Obstetric Care Access Impacts Maternal Outcomes

Maternal Health

Explore the latest trends in maternal health, including access to obstetric care, mental health, and resources for improving health outcomes.

• Maternal Care Units: Access to hospital-based obstetric care services is declining in the United States, especially in rural areas. Living in a maternal care desert–areas without hospitals or birth centers offering obstetrics care and no maternity care providers–was associated with a 36% and 26% higher risk for maternal and pregnancy-related mortality, respectively.

• The Role of Doulas: Doulas have been shown to improve maternal and infant health outcomes, and can be especially beneficial in maternity care deserts. As of August 2025, over 40 states have proposed, implemented, or expanded Medicaid reimbursement for doulas.

• Maternal Mental Health Rates: About 1 in 5 women experience maternal mental health disorders (MMHD) and often go undiagnosed. Recent studies show a decline in self-reported maternal mental health, particularly among single mothers, those with lower education levels, and those with publicly insured or uninsured children. Several states have taken steps to address maternal mental health, contributing to modest progress at the national level in terms of improving provider and program availability, screening and treatment, coverage, and reimbursement.

• Maternal Depression: Postpartum depression (PPD) is among the most common MMHDs. Maternal depression is linked to weakened emotional bonds between mothers and their children. The Food and Drug Administration (FDA) recently approved Zurzuvae, the first pill for PPD; however, outcomes have varied among women.

Resources & Initiatives

• The Health Resources & Services Administration offers a free, confidential hotline for maternal mental health at 1-833-TLC-MAMA.
• The National Academy for State Health Policy (NASHP) has partnered with eight states to develop strategies that expand maternal health services.
• Arkansas Blue Cross and Blue Shield provides pregnancy resources through its maternity program, offering information on gestational diabetes, lactation, parent education, and more.
• The BlueCross BlueShield of South Carolina Foundation has awarded grants to increase access to maternal health care at home, improve management of maternal diabetes, and address shortages in the maternal health care workforce, particularly in rural areas.
• Blue Cross Blue Shield of Texas has continued to support maternal and infant health through technology- and community-driven partnerships focused on expanding access to maternal health care.
• Blue Cross Blue Shield of Massachusetts has recently announced a virtual women’s health clinic, offering access to a doula care pilot program, lactation counseling reimbursement, and other women’s health services.
• Elevance Health aims to improve maternal and infant health outcomes through value-based incentives and by expanding access to doulas in their Medicaid plans.

Health Industry News

The latest news on changes to physician pay, technological advancements, and the pharmaceutical industry.

• Health Care Payment and Spending: The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule, including a boost to the annual hospital outpatient pay rate by 2.4%, and a step towards site-neutral payments. CMS also proposes increasing Medicare reimbursement pay for qualifying physicians by 3.8% and 3.3% for non-qualifying physicians through an alternative payment model.

• Premiums: Affordable Care Act Marketplace insurers are requesting a median premium increase of 18% for 2026, citing anticipated cost drivers, including rising costs and service utilization, the expiration of the enhanced premium tax credits at the end of the year, and potential cost increases due to tariffs.

• Digital Health: Findings from an Elevance Health, Apple, and University of California study on a digital asthma self-management program demonstrated a significant clinical improvement for people on Medicaid and commercial plans.

• Gene Therapy: After three deaths following usage of Sarepta Therapeutics gene therapy products, the FDA requested Sarepta halt shipping of Elevidys, the first gene therapy approved in the US for Duchenne's muscular dystrophy (DMD). Sarepta initially refused compliance, but a week later, the FDA reversed their decision, allowing Elevidys to be given to ambulatory DMD patients. However, shipping remains halted for non-ambulatory DMD patients, the same population group that experienced two deaths.

Health Policy Watch

Pressure on drug prices, challenges to protecting rural hospitals and preventive care services, and new policies to safeguard personal health data.

• Tariffs on Pharmaceuticals: The Trump Administration's new trade deal with the European Union will impose a 15% tariff on medicines imported to the US, potentially adding as much as $19 billion to pharmaceutical industry costs and raising insurance premiums, Medicare, and consumer out-of-pocket costs. Europe accounts for about 60% of pharmaceutical imports to the US and it is where the industry manufactures popular drugs such as Keytruda and the GLP-1 Ozempic. Certain generic drugs will be exempt from the tariff, though it is not yet clear which generics will be on that list.

• Rural Health Care at Risk: Policymakers and care providers are expressing concern that the $50 billion ($10 billion a year, over 5 years) Rural Health Transformation Program may not shield rural hospitals and care providers from the impact of the cuts in the One Big Beautiful Bill Act (OBBB). One potential issue is that states will have the option to use the money for other purposes, the funds will not go directly to hospitals. In addition, $25 billion will be distributed equally among the states, while states will have to apply to the Centers for Medicare and Medicaid Services to access the remaining $25 billion.

• Preventive Care Panel Cut: Health and Human Services Secretary, Robert F. Kennedy, Jr., plans to remove all members of the US Preventive Services Task Force (USPSTF), the group that makes recommendations on cancer screenings, other preventive tests, and what tests insurers should cover. Health experts, including the American Medical Association, have asked Kennedy not to disband the group.

• FDA Seeks Regulation of Illicit Substances: The FDA is asking the Drug Enforcement Agency to classify concentrated forms of Kratom containing high levels of 7-OH, an opioid-like byproduct of natural Kratom, as a Schedule 1 substance (the class that includes heroin). The FDA is also cracking down on imported illegal vaping products and attempting to limit access to tianeptine (“gas station heroin”), which can cause overdoses.
• Funding for mRNA Cut: Health and Human Services Secretary Robert F. Kennedy Jr. has announced the termination of approximately $500 billion in contracts supporting the further development of mRNA vaccines.
  

• Protecting Neurological Data: Colorado, California, and Montana are the first states to pass privacy laws protecting the neurological data collected by personal, non-medical devices such as earbuds, head phones, and app-linked devices that assess sleep, and even aging. A recent Neurorights Foundation report found that 29 of the 30 companies selling neurotechnology products that measure brain activity have no limitations on how this data is shared. Experts say the primary issue is that brain data is not protected by the Health Insurance Portability and Accountability Act, so consumers have no control over its use.

Infectious Disease Update

• COVID-19: COVID cases are rising in 27 states. As of August 1st, emergency department visits for COVID are increasing among all ages. Despite low uptake, new research shows how COVID vaccinations are protective against severe infection, especially for people with cancer. Other research findings show COVID infection during the first year of the pandemic was associated with 3 to 5 times higher odds of cognitive impairment 2 years after infection.
• Measles: As of August 5, 2025, there are 1,356 confirmed US measles cases. US measles cases are 4.5 times higher compared to ~285 cases reported the prior year.
• Vaccines: A new study finds low flu vaccine uptake from 2022 to 2024, and other research estimates that influenza vaccination has reduced the burden of influenza cases by 32.9% to 41.5%, benefiting both vaccinated and unvaccinated individuals. New data indicates US kindergarten vaccination rates declined last year, while vaccine exemptions rose to a record 4.1%.

Substance Use

New data and research on substance use disorders (SUD) and treatment approaches.

• New Federal Data: The Substance Abuse and Mental Health Services Administration (SAMHSA) released the results of the 2024 National Survey on Drug Use and Health (NSDUH), which captures how US residents reported their experiences with mental health conditions and substance use. Among individuals ages 12 years and older, more than 58% reported that they vaped nicotine, used alcohol or tobacco products, or an illicit drug in the past month.

• Nicotine Updates: The FDA is allowing Juul Labs to keep its e-cigarettes on the market. The NSDUH reported an increase in respondents who had vaped nicotine in the past 30 days between 2022 and 2024. Despite growing concerns about e-cigarette health effects and usage among teens, experts still generally consider them to be a safer alternative to traditional cigarettes. A new study discovers a sharp increase in accidental ingestion of nicotine by children, which can raise the risk of negative health outcomes.

• Methadone Restrictions: A team from Penn Leonard Davis Institute of Health Economics has been investigating policies easing restrictions on methadone dosing for opioid use disorder (OUD). Across three studies, they found that a pandemic era policy allowing take-home doses of methadone did not increase methadone overdose deaths.

• Hospitalization Risk: New, UCLA-led research finds that people with any SUD have a 24% higher risk of having an unplanned hospital readmission within 30 days of a previous discharge compared with those without the disorder.

• Treatment Access: A recent study from Yale School of Medicine underscores the crucial role emergency departments play in connecting patients to life-saving addiction treatment and offers strategies to enhance treatment equity. A Rutgers University research team discovered that patients with opioid addiction who rely exclusively on public insurance are less likely to receive behavioral health care compared to those receiving care through multiple funding sources.

Resources & Initiatives

• NASHP’s updated “Opioids and Substance Use Disorder” webpage includes information on expanding access to SUD/OUD treatment.
• Tradeoffs releases a new podcast interviewing a University of North Carolina epidemiologist on the impact of drugs, such as fentanyl and street opioids.
• Anthem Blue Cross and Blue Shield Foundation’s recent efforts to advance health outcomes and strengthen local communities included $4.7 million and $3.4 million in grants to address substance use disorders in New York and Indiana, respectively.
• Together Arkansas, an opioid-response program offering free, easy-to-use resources and tools to help Arkansas employers support a drug-free workforce, was relaunched with backing from the Arkansas State Chamber of Commerce, Arkansas Blue Cross and Blue Shield, and the Arkansas Opioid Recovery Partnership.
• Horizon Blue Cross offers resources and information on opioid use, including a free opioid abuse toolkit launched in 2017 and regularly updated; this toolkit has been widely used in schools, universities, and outreach events across the country.