Children and Families

Implementing and Evaluating Structural Interventions in Medicaid to Promote Racial Equity in Pregnancy and Child Health

The burdens of racist policies have produced vastly worse pregnancy and birth outcomes for Black and Native populations relative to White populations in the United States. Because state Medicaid programs are the largest single payer for pregnancy care in the country, changes to Medicaid policies are an important way to implement structural interventions to promote racial equity. 

Honoring Indigenous Families: Evaluating the Impact of Nebraska's Indian Child Welfare Act

The removal and placement of Indian children away from their families and communities is a central component of historical trauma. Indian child welfare practice must contend with both the restoration of balance at the level of the individual the family and the community while negotiating with a system which has been an instrument of community disruption in the past. The 1978 Indian Child Welfare Act (ICWA) was designed to address the race equity issues in the child welfare system that historically and disproportionately harm Indigenous youth and families. 

Reducing Black Infant Mortality in Alabama

Infant mortality, defined as the death of a baby after birth up to one year of age, is a national indicator of population-level health. The United States has an average infant mortality rate (IMR) of 6 deaths per 1,000 live births, a rate that is more than 70% higher than other comparable, high-resource nations.

Post-ACA, More Than One-third Of Women with Prenatal Medicaid Remained Uninsured Before or After Pregnancy

Since the early 1990s, Medicaid has been critical in providing insurance coverage for pregnant women with low incomes in the United States - pregnancy-related Medicaid coverage is available to women with incomes up to 200 percent of the federal poverty level in most states. Because pregnancy-related Medicaid eligibility is almost always more generous than eligibility for other adults, many women with low incomes not otherwise eligible for Medicaid gain coverage during their pregnancies but then lose that coverage sixty days after delivery, when their pregnancy-related eligibility expires. The American Rescue Plan Act of 2021 included an option for states to extend Medicaid coverage for twelve months postpartum. While the ACA provided coverage improvements for pregnant women outside of pregnancy, especially in states expanding Medicaid, many low-income women remain uninsured before or after their pregnancies. Building on existing studies tracking changes in Medicaid coverage and uninsurance under the law, researchers Emily M. Johnston, Stacey McMorrow, Clara Alvarez Caraveo and Lisa Dubay examined data for new mothers with Medicaid-covered prenatal care in this study published in Health Affairs.

Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, and Postpartum Contraception

The period before pregnancy is critically important for the health of a woman and her infant, yet not all women have access to health insurance during this time. Rebecca Myerson of the University of Wisconsin-Madison, Samuel Crawford of the University of Southern California, and Laura R. Wherry of New York University evaluated whether increased access to health insurance under the Affordable Care Act (ACA) Medicaid expansions affected ten preconception health indicators, including the prevalence of chronic conditions and health behaviors, birth control use and pregnancy intention, and the receipt of preconception health services.

Expanded Job Protection Improves Racial and Socioeconomic Equity of Parental Leave Access

Paid family and medical leave has important health benefits for parents and their children, but access to job-protected leave is limited and highly disparate in the United States. Increasingly, state and local governments have established policies such as paid leave to support parents and other caregivers. While these policies have been crucial in enabling more workers to take leave, their effects have been weakened due to only partial coverage of job protection laws. As part of their ongoing work evaluating the 2017 San Francisco Paid Parental Leave Ordinance, investigators Julia M. Goodman (Oregon Health & Science University/Portland State University) and William H. Dow (University of California, Berkeley) published an issue brief examining paid leave protections in the California Bay Area.

Combating Unstable Schedules for Low-wage Workers in Oregon

The advent of just-in-time scheduling technology and practices in the mid-1990s has led to increased schedule instability, resulting in a growing movement to address the need for predictable, stable schedules for workers paid low wages. Unstable schedules have been associated with earnings instability, increased stress and fatigue, sleep irregularity, and worse mental health outcomes for workers.  In this report, P4A researchers Amelia Coffey, Eleanor Lauderback and H. Elizabeth Peters, along with their partners at the University of Oregon’s Department of Sociology Lola Loustaunau, Larissa Petrucci, Ellen Scott and Lina Stepick, examine Oregon’s implementation of S.B. 828, the first statewide predictive scheduling law in the nation, in its first year.