High rates of pregnancy-related maternal deaths in the United States (U.S.) are alarming. The risk of a woman in the U.S. dying due to birth complications is higher than in any other developed country[i]. The Centers for Disease Control and Prevention (CDC) defines maternal mortality[ii] as the death of a woman while pregnant or within 42 days of termination of pregnancy. Recent data[iii] affirms that the maternal mortality rate among American women was 32.9 deaths per 100,000 live births in 2021. This equates to an estimated 1,201 deaths, of which the CDC has estimated 60% were preventable[iv]. Although many women and families throughout the US are affected by maternal mortality, wide racial and ethnic gaps exist and disproportionately affect non-Hispanic Black women.
Federal legislation has been enacted or is in progress to address this surmountable health crisis. At the same time, many states have developed and implemented initiatives such as Maternal Mortality Review Committees[v] (MMRCs) that aim to better understand and make recommendations to reduce maternal deaths.
State Review + High Maternal Mortality Rates
A state review from the America’s Health Ranking found that Louisiana[vi] and Alabama[vi] have the highest pregnancy-related deaths at 38.7 per 100,000, respectively.
Only Louisiana has expanded Medicaid and established Maternal Mortality Review Committees and Collaboratives amid increasing maternal deaths and significant racial gaps. Panels from both committees have agreed that hemorrhaging[vii] is one of the leading causes of maternal deaths among cases in their states and almost half were found to be preventable. To address this issue, Louisiana is set to establish new standards[xii] beginning in 2021. The goal is to better equip hospitals to handle emergencies during childbirth and tackle preventable deaths.
State Review + Low Maternal Mortality Rates
California[xiii] and Wisconsin[xiii] have the two lowest rates of maternal mortality in the United States, ranking at 8.4 deaths per 100,000 and 9.7 per 100,000, respectively. Specifically, Black mothers in California were found to die at a rate of 29.7 per 100,000 live births compared to 8.9 for White mothers and 7.6 for Hispanic mothers. California’s Birth Equity Collaborative reports that evidence points to racism as being a key cause of these birth disparities.
California[xviii] and Wisconsin[xix] have established Maternal Mortality Review Committees. Both states have also expanded healthcare coverage to include more residents, including expansion of their Medicaid programs. Access to quality healthcare positively affects health outcomes for women, contributing to these states’ lower maternal mortality rates, compared to states who did not expand Medicaid[xx]. Furthermore, California has determined the most prevalent causes of maternal mortality, recorded and shared data with providers, and developed and implemented care protocols related to preeclampsia and hemorrhaging. From 2006-2013 California saw a 55%[xxi] decline in maternal mortality.
Federal Initiatives
As states continue to grapple with high maternal mortality rates, Congress has provided some relief to address this crisis. The Maternal Deaths Act of 2018[xxii] was recently enacted and the Helping MOMS Act of 2019[xxiii] has been introduced. The Maternal Deaths Act allows for standardized reporting and data collection including best practices of MMRCs. Meanwhile, the MOMS Act seeks to provide states with the option to increase Medicaid postpartum coverage for up to one year after giving birth. Pregnant women are currently receiving only 60 days of post-delivery care. In addition, the Maternal CARE Act[xxiv] of 2019 seeks to allocate grants to fight racial bias in maternal health care settings and create programs to provide resources and support to high-risk pregnant women. A recent GAO report[xxv] found that California and Georgia along with three other states, receiving funds from the U.S. Department of Health and Human Services to reduce maternal mortality, reported that, “they were beginning or continuing to address racial/ethnic health differences.”
Analysis
There is no single solution to reducing maternal mortality rates - it will require reliable and consistent data collection, along with various interventions at all levels. At the federal level, increased Medicaid coverage is critical because it covers half of all births[xxvi] in the United States. In addition, Medicaid expansion has resulted in reduced rates[xxvii] of maternal mortality and has been a critical means to addressing racial disparities. Most importantly, federal legislators must ensure states’ funds allocated to reduce maternal deaths are effectively used to actively establish initiatives to reduce racial bias. At the same time, at the state and local levels, specific interventions from health care systems, professionals and community organizations to undertake existing health inequities are essential. As such, continuous support and growth from the active 38 MMRCs is critical. Some successful MMRCs initiatives were implemented approximately 10 years ago in California whereas others were recently developed. In states where newer initiatives are being explored or developed, it is too early to tell if programs will reduce pregnancy-related deaths and will actually close such alarming racial gaps.
Sources
(i) Julia Belluz, “We finally have a new US maternal mortality estimate. It’s still terrible.,” Vox (January 30, 2020), https://www.vox.com/2020/1/30/21113782/pregnancy-deaths-us-maternal-mortality-rate
(ii) Centers for Disease Control and Prevention, “First Data Released on Maternal Mortality in Over a Decade,” Centers for Disease Control and Prevention, (January, 30, 2020), https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2020/202001_MMR.htm
(iii) Centers for Disease Control and Prevention. (2023, March 16). Maternal mortality rates in the United States, 2021. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm#Table
(iv) Centers for Disease Control and Prevention, “Pregnancy-related deaths,” Centers for Disease Control and Prevention (May 7, 2019), https://www.cdc.gov/vitalsigns/maternal-deaths/index.html
(v) Review to Action, “Definitions,” Review to Action https://reviewtoaction.org/learn/definitions
(vi) Explore maternal mortality in Louisiana: AHR. America’s Health Rankings. (n.d.). https://www.americashealthrankings.org/explore/measures/maternal_mortality_c/LA
(vii) Lyn Kieltyka, Pooja Mehta, Karis Schoellmann, and Chloe Lake, “Louisiana Maternal Mortality Review Report 2011-2016” (August 2018) http://ldh.la.gov/assets/oph/Center-PHCH/Center-PH/maternal/2011-2016_MMR_Report_FINAL.pdf
(xii) World Population Review, “Maternal Mortality Rate By State 2020,” World Population Review (March 30, 2020) https://worldpopulationreview.com/states/maternal-mortality-rate-by-state/
(xiii) 2018 Health of Women and Children Report, “California,” America’s Health Rankings, (United Health Foundation, 2020) https://www.americashealthrankings.org/learn/reports/2018-health-of-women-and-children-report/state-summaries-california
(xvii) California Maternal Mortality Care Collaborative, “California Birth Equity Collaborative
Improving Care, Experiences and Outcomes for Black Mothers,” California Maternal Mortality Care Collaborative https://www.cmqcc.org/qi-initiatives/birth-equity
(xviii) Renee Montagne, “To Keep Women From Dying In Childbirth, Look To California,” NPR (July 29, 2018) https://www.npr.org/2018/07/29/632702896/to-keep-women-from-dying-in-childbirth-look-to-california
(xix) Centers for Disease Control and Prevention. (2023b, April 26). Enhancing reviews and surveillance to eliminate maternal mortality (erase MM). Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/index.htm
(xx) Adam Searing and Donna Cohen Ross, “Medicaid Expansion Fills Gaps in Maternal Health Coverage Leading to Healthier Mothers and Babies,” Georgetown University Health Policy Institute Center for Children and Families (May 2019) https://ccf.georgetown.edu/wp-content/uploads/2019/05/Maternal-Health-3a.pdf
(xxi) California Maternal Quality Care Collaborative, “Who We Are,” California Maternal Quality Care Collaborative https://www.cmqcc.org/who-we-are
(xxii) U.S. Congress, House, Preventing Maternal Deaths Act of 2018, H.R.1318, 115th Cong., 2nd sess., Became Law December 21, 2018, https://www.congress.gov/bill/115th-congress/house-bill/1318/text
(xxiii) U.S. Congress, House, Helping MOMS Act of 2019, H.R. 4996, 116th Cong., 1st sess., Introduced November 20, 2019, https://www.congress.gov/bill/116th-congress/house-bill/4996/text
(xxiv) U.S. Congress, Senate, Maternal Care Access and Reducing Emergencies Act, S. 1600, 1st. Sess., Introduced May 22, 2019, https://www.congress.gov/bill/116th-congress/senate-bill/1600/text
(xxv) United States Government Accountability Office, “Trends in Pregnancy-Related Deaths and Federal Efforts to Reduce Them,” United States Government Accountability Office, (March 2020)
https://www.gao.gov/assets/710/705331.pdf
(xxvi) Congresswoman Robin Kelly, “How the MOMMA Act Will Help to Reverse America’s Rising Maternal Mortality Rate,” Congresswoman Robin Kelly, (June 5, 2018), https://robinkelly.house.gov/media-center/in-the-news/how-the-momma-act-will-help-to-reverse-america-s-rising-maternal-mortality
[xxvii]Adam Searing and Donna Cohen Ross, “Medicaid Expansion Fills Gaps in Maternal Health Coverage Leading to Healthier Mothers and Babies,” Georgetown University Health Policy Institute Center for Children and Families (May 2019) https://ccf.georgetown.edu/wp-content/uploads/2019/05/Maternal-Health-3a.pdf