Racial and Ethnic Disparities in Perinatal Insurance Coverage

Jamie R. Daw, Giselle E. Kolenic, Vanessa K. Dalton, Kara Zivin, Tyler Winkelman, Katy B. Kozhimannil, Lindsay K. Admon

Research output: Contribution to journalArticlepeer-review

52 Scopus citations


OBJECTIVE:To measure the association between race-ethnicity and insurance status at preconception, delivery, and postpartum and the frequency of insurance gaps and transitions (disruptions) across these time points.METHODS:We conducted a cross-sectional analysis of survey data from 107,921 women in 40 states participating in the Centers for Disease Control and Prevention's Pregnancy Risk Assessment and Monitoring System from 2015 to 2017. We calculated unadjusted estimates of insurance status at preconception, delivery, and postpartum and continuity across these time points for seven racial-ethnic categories (white non-Hispanic, black non-Hispanic, indigenous, Asian or Pacific Islander, Hispanic Spanish-speaking, Hispanic English-speaking, and mixed race or other). We also examined unadjusted estimates of uninsurance at each perinatal time period by state of residence. We calculated adjusted differences in the predicted probability of uninsurance at preconception, delivery, and postpartum using logistic regression models with interaction terms for race-ethnicity and income.RESULTS:For each perinatal time point, all categories of racial-ethnic minority women experienced higher rates of uninsurance than white non-Hispanic women. From preconception to postpartum, 75.3% (95% CI 74.7-75.8) of white non-Hispanic women had continuous insurance compared with 55.4% of black non-Hispanic women (95% CI 54.2-56.6), 49.9% of indigenous women (95% CI 46.8-53.0) and 20.5% of Hispanic Spanish-speaking women (95% CI 18.9-22.2). In adjusted models, lower-income Hispanic women and indigenous women had a significantly higher predicted probability of uninsurance in the preconception and postpartum period compared with white non-Hispanic women.CONCLUSION:Disruptions in perinatal insurance coverage disproportionately affect indigenous, Hispanic, and black non-Hispanic women. Differential insurance coverage may have important implications for racial-ethnic disparities in access to perinatal care and maternal-infant health.

Original languageEnglish (US)
Pages (from-to)917-924
Number of pages8
JournalObstetrics and gynecology
Issue number4
StatePublished - Apr 1 2020

Bibliographical note

Funding Information:
Vanessa Dalton received grant funding from the Agency for Healthcare Research (ARHQ) and Quality, National Institutes for Health (NIH), American Association of Obstetricians and Gynecologists Foundation, the Laura and John Arnold Foundation, National Institute for Reproductive Health and Blue Cross Blue Shield Foundation. She is also a paid contributing editor for the Medical Letter and an author for UpToDate. She has also serviced as a paid expert witness for Bayer, a consultant for Bind and has participated on study sections for the NIH and ARHQ. The other authors did not report any potential conflicts of interest.

Funding Information:
From the Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York; the Departments of Obstetrics and Gynecology and Psychiatry and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; and the Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, the Hennepin Healthcare Research Institute, and the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota. Supported by a grant awarded to Drs. Admon (PI), Dalton (Co-I), and Winkelman (Co-I) from the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services (HHS) as part of an award totaling $100,000. The contents of the manuscript are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the federal government. Jamie Daw’s work on this project was supported by a Calderone Junior Faculty Prize. The funders had no role in the study design, writing of the report, or the decision to submit the article for publication.

Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.


Dive into the research topics of 'Racial and Ethnic Disparities in Perinatal Insurance Coverage'. Together they form a unique fingerprint.

Cite this