American women are more likely to die while giving birth than other women in any other developed country.  Further statistics are even more unnerving. American women die in pregnancy twice as often as Canadian women.. And, the United States is one of the very few countries, including North Korea and Zimbabwe, where the childbirth mortality rate has increased since 1990.


Access to quality healthcare is one major reason. Many poor American women can’t get it and they are the ones who need it the most. Such is not the case in many other countries, where health care is universal. Many pregnancies are unplanned, as many young girls and women are limited in their access to birth control and/or are unable to take care of a chronic health problem prior to their pregnancy.

There was a time when this country cared about its pregnant women. Nearly a century ago, in 1935, the government sponsored the Maternal and Child Health Services Block Grant Program, which strived to improve the health of women and children by affording access to prenatal and postnatal medical care. For the past thirty years, Medicaid covers pregnant women. And, the Children’s Health Insurance Program (CHIP) offers inexpensive medical services to expectant women.

This is an important distinction because it is a reminder that the intent of the coverage is to improve health outcomes for children.

The Affordable Care Act

The Affordable Care Act (ACA) or Obamacare, however, which lawmakers passed in March 2010, mandated all individual market health insurance plans to insure maternity care and newborns, as well as other essential health benefits.

If the ACA mandated maternity care, why are so many poor women still having difficulty accessing health care?

One of the ACA’s key coverage requirements is the expansion of Medicaid’s eligibility to low-income people. The expansion was supposed to be national, but a June 2012 Supreme Court ruling allowed the states to accept or reject it. As of April 2017, nineteen states had not expanded their programs, thereby leaving many adults and children ineligible.

Maternity Mandate

Many claim that the ACA requires more public funding for women and maternity related benefits and some argue that it’s unreasonable to men and women who do not plan on becoming pregnant. Are they correct? Is maternity care different?


When an expectant woman receives proper medical care, she safeguards her baby’s health both before and after it’s born. That’s a given.

Proper prenatal care also safeguards a pregnant women’s health both before and after her pregnancy.  It looks out for remediable conditions such as gestational diabetes, post-partum depression, infection, ectopic pregnancies. The last two of which can be deadly.

Without Coverage

If a woman doesn’t not have health insurance when she’s pregnant, she may skip prenatal and postnatal care, which pinpoints possible problems for which her physician could help.

The world without proper maternity care would be scary. Less than ten years ago, there were no maternity or day care laws or regulations. In the individual insurance market, women in three-quarters of the states were often unable to find or afford maternity coverage.

Current Administration

Just a few days earlier, in July 2017, Republican lawmakers tried one more time to overturn the ACA.  Fortunately, they failed.  Hopefully, this will end their quest, but who knows. In addition, they agree with those who argue that the pregnancy mandate isn’t just and, like the ACA, would have allowed states to reject it. The pregnancy mandate remains vulnerable.

Current Situation

In many states, the only way to secure maternity coverage is by purchasing a rider as a supplement to a health insurance plan. Costs vary but generally can be in the thousands, sometimes more than the base premium.

What if the Pregnancy Mandate is Overturned

Should the pregnancy mandate ever be removed, what could a woman do? One alternative is to purchase a rider. A rider is additional insurance. The Congressional Budget Office (CBO) figured that they would cost more than $1,000. The CBO additionally estimated that the total cost of a pregnancy is $17,000 for women for women covered by private insurance. Without insurance, that number would double. And, if women had a C-section or later-term miscarriage. Without coverage, a woman could be in serious debt.

Since the ACA, there’s at least a path toward providing maternal care. Lawmakers have to fix it, not overturn it.  Recent decisions show promise, but, with the current administration, there will always be concern. We were headed in the right direction and now we stand in the right direction.  Abolishing the maternal mandate would threaten women’s lives and place families in financial hardship.