A survey of more than 3,800 people nationwide who gave birth in 2023 and 2024 found those using Medicaid described worse outcomes than those on private insurance, that access to care remains limited for some, and that women often feel unheard and disregarded during pregnancy and labor and delivery.

The Listening to Mothers survey, conducted by the nonpartisan nonprofit National Partnership for Women and Families, was released earlier this month. The partnership says the survey is the largest of its kind, and it’s the fourth time the organization has published this type of survey since 2002. The organization says its survey represents approximately 90% of the childbearing population, defined as those at least age 18 who gave birth in a U.S. hospital to a single baby whom they lived with.

The survey highlighted what it called “hard-won gains” in policy changes, such as the expansion of Medicaid coverage from 60 days to 12 months postpartum in all but one state, as well as expanded state paid leave programs and new investments in maternal health and perinatal quality. But it said those gains are threatened by hospital maternity units closing in many states, as well as deep cuts to Medicaid programs at the state and federal levels.

Report: Arkansas child well-being improves in some areas but lags behind overall

“While preventing catastrophic outcomes rightly commands attention, surviving childbirth is the floor and not the ceiling,” the survey said. “Extensive evidence shows that precious few childbearing families are getting the care and support they need to truly thrive.”

Most respondents — 61% — said they received prenatal care by eight weeks’ gestation, which is earlier than the generally accepted recommendation to see a provider before 10 weeks. About 19% said they saw a provider between nine and 11 weeks, while 21% didn’t see one until after 12 weeks, which is past the end of the first trimester. About 1% said they received no prenatal care at all.

Among those respondents, 25% indicated they were unable to receive prenatal care as early as they wanted to, and about one-third of those were covered by Medicaid. The most common reasons for receiving care later were that no earlier appointments were available and that the provider wanted to see the patient at a later gestation. Others said they had to find a clinic accepting new patients or accepting Medicaid, or they had to wait to be enrolled in Medicaid.

Medicaid patients also had higher rates of complications such as high blood pressure and gestational diabetes during pregnancy, and higher rates of mental health issues such as depression and substance abuse disorders. 

About 43% of respondents said they received less than optimal care during pregnancy because their knowledge and experiences were not valued, while 42% said their providers did not respond in a timely manner to requests for help, and 40% said they generally felt unheard by providers.

About 6% of respondents said some kind of discrimination played a role in those feelings, with the most common area being discrimination based on race, including a lack of respect for the pregnant patient’s culture. American Indian and Alaska Native groups were most likely to report a lack of respect for their culture.

Stateline reporter Kelcie Moseley-Morris can be reached at kmoseley@stateline.org.