Does Universal Coverage Mitigate Racial Disparities in Potentially Avoidable Maternal Complications?

Anju Ranjit, Tomas Andriotti*, Cathaleen Madsen, Tracey Koehlmoos, Barton Staat, Catherine Witkop, Sarah E. Little, Julian Robinson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective Potentially avoidable maternity complications (PAMCs) have been validated as an indicator of access to quality prenatal care. African-American mothers have exhibited a higher incidence of PAMCs, which has been attributed to unequal health coverage. The objective of this study was to assess if racial disparities in the incidence of PAMCs exist in a universally insured population. Study Design PAMCs in each racial group were compared relative to White mothers using multivariate logistic regression. Stratified subanalyses assessed for adjusted differences in the odds of PAMCs for each racial group within direct versus purchased care. Results A total of 675,553 deliveries were included. Among them, 428,320 (63%) mothers were White, 112,170 (17%) African-American, 37,151 (6%) Asian/Pacific Islanders, and 97,912 (15%) others. African-American women (adjusted odds ratio [aOR]: 1.05, 95% CI: 1.02-1.08) were more likely to have PAMCs compared with White women, and Asian women (aOR: 0.92, 95% CI: 0.89-0.95) were significantly less likely to have PAMCs compared with White women. On stratified analysis according to the system of care, equal odds of PAMCs among African-American women compared with White women were realized within direct care (aOR: 1.03, 95% CI: 1.00-1.07), whereas slightly higher odds among African-American persisted in purchased (aOR: 1.05, 95% CI: 1.01-1.10). Conclusion Higher occurrence of PAMCs among minority women sponsored by a universal health coverage was mitigated compared with White women. Protocol-based care as in the direct care system may help overcome health disparities.

Original languageEnglish
Pages (from-to)848-856
Number of pages9
JournalAmerican Journal of Perinatology
Issue number8
StatePublished - 1 Jul 2021


  • claims data
  • potentially avoidable maternal complications
  • racial disparities
  • universal health coverage


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