# Medicaid Expansion and Maternal Health in Racial and Ethnic Minority Women

> **NIH NIH R21** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2021 · $202,500

## Abstract

The broad long-term objective of the proposed research project is to ensure equitable access to safe
and quality maternal care. Compared with non-Hispanic White women, racial and ethnic minority women are at
significantly increased risks of experiencing severe pain and life-threatening complications during childbirth.
Reducing racial and ethnic disparities in peripartum pain management and severe maternal morbidity is a
national priority. Neuraxial analgesia (i.e., epidural or spinal analgesia) is the most effective technique to
relieve labor pain, and it is associated with a reduced risk of severe obstetric hemorrhage. In the United States,
severe obstetric hemorrhage disproportionately affects racial and ethnic minority women and is the leading
cause of preventable maternal morbidity, peripartum maternal blood transfusion, hemostatic hysterectomy, and
intensive care unit admission. However, labor neuraxial analgesia is underutilized in uninsured racial and
ethnic minority women. Increasing access and utilization of labor neuraxial analgesia in uninsured racial and
ethnic minority women could help reduce peripartum disparities in pain management and severe maternal
morbidity. The 2014 Medicaid expansion under the Affordable Care Act has decreased the proportion of
uninsured pregnant women and may have been associated with increased utilization of labor neuraxial
analgesia and decreased risk of severe maternal morbidity.
 The proposed research project aims to assess in racial and ethnic minority women: 1) the association
between labor neuraxial analgesia and the risks of 1a) peripartum maternal blood transfusion or hemostatic
hysterectomy, and 1b) intensive care unit admission; and 2) the effectiveness of the 2014 Medicaid expansion
under the Affordable Care Act in 2a) increasing labor neuraxial analgesia utilization, and 2b) reducing the risk
of severe maternal morbidity. These specific aims will be achieved by analyzing birth certificate data from 2010
to 2018 from the National Vital Statistics System of the Centers for Disease Control and Prevention. This data
system is a census of US births in the 50 states and the District of Columbia, based on the 2003 revised US
Standard Certificate of Live Birth. Results of this project could provide scientific evidence for evaluating the
Affordable Care Act and for informing healthcare policy to reduce racial and ethnic disparities in maternal
health.

## Key facts

- **NIH application ID:** 10283253
- **Project number:** 1R21MD016414-01
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Jean R Guglielminotti
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $202,500
- **Award type:** 1
- **Project period:** 2021-09-24 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10283253

## Citation

> US National Institutes of Health, RePORTER application 10283253, Medicaid Expansion and Maternal Health in Racial and Ethnic Minority Women (1R21MD016414-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10283253. Licensed CC0.

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