Attendance at postpartum health care visits fell by nearly six percentage points during the COVID-19 pandemic, researchers report.
According to the study, uninsured women, black women and women under the age of 19 faced the largest declines in visits. The results show that the pandemic has exacerbated existing inequalities in postpartum care.
“Our study found that groups who already faced disproportionate barriers to care — black and Hispanic women, young women, and women without postpartum insurance coverage — experienced the largest decreases in postpartum visit attendance during the pandemic,” says study author Meghan Bellerose, PhD Student at Brown University’s School of Public Health.
“These are the same groups that experience higher rates of postpartum complications and maternal mortality, so it is imperative that we understand the factors preventing them from receiving essential pregnancy care.”
Bellerose and co-author Maria Steenland, assistant professor of health services, policy and practice, used data from 2016 through 2020 from the Pregnancy Risk Assessment Monitoring System — information maintained by the US Centers for Disease Control and Prevention and annual surveys by People having a live birth aggregate in 45 states, Washington, DC and New York City.
They found that in the first nine months of the COVID-19 pandemic, postpartum visits fell by 5.8 percentage points overall.
The sharpest decline was recorded by people without postpartum insurance, for whom the frequency of visits fell by 11.4 percentage points. Visiting visits to black women and women under 19 each decreased by 9.9 percentage points.
While some common barriers to participation pre-pandemic — such as being too busy, being unable to leave work, and inadequate access to transportation — existed prior to the pandemic, additional challenges were exacerbated or were the result of COVID-19, including worry about the lack of children and fear of leaving home because of the virus.
To break down these barriers in the future, the researchers recommend systematically addressing the public health and health system challenges that impede postpartum attendance—before the next pandemic or other public health crisis.
“To reduce persistent inequalities in postpartum care, clinical practices must ensure that care is delivered in a way that meets the preferences and needs of all patients – including postpartum people who do not have broadband access at home or who are affected by transport face persistent barriers, childcare and work schedules,” says Steenland.
The study appears in the journal Obstetrics & Gynaecology.
The Eunice Kennedy Shriver National Institute of Child Health and Human Development funded the work.
Source: Brown University