Medicaid-Insured Women’s Perceptions of Obstetric Care Quality: Implications for Reproductive Health Equity in the United States

Abstract

Racial and socioeconomic disparities in maternal health outcomes are significant in the United States. Expanded access to obstetric care through Medicaid, a public health insurance program, aims to address these disparities among racially and economically marginalized birthing people. However, limited research has examined the experiences of women whose obstetric care was covered by Medicaid. This study utilized a birth equity framework informed by reproductive justice principles to analyze interviews with 30 Medicaid-insured women in South Carolina. The analysis focused on study participants’ perceptions of their obstetric care experiences during their most recent pregnancy and hospital stay for labor and delivery. Thematic analysis revealed that participants felt disrespected, dismissed, and ignored by their obstetric care providers. Problems included insurance-related discrimination, insufficient explanations about treatment protocols, mismanagement of pregnancy complications, disregarded pain medication requests, inadequate monitoring of labor progression, and physician absences during delivery. The results substantiate the need for birth equity–informed interventions that facilitate structural competency and cultural humility among medical professionals to improve obstetric care quality among marginalized patients.