Maternal and Child Health Library

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June 22, 2007

1. STUDY EXPLORES COVERAGE OF MATERNITY CARE WITHIN CONSUMER-DRIVEN HEALTH PLANS

Maternity Care and Consumer-Driven Health Plans examines the costs of maternity care, the features of private health insurance affecting maternity coverage, and the issues raised by a relatively new type of health insurance called consumer-driven health plans (CDHPs). The report, prepared by the Georgetown University Health Policy Institute and the Kaiser Family Foundation, evaluates the level of insurance protection CDHPs provide against the cost of maternity care and presents estimates of likely care costs families will face using real CDHPs sold in group and individual markets. Three different clinical scenarios are examined -- an uncomplicated vaginal delivery, a Cesarean section delivery, and a delivery with significant complications  -- to gauge different types of costs families may experience. An executive summary, an introduction, a conclusion, endnotes, and appendices are included. The report is available at http://www.kff.org/womenshealth/7636.cfm.

Readers: The report was released at a forum held on June 12, 2007, which was co-sponsored by the Kaiser Family Foundation and the March of Dimes. The forum agenda, speaker biographies, presentations, a Webcast transcript, and related materials are available at http://www.kff.org/womenshealth/whp061207pkg.cfm.

• Among the Amish women, 81.3% had been pregnant at least once, and 80.2% had at least one live birth. At the time of the survey, 36% were pregnant. Among the general population, 72.1% had been pregnant at least once, and 68.4% had at least one live birth. At the time of the survey, 3.9% were pregnant.
• Amish women rated their physical health at approximately the same level as women in the general population but rated their mental health at higher levels.
• Amish women had a lower body mass index than women in the general population. Amish women were less likely to engage in physical exercise other than work, were more likely to perceive themselves as being at an appropriate weight, and were less likely to be trying to lose weight, compared with women in the general population.
• Intimate partner violence was reported by 0.7% of Amish women, compared with 7.0% of women in the general population.
• Amish women reported a mean of 11.6 people to whom they can turn to for support, compared with 7.0 people among women in the general population.
• Among the Amish women who had at least one live birth, there were fewer preterm births, compared to women in the general population with at least one live birth, but about the same percentage of preterm births.

• Fifty-eight percent of the adolescents came to the clinic for confidential services.
• Overall, 69.5% (N=41) of the adolescents told their parents they were coming to the clinic.
• Less than half (43.1%, N=25) of the adolescents reported that they would tell their parents if they were found to have a serious and sensitive reproductive health problem (sexually transmitted infection or pregnancy). Of those who would tell their parents, approximately half had come in for confidential services and half for non-confidential services.
• In terms of adolescents' decisions about whether to discuss their reasons for coming to the clinic and their future communication related to serious and sensitive reproductive health care issues with their parents, there was no significant difference between adolescents who came in for confidential vs. non-confidential services.

• Rates of antepartum and intrapartum stillbirth among African Americans were 5.6 and 1.1 per 1,000 births, respectively; corresponding rates among whites were 3.4 and 0.5 per 1,000 births, respectively.
• Advanced maternal age, late initiation of prenatal care or no prenatal care, being overweight or obese, and prior preterm or small-for-gestational-age births were significantly associated with increased risk for antepartum stillbirth among whites but not among African Americans.
• Being underweight was associated with risk for antepartum and intrapartum stillbirth among African Americans but not among whites.
• Congenital anomaly, placental abruption, and cord complications were significantly associated with antepartum stillbirth among both whites and African Americans.
• Premature rupture of the membranes was significantly associated with intrapartum stillbirth among both whites and African Americans.
• Approximately 45% and 80% of antepartum and intrapartum stillbirth cases, respectively, among African Americans, and 53% and 88% of antepartum and intrapartum stillbirth cases, respectively, among whites remained unexplained by the risk factors.
• The hazard ratio for antepartum stillbirth was lower among African Americans compared with whites at preterm gestational ages with cross-over in risk at term gestation.