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Blue Cross Blue Shield report finds racial and ethnic inequities in maternal health complications climbed during COVID-19 pandemic

By September 30, 2022February 20th, 2023BCBSA News Featured Press Releases

Pennsylvania saw a 13% increase in severe maternal morbidity rates for commercially insured members from 2018 – 2021, compared with a 23% rate of increase nationally

The Blue Cross Blue Shield Association (BCBSA) released a report that confirms women of color are at higher risk of pregnancy-related complications, regardless of having commercial health insurance or Medicaid coverage. Instead, the data indicate U.S. maternal health inequities are likely the result of broader health system and societal challenges, including underlying chronic conditions, racial inequities, and likely biases within the health care system. Pregnancy-related complications have worsened 9% since 2018, with a marked increase during the Covid-19 pandemic, with some women of color at nearly 70% higher risk of pregnancy-related complications than white women.

“When it comes to racial inequities in childbirth complications, the pandemic has only sent us further in the wrong direction—and we were in a bad place to begin with,” said Kim Keck, president and CEO of BCBSA. “We have a bold goal of reducing racial inequities in maternal health by 50% in five years, and BCBS companies are taking action through advocacy, partnerships and local programs to support mothers at every stage of their pregnancy. Every mother deserves to have a healthy pregnancy, deliver a healthy baby, and live a healthy postpartum life. We invite everyone to join us in making this a reality.”

The study, “Racial and Ethnic Disparities in Maternal Health,” examined the rate of childbirth complications in nearly 11 million U.S. births to women with either commercial insurance or Medicaid as measured by the CDC’s Severe Maternal Morbidity Measure (SMM).

This comprehensive analysis found Black, Latina and Asian women have higher rates of SMM than white women, regardless of age or type of health insurance. Preexisting health conditions, such as hypertension, diabetes or asthma, strongly correlate with higher SMM and worse pregnancy outcomes, increasing the likelihood of a risky delivery or challenges postpartum. While all women ages 35-44 were most likely to have an SMM event, Black women in this age range have a 66% higher rate of SMM and are more likely to suffer pregnancy-related complications than white women.

In Pennsylvania, overall SMM rates for commercially insured members increased by 13% from 2018 – 2021, compared with a 23% rate of increase nationally. The prevalence rate of SMM (per 10,000) in PA in 2021was 74% higher for Black women than for white women. Similarly, the prevalence rate of SMM (per 10,000) in PA in 2021 was 38% higher for Latina women than for white women and 23% higher for Asian women than white women.

“Every expectant and new mother deserves quality health care for herself and her baby. This report further highlights the serious health inequities in our country that must be addressed. We are fortunate to work with a number of well-respected community partners, such as Project HOME, Cayaba Care and, that connect directly with our region’s most vulnerable women to help ensure all women receive the care they need for a healthy pregnancy and birth. With many of the COVID-19 restrictions now lifted, these organizations can interact more closely with their clients, allowing more personal support. At Independence, we will continue to look for new collaborations and innovations to create more equitable care for all,” said Seun O. Ross, Ph.D., executive director of health equity at Independence.

To confront inequities in southeastern Pennsylvania, Independence has taken a leading role in developing programs and cultivating collaborations to help improve maternal health. These include the following:

  • Keystone Connection to Wellness: Independence is working with Project HOME and AmeriHealth Caritas to address significant health inequities experienced in North Philadelphia. Through this initiative expectant mothers in North Philadelphia are participating in Project Home’s Centering Pregnancy program – a national, evidence-based maternal health model.
  • Case management and data analysis: The Independence Informatics team uses predictive modeling to better understand how the social determinants of health affect high-risk maternity patients among different groups.  Efforts include in-depth educational information, behavioral health screenings and assessments for factors including transportation, food security, and financial wellbeing. Through case management programs, all pregnant members are screened for current/past history of behavioral health issues including post-partum depression. Members who screen positive are referred for mental health services.
  • Bright Start Maternity Program: Independence’s medical assistance managed care subsidiary, Keystone First, operates this maternal health program that is dedicated to ensuring members receive early and ongoing prenatal care to achieve healthy outcomes.
  • Provider reimbursement for long-acting reversible contraceptives: Independence is the first commercial health insurer in the Philadelphia five-county region to reimburse providers for inserting long-acting reversible contraceptives – such as intrauterine device (IUD) and the birth control implant – in the hospital setting after a patient gives birth. This type of reimbursement can help reduce unintended and short-interval pregnancies that can lead to premature birth and adverse maternal and neonatal outcomes.

In addition to these efforts, Independence is collaborating with Philadelphia-based and Cayaba Care to address racial inequities in maternal health:

  • is a community resource available to the public and is designed to support Black and Brown moms during pregnancy, postpartum, and loss of a child or significant loved one. It provides easy access to education and community resources such as free diapers, formula, and childcare services.
  • Cayaba Care provides pregnant and recently pregnant people with in-office, in-home, and virtual services that are personalized based on their needs. The company focuses on people who have been traditionally underserved.

In addition, the Independence Blue Cross Foundation is supporting a novel study on the impact that COVID-19 has had on pre-term birth outcomes. The study is led by Yale University, University of Pennsylvania, Northwestern University, the Children’s Hospital of Philadelphia, and Nemours Children’s Hospital. Additionally, the Foundation is focusing on maternal health through the IBC Foundation Institute for Health Equity, a $15 million commitment to equitable health in our region and nation that will address policies and practices through equity-driven research and collaborations.

Blue Cross and Blue Shield (BCBS) companies nationwide are committed to reducing racial disparities in maternal health by 50% in five years, as part of BCBSA’s National Health Equity Strategy. Through the strategy, BCBS companies are:

  • Advocating for all mothers by working with policymakers to strengthen and scale policies to make care more equitable nationwide.
  • Creating incentives and trainings for providers to offer care that is sensitive and remove unconscious bias within health care delivery.
  • Addressing social drivers of health, focusing on root causes to better help pregnant women, mothers and babies get the care they need.
  • Collaborating with industry partners to standardize data collection and analysis to better understand care gaps and create interventions that will address them.

Guided by efforts already underway at BCBS companies, BCBSA also developed a list of 10 actions organizations can adopt to improve maternal health and make a measurable difference in health inequities.

Read the full report, “Racial and Ethnic Disparities in Maternal Health,” part of the Blue Cross Blue Shield, The Health of America Report® series. For more information about the BCBSA National Health Equity Strategy and maternal health programs, visit