While federal immigration policy has become a flashpoint, research on how state-level decisions shape immigrants' access to critical health care is more important than ever. One new study, led by a team of researchers including Dr. Rachel Fabi, explores how different U.S. states approach postpartum coverage for immigrant families — and what those differences mean. 

 Dr. Fabi is an Associate Professor in Bioethics and Humanities at SUNY Upstate who has spent more than a decade researching immigration and reproductive health; more specifically, prenatal and postnatal care. Funded by a grant from the National Institute of Child Health and Human Development, Dr. Fabi worked with her colleagues Maria Steenland and Laura Wherry to track postpartum care for immigrants using MonQcle.  

We spoke to Dr. Fabi about her work, what surprised her most in the data, and where this research is headed next. 

CPHLR: Why is public coverage of postpartum services important for immigrant families? What do communities gain from improved access to care?  

Dr. Fabi: Well, it's important for everyone, right? We know in the United States, maternal morbidity and mortality is higher in the United States than in any other high-income country. Most pregnancy-related deaths occur after childbirth — over a quarter are in that two-month to one-year range postpartum. So, lack of postpartum care can have long-term consequences.  

Immigrant families often face significant coverage gaps due to federally funded insurance, especially for undocumented immigrants or those with a five-year eligibility waiting period for lawfully present immigrants. Expanding public coverage helps reduce these gaps, improving health outcomes not only for birthing people but also for infants and entire communities. Our study looked at how states try to fill those gaps — and the different ways they attempt to provide postpartum coverage for immigrant populations who already experience serious health disparities. 

CPHLR: What differences in how states cover postpartum care for immigrants surprised you the most?  

Dr. Fabi: We found that states vary widely in how they provide postpartum coverage to immigrant populations. Some states use state-only funding to cover postpartum care regardless of immigration status, while others rely on policies like the Children's Health Insurance Program's (CHIP) 'unborn child option' — now known as the 'from-conception-to-end-of-pregnancy (FCEP) option — that provide coverage only until birth, leaving a gap in postpartum care. The diversity of these approaches, and the fact that some states cover 12 months postpartum while others only provide 60 days or less, was striking. 

CPHLR: Now that you have these data, do you have plans for further research?  

Dr. Fabi: Our current research is descriptive, cataloguing the patchwork of policies across states. Moving forward, we plan to link these legal data with health outcomes to see if expanded postpartum coverage leads to improved utilization and better maternal and infant health among immigrant populations. This includes leveraging linked datasets that capture immigration status and health outcomes to fill important knowledge gaps. 

CPHLR: If you could make one policy recommendation based on these data, what would that be? 

Dr. Fabi: Once we have more data — on things like receipt of prenatal care and health outcomes — it’ll be easier to make a strong, evidence-based policy recommendation. 

But setting that aside, I’d say expanding postpartum coverage to 12 months is best practice. That’s what we’re doing for everyone else, so we should probably be doing it for immigrants too. If you want healthy births and healthy mothers, you need care for 12 months. 

CPHLR: Why did your team decide to use MonQcle to support your research? 

Dr. Fabi: MonQcle was really helpful for keeping track of all the variables we looked at — like who’s paying for care, how long coverage lasts, and which populations are covered. 

We also looked at contraception coverage, which varies a lot by state and often falls along political lines — some states cover it postpartum, others don’t. Tracking all that across 50 states was a lot, and being able to link each data point to documents and timelines in MonQcle made it way easier. We tried doing it in a 10-tab Excel spreadsheet before, and it just didn’t work as well. 

You can read Dr. Fabi's Research here.