By the time women reach 44 years old, roughly 85 percent have given birth. Yet even though pregnancy and childbirth are such commonplace events, health insurance coverage and support services to keep mothers and babies healthy are often seriously deficient.
Some private insurers, for example, treat pregnancy as a preexisting condition and charge pregnant women higher premiums, or refuse to cover costs associated with childbirth. Low-income women can get Medicaid coverage while they're pregnant, but they generally lose it 60 days after giving birth unless they're very poor.
The health-care overhaul greatly improves this situation. Some of the biggest changes don't kick in until 2014, but here's what to look for this year and next:
Starting in the fall, all new health plans must cover certain preventive screenings and other services for pregnant women at no additional cost to the patient. Those include folic acid supplements, which reduce the risk of neural tube defects in developing fetuses, and counseling to help pregnant women stop smoking. Medicaid will also begin to cover smoking cessation counseling and drug therapy for pregnant women.
The law requires employers to provide time off for new mothers to express breast milk, as well as a place to do so that's not a bathroom. It also authorizes funding for research and treatment of postpartum depression.
Additional support services will include a pregnancy assistance fund, which will provide $25 million annually for 10 years for housing, child care and other needs.
A much bigger chunk of money — $1.5 billion over five years — will be dedicated to expanding home-visiting programs in which nurses and other providers visit pregnant teenagers and young mothers. Among other things, the practitioners suggest ways to cope with the stress that inevitably comes with being a parent.
Studies of this model have shown that it results in better health for both mother and child, more stable relationships and lower rates of child abuse and delinquency. "Every mom wants to do the right thing for her kids, but so many don't know how," says Miriam Rollin, national director for Fight Crime: Invest in Kids, a nonprofit anti-crime organization based in Washington.
One such mother was Stephenie Rounds, who today is a 26-year-old preschool teacher in Aurora, Colo. But at 14, she says, she was "crazy" — a repeat runaway who drank and did drugs and got pregnant by her 19-year-old boyfriend.
She credits a program called the Nurse-Family Partnership with helping her get ready for the birth of her son. A visiting nurse helped Rounds quit smoking and enroll in a high school for pregnant teens. The nurse taught Rounds how to decipher what babies try to communicate when they cry, and gave her emotional support when her ex-boyfriend returned to town and started dropping by. "She gave me the tools I needed to succeed," says Rounds, whose son Michael is now 11 years old.
The bigger changes coming in 2014 include an expansion of Medicaid to cover adults with incomes up to 133 percent of the federal poverty level. Forty percent of pregnant women are covered by Medicaid, but many don't have health insurance before they become pregnant or after they give birth. Increasing the number of low-income women on Medicaid raises the odds they'll be healthier overall and have successful pregnancies, says Jocelyn Guyer, co-executive director of Georgetown University's Center for Children and Families.
Also in 2014, many health plans will be required to cover maternity and childbirth services as part of an "essential health benefits" package detailed by the federal government. And insurers won't be allowed to charge women who are pregnant higher rates, or refuse to cover them or their childbirth costs.
Some of the new and expanded initiatives, such as the funding for postpartum depression and break time for new mothers to express breast milk, have been on the wish lists of advocates and lawmakers for some time. But another factor may have played a role during the debate that preceded the new law.
"The dynamic around abortion was so controversial," says Guyer, "people working on the issue wanted to be sure that pregnancy and maternal support services were ensured."