Abstract
ObjectivePublic insurance (Medicaid) covered 42% of all U.S. births in 2018. This paper describes and analyzes the self-reported experiences of women with Medicaid versus commercial insurance relating to autonomy, control and respectful treatment in maternity care.MethodsThe sampling frame for the Listening to Mothers in California survey was drawn from 2016 California birth certificate files. The 30-minute survey had a 55% response rate. A secondary multivariable analysis of results from the survey included 2,318 women with commercial private insurance (1,087) or public (Medi-Cal) (1,231) coverage. Results were weighted and were representative of all births in 2016 in California. The multivariable analysis of variables related to maternal agency included engagement in decision making regarding interventions such as vaginal birth after cesarean and episiotomy, feeling pressured to have interventions and sense of fair treatment. We examined their relationship to insurance status adjusted for maternal age, race/ethnicity, education, nativity and attitude toward birth as well as type of prenatal provider, type of birth attendant and pregnancy complications.ResultsWomen with Medi-Cal had a demographic profile distinct from those with commercial insurance. In multivariable analysis, women with Medi-Cal reported less control over their maternity care experience than women with commercial insurance, including less choice of prenatal provider (AOR 1.61 95%C.I. 1.20, 2.17), or a vaginal birth after cesarean (AOR 2.93 95%C.I. 1.49, 5.73). Mothers on Medi-Cal were also less likely to be consulted before experiencing an episiotomy (AOR 0.30 95%C.I. 0.09, 0.94). They were more likely to report feeling pressure to have a primary cesarean (AOR 2.54 95%C.I. 1.55, 4.16) and less likely to be encouraged by staff to make their own decisions (AOR 0.63 95%C.I. 0.47, 0.85).ConclusionsChildbearing women with public insurance in California clearly and consistently reported less opportunity to choose their care than women with private insurance. These inequities are a call to action for increased accountability and quality improvement relating to care of the many childbearing women with Medicaid coverage.
Highlights
The increasing concern with disrespect and abuse during pregnancy and childbirth [1] has led to calls to support greater maternal agency over the childbearing process
Childbearing women with public insurance in California clearly and consistently reported less opportunity to choose their care than women with private insurance
The importance of maternity care to population health is coming into sharper focus with increasing understanding of the microbiome
Summary
The increasing concern with disrespect and abuse during pregnancy and childbirth [1] has led to calls to support greater maternal agency over the childbearing process, The 85% of U.S women who give birth one or more times The nation’s medical assistance program for low-income individuals, covered 42% of all births in the United States in 2018 [12] and serves a disproportionately marginalized population. Because of its scope and population served, Medicaid can be a vehicle for public programs and policies to improve the care, experiences and outcomes of a large proportion of childbearing women and newborns. Medicaid provides a safety net for at-risk populations, reducing the risks of adverse selection for private insurers [13] and Medicaid policies can have spillover effects on commercial insurance policies, [14] having even greater impact on the health of childbearing families
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
