David Sandman

May is the month for celebrating moms. It’s sometimes said that motherhood is the hardest job, but for some moms, it’s even harder from the moment they give birth.

Depending on where she delivers her baby and where she lives, a new mom may have to pay a lot more to give birth. And her race could make the likelihood of serious childbirth complications a lot higher.

Childbirth is the most common reason for hospital admission and is among the most expensive health care events for nonelderly New Yorkers. And prices differ. Across the five boroughs of New York City, the median price for childbirth ranges from nearly $13,000 in Brooklyn to nearly $17,000 in the Bronx — about a 30% difference — for vaginal deliveries. There’s huge variation within each borough, as well, with the highest-priced deliveries costing more than 13 times the lowest-priced deliveries.

The real-world stories of new moms struggling to pay for childbirth can be chilling. New York magazine recently profiled women who had to “get creative” to pay for their deliveries. One woman talked about having to take out a five-year payment plan to pay for the birth of her second child; another woman realized she could qualify for Medicaid (both she and her husband had lost their jobs because of the pandemic, and fear of losing Medicaid while pregnant deterred them from seeking new work); another realized that she needed to be in regular contact with her insurance company to make sure she knew what could be covered. Two of the women moved from New York — one to Chicago, another to Australia — to ensure they’d pay less.

Those kinds of maneuvers to have a baby, the most natural thing in the world, are an indictment of our health care system. Expectant parents shouldn’t have to move halfway across the world to deliver a child affordably. They shouldn’t have to worry about whether every test and every health care professional who comes to check on the new baby will end up costing them hundreds or thousands of dollars. Adding insult to injury, many parents won’t know how much their delivery will cost until they get a bill after the fact. Greater price transparency is coming; a new federal rule requires that all hospitals make price information publicly available.

Unwarranted price variation is worrisome, but equally concerning are the differences in maternal health outcomes by race and ethnicity. An analysis by my colleagues at the New York State Health Foundation found wide and persistent disparities in potentially life-threatening complications during or after childbirth, known as severe maternal morbidity. Across New York State, Black women were 2.3 times more likely than white women to experience such complications. Rates among Hispanic women were 1.7 times higher than for white women; among Asian women, rates were 1.5 times higher compared with white women.

New York is making maternal health a priority and demonstrating progress. Historically, New York has had higher rates of severe maternal morbidity than the national average, but more recent data show us in the top quartile among states. New York’s Taskforce on Maternal Mortality and Disparate Racial Outcomes, or MMDRO, made numerous recommendations related to reducing racial disparities in maternal health. The State has taken up many of these to improve data collection and monitoring, conduct case reviews of childbirth complications, address implicit racial bias among health care workers, and promote access to community health workers and doulas to improve maternal care and reduce disparities. The State also recently passed a measure that will extend insurance coverage to low-income women for a full year after giving birth.

Mother’s Day is about recognizing our own mothers, but it also gives us the chance to celebrate all moms. The best way to honor them is to make childbirth more affordable and safer for all mothers. That would be a nice gift each May — but keep the cards, flowers, phone calls, and love coming too.

By David Sandman, President and CEO, New York State Health Foundation
Published in Medium on May 24, 2021

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