Barriers to Health Care Among Pregnancy-Associated Overdose Deaths in Six States

To examine barriers to health care for individuals who experienced a pregnancy-associated (during pregnancy or in the year after pregnancy) death resulting from an overdose.

This mixed-methods study used quantitative and qualitative data from Maternal Mortality Review Committees (MMRCs) in six states that participated in the Centers for Disease Control and Prevention's Rapid Maternal Overdose Review initiative. The Rapid Maternal Overdose Review provided enhanced support for identifying and reviewing pregnancy-associated overdose deaths. Each MMRC shared their data through the Maternal Mortality Review Information Application, a data system designed to facilitate MMRC functions through a common data language. All pregnancy-associated overdose deaths that occurred between 2015 and 2019 in these six states were included. The Carrillo Health Care Access Barriers model was used as a guiding framework for analysis. Quantitative data were analyzed with descriptive statistics. Standard content analysis was applied to the qualitative textual data. The quantitative and qualitative results were merged in a final stage of interpretation.

There were 104 pregnancy-associated overdose deaths identified. Most were non-Hispanic White patients (n=83, 79.8%), were 25-34 years of age (n=68, 65.4%), and were enrolled in Medicaid (n=68, 65.4%). Structural (ie, lack of continuity of care, geographic distance), financial (ie, health care costs), and cognitive (ie, lack of knowledge) barriers to health care were identified. These barriers resulted in individuals experiencing reduced access to timely and appropriate maternal health care and treatment for substance use and mental health conditions.

Review of pregnancy-associated overdose deaths from six states identified major barriers to care and missed treatment opportunities. The MMRC recommendations, including improved care coordination, expanded resources, and practitioner education, are potential strategies to prevent future overdose deaths in pregnant and postpartum individuals.