Better Postpartum Care by 2030
We can improve maternal health in this country.
By 2030, women will have access to the postpartum coverage and benefits that they need for a full year following their pregnancy. This targeted change is possible, yet to realize our vision we need your help.
The 100 Weeks Project
Maternal health transcends the traditional 40-week marker.
It doesn’t capture the conscious choice to have a baby. Nor the pain of trying, but not being able to conceive. It can’t possibly recognize the anxiety that creeps up knowing the mortality rates for mothers of color and the fear of bringing a child into this world. Forty weeks doesn’t consider the doubts and questions – is her doctor giving her the highest level of care she needs, or ignoring her pain? And after the baby is born, forty weeks doesn’t capture the nearly endless streams of worries and questions in the weeks and months that follow: Should I be feeling this way? Is it okay for me to reach out to my doctor with these questions or is their job done? How much will that cost?
Forty weeks doesn’t capture the time before getting pregnant, the experiences during pregnancy, labor and delivery, nor the time after giving birth.
The Goal
What Happens to a New Mom After Giving Birth?
Our health care system isn’t set up to support postpartum care: health care coverage is fragmented and there is no systematic effort underway to ensure women are getting the care they need after pregnancy. Through our work, we aim to create solutions that ensure every pregnant woman has access to and coverage of postpartum care services regardless of health care coverage.
Home
home
Journey Map
Journey map
State of Postpartum care
Employer impact Collaborative
employer impact Collaborative
resources
Resources
The 100 Weeks Project is United States of Care's groundbreaking initiative dedicated to revolutionizing postpartum care over the next five years. This ambitious program aims to ensure every new mother receives the essential care and support she needs during the critical postpartum period (Up to one year after pregnancy).
takes into account a mother’s entire pregnancy journey, inclusive of the postpartum period, so that we can begin to see movement on this country’s dismal maternal mortality rates.
Vision for Postpartum Care
United States of Care
Her ideal postpartum experience is one where she receives thorough information and resources to help her understand each stage of the recovery process so that she feels confident and knowledgeable. Her employer would provide her with the time and space to fully recover before returning back to the workplace. She would have a strong support system from her health care providers, perinatal health workers, family, friends, and community–all of which check-in with her regularly and offer guidance and care tailored to her needs. She would feel genuinely supported, respected, and ready to embrace her new role as a mother.
Ideal Experience
Reagan
Age 41, Employer/spouse’s coverage, Kentucky
"Being aware of other Black Mamas who were still trying to figure out how to pay for their child(ren)'s hospital bills years and years later, I was terrified that that could happen to our family. We could not afford that. I had insurance coverage in mind when choosing our hospital for my pregnancy, childbirth and postpartum processes. I called and called and called to make sure that the health insurance was correctly applied so that we wouldn't have to pay so much out of pocket. I stayed home, in part, so that I could advocate for us in the health insurance process. Our health insurances called a few times postpartum to remind me of my options, but I was the driver of advocacy for medical coverage for myself and our baby."
Postpartum Period
Insufficient Support for Breastfeeding
She may not get enough support for breastfeeding, leaving her to feel uncertain without the guidance and encouragement needed to navigate the challenges.
Bright spot
She may seek a doula or lactation consultant that supports her with her breastfeeding challenges. She may access local programs like Breastfeeding Awareness and Empowerment (BAE) Café, a Philadelphia based community lactation and perinatal mental health support program that is replicable, scalable, peer-driven and low-barrier intervention that has the potential to improve outcomes.
Limited Postpartum Mental Health Support
She may struggle to manage overwhelming emotions and mental health challenges on her own, but have little to no knowledge on how to cope, get help, or find resources.
She may reach out to organizations focused on addressing maternal mental health like the Shades of Blue Project, which offers a structured journaling support group for Black women and aims to decrease the stigma related to seeking mental health treatment.
Lack of Postpartum Information and Resources
She may enter the postpartum period without enough information from her health care providers on what to expect and where to go for resources. As a result, she feels overwhelmed and lost, and has to rely on herself or her community for information and resources.
She may have attentive OB/GYNs and primary care providers that offer comprehensive support during the postpartum and address her physical, mental, and emotional needs beyond her six-week follow-up appointment. Her child may also have a supportive pediatrician, who may or may not be in-culture, that makes her feel supported and who takes the time to answer her questions.
Health Care System Pain Points and Bright Spots
"After my 6 week check up and my doctor didn't even listen to me about my periods, I just kind of took matters in my own hands. I didn't feel like I would get support from them, so I looked into my community to see how I could gain support that way. I went home 2.5 months after giving birth. It was good to be surrounded by family and not be isolated by myself. My mom left about a little over a month after I gave birth, so it was me and my thoughts many a nights after my daughter went to sleep. That trip back home help me realize that I did have community. It was needed."
Aria
Age 36, Employer/spouse’s coverage, NC
Thoughts and Emotions
The Lonely Hours of New Motherhood
Learn More
She may find herself overwhelmed by questions and self-doubt, adding on to the exhaustion and confusion she is also feeling. The same question pops up: Is this normal? She asks herself this when it comes to herself and her baby, and does not know where to turn for the answers. She tries to make sense of her physical and emotional state, and yearns for someone to talk to, someone who can provide her the support and reassurance she desperately needs.
A Mother's Search for Support
Her confidence may drain as she navigates motherhood with limited support and resources. When she thinks about her child’s health, she is unsure if the health care system will provide the compassionate care and treatment she desires. She wonders if she is failing because breastfeeding is not going as planned and if she is capable of caring for her child. This uncertainty takes a toll on her mental health, and she needs answers and guidance now more than ever.
Timely postpartum care Contraceptive care Postpartum depression screen Postpartum visit counseling Home visits Robust follow up care
Clinical Care Recommendations
Clinical Care Obstacles and Challenges
Breastfeeding stigma Low quality NICU care Lack of race concordant infant care Postpartum care inaccessibility and lactation consultants Lack of family leave Lack of postpartum insurance coverage Postpartum depression Unintended pregnancy Child wellness – inadequate oral health Return to work uncertainty
The journey does not end with childbirth. The postpartum period, or the “fourth trimester,” is the critical period one year following childbirth when mothers physically, mentally, and emotionally adjust to motherhood. This period involves physical recovery (and healing from childbirth), establishing baby feeding and care, and emotional transitions ranging from joy and excitement to fatigue and loneliness. She may also be navigating anxiety and complex feelings from how she was treated during her pregnancy and childbirth. During this time, support from health care providers, family, friends, and the community is essential to help mothers adapt, promote their well-being, and ensure they feel supported.
The Postpartum
Period
100 weeks
Great! You've Covered All Birth Periods
Go to Vision for Postpartum Care
“Being aware of other Black Mamas who were still trying to figure out how to pay for their child(ren)'s hospital..."
Read more +
Farah
Age 38, Employer/spouse’s coverage, New York
"I was on Maternity Leave for 4 months. It wasn't a choice. I had to in order to be able to provide for myself and my..."
Leah
Age 43, Employer/spouse’s coverage, NJ
“I felt feelings of happiness, sadness (this is a cold world), fearful for her, exhaustion. Bonding went well..."
Joy
Age 32, Employer/spouse’s coverage, Florida
"Thankfully the only concern we had with our baby was slow weight gain after she had lost her birth weight..."
Gina
Age 27, Government Program Insurance, Georgia
"My postpartum path had a few twists and turns and is still ongoing. It started at arriving home and ends on paper with me telling myself every day that I'm not a failure."
“The "what to physical or medically expect" was thoroughly covered prior to my delivery experience..."
“Being aware of other Black Mamas who were still trying to figure out how to pay for their child(ren)'s hospital bills years and years later, I was terrified that that could happen to our family. We could not afford that. I had insurance coverage in mind when choosing our hospital for my pregnancy, childbirth and postpartum processes. I called and called and called to make sure that the health insurance was correctly applied so that we wouldn't have to pay so much out of pocket. I stayed home, in part, so that I could advocate for us in the health insurance process. Our health insurances called a few times postpartum to remind me of my options, but I was the driver of advocacy for medical coverage for myself and our baby.”
“I was on Maternity Leave for 4 months. It wasn't a choice. I had to in order to be able to provide for myself and my household. It was always the plan to go back. My employer and team, were happy to have me back. I was blessed that we were all still working from home at the time, so I did not have to go back to the office. I am grateful for that. It was a rough transition initially. Because now I have 2 little people that need me, my team, and others at the job. I was in high demand. It was overwhelming. I figured it out somehow though. I've been blessed enough that my Manager is understanding. I don't really come to her with Motherhood related concerns, but when I do, she is on my side. My team is also very understanding and support me as I support them. I also have a couple of co-workers that i'm close to, who offer advise or even time (if ever needed).”
"I felt feelings of happiness, sadness (this is a cold world), fearful for her, exhaustion. Bonding went well, she’s my brilliant little sweetheart. I did not breastfeed. I didn’t want to be tied down to it, I know friends are breastfeeding 4 year olds! I discussed the best formulas and vitamins for babies with her doctor. There aren’t many resources in this town (maybe there really are but people don’t want to talk about them. It’s really frustrating.) I really take pride in caring for my children. Since this wasn’t my first pregnancy, I knew what to do. It’s just being exhausted at the time. This pregnancy (like all pregnancies) really do a number on women. I ended up getting shingles without any symptoms, woke up the day after my doctor’s appointment with shingles on the right side of my trunk. I still had to take care of her and my other children. This last pregnancy has brought so many things out of me. I used to have a high tolerance for pain. Now, I can feel any little pains, it’s depressing."
“Thankfully the only concern we had with our baby was slow weight gain after she had lost her birth weight. Previously stated, the practice my pediatrician is in, had a doctor that was pushing formula on us because our daughter was not going weight fast enough (despite my over-producing of breastmilk.) We found that my daughter had issues consuming all the milk due to a tongue tie and once we released her tongue tie, she had no more issues with breastfeeding and was steadily gaining weight! My husband was my biggest advocate during this time, truly believing in my mom instinct when something felt wrong or out of place. My pediatrician was a exemplary, even sharing with us that her kids had the same issue growing up as well (slow weight gain) but reminded our anxiety driven minds to focus on the fact that our daughter was on her growth curve and hadn't deviated from it since birth.”
“Prior to label I went to a few pediatricians to see how they ran their practices and how their service was. I was looking for a pediatrician that listened to us and really got to know our child. I was looking for an African American doctor and if not then a doctor of color. I had a doctor picked out and then once my son went into the NICU, the nurses recommended a closer Dr for our son to see. Being very vulnerable I just went with their recommendation. He was a nice Dr but I felt like he didn’t take the time to get to know us. He never even said my sons name and that made me really upset. I remember asking a question about the vaccines and he was so annoyed he told me to google it. That was our last visit. We ended up switching to a Black doctor and it was the best decision! Right away I felt so comfortable. She listened to us and connected so well.”
Brianna
Age 37, Government Program Insurance, NJ
The "what to physical or medically expect" was thoroughly covered prior to my delivery experience. But the non-physical discharge process had me overwhelmed and feeling "lost." It was heavy on the paperwork and decision-making that I was not prepared for. It was really overwhelming and I was concerned that I was not given my options with the paperwork early enough to make a more informed decision. (Who knew that I had to decide whether my baby would have an SSN?) The official naming, who'd be on the birth certificate, the insurance process ....was all too much for a very exhausted new mom like me. The insurance ended up being a headache that took over 1.5 years to correct and get resolved. Because my birthday and my husband's birthdates are very close - 2 days apart- ...and because My husband and my health insurance had the same company name (but were not the same), ...and because my birthdate was before his.....and because I am the Mother, the insurance person ASSUMED that I wanted our child on my insurance. I did not because my job was contract (1 year only) while my husband's job was more permanent. If I had not been able to take my full and mostly paid maternity leave and be a stay-at-home Mama for another year after, I may have been stuck with a $115k+ medical bill set because of the lack of clarity and consistency in the discharge process. While the hospital staff was supportive and helpful for the most part, there was a marked difference between how I was treated before delivery and after discharge was on the table.
Methodology and Resources
In collaboration with Deloitte's Public Health Transformation Team and C+R, this work involved several inputs which included literature reviews, examinations of clinical care best practices, maternal health data collection protocols, listening sessions, and key informant interviews with organizations who are creating change in this space (also known as Bright Spots). The clinical care recommendations include visits, tests, screenings, diagnostics, referrals and other the best practices recommended by various medical entities which translate into discrete health care interactions between patient and providers. This information was based on the following inputs:
We also identified 70 bright spots across the patient journey and they were narrowed to focus on 30 organizations that were created for Black women by Black women. All were invited to participate in key informant interviews. WE spoke to leaders from 12 organizations - 7 community based organizations (CBOs) and five tech-based organizations specifically addressing disparities in Black maternal health.
ACOG guidelines which recommend rental exams and timely and frequent postpartum care, checkpoints which were updated in recent years to be expanded upon from a single postpartum visit. AAP recommended wellness visits - which can also serve as opportunities for maternal health needs to be addressed as a part of the mother-child day. Literature review recommendations from peer-reviewed published studies that could add to the existing guidelines. Quality measures and recommendations by NCQA and NQF and measures collected by federally sponsored surveys. United States of Care in partnership with C+R Research conducted an asynchronous discussion, followed by in-depth interviews with self identified Black women who had given birth no earlier than 2021. Sessions and activities were designed to include discussions around their pregnancy journey – preconception, pregnancy, childbirth, and postpartum. N=23 participants in the asynchronous discussion and N = 12 participants in in depth interviews which were 90 minutes in length. Three interviews were conducted with a loved one participating. Insurance type was included in the quote attributes to highlight the experiences despite the type of insurance coverage the woman had at the time of her pregnancy.
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Her ideal childbirth experience is one filled with respect, compassion, and understanding. Her providers and hospital staff would see her as a partner in the journey by prioritizing her needs, offering support, and creating a space where she truly feels safe and heard. She desires options, from pain management choices to birth control preferences, and the confidence that her choices will be honored. She wants to be empowered during her birth experience, with reassurance and trust from her care team that allows her to focus on the incredible experience rather than try to advocate for herself.
“One example that stuck in my head was coming in for our daughter's 1-week check-up. She hadn't gained weight that she had lost from birth. We were scheduled with another healthcare provider that was white and not out regular pediatrician and this healthcare provider kept pushing formula on my husband and I saying, "if you can't produce enough milk to support your daughter you will need to supplement with formula to get her weight up." We felt so belittled and I felt like a failure as a mom (we ended up getting an appointment with a IBCLC, realizing our daughter had a tongue tie, got it clipped and her weight gain caught up.) We had a follow-up appointment in a week and our daughter had gained weight but not as much as expected but our pediatrician was able to meet with us and showed us that our daughter was still on her growth curve and to continue establishing good breastfeeding patterns.”
Childbirth and Labor
Heightened Tendency for C-Sections
She may be significantly more likely to have a cesarean delivery than other women likely due to implicit racial bias.
Her providers may use updated algorithms and data collection methods that address inherent biases, including recent edits to the Vaginal Birth After Cesarean (VBAC) calculator.
Needs Ignored and Not Feeling Heard
She may have her needs and concerns ignored by providers during childbirth, leaving her to feel unheard and vulnerable when attentive, empathetic care is crucial. This may feel like an extension of her overall pregnancy experience, where she felt disregarded.
She may have empathetic health care providers who listen to her concerns, provide personalized care, and address any issues or communications promptly–all of which ease her fears in the birthing process. These providers work well with other birthing specialists she desires in the room like doulas, or her care team will be composed of in-culture doulas and midwives that provide a sense of comfort, offer personalized care, and apply Respectful Maternity Care.
Racial Profiling and Prejudice
She may encounter providers with dismissive attitudes towards her pain and concerns, sometimes assuming she can withstand more discomfort or overlooking her symptoms because she is a Black woman (e.g. the strong Black woman stereotype and incorrect notions of pain perception among health care providers).
She and her providers may use the New York Times’ discussion guide on “Protecting Your Birth: A Guide for Black Mothers”, which outlines four steps for patients to understand how racism can impact care and advice for conversations throughout the journey.
"Right after I got the news that I would be having my son in 4 days, I remember talking to myself in the elevator saying "thank God this is almost over and we made it". I was relieved to be at the end. No labor involved this time, just surgery. There was a different set of nerves because I know the process already. Would it be as challenging of a recovery? Would the baby be ok given the effects of gestational diabetes? Would I have support once I got home? Could I recover, take care of my daughter, and take care of a newborn? There were a bunch of other situations to be concerned about, once I gave birth. "
Unspoken Birth Fears
As she approaches childbirth, she is filled with questions and unease for both herself and her baby: Will they survive childbirth? Why is she in pain and is this pain normal? Why is she not dilating? These questions hang over her as she experiences the pain and different sensations. She tries to calm herself down but additional fears may emerge, especially around preeclampsia and gestational diabetes–what risks do these conditions create?
Will They Hear Me?
Looming over all these thoughts and questions is: How do they treat Black women here? Will they listen to my needs? Who will listen to me, if anyone? She is scared of something going wrong, and when that happens, she worries that her concerns may be dismissed or overlooked when she is most vulnerable. She hopes that everything will be okay, that her voice will be heard, and that she and the baby will come out safely on the other side of the journey.
Delivery method recommendation Preventive antibiotic given before a c-section to reduce the risk of infection and for the prevention of blot clots in the legs Preventive antibiotics given during labor to prevent the newborn baby from getting a Strep infection
Poor quality birth location Traumatic birth experience Stillbirth or miscarriage Unequal pain treatment Heightened tendency for c-section Racial profiling and prejudice in the labor and delivery room
Childbirth and labor mark the final stages of pregnancy. Labor begins with contractions that intensify and the process unfolds in stages from early labor to active labor. For many, this part of the journey is both physically and emotionally demanding, requiring support, focus, and care. She is nervous and may have limited social support, so she will rely on the guidance of health care providers or a birth team to help her navigate this experience to welcome her baby.
Childbirth
and Labor
Next Postpartum
Kay
Age 26, Government Program Insurance, Florida
“I was looking for a provider who was compassionate and patient with children as well as the staff..."
"I was extremely scared to give birth. No matter how many questions I asked to my provider and other moms I felt..."
Jade
Age 34, Employer/spouse’s coverage, Louisiana
“A low point was the moment the OB told me I wasn’t bleeding and told go home..."
"The childbirth process was an interesting one - all of the birthing classes my husband and I took..."
Bianca
"Prior to labor I went to a few pediatricians to see how they ran their practices and how their service was..."
Camryn
Age 31, Employer/spouse’s coverage, NJ
“My water broke at home and then we made our way to the hospital as we planned. Things were very calm for..."
“I was looking for a provider who was compassionate and patient with children as well as the staff front desk and nurses etc. That everyone had a welcoming and exciting vibe to them as doctors can be very scary for kids especially if they are going frequently like in my case. At the beginning, I felt comfortable voicing my concerns but then after a while I felt rushed and like everything was dismissed or not a big deal when to me and my child it was. I understand medical professionals understand and have knowledge from being in school and seeing other patients but WE the PARENTS are with our child day in/day out. We aren't exaggerating or making stuff up and I was no longer okay with the treatment, and I HAPPILY found another who responded with empathy, care and attention. I'm not sure how the old provider responded as I requested my child's records and switched but since my last visit and medical records being switched to another provider, they haven't reached out to see why or what's happened.”
“I was extremely scared to give birth. No matter how many questions I asked to my provider and other moms I felt like I just didn't have it in me to birth a whole child. I also knew leading up to birth with my blood pressure being so high and all the swelling I could get induced to make sure me and baby are okay and that made me extremely anxious and nervous. I didn't feel like I had enough time to prepare/nest.”
“A low point was the moment the OB told me I wasn’t bleeding and told go home as though everything was normal. I felt ignored, belittled, and I was alone. I think having an empathetic doctor could have prevented increased anxiety and sadness I felt.”
“The childbirth process was an interesting one - all of the birthing classes my husband and I took, the instructors went into labor naturally and gave birth with with no pain management. It came as such a shock, how very little information is given about what to expect if you are induced and how the pain is intensified since they are using medication to ripen your cervix to give birth. I won't lie, I was disappointed with how my childbirth journey went but there came a point, where in my mind, I switched to, "get my baby here safely and keep me alive doing it." In the 2 weeks before delivery, I saw so any Black American women go into hospitals to deliver their babies and they end up in morgues, their babies now motherless.”
“Prior to laborI went to a few pediatricians to see how they ran their practices and how their service was. I was looking for a pediatrician that listened to us and really got to know our child. I was looking for an African American doctor and if not then a doctor of color. I had a doctor picked out and then once my son went into the NICU, the nurses recommended a closer Dr for our son to see. Being very vulnerable I just went with their recommendation. He was a nice Dr but I felt like he didn’t take the time to get to know us. He never even said my sons name and that made me really upset. I remember asking a question about the vaccines and he was so annoyed he told me to google it. That was our last visit. We ended up switching to a Black doctor and it was the best decision! Right away I felt so comfortable. She listened to us and connected so well.”
“My water broke at home and then we made our way to the hospital as we planned. Things were very calm for hours so I was given pitocin to speed things up. I felt like the hospital staff was nice but I won't forget that I was pressed about my pregnancy history. When I was asked about abortions, I let one of the resident doctors know that I never had one. She looked at me almost as if I was lying and proceeded to ask again. That made me uncomfortable. “
Her ideal pregnancy experience is one where her health concerns and preferences are met with care and respect. Her health care providers listen attentively and address her questions with understanding and compassion which make her feel seen and valued as an individual. They encourage her to create a birth plan and honor it, respecting her choices. Her insurance coverage is comprehensive and inclusive such that essential services are accessible and affordable, and doula care and at-home birth options are covered and available. She feels supported, respected, and able to focus on the joy of bringing her baby into the world.
Tina
Age 39, Marketplace coverage, Georgia
"So with my final baby, I found out I was pregnant. I ended up telling my husband and scheduled a doctor's appointment. The test came back positive of course, and they immediately told me because of my age and my previous child's condition, I had to see a maternal fetal specialist. So I went and they told me that we would need to have three consecutive appointments just to make sure that the baby's development was ok and that I was ok. The maternal fetal specialist said that I needed to take a stress test due to my age and of course I passed. The scan was good and I immediately told them "hey I'm opting out of any future appointments because we plan to have a home birth. We had doula care with Anna [second child] in a successful delivery and the baby was completely healthy." I was totally confident in this pregnancy the entire time. "
Pregnancy Period
Access to Health Care Services and Resources
She may encounter difficulties accessing her provider visits, especially if she lives in rural areas and lacks personal transportation. She may also experience housing instability, food insecurity, and other resource needs that have adverse impacts on her and her baby’s health outcomes.
She may be connected to community-based organizations like Developmental Understanding and Legal Collaboration for Everyone (DULCE) or local programs like Family Solutions in the S.C. Office of Rural Health that connect her with social supports throughout her pregnancy journey. Partnerships like those between Lyft and Babyscripts and Uber and Surgo Health can help her keep and travel to her prenatal appointments.
Access to Health Care Coverage and Affordability
She may have anxiety about out-of-pocket health care costs and may be confused about what is covered by her health insurance. The cost of care can be a significant barrier to her seeking and pursuing important care.
She may be eligible for Medicaid and receive assistance in enrolling in the program, which connects her to health care coverage and additional resources like prenatal classes.
Lack of Personalized Care
She may feel that she does not receive care that is personalized to her unique health care needs. She may be treated for comorbidities like diabetes, obesity, and preeclampsia because her provider assumes she has these conditions even if she does not.
She may seek perinatal health workers like doulas to provide personalized and culturally-concordant care that is tailored to her and guides her through the pregnancy journey. Additionally, telehealth and tech apps like Maven Clinic and Pomelo Care can promote racially-concordant care, provide access to interdisciplinary care teams, and bridge access to care gaps.
Racially Motivated Mistreatment
She may notice a discrepancy between how she is treated in the provider’s office and how a non-Black person is treated. She feels like she receives substandard care because of her race.
She may rely on in-culture support groups, online or in-person, that help ease anxiety and are tailored to her personal lived cultural experience. These groups can provide a safe space for mothers to talk about ways to self advocate throughout their pregnancy journey. Women-Inspired Neighborhood (WIN) Network in Detroit is the nation’s first program to pilot an enhanced model of group prenatal care for Black women using the CenteringPregnancy curriculum.
Dismissive Doctors, Racial Stereotypes, and the “Strong Black Woman” Trope
She may encounter health care providers who do not take her concerns seriously and dismiss her questions. She may feel that she is expected to be strong due to the “strong Black woman” trope.
She may seek in-culture health care providers that give her a sense of support and security that is specialized for her and her baby. Doulas can improve her experience by guiding her through the pregnancy journey and providing culturally-concordant care. The Irth App seeks to empower women to share satisfaction and care experience feedback with each other and to local hospitals for process improvement.
"My path was full of ups and downs. My journey started with a positive pregnancy test and ended with me giving birth to a beautiful, healthy baby boy. Finding my healthcare provider was easy in Ohio, I just used the same provider that I used with my previous pregnancies. Finding care in Georgia was slightly difficult and a little nerve-wracking. Because of my ethnicity, I was nervous about delivering my baby via cesarean and even more nervous about the possibility of delivering my baby with placenta previa. The hardest thing about my pregnancy was not having my husband physically there, especially when our only form of communication was snail mail. I felt so many emotions during my pregnancy like happiness, sadness, joy, anxiety, love, loneliness, nervousness and relief."
A Black Mother's First Steps
As she begins her pregnancy journey, she is on an emotional roller coaster: while she is excited for what lies ahead, her mind is also filled with questions and hopes. She wonders what her experience will be like, how her health care provider will treat her, and how her identity as a Black woman might impact her care. She may recall how her provider became cold after confirming her pregnancy, and wonders if she would be better off with a Black provider who better understands her needs and concerns.
When Doctors Don't Listen
She is nervous about what to expect: When should she go to the emergency room? Is she doing what is best for the baby–and equally as important, is her doctor? Her worry grows when she is reminded of times when providers seemed to withhold information or push interventions without clear explanation. She feels uncertainty and duress about the lack of communication from her providers, stereotypes that may fall on her, and inequity of treatment.
Third Trimester:
Fetal anatomic assessment VDRL / RPR GBS culture
Second Trimester:
Maternal weight monitoring Query for contractions, fluid, blood Breastfeeding assessment TDAP vaccine (once per pregnancy) Fluid level check Baby positioning check
First Trimester:
Laboratory screening History and physical exam Ultrasound
Prenatal care inadequacy Vitamin deficiency Awareness of Black maternal crisis Ectopic pregnancy diagnosis Abortion and counseling inaccessibility Miscarriage Anemia Gestational diabetes Preterm labor Near miss events
The pregnancy journey is the time when a person prepares physically, mentally, and emotionally to carry and nurture the baby. Pregnant women, both first-time and experienced mothers, seek ways to stay healthy and give birth to a healthy baby. Black women may enter with hopes and expectations shaped by their past encounters with the health care system and the experiences of family and friends. She may turn to trusted community members, doulas, and virtual checkups with providers for support and to create a network of care to navigate this chapter.
The
Pregnancy
Next Childbirth and Labor
"My path was not a straight line. There were definitely some unexpected points-changing my OB..."
Samantha
Age 31, Government Program Insurance, Illinois
"I was sick almost every single day. I couldn’t keep 90% of my food and drinks down..."
Jasmine
"My pregnancy journey was like a roller coaster & zig zags. I felt like a I had a bunch of highs and lows..."
"So with my final baby, I found out I was pregnant. I ended up telling my husband and scheduled a doctor's appointment..."
"While it was a shock to be hospitalized for 3 weeks on emergency admission, I FELT happy, proud..."
"My path was not a straight line. There were definitely some unexpected points-changing my OB, my children's Father being mostly absent, and the health concerns. My path started with an at-home pregnancy test. I didn't have to look far for my healthcare provider (initially), because she cared for me during my first pregnancy. After she left, I was handed off to someone else. I didn't even look elsewhere, because I was familiar with the new provider. The good thing was that I knew of her. So meeting was more of a formality. This made the transition easy, because she made me feel at ease, and she was very approachable. I think my ethnicity played a part in my c-section experience. My discomfort was minimized and I did not feel like I was taken seriously. My OB unfortunately was not there, which sucked. I spent all this time building a connection and comfortability with her, to not have her at the finish line with me. The persistent, underlying feelings during my pregnancy were: uncertainty, fear, sadness, abandonment, depression, and being overwhelmed. I rarely had happy moments, outside of my appointments. The best moments was feeling my baby move and hearing his heartbeat."
“I was sick almost every single day. I couldn’t keep 90% of my food and drinks down. I used to cry so much! It was unbelievable what I was experiencing. My husband supported me the entire time. I wish I knew if it could’ve been prevented or not. I would’ve done anything to not have that horrible experience.”
“My pregnancy journey was like a roller coaster & zig zags. I felt like a I had a bunch of highs and lows and I didn’t even know how to feel, think or even say some days. Just knowing I was going to meet a little someone who was going to change my life forever for the better was enough to keep me pushing. I’m grateful for every part of my journey and the care I received."
"So with my final baby, I found out I was pregnant. I ended up telling my husband and scheduled a doctor's appointment. The test came back positive of course, and they immediately told me because of my age in my previous child’s condition, I had to see a maternal fetal specialist. So I went there and then they told me that we would have three consecutive appointments just to make sure that the babies development was OK and that I was OK. The maternal fetal specialist said that I needed to take a stress test due to my aid and of course I passed because I’m not really all home to feed. A scan was good and I immediately told him “hey I’m opting out of any future appointments we plan to homebirth we had Doula care which Anna in a successful delivery, and the baby was completely healthy.” I was totally confident in this pregnancy, the entire time."
"While it was a shock to be hospitalized for 3 weeks on emergency admission, I FELT happy, proud, encouraged and tearful [in the best way] when I saw my short notes, special days (like when and how I told my hubby, my parents, his parents, and our families, and then our WWW of friends and family). Even thinking about how challenging it was to have both myself, our baby, and my husband to have unexpected, extended, and nearly fatal hospital stays, I remember my journey and even those low moments with gratefulness because my family is still here. I also felt like I had to draw with more than "a writing utensil." I wanted to show and share the beautiful chaos of it all. Back IN the pregnancy journey, there were more feelings of fear, anxiety, grief (that my grandparents weren't alive to see our daughter), anger (at a particular nurse that seemed to be thrilled to 'zap' me more than necessary when I was hospitalized with an underweight baby) alongside my constant hopefulness and overwhelm that I really was a whole Mama now."
Her ideal preconception experience is one where her health concerns are addressed with care, her preferences are respected, and her journey is supported by responsive health care providers. She imagines a team that not only listens but also understands the nuances of her past experiences, and inclusive insurance coverage that makes this care accessible to her. She would be cared for by a woman of color, who can offer advice and care tailored to her cultural needs and who understands her concerns without her needing to explain them. This provider would provide empathy, insight, and shared experience that would make her feel seen and heard.
Rachel
Age 34, Employer/spouse’s coverage, California
"Well at the beginning of this journey, I didn’t rely on no one because I wanted it to be a secret. I was scared if it didn’t happen I would feel like a failure. I wish I knew then that more people have that fear of wanting to become pregnant and it not happen. Because even though it happened, the first few months of us trying it was still a scary process. I was second-guessing the down syndrome test when I was pregnant because I felt like it wasn’t going to change how I felt about my baby and I was going to have her regardless but I did go through with it for peace of mind and because my doctor semi insisted. I did make some changes such as taking prenatal vitamins, going on frequent walks, and increasing my water intake."
Preconception
Birth Control Pressure
She may be pressured by health care providers to use birth control, a recommendation that may conjure historical injustices including forced sterilizations and reproductive control policies targeting Black communities. This fosters mistrust, making her wonder if birth control is truly the best option for her health or a reflection of a biased medical system.
Information Overload
She may feel overwhelmed by information–advice from doctors, stories from friends, and endless online content–which leaves her to navigate what applies to her unique needs and experiences.
She may cope with this by looking for in-culture conception advice–her community may share natural remedies to help foster better fertility for their path to conception. These practices may feel more personalized and tailored to her personal needs and tied to her cultural heritage.
Racial Stereotyping
She may experience racial stereotyping that leaves her health concerns dismissed or minimalized, often leaving her feeling unseen and misunderstood by her health care provider.
She may cope with this by finding empathetic health care professionals who listen to her concerns and provide personalized care that helps her overcome barriers to getting pregnant.
"I do feel like my ethnicity and culture always made people, especially my doctor’s, question if I was ready to have a kid and bring a kid into this world at a young age. I even had one doctor tell me that I should wait until I could take care of my baby without the help of welfare. I was a bit stunned by the comment and was really relieved when my sister who was with me informed her we weren’t on welfare and in the event we needed it, it was there just like it was for everyone."
Fighting to Be Heard
She feels uncertain about the journey she is about to embark on, knowing that Black women like herself are more likely to die from pregnancy-related causes than other women. She has experienced stereotyping in health care before so how will her pregnancy journey be any different? The stress of having to navigate these issues without clear communication from her provider feels like a burden. She feels like she will need to fight harder than others to be heard and to receive the respectful care she deserves.
Navigating Fertility Choices
She may have tried different methods to conceive, like menstrual cycle tracking, but she feels there must be other strategies out there that can help improve fertility and conception—perhaps natural or cultural remedies that meet her unique needs. She questions if doctors have her best interests in mind, especially when they recommend birth control. Is it safe or harmful to her body? She’s had negative experiences with one method; will others be the same?
As she embarks on her journey to conceive, the possibility of motherhood may fill her with excitement. Yet this excitement is often overshadowed by questions and worries that fill her mind. Why is it hard for couples to conceive? Are other Black women struggling with the same doubts and fears?
Pre-pregnancy education Pre-pregnancy counseling Pre-pregnancy assessment
Infertility Lack of contraception Pressure to be on birth control Unintended pregnancy Family and community stigma around birth control
The preconception period is the time before a person becomes pregnant, and may include physical, mental, and lifestyle preparation to optimize health for conception and pregnancy. Even before the 100 weeks begin, Black women may enter the journey with preconceived notions of what her pregnancy journey will look like as a result of her own past experiences with the health care system, experiences her family and friends may have had, and/or historical transgressions from the health care system.
Preconception Period
Next Pregnancy Period
"I used the resources of my primary care doctor, who is a Black woman who had her children 'later' in life..."
"I felt our first OB had some prejudice against my husband and I because we were overweight..."
“I kind of felt like I was bombarded with the contraceptive discussion because of my ethnicity, honestly. It made me a little upset at times.”
"I really only felt I could trust the word of Black folks like me and those who love Black folks like me..."
"I can’t speak for now. But when I was younger, Depo was pushed on Black and Brown women, as if it was the only/best option available."
Aisha
Age 23, Marketplace coverage, Tennessee
"I feel like the impact it had upon my culture was negative because the majority of the young girls in my ethnicity group don’t believe in using birth control because of the negative effects they take upon our body."
"I used the resources of my primary care doctor, who is a Black woman who had her children 'later' in life, wisdom from African American/Black (connected) families, and that was about it. I did not want to tell our families that we were trying because I did not want extra pressure in case we could not conceive the old-fashioned way. I wish I knew more about Black professionals and maternal health support during our "try" period. Because my doctor is Black and female and is trained in Western medicine and also utilizes natural/holistic methods. I felt good about my status (healthy) in my attempt to get pregnant. I regularly got my annual uterine checks and general health visits. I also confirmed with the hospital that I wanted to deliver my child, in part, because of conversations and experiences shared by my doctor. My family lives in a city where we have no other family, so hearing from my Black doctor and our Black [church] community of parents helped.
"I felt our first OB had some prejudice against my husband and I because we were overweight, immediately giving us Clomid when we talked about struggling to get pregnant, as well as our race (our first OB was an older, white man.) Our second OB (younger, white woman) was much more caring and actually asked more lifestyle questions (for example, when my recurrent pregnancy loss panel came back, we found out that I was a carrier for cystic fibrosis which she found fascinating since black women are usually not carriers - upon explaining to her that I had white great-great grandparents on my dad's side, she was able to discuss the low probability of passing on the gene to future generations.)"
"I really only felt I could trust the word of Black folks like me and those who love Black folks like me. I had no idea the resources or questions that I should ask to get ready for becoming pregnant. I worked in a hospital that I was SURE that I did not want to deliver my child in because I saw first-hand the disparities in how they treated Black families, mothers, and children versus non-Black families. The hospital I did deliver in had many traditional (western medicine-trained staff) and non-traditional (midwifery staff) that publicly and privately promoted Black Maternal Health. Talking with them got me connected the resources after I became pregnant, but the global shutdown due to COVID19 kept me from being able to fully connect to those resources. I could only follow the word of mouth of those in my tight, safe circle.
Robin Kay
Postpartum
The 100 Weeks Framework encapsulates pivotal moments in the maternal health journey, inclusive of the highs, lows, stressors, challenges, and supports across the entire journey: preconception, pregnancy, labor & delivery, postpartum, child wellness and interconception.
Black women are three times more likely to die from a pregnancy-related cause than white women. At United States of Care we sought out to learn more about what was happening by listening to Black women.
*We use the term “woman” and “women” throughout this piece because our maternal health listening research was conducted with people who self-identified as women.
This tool captures the lived experiences, emotions, bright spots, and critical points of failure across the 100-week journey for Black women* in the US.
The journey to motherhood is more than just 40 weeks.
State of Postpartum Care
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Nevada
Illinois
WY
WA
UT
OR
NM
NV
MT
ID
HI
CO
CA
AZ
AK
WV
VA
TN
SC
OK
NC
MS
MD
LA
KY
GA
FL
DE
AR
AL
TX
WI
SD
OH
ND
NE
MN
MI
IN
IA
IL
MO
KS
VT
NY
NH
ME
RI
NJ
MA
CT
PA
coming soon...
Access to Postpartum Information
Postpartum Mental Health
Number of women aged 15-49* - 1,143,118 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 1140 Doula counts (by state)2 - 17 Number of certified lactation consultant (by state)3 - 233 Total number of Perinatal health workers - 1390 Number of Perinatal health workers per 10,000 women age 15-49 - 12
Alabama
via Perinatal Health Workers
Self reported PPD symptoms1 - 16.2% PPD screening at prenatal visit2 - N/A PPD screening postpartum visit3 - N/A
Self reported PPD symptoms1 - N/A PPD screening at prenatal visit2 - 90.7% PPD screening postpartum visit3 - 94.2%
Alaska
Self reported PPD symptoms1 - 11.7% PPD screening at prenatal visit2 - N/A PPD screening postpartum visit3 - N/A
Arizona
Self reported PPD symptoms1 - N/A PPD screening at prenatal visit2 - N/A PPD screening postpartum visit3 - N/A
Arkansas
California
Self reported PPD symptoms1 - 12.5% PPD screening at prenatal visit2 - 82.5% PPD screening postpartum visit3 - 93%
Colorado
Self reported PPD symptoms1 - 12.2% PPD screening at prenatal visit2 - 73.5% PPD screening postpartum visit3 - 89.8%
Connecticut
Self reported PPD symptoms1 - 10.4% PPD screening at prenatal visit2 - 85.1% PPD screening postpartum visit3 - 88.7%
Delaware
Florida
North Carolina
South Carolina
Indiana
Self reported PPD symptoms1 - N/A PPD screening at prenatal visit - N/A PPD screening postpartum visit - N/A
Ohio
Maryland
New Hampshire
Self reported PPD symptoms1 - 8% PPD screening at prenatal visit2 - 83.9% PPD screening postpartum visit3 - 91.8%
Rhode Island
Idaho
Texas
Iowa
Self reported PPD symptoms1 - N/A PPD screening at prenatal visit2 - 79.1% PPD screening postpartum visit3 - 85.8%
Georgia
Self reported PPD symptoms1 - 13% PPD screening at prenatal visit2 - N/A PPD screening postpartum visit3 - N/A
Hawaii
Self reported PPD symptoms1 - N/A PPD screening at prenatal visit2 - 82.2% PPD screening postpartum visit3 - 91.7%
Self reported PPD symptoms1 - 11.9% PPD screening at prenatal visit2 - 77.9% PPD screening postpartum visit3 - 85.2%
Kansas
Self reported PPD symptoms1 - 17.6% PPD screening at prenatal visit2 - 69.7% PPD screening postpartum visit3 - 85.4%
Kentucky
Self reported PPD symptoms1 - N/A PPD screening at prenatal visit2 - 70.8% PPD screening postpartum visit3 - 75%
Louisiana
Self reported PPD symptoms1 - 9.8% PPD screening at prenatal visit2 - 90.5% PPD screening postpartum visit3 - 95.5%
Maine
Self reported PPD symptoms1 - 10% PPD screening at prenatal visit2 - 82.7% PPD screening postpartum visit3 - 93.6%
Massachusetts
Self reported PPD symptoms1 - 14.3% PPD screening at prenatal visit2 - 83.4% PPD screening postpartum visit3 - 88.6%
Michigan
Self reported PPD symptoms1 - N/A PPD screening at prenatal visit2 - 90.6% PPD screening postpartum visit3 - 95.9%
Minnesota
Self reported PPD symptoms1 - N/A PPD screening at prenatal visit2 - 69.4% PPD screening postpartum visit3 - 76.9%
Mississippi
Self reported PPD symptoms1 - 15.6% PPD screening at prenatal visit2 - 77.9% PPD screening postpartum visit3 - 85.2%
Missouri
Self reported PPD symptoms1 - 12.5% PPD screening at prenatal visit2 - N/A PPD screening postpartum visit3 - N/A
Montana
Self reported PPD symptoms1 - 12.8% PPD screening at prenatal visit2 - 86.3% PPD screening postpartum visit3 - 89.8%
Nebraska
Self reported PPD symptoms1 - 9% PPD screening at prenatal visit2 - 71.6% PPD screening postpartum visit3 - 84.8%
New Jersey
Self reported PPD symptoms1 - 12.4% PPD screening at prenatal visit2 - 89.1% PPD screening postpartum visit3 - 93.7%
New Mexico
Self reported PPD symptoms1 - 11.5% PPD screening at prenatal visit2 - N/A PPD screening postpartum visit3 - 84.2%
New York
Self reported PPD symptoms1 - 10.5% PPD screening at prenatal visit2 - 89.6% PPD screening postpartum visit3 - 94.1%
North Dakota
Self reported PPD symptoms1 - 14.9% PPD screening at prenatal visit - N/A PPD screening postpartum visit - N/A
Oklahoma
Oregon
Self reported PPD symptoms1 - 12.4% PPD screening at prenatal visit2 - 81.4% PPD screening postpartum visit3 - 90.7%
Pennsylvania
Self reported PPD symptoms1 - 11% PPD screening at prenatal visit2 - 87.1% PPD screening postpartum visit3 - 95%
South Dakota
Tennessee
Self reported PPD symptoms1 - 15.3% PPD screening at prenatal visit2 - 69.5% PPD screening postpartum visit3 - 87.3%
Utah
Self reported PPD symptoms1 - 12.9% PPD screening at prenatal visit2 - 89.6% PPD screening postpartum visit3 - 96.2%
Vermont
Self reported PPD symptoms1 - 14% PPD screening at prenatal visit2 - N/A PPD screening postpartum visit3 - N/A
Virginia
Self reported PPD symptoms1 - 11.8% PPD screening at prenatal visit2 - N/A PPD screening postpartum visit3 - N/A
Washington
West Virginia
Self reported PPD symptoms1 - 9.2% PPD screening at prenatal visit2 - N/A PPD screening postpartum visit3 - N/A
Wisconsin
Self reported PPD symptoms1 - 14.4% PPD screening at prenatal visit2 - N/A PPD screening postpartum visit3 - N/A
Wyoming
Number of women aged 15-49* - 163,121 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 272 Doula counts (by state)2 - 3 Number of certified lactation consultant (by state)3 - 101 Total number of Perinatal health workers - 376 Number of Perinatal health workers per 10,000 women age 15-49 - 23
Number of women aged 15-49* - 1,637,098 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 1795 Doula counts (by state)2 - 36 Number of certified lactation consultant (by state)3 - 332 Total number of Perinatal health workers - 2263 Number of Perinatal health workers per 10,000 women age 15-49 - 14
Number of women aged 15-49* - 677,271 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 613 Doula counts (by state)2 - 6 Number of certified lactation consultant (by state)3 - 121 Total number of Perinatal health workers - 740 Number of Perinatal health workers per 10,000 women age 15-49 - 11
Number of women aged 15-49* - 9,124,204 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 11568 Doula counts (by state)2 - 361 Number of certified lactation consultant (by state)3 - 2766 Total number of Perinatal health workers - 14695 Number of Perinatal health workers per 10,000 women age 15-49 - 16
Number of women aged 15-49* - 1,380,866 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 1951 Doula counts (by state)2 - 36 Number of certified lactation consultant (by state)3 - 470 Total number of Perinatal health workers - 2457 Number of Perinatal health workers per 10,000 women age 15-49 - 18
Number of women aged 15-49* - 804,136 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 1657 Doula counts (by state)2 - 43 Number of certified lactation consultant (by state)3 - 266 Total number of Perinatal health workers - 1966 Number of Perinatal health workers per 10,000 women age 15-49 - 24
Number of women aged 15-49* - 216,513 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 297 Doula counts (by state)2 - 7 Number of certified lactation consultant (by state)3 - 56 Total number of Perinatal health workers - 360 Number of Perinatal health workers per 10,000 women age 15-49 - 17
Number of women aged 15-49* - 4,695,524 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 5853 Doula counts (by state)2 - 80 Number of certified lactation consultant (by state)3 - 810 Total number of Perinatal health workers - 6743 Number of Perinatal health workers per 10,000 women age 15-49 - 14
Number of women aged 15-49* - 2,599,616 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 3341 Doula counts (by state)2 - 49 Number of certified lactation consultant (by state)3 - 527 Total number of Perinatal health workers - 3917 Number of Perinatal health workers per 10,000 women age 15-49 - 15
Number of women aged 15-49* - 302,734 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 547 Doula counts (by state)2 - 6 Number of certified lactation consultant (by state)3 - 110 Total number of Perinatal health workers - 663 Number of Perinatal health workers per 10,000 women age 15-49 - 22
Number of women aged 15-49* - 436,965 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 369 Doula counts (by state)2 - 22 Number of certified lactation consultant (by state)3 - 143 Total number of Perinatal health workers - 534 Number of Perinatal health workers per 10,000 women age 15-49 - 12
Number of women aged 15-49* - 2,852,991 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 4203 Doula counts (by state)2 - 79 Number of certified lactation consultant (by state)3 - 637 Total number of Perinatal health workers - 4919 Number of Perinatal health workers per 10,000 women age 15-49 - 17
Number of women aged 15-49* - 1,530,011 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 1697 Doula counts (by state)2 - 29 Number of certified lactation consultant (by state)3 - 487 Total number of Perinatal health workers - 2213 Number of Perinatal health workers per 10,000 women age 15-49 - 14
Number of women aged 15-49* - 693,875 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 654 Doula counts (by state)2 - 13 Number of certified lactation consultant (by state)3 - 165 Total number of Perinatal health workers - 832 Number of Perinatal health workers per 10,000 women age 15-49 - 12
Number of women aged 15-49* - 649,589 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 709 Doula counts (by state)2 - 13 Number of certified lactation consultant (by state)3 - 211 Total number of Perinatal health workers - 933 Number of Perinatal health workers per 10,000 women age 15-49 - 14
Number of women aged 15-49* - 988,972 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 1141 Doula counts (by state)2 - 10 Number of certified lactation consultant (by state)3 - 179 Total number of Perinatal health workers - 1330 Number of Perinatal health workers per 10,000 women age 15-49 - 13
Number of women aged 15-49* - 1,043,544 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 1558 Doula counts (by state)2 - 6 Number of certified lactation consultant (by state)3 - 197 Total number of Perinatal health workers - 1761 Number of Perinatal health workers per 10,000 women age 15-49 - 17
Number of women aged 15-49* - 282,427 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 430 Doula counts (by state)2 - 18 Number of certified lactation consultant (by state)3 - 92 Total number of Perinatal health workers - 540 Number of Perinatal health workers per 10,000 women age 15-49 - 19
Number of women aged 15-49* - 1,395,676 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 2442 Doula counts (by state)2 - 74 Number of certified lactation consultant (by state)3 - 493 Total number of Perinatal health workers - 3009 Number of Perinatal health workers per 10,000 women age 15-49 - 22
Number of women aged 15-49* - 1,610,759 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 2714 Doula counts (by state)2 - 84 Number of certified lactation consultant (by state)3 - 466 Total number of Perinatal health workers - 3264 Number of Perinatal health workers per 10,000 women age 15-49 - 20
Number of women aged 15-49* - 2,176,561 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 3177 Doula counts (by state)2 - 38 Number of certified lactation consultant (by state)3 - 503 Total number of Perinatal health workers - 3718 Number of Perinatal health workers per 10,000 women age 15-49 - 17
Number of women aged 15-49* - 1,255,719 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 1799 Doula counts (by state)2 - 44 Number of certified lactation consultant (by state)3 - 461 Total number of Perinatal health workers - 2304 Number of Perinatal health workers per 10,000 women age 15-49 - 18
Number of women aged 15-49* - 669,121 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 690 Doula counts (by state)2 - 3 Number of certified lactation consultant (by state)3 - 111 Total number of Perinatal health workers - 804 Number of Perinatal health workers per 10,000 women age 15-49 - 12
Number of women aged 15-49* - 1,368,368 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 1715 Doula counts (by state)2 - 31 Number of certified lactation consultant (by state)3 - 376 Total number of Perinatal health workers - 2122 Number of Perinatal health workers per 10,000 women age 15-49 - 16
Number of women aged 15-49* - 239,382 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 287 Doula counts (by state)2 - 3 Number of certified lactation consultant (by state)3 - 67 Total number of Perinatal health workers - 357 Number of Perinatal health workers per 10,000 women age 15-49 - 15
Number of women aged 15-49* - 435,512 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 513 Doula counts (by state)2 - 7 Number of certified lactation consultant (by state)3 - 148 Total number of Perinatal health workers - 668 Number of Perinatal health workers per 10,000 women age 15-49 - 15
Number of women aged 15-49* - 719,713 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 687 Doula counts (by state)2 - 9 Number of certified lactation consultant (by state)3 - 114 Total number of Perinatal health workers - 810 Number of Perinatal health workers per 10,000 women age 15-49 - 11
Number of women aged 15-49* - 2,039,450 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 3110 Doula counts (by state)2 - 91 Number of certified lactation consultant (by state)3 - 547 Total number of Perinatal health workers - 3748 Number of Perinatal health workers per 10,000 women age 15-49 - 18
Number of women aged 15-49* - 290,658 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 483 Doula counts (by state)2 - 21 Number of certified lactation consultant (by state)3 - 98 Total number of Perinatal health workers - 602 Number of Perinatal health workers per 10,000 women age 15-49 - 21
Number of women aged 15-49* - 464,654 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 640 Doula counts (by state)2 - 4 Number of certified lactation consultant (by state)3 - 134 Total number of Perinatal health workers - 778 Number of Perinatal health workers per 10,000 women age 15-49 - 17
Number of women aged 15-49* - 4,457,006 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 7795 Doula counts (by state)2 - 201 Number of certified lactation consultant (by state)3 - 1087 Total number of Perinatal health workers - 9083 Number of Perinatal health workers per 10,000 women age 15-49 - 20
Number of women aged 15-49* - 2,483,121 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 3210 Doula counts (by state)2 - 96 Number of certified lactation consultant (by state)3 - 823 Total number of Perinatal health workers - 4129 Number of Perinatal health workers per 10,000 women age 15-49 - 17
Number of women aged 15-49* - 172,587 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 196 Doula counts (by state)2 - 1 Number of certified lactation consultant (by state)3 - 34 Total number of Perinatal health workers - 231 Number of Perinatal health workers per 10,000 women age 15-49 - 13
Number of women aged 15-49* - 2,567,828 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 3500 Doula counts (by state)2 - 71 Number of certified lactation consultant (by state)3 - 716 Total number of Perinatal health workers - 4287 Number of Perinatal health workers per 10,000 women age 15-49 - 17
Number of women aged 15-49* - 911,644 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 804 Doula counts (by state)2 - 8 Number of certified lactation consultant (by state)3 - 225 Total number of Perinatal health workers - 1037 Number of Perinatal health workers per 10,000 women age 15-49 - 11
Number of women aged 15-49* - 960,141 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 1505 Doula counts (by state)2 - 85 Number of certified lactation consultant (by state)3 - 518 Total number of Perinatal health workers - 2108 Number of Perinatal health workers per 10,000 women age 15-49 - 22
Number of women aged 15-49* - 2,804,185 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 4057 Doula counts (by state)2 - 94 Number of certified lactation consultant (by state)3 - 740 Total number of Perinatal health workers - 4891 Number of Perinatal health workers per 10,000 women age 15-49 - 17
Number of women aged 15-49* - 246,284 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 458 Doula counts (by state)2 - 18 Number of certified lactation consultant (by state)3 - 61 Total number of Perinatal health workers - 537 Number of Perinatal health workers per 10,000 women age 15-49 - 22
Number of women aged 15-49* - 1,169,623 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 1396 Doula counts (by state)2 - 29 Number of certified lactation consultant (by state)3 - 268 Total number of Perinatal health workers - 1693 Number of Perinatal health workers per 10,000 women age 15-49 - 14
Number of women aged 15-49* - 191,168 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 224 Doula counts (by state)2 - 1 Number of certified lactation consultant (by state)3 - 47 Total number of Perinatal health workers - 272 Number of Perinatal health workers per 10,000 women age 15-49 - 14
Number of women aged 15-49* - 1,598,739 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 2032 Doula counts (by state)2 - 25 Number of certified lactation consultant (by state)3 - 342 Total number of Perinatal health workers - 2399 Number of Perinatal health workers per 10,000 women age 15-49 - 15
Number of women aged 15-49* - 7,214,941 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 7774 Doula counts (by state)2 - 119 Number of certified lactation consultant (by state)3 - 1447 Total number of Perinatal health workers - 9340 Number of Perinatal health workers per 10,000 women age 15-49 - 13
Number of women aged 15-49* - 842,091 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 846 Doula counts (by state)2 - 19 Number of certified lactation consultant (by state)3 - 202 Total number of Perinatal health workers - 1067 Number of Perinatal health workers per 10,000 women age 15-49 - 12
Number of women aged 15-49* - 137,539 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 285 Doula counts (by state)2 - 6 Number of certified lactation consultant (by state)3 - 85 Total number of Perinatal health workers - 376 Number of Perinatal health workers per 10,000 women age 15-49 - 27
Number of women aged 15-49* - 1,978,978 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 2651 Doula counts (by state)2 - 100 Number of certified lactation consultant (by state)3 - 630 Total number of Perinatal health workers - 3381 Number of Perinatal health workers per 10,000 women age 15-49 - 17
Number of women aged 15-49* - 1,786,627 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 2039 Doula counts (by state)2 - 286 Number of certified lactation consultant (by state)3 - 652 Total number of Perinatal health workers - 2977 Number of Perinatal health workers per 10,000 women age 15-49 - 16
Number of women aged 15-49* - 365,994 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 440 Doula counts (by state)2 - 4 Number of certified lactation consultant (by state)3 - 71 Total number of Perinatal health workers - 515 Number of Perinatal health workers per 10,000 women age 15-49 - 14
Number of women aged 15-49* - 1,269,086 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 1540 Doula counts (by state)2 - 31 Number of certified lactation consultant (by state)3 - 374 Total number of Perinatal health workers - 1945 Number of Perinatal health workers per 10,000 women age 15-49 - 15
Number of women aged 15-49* - 124,653 OBGYNs, nurses & midwives specializing in obstetrics or neonatal care (demographic data by state)1 - 134 Doula counts (by state)2 - 3 Number of certified lactation consultant (by state)3 - 21 Total number of Perinatal health workers - 158 Number of Perinatal health workers per 10,000 women age 15-49 - 13
Medicaid expansion status1 Not Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Taking Adjacent Efforts Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) No Coverage Outpatient (OP) No Coverage States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Coverage of Postpartum Services and Benefits
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Taking Adjacent Efforts Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) No Coverage Outpatient (OP) No Coverage States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Taking Adjacent Efforts Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 No Action Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) No Coverage Outpatient (OP) No Coverage States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Covered Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Covered as DRG/Global Fee Component Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 In Process Insurance coverage benefits - Medicaid coverage for home visits7 Covered as DRG/Global Fee Component
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 In Process Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Covered as DRG/Global Fee Component Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 Covered as DRG/Global Fee Component
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 In Process Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Covered as DRG/Global Fee Component Outpatient (OP) Covered as DRG/Global Fee Component States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 Covered as DRG/Global Fee Component
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 In Process Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Covered as DRG/Global Fee Component Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Not Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Covered Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Taking Adjacent Efforts Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) Covered as DRG/Global Fee Component States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 In Process Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 No Action Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Taking Adjacent Efforts Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 In Process Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 In Process Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Taking Adjacent Efforts Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Not Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Taking Adjacent Efforts Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Not Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 In Process Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) No Coverage States expanding private coverage of doula care.4 In Process Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Taking Adjacent Efforts Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Covered as DRG/Global Fee Component Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Covered Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Covered as DRG/Global Fee Component Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 Covered as DRG/Global Fee Component
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Covered Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) No Coverage Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 Considering Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Covered Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Covered as DRG/Global Fee Component Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Covered Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) No Coverage Outpatient (OP) No Coverage States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Not Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 No Action Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) No Coverage States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Taking Adjacent Efforts Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Covered as DRG/Global Fee Component Outpatient (OP) Separate States expanding private coverage of doula care.4 Considering Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 No Action Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Covered Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 In Process Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) No Coverage Outpatient (OP) No Coverage States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Covered Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) No Coverage States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Covered Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 Covered Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Covered Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) No Coverage States expanding private coverage of doula care.4 Covered Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Not Adopted Medicaid Postpartum Coverage Extension to 12 months2 Not Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Taking Adjacent Efforts Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 No Action Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 In Process Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Not Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Covered Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 In Proceess Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Adopted Medicaid Postpartum Coverage Extension to 12 months2 Adopted Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 #N/A Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 #N/A Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Medicaid expansion status1 Not Adopted Medicaid Postpartum Coverage Extension to 12 months2 Limited Coverage Extention8 Insurance coverage benefits - postpartum doula coverage reimbursement under Medicaid (by Medicaid insurance payer per state)3 Taking Adjacent Efforts Insurance coverage benefits - lactation consultant reimbursement under Medicaid (by Medicaid insurance payer per state)5,6 Inpatient (IP) Separate Payment Outpatient (OP) Separate Payment States expanding private coverage of doula care.4 No Action Insurance coverage benefits - Medicaid coverage for home visits7 No Coverage
Late Stage Pregnancy Loss
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 7.4
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 4.6
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 6.3
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 7.0
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths)- 5.0
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 6.2
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 4.7
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 5.9
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 6.8
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 7.6
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 5.5
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 6.1
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 4.4
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 5.3
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 5.1
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 3.5
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 6.4
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 3.9
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 5.2
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 9.9
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths)- 5.5
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 5.0
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 7.8
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths)- 3.7
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 5.6
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 5.8
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 4.3
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 4.1
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 6.5
Fetal Mortality Rate (averages by state, number per 1,000 live births and fetal deaths) - 3.7
Sources 1 Postpartum depression (PPD) illness (self reported) Data from PRAMS survey 2022, N = 30,706* (for the question); Data type - Self-reported PPD symptoms; 29 states reporting 2 The data contains percentage of women who were asked about depression by their HCPs during Prenatal visit Data from PRAMS survey 2018, N = 32,619 3 The data contains percentage of women who were asked about depression by their HCPs during Postpartum visit Data from PRAMS survey 2018, N = 29,187
* CDC Wonder, 2022 Population defined as women of all races and ethnicities between 15-49. Disclaimer: Materials developed by CDC ATSDR and/or HHS and the use of these data including any links to the materials on the CDC, ATSDR or HHS websites, does not imply endorsement by CDC, ATSDR, HHS or the United States Government of you, your company, product, facility, service or enterprise. Material is otherwise available on the agency website for no charge. 1 Area Health Resources Files 2022-2023, Data type- No. of HCPs across specialities, per state; Data was calculated by the Sum of number of HCPs (including M.D.s specializing in Obstetrics and Gynecology, Nurses and Nurse Midwives with National Provider Identifier (NPI), Physicians practicing in Obstetrics and Gynecology and Physicians) specializing in Neonatal-Perinatal Medicine 2 DoulaMatch.net; data was compiled from the reported number of Postpartum doulas for each state 3 International Board of Lactation Consultant Examiners (IBLCE 2024); data was compiled from the reported number of Internationally Board certified Lactation Consultants in the U.S. & Territories
Sources
Definitions *DRG/Global Fee Component = Diagnostic Related Grouping (DRG) is a payment model which categorizes hospitalizations and calculates insurance reimbursement based on diagnosis and patient circumstances. Global Fee Component is a payment model which gives providers a fixed payment to cover patient costs for a specified time. Definitions adapted from the Center for Medicare & Medicaid Services Classifications. Separate Payment = This category describes states which do not include the listed service in their global maternity fees or as part of office visits, but rather bill / reimburse them as separate services. Definition produced from information provided by KFF Medicaid Coverage of Pregnancy-Related Services 2021. In Process = This category describes states which have passed Medicaid reimbursement legislation, but the legislation has not yet been implemented. Definition produced from information provided by The National Health Law Program as of January 2024. Taking Adjacent Efforts = “Adjacent Efforts” are not a singular phenomenon, but rather a series of actions that are considered similar to Medicaid reimbursement benefits. These actions range from initiating doula pilot programs, forming perinatal health worker alliances / registries, and increasing advocacy efforts. Definition produced from information provided by The National Health Law Program as of January 2024. No action = This category describes states which have not enacted any legislation/ efforts toward Medicaid reimbursement nor expressed any intention to draft legislation based on information provided by The National Health Law Program as of January 2024. Sources 1 KFF Status of State Medicaid Expansion decisions; data compiled from the reported current scenario of states implementing/ not implementing Medicaid expansion to cover individuals with incomes up to 138% of the Federal Poverty Level as of May 8, 2024. 2 KFF Medicaid Postpartum Coverage Extension Tracker; data compiled from the reported current scenario of states considering/ implementing Section 1115 waivers to extend Medicaid Postpartum care coverage to 12 months as of August 1, 2024. 3 National Health Law Program 2024; data compiled from the reported Current scenario of postpartum doula coverage reimbursement under Medicaid as of map publication date. 4 National Health Law Program 2024; data compiled from the reported Current scenario of states considering expansion of private coverage of doula care as of map publication date. 5 KFF Medicaid Coverage of Pregnancy-Related Services 2021; data compiled from the reported Current scenario of coverage for Lactation Consultation Inpatient. 6 KFF Medicaid Coverage of Pregnancy-Related Services 2021; data compiled directly from the reported Current scenario of coverage for Lactation Consultation Outpatient. 7 KFF Medicaid Coverage of Pregnancy-Related Services 2021; data compiled directly from the Current scenario of coverage for Lactation Consultation Home Visit through Medicaid. 8 Wisconsin’s BadgerCare Plus program has expanded maternal Medicaid eligibility from 138% to 306% of the Federal Poverty Level (giving it the highest eligibility threshold in the US). However, Wisconsin has not adopted the Section 11152 waiver to postpartum care coverage from 60 days to 12 months. Winson’s proposed Senate Bill 110 would adopt the Section 11152 waiver but is currently awaiting further review.
*Source National Vital Statistics Reports 2023, provisional data compiled from the reported Fetal Mortality rate at 20 weeks of gestation or more (number of fetal deaths per 1000 live births and fetal deaths)
Key Contributors: ZS Associates Venice Haynes, PhD Mariah Bridges Varner Annie Yu Caitlin Westerson Kristin Wikelius
States that have the most coverage for postpartum services States that have partial coverage for postpartum services States that have minimal coverage for postpartum services
The map below displays states that have expanded Medicaid, extended their Medicaid postpartum coverage to one year (or more), and states that are covering or reimbursing for doula care, lactation consultants or home visits. The more postpartum services and benefits that are covered by insurance in a given state, the better the access.
The map below shows the percentage of women that self-reported postpartum depression (PPD) symptoms, and screening rates for PPD at prenatal and postpartum visits.
The map below shows the number and ratio of health care providers to the women of birthing age in each state.
Since 2023, United States of Care conducted research to understand the experiences and challenges from early pregnancy through the first-year as a new parent. Four themes emerged to define the often-neglected postpartum experience: mental health, availability and access to information related to postpartum care, coverage for postpartum care services, and experiences with pregnancy loss. In an effort to better understand the postpartum landscape from these perspectives, United States of Care partnered with ZS Associates to capture available data at the state level that fall under each of the four themes. The four maps below illustrate the postpartum landscape based on maternal mental health, access to information via perinatal health workers, coverage for postpartum services and late stage pregnancy loss for each state across the country. The full report on our findings and our key takeaways can be downloaded here.
The map below shows the stillbirth rates across states.
≥12.9% 11.7-12.8% ≤11.5% data not available
≥21 (16-20) ≤15 data not available
>6.5 5.6–6.5 4.5–5.5 <4.5
The map below captures the fetal mortality rates for each state
perinatal health workers per 10,000 women aged 15-49
<4.5 4.5 -5.5 5.6-6.5 >6.5
Fetal Mortality Rates
Percentage of women reporting postpartum depression (PPD) symptoms
We envision a health care system where postpartum women receive personalized care, comprehensive care, and understandable care that empowers them to have a joyful postpartum experience.
Our vision, informed by listening sessions with women, research, and expert discussions, outlines the essential components of postpartum care that every woman should receive, regardless of her insurance coverage. This vision is ambitious, yet it focuses on actionable changes within the health care system, providing a clear path to improved outcomes for postpartum women nationwide.
The Current Challenges
Despite the availability of services like doulas and home visits, many women struggle to access them due to cost, coverage gaps, and lack of awareness. Our comprehensive vision focuses on providing personalized, whole-person care to address physical, mental, and social needs during the postpartum period.
Download the Vision for Postpartum Care
executive summary
Checklist
Ongoing Provider Visits
Interdisciplinary Care Team
Postpartum Data Collection
Social Determinants of Health
Comprehensive Screenings Linked to Provider Referrals
Bring Care Home to Meet Women Where They Are
Full Range Contraceptive Resources
Oral Health
Programs Fostering Community
Breastfeeding Support
Postpartum Care Plans
By offering a clear, actionable roadmap, we aim to improve outcomes and experiences for postpartum women nationwide.
ISSUE BRIEF
Postpartum Care Insights, Experiences, and Bright Spots
The postpartum period is a critical chapter in the maternal health journey, impacting a woman’s1 health, well-being, and overall experience.
See More
Highlighting “Bright Spots” to Address Gaps in Maternal Health
Throughout 2023, USofCare engaged in conversations with Black women and other women of color to gather insights into the challenges they faced during their pregnancy journey, as well as what their ideal journey looked like.
Trends in Maternal Health “Bright Spots”
Increased awareness of racial disparities has prompted many states and organizations to implement programs to improve maternal health outcomes for Black women.
Birthing Bias: What We’ve Learned from Women of Color About Giving Birth in the U.S.
With the Black maternal mortality crisis continuing and health outcomes for women of color throughout the birthing experience still lagging behind those of white women, we leaned in on this issue and listened to the maternal health experiences of women of color across the nation.
USofCare’s Listening Work on Maternal Health: Understanding the Pregnancy Experience of Women of Color
As we search for solutions to the maternal health crisis, we must center the voices of people affected most. By engaging in conversations with women of color about their maternal health experiences, we uncovered crucial insights into challenges within our current maternal health care system, and how we might make it right
Black Maternal Health: The Disparity in Outcomes, Insights From Our Listening Work, and How We Can Find Solutions
With a bipartisan majority of Americans supporting improvements in maternal and newborn care and a robust advocacy network highlighting the impact this inequity has on our communities, the question remains — why has our health care system failed Black women so severely?
Maternal and Child Health Medicaid Policy Landscape & State Trends
USofCare presents our research on maternal health policy within Medicaid programs across all 50 states and DC; we focused specifically on Medicaid because it covers 45% of all births in the U.S.–playing such an important role in providing care to pregnant people.
100 Weeks of Care for Black Maternal Health Key Overarching Insights
Uncover the current Black maternity journey in the United States to better understand gaps and inequities in maternity health care across the full 100- week journey span.
USofCare is proud to share resources based on our listening work and research that uncover how we can ensure everyone has a joyous birthing experience and a joyful, safe, and supported pregnancy.
TOOLKIT
USofCare's Black postpartum social media toolkit.
The purpose of this document is to supply our partners with impactful social media copy. The copy in this toolkit can be used verbatim if desired.
POLICY SCAN
A Roadmap: Building a Path to Better Postpartum Care
Improving postpartum care requires a unified approach. We mapped 17 key national organizations to identify gaps, opportunities, and alignments, ensuring a more cohesive effort to enhance maternal health care.
PRESS RELEASE
United States of Care Launches Initiative to Expand Employer-based Coverage of Postpartum Care at Clinton Global Initiative
As part of the organization’s 100 Weeks Campaign, employers are called to commit to the “Vision for Postpartum Care” in order to better support women and strengthen the workforce.
REPORT
Our Vision establishes a comprehensive framework for the postpartum care that every women, regardless of her insurance coverage, should have access after pregnancy.
USofCare's Vision for Postpartum Care
BRIEF
The Role of U.S. Employers in the Postpartum Experience
Comprehensive benefits such as robust health care coverage, extended paid parental leave, lactation support, and child care assistance can alleviate many stressors faced by postpartum women, resulting in healthier families and more productive workplaces.
Exploring Partners' Views on the Postpartum Period
Including partners’ perspectives is essential to fully understanding the maternal health landscape, especially post-childbirth. Expanding support and services for non-birthing partners will create a more holistic postpartum experience for all.
Federal and State Coverage Requirements for Postpartum Care
This issue brief analyzes federal and state requirements for postpartum care coverage and finds significant gaps and inconsistencies. Aligning federal and state policies to establish a comprehensive and consistent standard of postpartum care can improve access to essential postpartum care services.
