More Than Half of Pregnant Mothers Can’t See All the Healthcare Professionals They Want To See

GoodRx Health

This story is part of the GoodRx Research Maternal Care Access series, where we dive into the experiences of mothers and the care they received during pregnancy, labor and birth, and postpartum.

We'll share findings from a survey of 1,015 mothers and combine those insights with additional data to get a clearer picture of the state of U.S. maternal care access.

Appropriate and comprehensive maternal care is essential. But GoodRx Research finds that nearly 60% of women who recently gave birth were not able to see all of their desired healthcare professionals (HCPs).

This new research emerges alongside a worrisome trend: Maternal mortality has increased. And that trend is even worse for the American Indian/Alaska Native and Black populations.

The rise in maternal mortality is paired with reports that access to maternal care has also worsened in recent years. Over 5.6 million women live in counties with no or limited access to maternity care services.

Given this, the GoodRx Research team wanted to understand what happens when women can't get maternal care. This piece is part of a series documenting the state of maternal care in the U.S.

More than half of mothers had an HCP that they wanted to see during their pregnancy but couldn't

A majority of women (68%) in our survey saw between one and three different HCPs throughout their pregnancy, labor, and birth. And even though 88% of women saw an OB-GYN throughout their pregnancy, an unmet need remained.

Specifically, 57% of women had at least one HCP that they wanted to see, but weren't able to. These HCPs included doulas, lactation consultants, mental health professionals, and nutritionists.

Above, the blue bar shows the percent of women who saw a particular HCP. The orange bar shows the percent of women who wanted to see an HCP but weren't able to.

If the length of the orange bar exceeds the length of the blue bar, that means there were more women who wanted but were unable to see that HCP than the number of women who actually saw them. This was the case for two HCPs: birth doulas and genetic counselors.

Of the women who had HCPs that they wanted to see but couldn't, 49% had two or more additional HCPs they wanted to see.

Non-white mothers reported a higher rate of not being able to see desired HCPs than white mothers

We found that non-white mothers reported a higher rate of not being able to see desired HCPs than white (non-Hispanic/Latino) mothers.

As shown in the chart above, while 51% of white (non-Hispanic/Latino) mothers reported having an HCP they wanted to see but couldn't, all other race and ethnicity groups reported a rate that was at least 10 percentage points higher.

This highlights a disparity in not being able to see an HCP when comparing the race and ethnicity of mothers.

Availability, convenience, and financial barriers were cited as primary reasons for not being able to see a desired HCP

Survey respondents noted many reasons for not being able to see HCPs. Some reported that "​​[the HCPs] were not covered under my healthcare plan and I could not afford out-of-pocket costs." Others noted that they were not able to "see those providers because they were always booked."

Responses tended to fall into four categories: (1) availability, timing, or convenience barriers; (2) financial barriers; (3) transportation or distance barriers; and (4) knowledge barriers.

Availability, timing, or convenience barriers included reasons such as:

• Not having an HCP available to them

• Not being able to get an appointment even if an HCP was available

• General timing issues

• Difficulty seeing an HCP

Financial barriers included issues with insurance coverage, finding an in-network HCP, and affording the costs or copays.

Distance or transportation barriers meant someone could not find an HCP in their area or they had to travel far to see one. It also included those who did not have transportation to see an HCP.

Knowledge barriers included not having theknowledge on howto find an HCP or not knowing what was available under their insurance.

Below, the chart shows how many mothers faced specific barriers .

As shown above, 40% of the women cited availability or convenience barriers as the reasons for not being able to see an HCP, and 31% reported financial barriers.

In general, non-white and Hispanic/Latino mothers reported a higher rate of financial barriers than white (non-Hispanic/Latino) mothers. However, this pattern did not hold true when looking at the other barriers.

Summing it up

Prior research has shown that maternal mortality is increasing, but access to maternal HCPs is decreasing. In our survey, nearly 60% of mothers who recently gave birth had an HCP that they wanted to see during their pregnancy but weren't able to.

The reasons mothers were not able to see these HCPs are multifaceted and can give us a better idea of how to meet the needs of future mothers.

Stay tuned as we release more research in our Maternal Care Access series.

Methodology

Survey: Our survey was run through Qualtrics. The survey ran from October 26, 2023 to November 15, 2023. A total of 1,015 responses were collected and analyzed. The survey screened in people who gave birth up to 24 months prior to the date of the survey and were at least 18 years of age. We also required that they saw an HCP for their pregnancy, labor and birth, and post-birth care. We oversampled specific race groups (American Indian, Alaskan Native, and Black Americans) to ensure that we captured sufficient responses by race.

Survey weighting: To obtain nationally representative numbers, we created weights based on the race and ethnicity reported in the survey. Our weights were created using the race and ethnicity shares reported by the American Community Survey (ACS) 2022 5-year estimates (Table B03002: Hispanic or Latino Origin by Race). To evaluate the representativeness of our weights, we calculated the share of our weighted sample by region and by income groups in comparison to national shares using ACS 2022 5-year estimates (Tables B01003: Total Population and Table B19001 Household Income in the Past 12 Months (in 2022 Inflation-Adjusted Dollars). The comparisons are shown below.

Analysis

All analyses reported above describing national representative numbers used the survey weights described above. All analyses comparing rates by race/ethnicity groups were unweighted.

For all data reported by race and ethnicity, we assigned a survey respondent to a group by first assigning anyone who self-reported as all or some part Black or AI/AN (American Indian and Alaskan Native) to the group "All or some part Black or AI/AN." Then, anyone who self-reported as Asian, NHPI (Native Hawaiian and Other Pacific Islander), or Other was grouped as "All or some part Asian, NHPI, Other." Therefore, if someone was to self-report as both Black and Asian, they would be assigned to the "All or some part Black or AI/AN" group.

Our analysis reports data from the following survey questions:

• What providers did you see for your pregnancy, labor and birth, or post-birth care? Select all that apply.

• Were there any providers you wanted to see but weren't able to for your pregnancy, labor and birth, or post-birth care? Select all that apply.

  • You indicated in the previous question that you wanted to see the following provider(s) but weren't able to: [Choices displayed here]. Could you expand on why you weren't able to see those provider(s)?

For the free-response question asking to expand on why they were unable to see HCPs that they wanted to, two reviewers read through all the responses and classified each into the following categories of barriers: (1) availability, timing, or convenience; (2) financial barriers; (3) distance or transportation barriers; and (4) knowledge barriers. A single response could be classified into multiple barriers because respondents provided multiple reasons for not being able to see an HCP.

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