Measuring State-Level Racial Inequity in Severe Maternal Morbidity in the Medicaid Population

Tyler Barreto, Chaohua Li, Yoon Kyung Chung, Yalda Jabbarpour, Peter Baltrus, Anne Gaglioti

Research output: Contribution to journalArticlepeer-review


Objective: Severe maternal morbidity represents a “near miss” mortality and is an important measure of quality and safety. Racial inequity in maternal morbidity is stark and the reasons for this disparity are poorly understood. We aimed to identify states achieving racial equity in maternal morbidity in order to identify policies that may promote racial equity. Methods: We analyzed Medicaid deliveries from 2008 to 2009 in a sample that included 28 states and the District of Columbia. This dataset included approximately 80% of all Medicaid enrollees and 90% of minority Medicaid enrollees in the US. We determined the Non-Hispanic Black/Non-Hispanic white SMMI rate ratio for each state and categorized the states into groups by rate ratio. We described demographic features of both the general population and study population for these groups of states. Results: In a sample that included a total of 1,489,134 births, we found that no state/district is achieving equity in severe maternal morbidity. The severe maternal morbidity rate is higher for Non-Hispanic Black than Non-Hispanic white patients in every state included. With a rate ratio ranging from 1.14 to 2.66, there are varying degrees of inequity. States in the group with the most equitable maternal morbidity rates had less inequity across racial subgroups with respect to educational attainment and poverty. Conclusions: Identifying geographic areas with varying degrees of inequity may be key to identifying policies to promote equity. Socioecological disparities and inadequate access to care may be factors in racial inequity in maternal morbidity.

Original languageEnglish (US)
Pages (from-to)682-690
Number of pages9
JournalMaternal and Child Health Journal
Issue number4
StatePublished - Apr 2022
Externally publishedYes


  • Health disparities
  • Health services research
  • Maternal morbidity
  • Racial disparities

ASJC Scopus subject areas

  • Epidemiology
  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology
  • Public Health, Environmental and Occupational Health


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