• Jordan Cahn, Ayesha Sundaram, Roopa Balachandar, Alexandra Berg, Aaron Birnbaum, Stephanie Hastings, Matthew Makansi, Emily Romano, Ariel Majidi, Danny McCormick, and Adam Gaffney.
• Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA. jcahn@challiance.org.
• J Gen Intern Med. 2023 Aug 1; 38 (10): 234023462340-2346.

BackgroundMedical debt affects one in five adults in the USA and may disproportionately burden postpartum women due to pregnancy-related medical costs.ObjectiveTo evaluate the association between childbirth and medical debt, and the correlates of medical debt among postpartum women, in the USA.DesignCross-sectional.ParticipantsWe analyzed female "sample adults" 18-49 years old in the 2019-2020 National Health Interview Survey, a nationally representative household survey.Main MeasuresOur primary exposure was whether the subject gave birth in the past year. We had two family-level debt outcomes: problems paying medical bills and inability to pay medical bills. We examined the association between live birth and medical debt outcomes, unadjusted and adjusted for potential confounders in multivariable logistic regressions. Among postpartum women, we also examined the association between medical debt with maternal asthma, hypertension, and gestational diabetes and several sociodemographic factors.Key ResultsOur sample included n = 12,163 women, n = 645 with a live birth in the past year. Postpartum women were younger, more likely to have Medicaid, and lived in larger families than those not postpartum. 19.8% of postpartum women faced difficulty with medical bills versus 15.1% who were not; in multivariable regression, postpartum women had 48% higher adjusted odds of medical debt problems (95% CI 1.13, 1.92). Results were similar when examining inability to pay medical bills, and similar differences were seen for privately insured women. Among postpartum women, those with lower incomes and with asthma or gestational diabetes, but not hypertension, had significantly higher adjusted odds of medical debt problems.ConclusionsPostpartum women experience higher levels of medical debt than other women; poorer women and those with common chronic diseases may have an even higher burden. Policies to expand and improve health coverage for this population are needed to improve maternal health and the welfare of young families.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.

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