How Do Policies Pre-Conception, at Delivery, and Postpartum Shape Maternal and Infant Health Outcomes and Disparities? - PROJECT SUMMARY/ABSTRACT The US fares poorly on international rankings of infant and maternal health. Evidence on causal policy impacts on these outcomes is necessary for improving the well-being of US mothers and children. Yet while there is abundant evidence on the effects of policies during pregnancy, less is known about policies during other important periods around childbirth: pre-conception, during delivery, and postpartum. Further, there are large maternal and infant health disparities. Previous research by the project team found that infants and mothers in families with incomes in the bottom 5% of the income distribution are two and three times more likely to die in the first year post-birth, respectively, than those with incomes in the top 5%. It also found that Black infants and mothers at the bottom of the income distribution are two and three times more likely to die, respectively, than their non-Hispanic white counterparts, and these racial gaps do not narrow as incomes rise. Reducing these gaps requires knowledge about differential policy impacts across race and income, and at different periods around childbirth. This project will use a novel linkage between multiple administrative datasets from California and natural experiment designs to deliver causal estimates of the effects of currently active and debated policies that could have disparate impacts by race and income: Medicaid coverage pre-conception and postpartum, and a California Maternal Quality Care Collaborative (CMQCC) intervention aimed at lowering cesarean section (c-section) deliveries. The research team has already linked data on the universe of California birth records, hospitalizations, emergency department (ED) visits, and death records with parental income from Internal Revenue Service tax records and Medicaid enrollment files for 2007—2019. These data allow for the calculation of women’s Medicaid eligibility in the year before conception and in the year after childbirth. Using a regression discontinuity design (RDD), the project will compare outcomes of women with incomes just above and just below the eligibility threshold. When examining impacts of preconception coverage, outcomes will include measures of pregnancy health (hospitalizations/ED visits during pregnancy, gestational diabetes and hypertension, preeclampsia), delivery characteristics (c-section, labor induction, complications), infant health (birth weight, gestation length, newborn complications, infant readmissions to the hospital, infant mortality), and postpartum health (severe maternal morbidity and mortality). Additionally, a differences-in-differences (DD) method that compares changes in outcomes in treatment and control hospitals will be used to study the CMQCC intervention, separately by maternal race and income. Outcomes will be c- section rates, birth outcomes and labor/delivery complications, maternal mortality, as well as c-section deliveries and complications at subsequent births. Results will be disseminated to key stakeholders and help policymakers, healthcare organizations, providers, and patients understand the effects of policies pre- conception, at delivery, and postpartum on maternal and infant health outcomes and disparities in the US.
