This is NOT to suggest that African-American maternal mortality and Medicaid maternal mortality are mutually synonymous. There is some overlap, however.
The Medicaid administration freely admits that one of the major issues with delivering healthcare to their clientele is that recipients are more likely to "blow-off" appointments than people who receive private healthcare insurance. More than a third of Medicaid recipients showed up for five-or-fewer of nine-recommended well-baby visits.
One factor is that people with private insurance are usually held responsible for the cost of the appointment if they do not show up at the required time. At more than $120 per appointment that is a very strong incentive to either show up or call more than 24 hours in advance. People on Medicaid have very little monetary skin-in-the-game.
Transportation to appointments can also be a problem. Most doctors choose to have their offices in swanky, low-crime areas. Some people on Medicaid live in higher crime areas distant from the doctor's office. Bus rides are long. Uber drivers not always thrilled to pick up clients in areas they perceive as dangerous.
Dilution of Responsibility
A third factor, one that advocates-for-the-poor NEVER want to talk about is that some mothers on Medicaid have children by multiple fathers and do not attend scheduled pre-and-postpartum appointments because they have nobody to watch their children.
Where-as a married couple has two sets of grandparents and aunts to pull on for emergency childcare, the mother with children from multiple fathers lacks that second set of family.
Many factors come into play. The grandmother of an ex-boyfriend is unlikely to take all of the other kids even if she is willing to watch her own grandchild.
The mother of the current boyfriend might consider the current liaison to be temporary at best and be resentful of the probability that the mother-to-be will break up with their son and then ding him for child-support for the next 18 years. After all, she has a history if she already has at least one kid from a different father.
In some cases, the second set of grandparents do not even know about the grandchild spawned by their son.
One man, one woman, till death do us part...
Still the best plan.