Health complications stemming from childbirth drain at least $32.3 billion from the U.S. economy, according to a new study.
Maternal mental health disorder accounted for the biggest share of both medical and societal costs like loss of economic output at $18.1 billion over a six-year span, according to new research from Mathematica and the Commonwealth Fund. Children of moms who suffer from mental health issues, hypertension, gastrointestinal diabetes, blood loss and other conditions are more likely develop chronic health issues or behavioral health disorders, according to the analysis of nine maternal morbidity conditions spanning conception to a child's first five years across more than 6.3 million births.
Those costs and negative healthcare outcomes disproportionately fall on people of color and the disenfranchised, said So O'Neil, lead author of the study and senior researcher at Mathematica.
"This is likely an underestimate of what the actual cost is," she said, noting that they only studied nine of the 31 maternal morbidity conditions that had both cost and outcome data. "Even the cost of maternal mental health alone is staggering at $18 billion. That really says a lot about postpartum coverage. Extending postpartum coverage is important because mental health conditions can last much longer than three months, which is when Medicaid coverage runs out."
The maternal mortality rate in the U.S. is twice as high as most other developed countries at 17.4 deaths per 100,000 births. Meanwhile, healthcare for expecting mothers continues to deteriorate as financially struggling hospitals cut obstetrics services and coverage gaps widen.
About 45% of all births are paid for by taxpayers via Medicaid, said Katy Kozhimannil, a health policy professor at University of Minnesota who has studied maternal morbidity and mortality rates.
"We are all paying for the terrible outcomes we get," she said. "This could be avoided by better upfront investments in people's health—not just prenatal care but broader preventative care that accounts for broader social and political determinants of health. We see rural communities lose hospital-based obstetrics services every year. Those aren't coming back."
Obstetrics are among the riskiest and most costly service lines, which is why rural hospitals tend to eliminate those services first amid financial trouble. This has created vast care deserts that has forced people to drive farther for care.
More than 165 rural hospitals eliminated obstetrics care from 2011 to 2018, according to data from the Chartis Center for Rural Health. More than half of the nation's 2,200 rural hospitals no longer provide obstetrics, said Michael Topchik, national leader for Chartis.
"One of our biggest concerns is the erosion of general services across the rural hospital landscape," he said. "Oftentimes, when a hospital loses OB, general surgery and anesthesiology follow, which means they can't do routine care. One of the fundamental services of a hospital is to safely give birth, but that has eroded so substantially it is unbelievable."
That is, in part, why the U.S. remains one of the most dangerous and expensive places to give birth among other developed countries.
Nearly three-fourths of maternal morbidity costs stem from health issues associated with children rather than mothers, according to the study. Child outcomes with the highest costs included preterm birth at $13.7 billion, developmental disorders at $6.5 billion and respiratory distress at $2.1 billion.
