Last fall, the Colorado Perinatal Care Quality Collaborative (CPCQC) and the Center for Improving Value in Health Care (CIVHC) released findings on perinatal mental health and postpartum care in Colorado. Today, we’re sharing the next chapter of that work. New findings extend the analysis through 2024, follow individuals through the full year postpartum, and answer two questions we hadn’t yet been able to address: how perinatal health care varies across Colorado geographically, and what perinatal care actually costs Colorado families.

CPCQC partnered with CIVHC to analyze 208,282 deliveries that occurred in Colorado between 2019 and 2024 — about 56% of all births in the state during that period — using data from the Colorado All-Payer Claims Database (CO APCD).

Key Takeaways

• About 70% of Coloradans accessed a postpartum visit within a year of delivery — meaning 3 in 10 received no postpartum care at all. Of those who did, 96% had their visit within 12 weeks of delivery.
• Postpartum visit access was lowest among Hispanic or Latino individuals (57%) and those covered by Medicaid (66%). At the intersection, Hispanic or Latino individuals on Medicaid had a postpartum visit rate of just 55%. Medicaid was associated with lower access within every racial and ethnic group, suggesting that insurance type shapes access on its own.
• Birthing people in rural (62%) and frontier (59%) counties accessed postpartum visits less often than those in urban counties (72%) — and access varied widely within each region. Rates ranged from 40% to 79% across frontier counties alone, suggesting that local conditions, not just geographic category, shape access.
• 1 in 3 birthing Coloradans had or were diagnosed with a mental health condition during the perinatal period, but only 1 in 5 (22%) accessed any mental health visit — meaning a substantial share of those with a documented diagnosis received no mental health care.
• Telehealth went from 2% of perinatal mental health visits before COVID-19 to more than half from 2021–2024, fundamentally reshaping how this care is delivered. Counterintuitively, rural Coloradans accessed mental health visits in person more often than via telehealth — a pattern that runs against the assumption that telehealth would help bridge rural access gaps and raises questions about broadband access, privacy at home, care-seeking preferences, and the geographic distribution of providers.
• The average commercially insured birthing Coloradan paid $2,563 out of pocket for an inpatient delivery alone — more than 2.2 times what the average commercially insured American pays out of pocket for all health care in a year. Across the full perinatal period, average out-of-pocket spending was $4,754, or about 4.9% of the 2024 Colorado median annual income.

Read the Report

• Download the Full Report (PDF) Developed by CIVHC in partnership with CPCQC.
• For readers interested in the underlying methodology, code definitions, and summary tables, the data tables are also available.

Why It Matters

Pregnancy and the year that follows are among the most vulnerable periods for birthing people — especially for those with mental health conditions. Suicide remains the leading cause of pregnancy-associated death in Colorado, and all such deaths have been deemed preventable. These findings sharpen our picture of where Colorado’s perinatal care system is and isn’t reaching people, and they point to clear opportunities: targeted outreach for Medicaid-insured and Hispanic or Latino communities, integration of mental health within perinatal care so that diagnosis more reliably leads to treatment, attention to local-level barriers in rural and frontier areas, and a broader policy conversation about the financial burden families bear when bringing a baby into the world.

A Note on This Analysis

This analysis examines mental health care utilization but does not include claims associated with substance use disorders. Although accidental overdose is the second-leading cause of pregnancy-related death in Colorado, and reflects what is often comorbid mental health conditions and substance use disorders, claims associated with substance use disorders — including overdose, withdrawal, or related care — were excluded due to CO APCD intake restrictions during the study period.

About the Partners

Center for Improving Value in Health Care (CIVHC): A nonprofit organization managing the Colorado All-Payer Claims Database (CO APCD) to advance data-driven insights and value-based care.

Colorado Perinatal Care Quality Collaborative (CPCQC): A statewide nonprofit working to improve maternal and infant health through data, collaboration, and quality improvement.