Birthing people build the foundation for long-term health and well-being in the weeks and months after birth, yet data on postpartum health and health outcomes are inadequate to support clinical and policy efforts to ensure optimal postpartum health. Key information is inconsistently measured, often poor in quality, and lacking in continuity throughout the postpartum year. Such data deficits disproportionally impact Black, Indigenous, and People of Color, who experience greater risk for adverse maternal health outcomes compared with non-Hispanic White patients and for whom better data collection and use could have a great impact (DeMeester and Mahadevan, 2014DeMeester R. Mahadevan R. Using data to reduce disparities and improve quality: A guide for health care organizations.www.rwjf.org/en/library/research/2014/04/using-data-to-reduce-disparities-and-improve-quality--a-guide-fo.htmlDate: 2014Google Scholar; Hoyert, 2021Hoyert L.,D. Maternal mortality rates in the United States, 2019.2021Crossref Google Scholar; Huyser et al., 2021Huyser K.R. Horse A.J.Y. Kuhlemeier A.A. Huyser M.R. COVID-19 Pandemic and Indigenous representation in public health data.American Journal of Public Health. 2021; 111: S208-S214Crossref PubMed Scopus (4) Google Scholar). These data deficits also negatively impact rural residents, who face decreasing access to obstetric care and for whom better data to inform and evaluate rural-specific policy solutions are necessary (Kozhimannil et al., 2020Kozhimannil K.B. Interrante J.D. Tuttle M.K.S. Henning-Smith C. Changes in hospital-based obstetric services in rural US counties, 2014-2018.JAMA. 2020; 324: 197Crossref PubMed Scopus (7) Google Scholar). In addition, many individuals, especially those covered by Medicaid during pregnancy, lose insurance in the weeks and months after birth. Without consistent access to care, data to track and improve postpartum health outcomes among this population are largely absent (Romano and Kleinke, 2021Romano A. Kleinke J.D. Medicare for all? Start at the beginning: Cover all births and modernize maternity care.Health Affairs Blog. 2021; (Available: https://www.healthaffairs.org/do/10.1377/forefront.20210511.549499/abs/. Accessed: December 6, 2021.)Google Scholar). Better data are urgently needed to support a new standard of postpartum care. One-half of all cases of maternal mortality occur in the year after birth (Callaghan et al., 2012Callaghan W.M. Creanga A.A. Kuklina E.V. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States.Obstetrics and Gynecology. 2012; 120: 1029-1036Crossref PubMed Scopus (500) Google Scholar), and although most severe maternal morbidity occurs during childbirth, approximately 15% of these events occur between 1 and 42 days postpartum (Chen et al., 2021Chen J. Cox S. Kuklina E.V. Ferre C. Barfield W. Li R. Assessment of incidence and factors associated with severe maternal morbidity after delivery discharge among women in the US.JAMA Network Open. 2021; 4: e2036148Crossref PubMed Scopus (23) Google Scholar). Common postpartum health challenges include breastfeeding difficulties, fatigue, sexual dysfunction, pain, incontinence, and depression or anxiety, which impact almost three-quarters of all birthing people (Declercq et al., 2013Declercq E.R. Sakala C. Corry M.P. Applebaum S. Herrlich A. Listening to Mothers III: New mothers speak out - Report of the National Survey of Women’s Childbearing Experiences Conducted October-December 2012 and January-April 2013. Childbirth Connections, New York, NY2013Google Scholar). For many individuals, management of these postpartum challenges is further complicated by ongoing care required for chronic conditions such as obesity, hypertension, diabetes, and mood and substance use disorders (Admon et al., 2017Admon L.K. Winkelman T.N.A. Moniz M.H. Davis M.M. Heisler M. Dalton V.K. Disparities in chronic conditions among women hospitalized for delivery in the United States, 2005–2014.Obstetrics & Gynecology. 2017; 130: 1319-1326Crossref PubMed Scopus (85) Google Scholar). Figure 1 displays information on common health challenges individuals experience during the postpartum year, within the data limitations and caveats mentioned elsewhere in this article. Despite the myriad health and equity issues that arise in the weeks and months after childbirth, postpartum care in the United States has traditionally consisted of a single checkup at 6 weeks. This practice is clearly insufficient, as has been well-documented (Tully et al., 2017Tully K.P. Stuebe A.M. Verbiest S.B. The fourth trimester: A critical transition period with unmet maternal health needs.American Journal of Obstetrics and Gynecology. 2017; 217: 37-41Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar). By 6 weeks postpartum, the prevention window for many complications has passed (Declercq et al., 2013Declercq E.R. Sakala C. Corry M.P. Applebaum S. Herrlich A. Listening to Mothers III: New mothers speak out - Report of the National Survey of Women’s Childbearing Experiences Conducted October-December 2012 and January-April 2013. Childbirth Connections, New York, NY2013Google Scholar). After the 6-week visit, one-third of patients continue to experience childbirth-related complications. This is around the time that pregnancy-related Medicaid eligibility traditionally ends, which happens after 60 days postpartum, causing disruptions in insurance and access to care during this critical period (Numanovic, 2017Numanovic A. Why policy advocates should pay more attention to data visualization?.https://medium.com/@numanovicamar/why-policy-advocates-should-pay-more-attention-to-data-visualization-81bba1b8bceaDate: 2017Google Scholar). Changes to postpartum care, policies, and financing are essential, and making such changes requires relevant data. The definitions and timeframes of important postpartum health outcomes vary across institutions and reporting mechanisms; this variation complicates the reporting of health needs after childbirth, inhibits the creation of evidence-based guidelines, and affects health and health care access. For example, the most commonly cited maternal health metrics—severe maternal morbidity and mortality—are not consistently defined, assessed, or reported; are limited by data source and quality concerns; and are measured across inconsistent timeframes (Centers for Disease Control and Prevention, 2019Centers for Disease Control and PreventionHow does CDC identify severe maternal morbidity?.www.cdc.gov/reproductivehealth/maternalinfanthealth/smm/severe-morbidity-ICD.htmDate: 2019Google Scholar; Harvey et al., 2018Harvey E.M. Ahmed S. Manning S.E. Diop H. Argani C. Strobino D.M. Severe maternal morbidity at delivery and risk of hospital encounters within 6 weeks and 1 year postpartum.Journal of Women’s Health. 2018; 27: 140-147Crossref PubMed Scopus (16) Google Scholar; Review to Action, 2021Review to Action. (n.d.)Maternal mortality: Definitions.https://www.reviewtoaction.org/learn/definitionsDate accessed: September 19, 2021Google Scholar). Additionally, the most common postpartum challenges (including pain, fatigue, depression, and anxiety) are measured infrequently and assessed inconsistently, making it difficult to pinpoint when problems are most commonly occurring. Where data are available, postpartum health outcomes are rarely disaggregated by race, ethnicity, or rurality, creating an enormous evidence gap on how to best target interventions. Without a clear understanding of when specific health challenges occur postpartum, and to which types of patients, policies aimed at improving maternal health will continue to face challenges in implementation and evaluation, and ultimately may even exacerbate existing disparities. Payment policies and current quality measures also inhibit comprehensive data collection on postpartum health. Payment to maternity care clinicians for postpartum care is often bundled into a global obstetric fee, which is generally paid at childbirth, decreasing financial incentives for clinicians to ensure patients attend postpartum visits. Further, use of global obstetric billing codes and the lack of payment associated with screening and other care component billing codes often make it difficult for organizations and researchers to report and assess timing and content of postpartum care (Mathematica, 2020MathematicaRecommendations for improving the core sets of health care quality measures for Medicaid and CHIP: Summary of a multistakeholder review of the 2021 child and adult core sets.2020Google Scholar). Current quality measures, which are often tied to payment incentives, include the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set measure of postpartum care (used by 90% of health plans): a single measure of any postpartum visit between 7 and 84 days (as of 2020, replacing the prior timeframe of 21–56 days; a postpartum depression screening measure has been developed but not implemented) (National Committee for Quality Assurance, 2020National Committee for Quality Assurance (NCQA)HEDIS measures and technical resources - Prenatal and postpartum care.https://www.ncqa.org/hedis/measures/prenatal-and-postpartum-care-ppc/Date: 2020Google Scholar). This NCQA measure of postpartum care does not allow for discernment of care timing, frequency, or quality. The 2021 Maternity Core Set includes two questions on postpartum contraceptive use and the NCQA measure of postpartum care (Centers for Medicare and Medicaid Services (CMS), 2021Centers for Medicare and Medicaid Services (CMS)2021 Core Set of Maternal and Perinatal Health Measures for Medicaid and CHIP (Maternity Core Set).2021Google Scholar). The quality of postpartum care is typically assessed by the presence of a single visit and some form of contraception, and even these measures are not reported universally (Centers for Medicare and Medicaid Services, 2020Centers for Medicare and Medicaid ServicesQuality of Maternal and Perinatal Health Care in Medicaid and CHIP: Findings from the 2019 Maternity Core Set: December 2020 Chart Pack.2020www.medicaid.gov/medicaid/quality-of-care/downloads/2020-maternity-chart-pack.pdfGoogle Scholar). This is insufficient. In 2018, the American College of Obstetricians and Gynecologists (ACOG) released recommendations for a new standard of care: restructuring postpartum care as an ongoing process specific to individual needs, involving clinician contact within three weeks, ongoing care as needed, and a comprehensive visit by 12 weeks followed by transition to enduring well-woman care (ACOG Committee Opinion No, 736ACOG Committee Opinion No. 736Optomizing postpartum care.Obstetrics & Gynecology. 2018; 131: e140-e150Crossref PubMed Scopus (320) Google Scholar). As a companion to these recommendations, the ACOG also developed a postpartum follow-up checklist to support the more comprehensive (including common conditions) components of postpartum care (ACOG Committee Opinion No, 736ACOG Committee Opinion No. 736Optomizing postpartum care.Obstetrics & Gynecology. 2018; 131: e140-e150Crossref PubMed Scopus (320) Google Scholar). Despite these recommendations being released more than 3 years ago, not much in postpartum care has actually changed (Hoyert, 2021Hoyert L.,D. Maternal mortality rates in the United States, 2019.2021Crossref Google Scholar). Few clinicians and practices have transitioned to this new standard of care (Hostetter and Klein, 2019Hostetter M. Klein S. Q&A with Alison Stuebe, M.D.: Strategies for ensuring women’s needs are met. The Commonwealth Fund.www.commonwealthfund.org/publications/2019/oct/qa-alison-stuebe-mdDate: 2019Google Scholar). Why? Without high quality data on postpartum care and health, we do not know what we need to know: 1) How many clinicians have adopted the 2018 ACOG recommendations? 2) What barriers do clinicians face in implementing the recommendations? 3) Have any insurers adjusted payment policies to support this new paradigm for care? 4) Do the recommended changes to postpartum care improve outcomes, equity, safety, and patient satisfaction? and 5) How can clinicians and insurers be best incentivized to adopt improvements to postpartum care? A compelling piece was recently published calling for improved data infrastructure to address the high rates of adverse maternal health outcomes in the United States (Chappel et al., 2021Chappel A. DeLew N. Grigorescu V. Smith S.R. Addressing the maternal health crisis through improved data infrastructure: Guiding principles for progress. Health Affairs Blog, 2021Google Scholar), and it highlights current efforts for improving data linkages and sharing. These improvements in the current maternal health data infrastructure are necessary, but they are not sufficient to achieve a new standard of care for postpartum health. More comprehensive, consistent postpartum data are needed to encourage insurers, clinicians, and policymakers to better align care after childbirth with postpartum health needs. Current postpartum data limitations include inconsistency in data collection and reporting; inadequate quality measures; limited ability to follow people across insurance disruptions and transitions in claims-based data; a lack of national survey data extending into the postpartum year (beyond the important initial work being conducted as part of the Postpartum Assessment of Women Survey; Columbia University, 2021Columbia UniversityPostpartum Assessment of Women Survey (PAWS).https://worldprojects.columbia.edu/postpartum-assessment-women-survey-pawsDate: 2021Google Scholar); and to date a limited focus on racial equity in the postpartum period. With so much recent attention to improving maternal health in the United States, there are many opportunities to incorporate collecting better postpartum data. These are included below (and are summarized in Table 1).Table 1Unanswered Questions to Support a New Standard of Postpartum Care and Roadmap to Answering the Questions with Better Data Collection and AnalysisUnanswered QuestionsCurrent Data LimitationsSolutions (New Analyses of Current Data/New Data Elements Needed)How many clinicians have adopted the 2018 American College of Obstetricians and Gynecologists recommendations (including timing, frequency, and content of postpartum care)?Lack of national survey data specific to recommendation adoptionGlobal obstetric fee billing obscures timing/frequency of postpartum visits in claims dataInclude two rates (early and later postpartum visit) and completion of comprehensive postpartum follow-up checklist in the National Committee for Quality Assurance measuresAdditional data collection via Pregnancy Risk Assessment Monitoring SystemWhat barriers do clinicians face in implementing the recommendations?Lack of systematic/national survey data specific to recommendation implementationFinancing data collection and reportingAnalyzing survey data and claims data to understand the impact of financial incentives on care and outcomesHave any insurers adjusted payment policies to support the recommendations?Silos of payment policy information across and within private insurers and across Medicaid managed careAnalyzing policy changes and assessing effects of payment reforms on postpartum careChanges in data reporting requirements to align public and private payersDo the recommended changes to postpartum care (timing, frequency, content) improve outcomes, equity, safety, and patient satisfaction? And what further targeted clinical and payment reforms are needed?Inconsistency in data collection and reportingInadequate current quality measures and limited focus on the postpartum person (National Committee for Quality Assurance/maternity core set)Limited ability to follow people across insurance disruptions and transitions in claims-based dataLack of national survey data extending into the postpartum year (including common conditions and quality of life)Limited focus on racial and geographic equityNational standards for key postpartum health indicatorsExpand postpartum data elements collected in current maternal health efforts (Pregnancy Risk Assessment Monitoring System, state perinatal quality collaboratives, etc.) beyond focusing only on mortality or severe morbidity (i.e., common conditions/quality of life)Adopt antiracist practices in data collection and reportingEnsure data interpretation and policy is informed by those most impacted and disaggregated by key disparity intersections (race/geography/income)Make comprehensive postpartum follow-up checklist a standard data collection toolLink clinician/insurer postpartum policies with health outcomes dataEnsure adequate funding/tie payment incentives to additional reporting requirementsHow can clinicians and insurers be best incentivized to adopt the recommendations/improve postpartum care?Lack of evaluation of the recommendationsGap between research and practiceImprove postpartum data (as described above)Improve dissemination of research findings Open table in a new tab Standards should include clear definitions and timeframes for the assessment of measured conditions composed not only of severe maternal morbidity and mortality, but also common conditions (depression, anxiety, breastfeeding difficulties, fatigue, sexual dysfunction, pain, etc.) that impact quality of life and mental health. The data should reflect the diversity of the postpartum population, and indicators of postpartum health should be selected within the context of reproductive justice (e.g., concerns about reproductive coercion in receipt of postpartum long-acting reversible contraception) (Holt et al., 2020Holt K. Reed R. Crear-Perry J. Scott C. Wulf S. Dehlendorf C. Beyond same-day long-acting reversible contraceptive access: A person-centered framework for advancing high-quality, equitable contraceptive care.American Journal of Obstetrics and Gynecology. 2020; 222: S878.e1-S878.e6Abstract Full Text Full Text PDF Scopus (38) Google Scholar). Such metrics could be adopted by ongoing efforts to improve maternal health, including state perinatal quality collaboratives and initiatives to extend postpartum Medicaid coverage. Improvements to quality measurement for postpartum care are essential and can build upon recommendations such as the Healthcare Effectiveness Data and Information Set bid to replace its measure of a single postpartum visit at 21-56 days with a measure of two visits (earlier and later) within 1–84 days postpartum (National Committee for Quality Assurance, 2019National Committee for Quality Assurance (NCQA)Proposed changes to existing measure for HEDIS 2020: Prenatal and postpartum care (PPC).www.ncqa.org/wp-content/uploads/2019/02/20190208_15_PPC.pdfDate: 2019Google Scholar). Quality measurement that truly holds payers and health care systems accountable could adopt metrics based on the ACOG checklist for recommended postpartum care (Redefining the Postpartum Visit Task Force, 2018Redefining the Postpartum Visit Task ForceACOG postpartum toolkit. American College of Obstetricians and Gynecologists, Washington, DC2018https://www.acog.org/-/media/project/acog/acogorg/files/pdfs/publications/2018-postpartum-toolkit.pdfGoogle Scholar). A new standard of postpartum care should align clinical care recommendations with financing, workforce, and access policies, through an antiracist lens, to build a postpartum care system that improves outcomes, equity, safety, and patient satisfaction (Bailey et al., 2021Bailey Z.D. Feldman J.M. Bassett M.T. How structural racism works — Racist policies as a root cause of U.S. racial health inequities.New England Journal of Medicine. 2021; 384: 768-773Crossref PubMed Scopus (297) Google Scholar; Ford and Airhihenbuwa, 2010Ford C.L. Airhihenbuwa C.O. Critical race theory, race equity, and public health: Toward antiracism praxis.American Journal of Public Health. 2010; 100: S30-S35Crossref PubMed Scopus (404) Google Scholar; Hostetter and Klein, 2019Hostetter M. Klein S. Q&A with Alison Stuebe, M.D.: Strategies for ensuring women’s needs are met. The Commonwealth Fund.www.commonwealthfund.org/publications/2019/oct/qa-alison-stuebe-mdDate: 2019Google Scholar). This process should include attention to both historical and contemporary aspects of structural racism, and collecting and disaggregating data and analyses by race to support targeted changes to care systems and delivery (Howell et al., 2018Howell E.A. Brown H. Brumley J. Bryant A.S. Caughey A.B. Cornell A.M. Grobman W.A. Reduction of peripartum racial and ethnic disparities: A conceptual framework and maternal safety consensus bundle.Obstetrics & Gynecology. 2018; 131: 770-782Crossref PubMed Scopus (61) Google Scholar). Additionally, “centering at the margins” by incorporating Black, Indigenous, and People of Color with lived experience into the data collection processes and policy development within health care systems will help to dismantle racialized drivers that have led to disparities in postpartum outcomes (Crear-Perry et al., 2021Crear-Perry J. Correa-de-Araujo R. Lewis Johnson T. McLemore M.R. Neilson E. Wallace M. Social and structural determinants of health inequities in maternal health.Journal of Women’s Health. 2021; 30: 230-235Crossref PubMed Scopus (93) Google Scholar).