinthera.2020.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
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Evans ML, McGregor AJ. Improving the Health of Women Across the Life Span: Recognizing Biological Barriers and Beyond. Clin Ther 2020; 42:382-384. [DOI: 10.1016/j.clinthera.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 10/24/2022]
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